1. What is Obsessive Compulsive Disorder (OCD)?
Obsession (obsession, obsession): It is defined as an anxiety-provoking and repetitive thought, impulse or image that comes to the mind in a persistent and compelling way against the will of the person, which is seen as absurd and irrational by the person. Compulsions are repetitive ritual acts or mental acts that the person feels compelled to perform in response to obsessions or according to certain rules.
People with obsessive-compulsive disorder become restless because of recurring and stressful thoughts, fears, or images (obsessions) that they cannot control. The anxiety created by these thoughts causes the urgent need to perform certain movements or rituals (compulsions). Rituals are performed in an attempt to prevent or banish obsessive thoughts. Repetitive movements temporarily stop the tension, when obsessive thoughts occur again, the person needs to repeat these movements immediately. People with obsessive-compulsive disorder may be aware that their obsessions and obsessions are unreal or meaningless, but they cannot stop themselves.
In fact, people with OCD don’t think much differently than we do; We all have worries and fears that we can barely forget. The main difference between people with and without OCD is the importance of these thoughts to the person. People with OCD find these thoughts ominous and exaggerate. To them, having these thoughts makes them immoral or out of control. People without OCD may have similar thoughts, but for them these thoughts are like soft background noises; they are there but they do not disturb the person. For people with OCD, obsessive thoughts are so powerful that they can destroy a person’s happiness and well-being.
2. Types of obsessions;
▪ Danger of contamination, contamination; When you go to the toilet, urine may be splashed on it; These are very common obsessions that appear as germs, urine, feces, and sperm can be transmitted by touching objects such as handshakes, doorknobs, money. People with such obsessions avoid touching things and being in close contact with people to prevent contamination. They may try to distance themselves from close family members or social circles.
▪ Thoughts of harming someone or yourself; It occurs in the form of thoughts of killing, injuring, and harming others in various ways, including aggression in the background. It’s like a mother or father’s thoughts of killing or injuring her child, strangling a newborn’s baby, or throwing it out the window. People with an obsession to harm may avoid sharp objects such as knives, scissors, needles, and being alone with their loved ones. Others are more afraid of harming themselves. Such obsessions may manifest as thoughts of jumping in front of cars, throwing oneself out of a window.
▪ Doubt at the thought of not doing something that should have been done; Doubt obsession is mentioned when one cannot be sure that an action has been taken. For example; He cannot be sure whether he has unplugged the iron, locked the door, turned the stove off or not. Compulsions to control develop because it often indicates a situation of danger.
▪ The urge to sort things out, the need for symmetry and precision;They are obsessions that are shaped by the fact that objects and events are in a certain order and position, or that the objects are in a complete symmetry and orderliness.
▪ Thoughts of doing or saying something inappropriate (sexual and religious obsessions); Sexuality is among the most common obsessive themes. The content of sexual obsessions is often embarrassing and unacceptable to the person. A person with sexual obsessions may have thoughts or images of having sex with their child or parent. Such images may appear before your eyes. Such obsessions can also appear in the form of thoughts that include fears about being gay.
They are obsessions that usually occur in the form of thoughts that are considered sinful in a religious person. Like denying the existence of Allah, blaspheming Allah, not knowing the Prophet.
▪ Somatic obsessions; Such obsessions may be related to contracting a life-threatening disease such as cancer, AIDS or tetanus. In such cases, the person is in constant fear of catching the diseases in question and resorts to various measures to be protected.
3. Compulsion types;
▪ Cleaning compulsions:Repetitive compulsions include washing hands, bathing, constantly cleaning the house and furniture, washing dishes and laundry for hours.
▪ Checking compulsions: They are compulsions that often occur in relation to maintaining security. For example; The person can repeatedly check whether the air gas tap is closed or whether the iron has been forgotten in the socket.
▪ Editing compulsions: They are compulsions in the style of trying to keep things in a certain order to provide balance and symmetry. It is often done to alleviate a general feeling of discomfort.
▪ Repetitive compulsions: They are compulsions in which certain behaviors are repeated in a certain manner and number. In such cases, one cannot be sure that the ritual was performed properly, and the behavior may be repeated until it is certain.
▪ Counting compulsions: Car license plates, house numbers, etc. occurs in counting style.
▪ Touch compulsions:Compulsions in which the person feels compelled to touch certain objects.
▪ Spool compulsions:It is seen in the manner of buying many things when they are not needed, of not throwing away anything they have.
4. What are the Causes of OCD?
We can divide the causes of obsessive compulsive disorder into two as biological and psychosocial. While this disorder was thought to be mostly psychological until recent years, its frequency and efficacy of some drugs have begun to indicate the presence of a biological origin. Dysfunction of the “serotonin system”, one of the chemical transmitters that provides communication between nerve cells in the brain, is known in those with OCD.
From a psychosocial point of view, it is thought that social rules and social structure are effective in the disease. It is thought that it is more common in societies that provide meticulous, prescriptive and ceremonial education, especially in childhood, which is extremely prescriptive and disciplined. Again, studies conducted in recent years have shown that obsessive compulsive disorder is caused by biological factors as well as psychological factors such as life experiences, stress, traumas, beliefs and attitudes. Many psychiatric disorders can occur simultaneously with obsessive-compulsive symptoms. Examples of diseases in the same spectrum as OCD are alcoholism, substance abuse, compulsive gambling, and eating disorders.
