Patient's Gender: Male
● Patient's Age: 20
During junior high school, I was particularly fond of styling my hair. There were so many strands, but I had to style each one individually. Once styled, it couldn't be touched; my neck would stiffen because I was afraid of ruining the hairstyle. Later, it became too exhausting, so I went to Tongji Hospital in Hubei Province for psychological treatment. However, the environment there wasn’t good, and the medical techniques were not advanced. So, I returned home and gradually adjusted myself. After a month, I was better and no longer cared so much about my hair. But last year, I realized I started having obsessive-compulsive disorder (OCD). I always worried that things in my wallet would fall out, and I had to repeatedly check them, yet I still felt extremely worried. Mentally, I was very tired and distressed, but I didn't know what to do. I don't understand the root cause of OCD or why I have become this way. Is it related to my living environment? Since childhood, I have been a very competitive person, and my mother has spoiled me a lot. I love playing computer games and can play for long periods, but even while playing, I still worry about things falling out of my wallet, which makes me very annoyed and unable to enjoy the game. I'm almost at my wit's end.
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 rigid and repetitive ideas, images, or intentions that enter the patient's consciousness. These thoughts, images, or intentions are meaningless, unnecessary, or excessive to the patient. The patient realizes these are their own thoughts and wants to get rid of them but cannot, leading to great distress. Compulsive actions are repetitive, stereotyped behaviors or ritualistic movements that result from the patient succumbing to obsessive thoughts as a way to alleviate inner anxiety.
The essence of OCD: OCD occurs when patients regard normal physiological and psychological phenomena as abnormal and strive to eliminate them, causing intense psychological conflict and entering a vicious cycle. Simply put: OCD = normal psychological phenomena + attempts to escape. Cure for OCD = abandon attempts to escape = accept normal psychological phenomena = act appropriately despite discomfort.
Symptoms of OCD: What are the symptoms of OCD? Clinically, OCD manifests as obsessions in thinking, emotions, intentions, and behavior. (1) Obsessive thoughts: Knowing that certain thoughts and expressions, such as obsessive doubts, opposing concepts, and overthinking, are inappropriate and unnecessary, yet causing tension, unease, and pain, and being unable to shake them off. (2) Obsessive emotions: Experiencing uncontrollable unnecessary worries, such as fearing loss of self-control and committing illegal or immoral acts or becoming mentally unstable. (3) Obsessive 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) Obsessive actions: Repetitive actions or ritualistic behaviors exhibited by the patient to comply with or resist obsessive thoughts.
Treatment of OCD: Generally, a combination of drug therapy and psychological therapy produces good results for OCD. 1. Psychological Therapy: The aim 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 their surroundings and current situations, discard mental burdens to reduce insecurity, learn reasonable stress management methods to boost confidence and reduce uncertainty, avoid aiming too high or being overly perfectionistic to reduce 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 the trap of overthinking. Behavioral therapy, cognitive therapy, and psychoanalytic therapy can all be used for OCD. Systematic desensitization can gradually reduce the frequency and duration of repetitive behaviors. For example, when treating a patient with compulsive handwashing, specify that in the first week, each wash should not exceed 20 minutes and occur no more than 5 times per day; in the second week, each wash should not exceed 15 minutes and occur no more than 3 times per day; subsequently, decrease incrementally. If anxiety arises, practice full-body relaxation and meditation. Initially, the patient may exhibit signs of anxiety when reducing handwashing time, but teaching muscle relaxation techniques and possibly using diazepam and propranolol can alleviate anxiety. Aversion therapy involving snapping a rubber band on the arm can treat compulsive thoughts when medications fail. When the patient experiences an uncontrollable thought, they snap the rubber band on their arm dozens or hundreds of times until the thought can be suppressed. 2. Drug Therapy: Tricyclic drugs are mainly used, with clomipramine being the most common. The daily dosage is 150mg-300mg, taken twice a day. Effects usually start after 2-3 weeks, starting with small doses. If ineffective after 4-6 weeks, consider switching or combining with other drugs. Treatment generally lasts no less than 3-6 months. Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and paroxetine can also be used to treat OCD, with effects similar to tricyclics but fewer side effects. Additionally, for OCD accompanied by severe anxiety, benzodiazepines like clonazepam can be combined; for difficult-to-treat OCD, mood stabilizers like carbamazepine or sodium valproate may yield some efficacy.