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 comb them one by one. Once the hairstyle was set, it couldn't be touched, and my neck became stiff because I was afraid of messing up the style. Later, I got too tired and went to Tongji Hospital in Hubei Province for psychological treatment. However, the environment there was not good, and the medical techniques were not sophisticated. So, I returned home and gradually adjusted myself. After a month, I felt better. Now, I no longer care so much about my hair. But last year, I realized that I started having obsessive-compulsive disorder (OCD). I always worried about things falling out of my wallet and repeatedly checked it, but I still felt extremely anxious. I felt very exhausted mentally and troubled, but there seemed to be no solution. I don’t know the root cause of OCD or why I became like this? Is it related to the living environment? Since childhood, I have been a very competitive person, and my mother has been overly indulgent towards me. I love playing computer games and can play for a long time. But during the game, I still worry about things falling out of my wallet, which makes me very annoyed and unable to enjoy the game. I'm almost on the verge of collapse.
Reply 1:
Definition of Obsessive-Compulsive Disorder (OCD): OCD refers to a class of neurotic disorders characterized by the repeated appearance 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 are meaningless, unnecessary, or excessive to the patient. The patient realizes that these are their own thoughts and wants to get rid of them but is powerless to do so, causing great distress. Compulsive actions are repetitive stereotyped behaviors or ritualistic movements, which are the result of the patient succumbing to obsessive thoughts in order to alleviate inner anxiety.
The essence of OCD: OCD occurs when patients regard some normal physiological and psychological phenomena as abnormal and try hard to get rid of them, resulting in intense psychological conflicts and entering a vicious cycle. Simply put: OCD = normal psychological phenomena + attempts to escape. Cure for OCD = giving up the attempt to escape = accepting normal psychological phenomena = doing what needs to be done.
Symptoms of OCD: What are the symptoms of OCD? Clinically, OCD manifests as compulsive symptoms in thinking, emotions, intentions, and behavior. (1) Compulsive thoughts: Knowing that certain thoughts and manifestations, such as compulsive doubts, opposing ideas, and excessive thinking, are inappropriate and unnecessary, yet they cause tension and suffering and cannot be shaken off. (2) Compulsive emotions: Experiencing uncontrollable unnecessary worries, such as fearing losing self-control and committing illegal or immoral acts or becoming mentally unstable. (3) Compulsive intentions: Feeling an intense internal drive or impulse to act immediately, which never translates into action but causes the patient significant tension, worry, and pain. (4) Compulsive actions: Repetitive actions or ritualistic behaviors exhibited by the patient in response to or resistance against compulsive thoughts.
How to treat OCD: The treatment of OCD generally combines drug therapy with psychotherapy, producing good results. 1. Psychotherapy: The purpose of psychotherapy is to help patients have a correct and objective understanding of their personality traits and the disease they suffer from, make correct and objective judgments about the surrounding environment and real situations, discard mental burdens to reduce insecurity; learn reasonable stress management methods to enhance confidence and reduce uncertainty; avoid being overly ambitious and perfectionist to reduce imperfection feelings. At the same time, mobilize relatives and colleagues to neither indulge nor overcorrect the patient, helping the patient actively engage in sports, entertainment, and social activities, gradually freeing themselves from the state of excessive rumination. Behavioral therapy, cognitive therapy, and psychoanalytic therapy can all be used for OCD. Systematic desensitization therapy can gradually reduce the frequency and duration of the patient's repetitive behaviors. For example, in treating a patient with compulsive handwashing, the first week limits each wash to no more than 20 minutes and no more than 5 times a day; the second week limits each wash to no more than 15 minutes and no more than 3 times a day; then progressively reduces the time. If the patient feels anxious, they should relax their entire body and meditate. Initially, the patient may show signs of anxiety when reducing handwashing time, so in addition to teaching muscle relaxation, diazepam and propranolol can also be prescribed to reduce anxiety. Aversion therapy using wrist snapping can be attempted for those who do not respond to medication. When the patient experiences uncontrollable thoughts, they snap a rubber band on their wrist dozens or even hundreds of times until the thought can be suppressed. 2. Drug Therapy: Mainly tricyclic drugs are used, with clomipramine being the most commonly used. The daily dosage is 150mg to 300mg, taken in two doses. It usually takes 2 to 3 weeks to start showing effects, starting with a small dose, and if ineffective after 4 to 6 weeks, other drugs can be considered or combined. Generally, the treatment period should not be shorter than 3 to 6 months. SSRIs such as fluoxetine and paroxetine can also be used to treat OCD, with similar effects to tricyclics but fewer side effects. Additionally, benzodiazepines such as clonazepam can be combined for OCD accompanied by severe anxiety. For refractory OCD, mood stabilizers such as carbamazepine or sodium valproate can be combined, potentially achieving certain therapeutic effects.