Obsessive-compulsive disorders

Breaking free of compulsions

Cleaning, washing hands, keeping things tidy – all completely normal actions. But the line between that and a compulsion is fluid. “I have to do this again and again, even though I know it makes no sense”, “I feel like I’m mad when I think clearly” – these or similar statements are often heard from patients suffering from obsessive-compulsive disorder (formerly also  called obsessional neurosis). Such compulsions considerably restrict the daily way of life.

Our consultants at Schoen Clinic specialise in mental illness.  With effective therapies, we help you to overcome your compulsions.

Causes & symptoms

What are obsessive-compulsive disorders?

Obsessive-compulsive disorders are among the most common mental illnesses in adulthood. There are obsessive-compulsive disorders in which obsessive-compulsive thoughts primarily occur and those in which compulsive actions represent the main symptoms.

Obsessive thoughts impose themselves on those affected and constantly occupy them in the same form. These thoughts are almost always threatening or tormenting. Attempts to suppress the thoughts are usually unsuccessful.

Compulsive actions or rituals are neither perceived as pleasant, nor do they serve to perform useful tasks in themselves. Sufferers often experience them as prevention against an objectively unlikely event that could harm them or cause harm themselves. In general, patients experience this behaviour as pointless and therefore keep trying to tackle it. Fear, tension or disgust are usually present all the time and intensify further when attempting to suppress these actions.

Obsessive-compulsive disorder – causes: How do compulsions occur?

In order for obsessive-compulsive disorder to develop, several components usually have to come together. Risk factors are
  • Hereditary
    Various research projects have found an increased incidence of obsessive-compulsive and anxiety disorders among relatives of sufferers. If one or both parents suffer from obsessive-compulsive disorder, the risk of also suffering from obsessive-compulsive disorder is increased in the children. A similar picture emerges in twins. However, as many members of affected families also remain healthy, the genetic connection is assessed to be rather low. It is also unclear to what extent the children take on compulsions from their parents through model learning.
  • Neurobiological factors
    Some parts of the brain are hyperactive in sufferers. These areas are, among other things, assigned to special filter systems for information processing and are influenced by the messenger substance serotonin. Successful treatment of the compulsions leads to normalisation of the hyperactivity in these brain regions. Collecting compulsions (the hoarding of objects of no value in themselves) also occur more frequently, but can also exist independently of obsessive-compulsive disorders. Disorders related to compulsions include the compulsive scratching of the skin and the compulsive pulling out of hair.
  • Styles of upbringing
    Sensitive children can become insecure if high expectations in terms of independence and responsibility exist at an early stage, if mistakes are assessed very critically and successes are barely acknowledged. They then react more cautiously and fearfully to requirements and in interpersonal contact. This can cause them to increasingly strive for safety. They try to avoid mistakes and criticism through perfectionism. If parents repeatedly warn their children of dangers and overprotect them, this can also lead to continued insecurity. Styles of upbringing, however, are never solely responsible for the disorder.
  • Formative events in the sufferer’s personal history
    If extraordinary stress occurs in the course of life (for example, physical or sexual violence, emotional neglect, the early death of a parent), people who are already insecure may feel very overwhelmed. The obsessive-compulsive symptoms are then used to try to regain control over an apparently unmanageable situation.
  • Personality traits
  • People who absolutely want to avoid mistakes often double check things. High anxiety and low self-esteem also demand more security and can lead to compulsions. Pronounced shyness and a low assertiveness are also risk factors.
  • Triggers for the occurrence or worsening of obsessive-compulsive disorders or a relapse
    Emotionally stressful life events are often associated with intense, negative emotions. This includes severe stress in a relationship and family, the transition into a new phase of life, or even ongoing work overload. These events need not necessarily be the cause of obsessive-compulsive disorder. However, you can activate an existing vulnerability (predisposition), even if the compulsions could have been successfully overcome at an earlier point in time.

Obsessive-compulsive disorder – symptoms: Which symptoms occur?

People suffering from OCD feel a strong inner urge to think or do things that they themselves – at least at the beginning of the symptoms – regard as absurd or excessive. Attempts to defend oneself against this urge usually fail or even lead to an increase in thoughts and impulses. Burdensome thoughts and feared catastrophes keep pushing themselves into the person’s consciousness and trigger a huge amount of restlessness, tension or disgust. Although the mind knows that the thoughts and fears are absurd or exaggerated, the feeling of threat cannot be calmed down. It can only be reduced by taking ritualised countermeasures involving compulsive actions or mental rituals. This can sometimes take up to hours and affect the entire daily routine.

Insight into the absurdity of thoughts and actions is often associated with shame. As a result, many people try to hide their symptoms from friends and family.

Symptoms of all obsessive-compulsive disorders

All compulsions have a threatening and a defensive component. Example:
A thought experienced as uncontrollable signals threat: “If you don't check again, something bad will happen.” 
This thought is neutralised by a compulsive action, for example by repeatedly checking the stove. 
The insidious thing is that the fears cannot be quelled with a single check. It takes several time-consuming checks and aid rituals or reinsurance before the fears begin to calm down. As a rule, this increases the insecurity of those affected.

Symptoms of a compulsion to wash and control

In the case of a compulsion to wash, those affected fear that they or other people may become infected or injured by contact with dangerous substances or pathogens. The fear and disgust caused by the unpleasant ideas can supposedly only be alleviated by extensive cleaning rituals. 

People who suffer from a compulsion to control are constantly afraid of being responsible for disasters. They fear causing a fire, a flood or a break-in through negligence. Others think about having run someone over without realising. They therefore drive the route several times or call the police.

Symptoms of other obsessive-compulsive disorders

Some patients are driven by their fears to follow magical rituals or rules in order to prevent relatives from suffering misfortune. They have to do things in a certain order and at a certain frequency, for example, they must not step on joints. Others develop reassurance and repetition compulsions.

Further symptoms 

Obsessive-compulsive disorder often occurs together with other disorders, such as 
  • Depression
  • Panic disorder
  • Social anxiety
  • Personality disorders 
  • Body dysmorphic disorder (excessive preoccupation with one's own appearance)
  • Attention-deficit hyperactivity disorder (ADHD)
  • Post-traumatic stress disorders (PTSD)
  • Eating disorders

Diagnostics

Diagnosis: This is how obsessive-compulsive disorder is detected.

In order to diagnose obsessive-compulsive disorder, the compulsive actions or thoughts must have occurred on most days for at least two weeks. The compulsions must be experienced as tormenting or interfere with your normal activity.

Standardised interviews or questionnaires enable us to precisely determine the severity of your obsessive-compulsive disorder. We are very sensitive in our diagnostic discussions and give you enough time and space to develop the necessary trust in us.