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Depression with obsessions – OCD
Obsessive depression is characterized by a predominance in the clinical picture of phobic or obsessive-compulsive experiences that are combined with dreary, but more often anxious affect, psychomotor fussiness and vegetative-asthenic symptoms.
With obsessive depression, the daily rhythm of affect is irregular. The course of the depressive syndrome is characterized by pronounced reactivity, i.e. Dependence on external unfavorable circumstances.
Obsessions are characterized by:
- Involuntary, incomprehensible origin;
- Stereotyped repeatability;
- Alienation, incomprehensibility of content;
- The lack of the character of “being made by someone” (obsessive thoughts are experienced as their own);
- The presence of a constant sense of anxious anticipation of any trouble.
In addition, patients, as a rule, are aware of the morbid nature of obsessions, and only at the height of the state of criticism they fall sharply or disappear altogether. Obsessions are strengthened in the fight against them and are almost never realized.
By its structure, obsessions are divided into:
- Ideal (actually obsessions);
- Emotional (phobias);
- Motor (compulsive).
On the content side, the following types of obsessions are distinguished:
- Hypochondriacal phobias: a variety of nosophobia, including cardiopathy, carcinophobia, spidophobia, obsessive fear of death and insanity.
- Isolated phobias: fear of certain animals, fear of open spaces (agoraphobia) or closed spaces (claustrophobia), fear of heights, flight on an airplane and many others.
- Social phobia is a fear of being in the center of attention of others and manifests itself in various fears: an answer at the blackboard, examinations, loss of consciousness in a public place, for example in transport, etc.
- Obsessions of a psychotraumatic situation: quarrels with children, husband, conflict in the workplace or in the home.
Contrasting obsessions (thoughts, drives and / or representations) that contradict the moral and ethical attitudes of the individual. They are experienced especially painfully and are often combined with ideas of self-blame.
Their content is different, for example: the desire for death or injury to a loved one, the desire for unacceptable sexual contacts, a variety of blasphemous thoughts.
Obsessive doubts, consisting in painful uncertainty about the correctness and completeness of the performance of an action.
With obsessive doubts, fear of pollution (misophobia) is often combined. Such patients constantly wash their hands, boil pots or experience excruciating doubts about the purity of their own body. Obsessive doubts are more often than other obsessions combined with dreary affect and ideational inhibition.
Ideator obsessions with indifferent content, which include obtrusiveness, obsessive computation, etc. Motor compulsions are a variety of compulsive actions, often occurring as rituals to overcome phobias or obsessions.
Compulsive actions should be distinguished from impulsive and violent actions (the latter are not distinguished by all authors).
Compulsive action is characterized by insurmountability, arises contrary to reason and will, often carries an unacceptable and incomprehensible character for the patient. Compulsions, especially contrast, are painfully experienced by the individual and are realized only in isolated cases.
Impulsive action takes place instantly, without deliberation, under the influence of affect. It is brief and almost always unmotivated. Impulsive actions occur in schizophrenia, in patients with epilepsy and in psychopathies of an excitable circle.
Violent action (Yushchenko AI, 1924) is committed after a long struggle of internal tension. After the performance of the action, he has a discharge and a feeling of relief, and sometimes euphoria. Examples of violent actions are kleptomania, pyromania, dromomania and other “disorders of habits and drives”.
Obsessions, regardless of the nosological form at which they arise, are characterized by their own internal dynamics of development and complication: from isolated and hypochondriacal phobias to obsessions and contrast drives, and then to obsessive doubts and compulsive wisdom (obsessions). And, finally, to obsessive actions (compulsions).
In addition to the dynamics of complication, obsessions are inherent in external dynamics. Initially, obsessions arise as reactions to minor psychotraumatic circumstances or astheniziruyuschy factor. In the future, they are updated in the situation of “waiting” for the traumatic factor.
And, finally, they arise in the patient already spontaneously – autochthonous, acquiring the character of development or phase.
In the vast majority of cases, depressive-obsessive syndrome is formed in individuals with anankast personality traits. Such people are distinguished by insecurity, suspicion, distrust, exaggerated delicacy. They are afraid of everything new and are overwhelmed with persistent painful doubts. In many cases, they are painfully experiencing a lack of fullness of life, are prone to constant self-control, self-observation and pessimism.
Often they are tormented by thoughts about their own inferiority, unattractiveness. Usually they are hypersensitive: they feel an inflated need for their physical security, evade meaningful social contacts and are overly apprehensive of criticism, disapproval and rejection.
Anankast personalities are very proud, painfully resentful, inclined to impose their opinions, exaggerate the significance of small, everyday facts and do not tolerate changes in the habitual life stereotype. According to Gebsattl, the cardinal feature of the anankast personality is the fear of “contamination”.
They all have to be “clean”: the body, the objects, and the actions that must be performed correctly, that is, “clean.” If the action is carried out “not cleanly” – not exactly, not correctly, then it is as if not legitimate. And to complete it requires repeated repetition.