PURE OBSESSIVE DISORDER: SYMPTOMS, TREATMENTS - ECONOMÍA - 2024

The pure obsessive disorder is one in which both obsessions and rituals occur covertly. The human brain naturally creates nonsensical thoughts that can be uncomfortable and strange. We have all ever had an intrusive thought of a violent, immoral or sexual type, however, this begins to be a problem when they become recurrent obsessions that make the individual suffer.

Also called primarily obsessive obsessive compulsive disorder or pure obsessive OCD, this disorder is a subtype of OCD in which the person primarily experiences obsessions, but does not manifest observable compulsions typical of OCD such as repeated hand washing or checking repeatedly to see if the hand has been closed. door.

Rather, they frequently present obsessions that appear as intrusive, unpleasant, and unwanted thoughts that are considered violent, immoral, or sexually inappropriate for the person.

In general, obsessions have a theme centered on the fear of not controlling oneself and doing something inappropriate for oneself that can have very negative consequences for oneself or for others.

These thoughts are lived as if it were a nightmare and can be very tortuous for the person since it goes against their values, religious beliefs, morals or social habits. It has been considered one of the most difficult and distressing forms of OCD.

Difference between pure TOC and TOC

One difference from traditional OCD is that people with the obsessive subtype suffer more and experience thoughts with great dread; while in the typical way the subject is more concerned with carrying out her compulsive behaviors, managing to avoid unpleasant and obsessive thoughts temporarily.

As obsessives do not usually manifest compulsions (or do so much less) they try to turn the matter around (rumination) to try to neutralize that thought or avoid it, asking themselves questions such as: "Would I be able to do it for real?" or "what if it really happens?"

This works as a vicious circle in which thoughts appear and the person will try to neutralize them by giving it even more thought because he believes that this will solve the problem or reach a conclusion. But what it does is that these obsessions are reinforced and become increasingly important, making it more likely that they will appear again.

Those affected know that the things they fear have very little probability of happening, they may even be impossible; but this will not prevent them from continuing to feel great anxiety that will make them think that they are real causes worthy of concern.

These thoughts are closely associated with numerous cognitive biases such as giving great importance to thoughts, the need to try to control and manage them, and believing that thinking equals action.

For example, someone may have the intrusive thought that they could speed up and run over a pedestrian while driving, and that makes them start looking for an origin to that thought; being able to come to believe that he could be a psychopath and begin to monitor himself continuously looking for evidence that tells him if he really is or not.

Curiously, everything is a product of oneself and people with pure obsessive disorder never actually perform the acts they fear, nor are their fears fulfilled as they had thought.

Common themes in pure obsessive disorder

Usually the obsessions are focused on:

- Violence: it is the fear of harming oneself or other people important to the person such as physically attacking or killing their parents, a child, partner, etc.

- Responsibility: they care enormously for the well-being of someone, since they feel guilty or believe that they harm (or will do) others.

- Sexuality: a very common obsession is doubting about their own sexuality, orientation and desires: if they are homosexual or heterosexual, and they may even begin to think that they are going to become pedophiles.

- Religion: intrusive thoughts of a blasphemous nature and that go against that person's religion, such as thinking that they want to obey the devil.

- Health: obsessions about the appearance of diseases, distrusting the doctors' instructions or thinking that they are going to contract diseases in improbable or impossible ways (such as having touched an object that belongs to a patient). They are always experiencing symptoms that they attribute to some illness when in reality they do not matter. Obsession, on the other hand, may be focused on some part of the body. It is different from hypochondria.

- Of social relationships: for example, a person who is in a relationship may continually wonder if he is still in love, if he has really found the right partner, if the relationship is true love, etc.

Symptoms

It appears that these individuals do not display compulsions because they are undetected by the naked eye and must be explored more deeply to find them.

These patients very rarely show a single obsession or more than four, but are usually around 2 or 3 at the same time; associating this condition with depression.

An adequate evaluation will uncover numerous compulsive behaviors, avoidance and peace-seeking behaviors, and especially mental compulsions. For example:

- They avoid those situations in which they believe that unpleasant thoughts may appear.

- They repeatedly ask themselves if they have really carried out or would carry out the behaviors they fear doing (such as murder, rape or going crazy, etc.)

- Check your own sensations, symptoms, or experiences seeking to verify your obsessions such as being aware of whether you feel desires for someone of the same sex when you fear being homosexual, or if you feel the symptoms of any disease that you think you could contract.

- Repeat specific phrases or pray silently, to mask unpleasant thoughts.

- Carry out behaviors of a superstitious nature such as compulsively knocking on wood in order to try to prevent bad things from happening.

- Confess to everyone, even strangers, that you have had thoughts that you consider unacceptable.

- Constantly ruminate on obsessions trying to prove to himself that everything is fine and that he has not done anything wrong or that he is not to blame for certain events.

Diagnosis

Diagnosis of this particular subtype is difficult to make, and most are diagnosed as generalized anxiety, hypochondria, or traditional OCD.

This is because apparently these people appear to lead normal, healthy lives and it does not normally interfere significantly with their daily functioning. However, behind everything they hide constant obsessions trying to answer the questions that their thoughts pose.