5. How Is OCD Treated?
Antidepressants used in OCD should be used in higher doses and for a longer period of time compared to the treatment of depression. The positive effects of the treatment appear only a few months after the start of the treatment. The results of various studies suggest that the combination of drug and behavioral treatments gives the best results.
The main purpose of psychotherapy is to show the patient the assumptions underlying their problems and help them overcome them in order to change their behavior and emotions. In the treatment, the patient is provided to go over the situations that increase his distress and compulsions within a certain program, and at the same time, his compulsions are prevented. By effectively stopping or preventing compulsions, patients are enabled to face the situations they fear most. And they are no longer affected by it. A sense of comfort and confidence is developed.
False beliefs cause many patients to avoid using these drugs or to use them at lower doses or for shorter periods than the doctor recommends. This situation makes Balikesir OCD treatment more difficult.
One of the best ways to deal with OCD is to try to take control of your thoughts. Expose yourself little by little to worrying thoughts will gradually reduce the fears that come with these thoughts.
▪Overcoming OCD (Robert L. Leahy):
1) Identify your fears: Sometimes it can be helpful to write a list of your own obsessions on paper. Start with your fear first (fear of contamination, fear of making mistakes…) and then write down the predictions underlying the obsessions (I’ll get in trouble, I’ll get sick, people make fun of me…). You can also add your feelings and thoughts to this list (very strange behavior, I’m so ashamed, I have an evil thought system…).
2) Identify your avoidance behaviors: Compulsions are avoidance and shelter behaviors. They are the things that protect you from your fears; Although it may seem very strange to other people, for a person with OCD these behaviors are the only thing that makes them feel safe. Write down the rituals and behaviors you use to cope with your obsessions in detail on your list above.
3) Increase your motivation to change: The key to beating OCD is exposure. Confronting these thoughts and situations rather than avoiding them is one of the best things to do. With every opportunity to face the obsession, fear and anxiety will decrease a little more. This experience will of course not be pleasant; It will be very uncomfortable for people with OCD to come face to face with what they have been avoiding for years. However, being able to face will not only bring fear, but it will also show the person that the world does not end when compulsive behaviors are not done. In other words, if he doesn’t, the person will understand better that his obsessions are edible unless the things he thinks will happen to him and his predictions turn out to be correct.
4) Change your relationship with your obsessions: Prove to yourself that repression is not a good way to deal with that thought. For example, the more you condition yourself not to think of a white bear, the more likely you will be to think of a white bear. Also, prove to yourself that your obsessive thoughts don’t match reality. If you are constantly praying that nothing will happen to your loved ones, accept that your prayer will not change reality and what will happen. When an obsessive thought comes, try to observe it instead of controlling it. When you do nothing, you will find that thought passes you by. If people with OCD are a victim, obsessive thinking is also a tormentor. Don’t let your obsessive thinking attack and victimize you, look at it as a temporary guest. If you get angry with him, if you try to suppress it, his aggression will increase.
5) Create a hierarchy of fears: Based on your list in the first item, create a list in order from the least disturbing obsessive thought to the most disturbing obsessive thought. Give each thought a number from 0 to 10 according to the fear and anxiety it creates in you.
6) Evaluate your fear logically: Although people with OCD cannot get rid of their obsessions using logic, it is always helpful to examine fears calmly and rationally. You might ask yourself, “How can anyone other than myself think about and evaluate this situation rationally?” For example, how would it make you feel to know that most people can think like you? Would it be comforting? In fact, other people have similar thoughts, but these people may not have OCD. Then there is a less disturbing and more logical way to have these thoughts.
7) Visualize your fears: Try to visualize your fears by using what you wrote in the hierarchy list. For example, if the compulsive behavior is checking the door to see if it’s locked, imagine checking the door once and leaving. Visualize this image in your head for 10 minutes and see what’s going on. Your fear will probably lessen as you get used to the thought. After thinking about it for a while, this image will start to get boring now, and that’s what we’re aiming for. Animate more and more terrifying images like the hierarchy list and see what happens.
8) Bring your fears to real life with “exposure”: gradually expose yourself to situations that trigger your obsessions and see what happens. Again, start with the least disturbing thought and give a 0 to 10 rating each time the fear you experience. The important thing here is to go step by step rather than accomplishing everything at once. Every small step is a success in overcoming the obsession.
9) Follow a long-term strategy: Most people with OCD are not usually 100% free of all their obsessions and compulsions. However, this does not mean that obsessive thoughts have as much effect on people as they used to be. The important thing here is to accept; knowing that these thoughts can happen, but they don’t matter. At times, especially during the person’s stressful times, there may be some backlash. It’s important to be aware of this setback and be prepared to deal with it again. As long as the person carries these principles, even if there are thoughts, he will not be disturbed by them as before, and these thoughts will not overtake the person.