The term "OCD" has become an everyday part of language, to the point where the true meaning of the term has been lost. "I am so OCD about that" has come to mean that a person is worried or thinking a lot about something. "I can be so OCD about how I do things" really means that an individual has a specific preference or can be very precise. While it is human nature to sometimes get obsessed about a particular thought or to feel compelled to complete a particular action, a psychiatric diagnosis of强迫症(OCD)是一个定性不同的经验 - 为2.5%的人口造成重大痛苦和损害的体验,他们将在其生命中的某些地方挣扎。

强迫症由四个不同的元素组成:痴迷,强迫,避税和痛苦。通过了解每个元素,可以更清楚地了解诊断以及它与常规担忧和习惯的不同。

“o” - 痴迷

痴迷被定义为经常性的侵入性思想,包括精神图像或冲动以进行特定行为。这些思想可以突然出现,并且具有意外的高度强度,导致显着的痛苦。虽然痴迷可以被夸张或不恰当地分类,但是许多人的个人多次感到无能为力,不能控制压倒性的痴迷思想的持续流入。

强迫思想涵盖了广泛的频谱。一些更常见的一些包括:

  • Scrupulosity themes (religiosity, blasphemy, morality) – Could I have offended God?
  • Need for evenness, order, or symmetry – It feels uncomfortable if I don't have things balanced.
  • 失去控制 - 如果我不能一起把它握在一起怎么办?
  • 怀疑一个人的记忆或感知 - 我真的锁了前门吗?
  • Harm to self or others (Safety) – Maybe something bad will happen to my family.
  • Illness or disease – What if I have breast cancer?
  • 污染 - 可以有脏或有毒吗?
  • 迷信 - 如果我踩到裂缝,我可能会打破母亲的背部。
  • 不必要的性或侵略性的想法 - 我将把某人推到交通中(Fear of Acting Out)。
  • Perfectionism– What if I've made a mistake?

大多数人都经历过李侵入性的思想ke these before, though they might not have recognized them as such. To better visualize this: imagine the brain is like an e-mail account. When these thoughts happen, most brains are able to filter them into the "Junk" folder and dismiss them (like you dismiss the notification that your free "Roolexx" watch is ready for pick-up). The OCD brain's filter, however, tends to let some of these thoughts through. This leads to the perception that the thought might be legitimate and should be responded to accordingly. So when the thought "I want to push my husband in front of an on-coming train" arises, it triggers a significant level of distress, anxiety, and panic. An individual may begin to think:

  • 我为什么这么想?
  • 我必须是一个可怕的人。
  • I can't be trusted around my husband.
  • 也许我真的不爱他。
  • 我想这么做的是什么?
  • Who else might I want to hurt?

为了安静痛苦的痴痛思想并让人放心,令人惊恐地,不会发生恐怖的事情,那个人会从事......

"C" - Compulsions

Compulsions are the response to these intense, anxiety-provoking obsessive thoughts. Compulsions are repetitive physical or mental behaviors that are the individual's attempt to neutralize an obsession. These rituals and behaviors must be completed in accordance with certain strict, rigidly applied rules. The goal of these actions is to lessen distress or to prevent a dreaded outcome. These compulsions and rituals, however, are not really connected to the feared event, or are distinctly excessive. While compulsive behavior can help foster a sense of control over obsessions and the related emotional reactions, this relief is only temporary. Engaging in compulsions can actually strengthen the influence obsessions.

常见的强迫包括:

  • Washingand cleaning
  • Checking
  • 计数和重复
  • Arranging objects
  • 触摸物体
  • 心理仪式(思维特定的单词或短语)
  • 收集或获取对象
  • “只是正确的”感情(某事或行为必须“恰到好处”)
  • Confessing
  • 保证寻求

为了在迫切恐惧推动她的丈夫在火车前来提供救济,个人可能:

  • 紧紧地握住他的手,在车站平台上拖着他走向她
  • 与他一起办理登机手续,以确保他既没有武装,也不知道她爱他
  • 精神上重复这句话“我永远不会伤害他”
  • 向他承认这些想法已经发生了
  • 向自己保证“我真的爱他”

关于OCD的事情是强迫措施永远不足以满足强迫思想。OCD继续提高赌注并需要更多的个人。在火车场景中,强迫思想可能会扩展到其他地方(在人行道上,在停车场,在汽车中,在前场,在家里的前院)或可能开始包括其他人(家庭成员,朋友,完全陌生人)。为了安静的思想,仪式变得越来越精细,更加精致和苛刻。

For our example train situation, compulsions may grow to include:

  • 用手走在口袋里
  • 坚持认为丈夫在驾驶车站时走在她身后并将手放在她的肩膀上(这提供了他在那里的保证,同时阻止她用自己的手推他。
  • Keeping eyes downcast so as to not make eye contact with anyone who may otherwise become a victim of this feared action
  • 曾经坐在火车上,拍摄他的手臂4次,同时重复“我是一个好人”
  • 让丈夫用进入车站的不同入口并乘坐不同的汽车

即使有最精心的强制性,侵犯思想带来的恐惧也永远不会被完全熄灭。这将个人推动到......

避免

The third element of OCD is the avoidance of situations that cause distress. Sometimes obsessions are so painful and compulsions are so elaborate that it can be easier to steer clear of triggering things or situations. When a place or activity no longer feels "safe" from obsessive thoughts, the initial impulse is to steer clear of those "unsafe" things.

在火车的情况下,个人可能:

  • 乘坐火车在耗时的时间,以避免一个更拥挤的平台
  • 根本不乘火车,而是驾驶
  • Avoid traveling with the husband because of the associated fears
  • 拒绝乘火车旅行的机会
  • Stay at home
  • Avoid being around the husband all together

与强迫一样,避免行为对于个人的日常生活可能是非常破坏性的。向焦虑交伤并避免令人痛苦的情况可能会简短起作用,但焦虑越来越慢地要求​​越来越多。最终,无法保护自己免受所有触发情况。OCD可能就像一杯水中的一滴墨水,散布出来覆盖一切,所以无处可防造安全。

"D" - Distress

The main indicator of a disorder is that the thoughts and behaviors in question cause significant distress and disruption in daily life. Without the distress aspect, thoughts would not be triggering elevated levels of anxiety. The behaviors in question would not be rituals one is compelled to do, but rather habits or actions that 'just happen', without any larger meaning or purpose.

痛苦的经验是非常主观的。没有绝对的标准,可以测量麻烦和痛苦。在治疗中,个人受到教育的主观痛苦单位(SUD),并学习如何在规模上评价遇险的相对体验。通过认识到经验丰富的不适和因素,有助于痛苦的因素,可以管理一个人的反应 - 而不是通过强迫一个人的头部或者给予每个仪式的兴奋,而是通过学习导航所需的技能来管理并最终克服了与这些思想和行为相关的不适。

Treating and Coping With OCD

治疗师训练有素认知行为治疗(CBT)可以帮助制定一个融合每个人独特的OCD经历的细微差别的治疗计划,以便个人可以将其侵入性的想法放在他们的位置并重新获得一个人的生命中的权威。治疗师可以通过建立渐进挑战的等级和加强应对技能来帮助您通过这个过程。如果您认为您可能会与OCD挣扎,请达到培训的治疗师。可以克服OCD,有能力有所帮助的资源。

为你推荐

Jon Hershfield,MFT
Francine Rosenberg, Psy.D.
Jill M. Hooley, D.Phil.
Jon Hershfield,MFT
Jon Hershfield,MFT

注释

原始出版日期:

更新时间:2016年10月29日