Professionals usually carry out incorrect treatment because this disorder is not yet well understood, so the affected person may come to think that they have more serious problems or that they are going completely crazy.

To detect it, the patient must meet the OCD diagnostic criteria of the DSM-V or the ICD-10 and subsequently carry out a comprehensive evaluation with different tests to corroborate whether the compulsions are more internal or more behavioral.

If they meet the symptoms mentioned here, it is better to make a specific diagnosis and treatment for pure obsessions and not for OCD in general.

Prevalence

It appears that the percentage of purely obsessive OCD is higher than previously thought. There are studies that have placed the percentage between 20% and 25% of patients with OCD, although there are some that have come to estimate that it occurs between 50 and 60% of these patients.

This variability may be due to the fact that each professional identifies with different concepts of what an obsession and neutralization mean, as well as the evaluation tests; that each researcher uses different tests.

Typically the prevalence is estimated for OCD in general, without focusing on its subtypes, which is close to 3% of the general population.

In the study by Barajas Martínez (2002) it was found that 23.5% of the patients with OCD they studied were pure obsessives. In addition, they observed that it was more frequent in men (58.3%) than in women (41.7%).

On the other hand, the average age of onset is approximately 18.45 years, but it can vary. It was also found that its evolution is usually less than four years.

However, the results obtained between the different studies are contradictory. For example, in an investigation developed by Torres et al. (2013) studied 955 patients with OCD and it was found that only 7.7% present the pure obsessive subtype.

Treatment

Treatment will depend on the diagnosis: if a correct diagnosis is not made, it will not be treated properly and the disorder will not improve.

In addition, within this subtype we find certain problems. For example, exposure is better in motor rituals, but not so much in covert rituals as is the case. On the other hand, it is difficult to distinguish between thoughts that decrease anxiety (which must be treated with response prevention technique) and those that increase it (which must be treated with exposure).

If symptoms occur, the best solution is to go to psychological therapy as soon as possible.

The goal of therapy will be for the patient to stop feeling the need to ruminate over their obsessions and try to corroborate or discard them. We remember that the problem with this disorder is that the affected person gives too much importance to harmless and common intrusive thoughts, turning into obsessions.

It is not a good technique for this condition to offer reassurance and help the patient achieve the response to their obsession, because that would further fuel the vicious circle. Also, it wouldn't be very helpful either as pure obsessive people always find a new reason to break their peace of mind and worry again if they are not treated properly.

Here are the best treatments for pure obsessive disorder:

Cognitive behavioral therapy

Specifically, exposure to fear and anxiety-producing thoughts and response prevention. Mainly, cognitive techniques are used in which the affected person is invited to assume the risks of their obsessions and end them, such as cognitive restructuring.

For example, instead of thinking all day about whether or not you have cancer and being attentive to possible signals from your own body, you might face it and think that you can live with the possibility of cancer developing or not. These people are very afraid of uncertainty, so it is effective that strategies of habituation to uncertainty are developed.

Sometimes the technique of “putting on the worst” is used, that is, elevating the situation that the patient fears to the extreme: “What if you lose control of your thoughts and end up stabbing your son, what would happen? And then?". Thus the person is exposed to the thoughts that frighten her and her anxiety-producing power is weakened.

Mental rituals that serve to reduce anxiety should be reduced and abandoned, taking great care that they are not replaced by new rituals. In this way we break the vicious circle since the patient is exposed to the obsessions they fear without the rituals or rumination that serves to try to avoid them. For example, eliminating the repetition of phrases, counting, praying, asking questions or going to places that he avoided.

In conclusion, the important thing is to expose yourself to the annoying thoughts without performing mental rituals until they do not produce anxiety.

Mindfulness based on cognitive behavioral therapy

It is a form of meditation in which the trained person can learn to accept their thoughts and feelings without judging, avoiding or rejecting them. This decreases the attempt to control all thoughts, which is what causes the discomfort in patients with pure obsessive disorder.

Accompanying drugs

In some cases, the use of medications such as Selective Serotonin Reuptake Inhibitors (SSRIs), along with the techniques mentioned above, may help, but they do not solve the problem if taken alone.

References

1. Hyman, BM & Pedrick, C. (2005). The OCD workbook. Oakland, CA: New Harbinger Publications.
2. Martínez, SB (2002). Subtypes of obsessive-compulsive disorder, differential characteristics of pure obsessives and association with symptoms of anxiety, depression and worries. Clínica Y Salud, 13 (2), 207-231.
3. McKay, D. (2008). The Treatment of Obsessions. Primary Care Companion to The Journal of Clinical Psychiatry, 10 (2), 169.
4. Primarily obsessional obsessive compulsive disorder. (sf). Retrieved on July 28, 2016, from Wikipedia.
5. Pure Obsessional OCD (Pure O): Symptoms and Treatment. (sf). Retrieved on July 28, 2016, from OCD CENTER OF LOS ANGELES.
6. Torres, AR, Shavitt, RG, Torresan, RC, Ferrão, YA, Miguel, EC, & Fontenelle, LF (2013). Clinical features of pure obsessive-compulsive disorder. Comprehensive Psychiatry, 541042-1052.
7. Wochner, SK (2012). PURE OBSESSIONAL OCD: Symptoms and Treatment. Social Work Today, 12 (4), 22.