Exploring obsessive-compulsive disorder (OCD), describing its characteristics such as intrusive ideas and compulsive behaviors. This article addresses the diversity of OCD manifestations, the difficulties of diagnosis and treatment, and proposes a systemic perspective for a better understanding and management of these disorders.
An obsession is defined as an intrusive, repetitive idea or vision that haunts an individual's mind, often beyond the reach of their voluntary control. These obsessions can be intensely persistent and difficult to shake. They can take the form of disturbing thoughts, causing distress and anxiety in the affected person. Furthermore, a compulsion refers to a repeated action or thought to which the individual feels irresistibly driven in order to alleviate their anxiety. These compulsive acts may remain discreet or be more apparent, including rituals such as repeating phrases to oneself to calm down or recurring checks to see if doors are closed. Although aware of the irrationality of these behaviors, patients often struggle to break away from them. Obsessive-compulsive disorder (OCD) is thus interpreted as an alteration of real perception, influenced by a deep fear pushing the individual to engage in compulsive actions or thoughts in order to moderate their fears. Strategies commonly adopted by those with OCD to cope with anxiety-provoking situations include either avoiding these situations or engaging in compulsions or rituals. Specific triggers, such as certain situations, people or objects, can be so frightening that they are avoided entirely. OCD, once considered a rare disorder in early clinical literature and until the early 1980s, is now recognized as a common disorder.
How does OCD manifest?
OCD itself in a variety of ways, with as many variations as there are affected individuals. The most common forms include a preoccupation with cleanliness and germs, followed by intensive cleaning rituals and a tendency to avoid contact with suspected contaminated objects. These perceptions of contamination do not always correspond to real unsanitary conditions but rather represent the subjective vision of the patient. So what may appear pristine and safe to the general public may be perceived as dangerously contaminated by those affected by OCD. Patients are also commonly observed engaging in excessive hand washing or isolating themselves at home due to fear of germs and infections. Another recurring pattern is obsessive doubt, leading to compulsive checking which, far from alleviating the initial uncertainty, increases it and leads to even more pronounced cycles of doubt and checking. These doubts can also lead to feelings of guilt for having neglected something important or fear of having committed a wrongdoing.
tendency to hoard objects, or various eating disorders such as vomiting , bulimia and overeating. Identifying OCD, particularly in its initial stages, is often difficult for both patients and healthcare professionals, which can delay diagnosis and treatment.
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How does OCD appear?
Fear-based compulsions, such as hand-washing to avoid contamination, are distinct from those motivated by pleasure, such as compulsive shopping or excessive gambling. The latter are characterized by rituals repeated over long periods to generate a pleasant sensation.
Multiple compulsions can arise from a variety of origins, including initial doubts, rigid beliefs and ideologies, excessive thinking leading to irrationality, preventive health phobia, or responses to trauma.
OCD can turn into real constraints, making the individual captive to their own strategies which over time become additional obstacles. This illustrates how an attempted solution can turn into a new source of problems.
How to recognize OCD?
The DSM-5 presents obsessive-compulsive disorder (OCD) as a diagnostic category characterized primarily by the presence of obsessions and/or compulsions, where obsessions are intrusive and unwanted thoughts, impulses, or images, and compulsions are repetitive behaviors or mental acts performed in response to these obsessions. However, a more nuanced interactional reading allows us to distinguish specific variants or manifestations within the OCD spectrum, including OCD with rituals, OCD without rituals or pathological doubt, and pathological doubt.
How to identify the different types of OCD?
OCD with rituals
In OCD with rituals , individuals experience repetitive compulsions such as hand washing, checking, or tidying up, which are performed to alleviate the anxiety generated by the obsessions. These rituals may become less effective over time, but the habit of performing them persists. Although the DSM-5 recognizes this dynamic, an interactional reading deepens understanding by examining how these rituals interact with the individual's daily environment, their personal meaning, and their impact on the person's life.
OCD without rituals or pathological doubt
OCD without rituals or pathological doubt is characterized by the presence of obsessions without the overt compulsions typically associated with OCD. Although the DSM-5 acknowledges the existence of these cases, it does not clearly distinguish them as a distinct subtype. An interactional approach emphasizes how obsessions persist without leading to external rituals, highlighting individual variations in the experience of OCD and different coping strategies that do not involve compulsive behaviors.
OCD and pathological doubt
Pathological doubt, although not explicitly defined in the DSM-5, is integrated into the general description of OCD obsessions. This term describes a form of OCD where uncertainty and intense fear of making a mistake or making the wrong decision lead to a constant cycle of doubt and checking. An interactional reading helps identify these specific patterns of thought and behavior, thus offering perspectives for targeted therapeutic interventions.
Treatment of OCD with systemic approaches
The distinction made through an interactional reading reflects a more dynamic and personalized understanding of OCD, recognizing that individuals may experience and manifest their symptoms in unique ways. This approach promotes personalization of treatment, allowing deeper exploration of underlying dynamics and improving therapeutic engagement. While the DSM provides a structured framework for classifying disorders, interactional reading enriches clinical understanding by highlighting the diversity of OCD experiences and informing therapeutic approaches tailored to each individual.
The systemic and strategic approach is very effective in the treatment of OCD. Obsessive and compulsive disorders are part of the psychopathologies studied in the third year of the LACT course and in the Clinical Master of Giorgio Nardone (CTS) .
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