Patient's gender: Male
● Patient's age: 20
In junior high school, I was particularly fond of styling my hair. There were so many strands, but I had to straighten each one individually. Once the hairstyle was done, it couldn't be touched; my neck became stiff because I was afraid of ruining the hairstyle. Later, I got too tired and went to Tongji Hospital in Hubei Province for psychological treatment. However, the environment there wasn’t great, and the medical techniques weren’t very sophisticated. So, I returned home and gradually adjusted myself. After a month, I felt better. Now, I don’t care as much about my hair. But last year, I found that I started having obsessive-compulsive disorder (OCD). I always worried that things would fall out of my wallet, and I had to repeatedly check. But I still worried a lot, feeling very exhausted mentally and extremely troubled. I don’t know what caused my OCD or why I became this way? Is it related to my living environment? I have always been a very competitive person, and my mother has spoiled me a lot. I love playing computer games and can play for a long time. But during the game, I still worry that things will fall out of my wallet, which makes me very annoyed and unable to enjoy the game. I am almost on the verge of collapse.
Reply 1:
Definition of Obsessive-Compulsive Disorder (OCD): OCD is a type of neurotic disorder characterized by the repeated occurrence of obsessive thoughts and compulsive actions. Obsessive thoughts are repetitive ideas, images, or intentions that enter the patient's consciousness in a rigid manner. These thoughts, images, or intentions seem to the patient to be meaningless, unnecessary, or excessive. The patient realizes these are their own thoughts and wants to get rid of them but feels powerless to do so, causing great distress. Compulsive actions are repetitive rigid behaviors or ritualistic actions performed by the patient to relieve inner anxiety by succumbing to obsessive thoughts. The essence of OCD is when patients regard normal physiological and psychological phenomena as abnormal and try hard to get rid of them, leading to intense psychological conflicts and entering a vicious cycle. Simply put: OCD = normal psychological phenomena + trying to get rid of them. Cure for OCD = giving up trying to get rid of them = accepting normal psychological phenomena = doing what needs to be done.
Symptoms of OCD: What are the symptoms of OCD? Clinically, the main manifestations are obsessive symptoms in thinking, emotions, intentions, and behavior. (1) Obsessive thoughts: Knowing that certain thoughts and behaviors, such as obsessive doubts, opposing concepts, and overthinking, are inappropriate and unnecessary, yet they cause tension, restlessness, and suffering, and cannot be escaped. (2) Obsessive emotions: Experiencing uncontrollable unnecessary worries, such as worrying about losing self-control and committing illegal or immoral acts or becoming mentally unstable. (3) Obsessive intentions: Feeling a strong internal drive or an immediate impulse to act, which never manifests as behavior but causes the patient to feel tense, worried, and distressed. (4) Compulsive actions: Repetitive actions or ritualistic behaviors performed by the patient to conform to or resist obsessive thoughts.
How to treat OCD: Generally, the treatment of OCD combines medication with psychotherapy, producing good results. 1. Psychotherapy: The purpose of psychotherapy is to make patients have a correct and objective understanding of their personality traits and the disease they suffer from, to make correct and objective judgments about their surroundings and reality, to discard mental burdens and reduce insecurity; to learn reasonable stress response methods, enhance confidence, and reduce uncertainty; not to aim too high or overly pursue perfection, thereby reducing feelings of imperfection. At the same time, mobilize relatives and colleagues to neither indulge nor overcorrect the patient, helping them actively engage in sports, entertainment, and social activities, gradually freeing themselves from being immersed in overthinking. Behavioral therapy, cognitive therapy, and psychoanalysis can all be used for OCD. Systematic desensitization can gradually reduce the frequency and duration of the patient's repetitive behaviors. For example, when treating a patient with compulsive handwashing, specify that in the first week, each handwash should not exceed 20 minutes and no more than 5 times per day; in the second week, each wash should not exceed 15 minutes and no more than 3 times per day; then continue decreasing incrementally. If there is anxiety, the entire body should relax and enter a meditative state. Each time the handwashing time is reduced, initially the patient may show signs of anxiety. In addition to teaching muscle relaxation, diazepam and propranolol can also be used to alleviate anxiety. Aversion therapy by snapping elastic bands on the arms can be tried for those who fail drug treatments. When the patient exhibits an uncontrollable thought, they snap the elastic band hundreds of times until they can suppress the thought. 2. Medication treatment mainly uses tricyclic drugs, with clomipramine being the most commonly used. The daily dosage is 150mg to 300mg, divided into two doses. Usually, effects begin to appear after 2 to 3 weeks, starting from a small dose. Those who see no effect after 4 to 6 weeks can consider switching or combining with other drugs, and the treatment period generally should not be less than 3 to 6 months. SSRIs like fluoxetine and paroxetine can also be used to treat OCD, with similar effects to tricyclics but fewer side effects. Additionally, for OCD accompanied by severe anxiety, benzodiazepines such as clonazepam can be combined; for difficult-to-treat OCD, mood stabilizers such as carbamazepine or sodium valproate can be combined, possibly achieving some therapeutic effect.