Česky
Professor, what is obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD) has two main components - intrusive, unwanted thoughts, which we call obsessions, and subsequent repetitive behaviour, or compulsions. Typically, the thought may be, "What if I get locked up?", "What if I get infected?", or "What if I hurt someone?". The person usually realizes that these thoughts are not rational, but he or she cannot suppress them, so he or she tries to relieve himself or herself of them by certain behaviors-for example, repeated checking, excessive washing, praying, or other specific rituals. Often, he also begins to avoid situations that trigger anxiety.
This is very burdensome. And what happens next?
The patient gets into a vicious cycle - the more he tries to manage the anxiety through rituals, the more the thoughts return. Clinically significant OCD usually manifests when obsessions and compulsions bother for more than an hour a day and interfere with normal functioning. Approximately 2% of the population suffers from the more severe form, and another 4% from the milder forms. Most people have experienced an intrusive thought at some point - and this is a perfectly normal phenomenon.
Can obsessions take a more serious form?
The severity is related to one's outlook on problems and one's ability to resist compulsions. The more a person believes he or she must do the compulsion and the less able he or she is to resist the urge to perform the compulsion, the more severe the picture of the disorder becomes. Some forms of OCD appear more severe because of the content of the obsessions, but are not more difficult to treat, e.g. obsessions with aggressive or sexual content. For example, a person may think of hurting someone close to them - for example, a mother may think of hurting her own child. However, it is not the wish to do such a thing, but the anxiety of the mere thought that is very disturbing to the patient. Such thoughts make people feel shame and fear, even though they would never act that way in reality. However, because of OCD, they themselves are not sure whether this is not a threat. I had a patient who, because of these fears, used to lock herself in the basement at night to make sure she didn't hurt anyone. She loved her children. It's important to say that these fears never materialized in practice - but the experience of fear is very real and intense.
Where can we look for the causes of OCD? Could this disorder be hereditary?
A congenital predisposition plays a role in approximately 30-40% of cases, although OCD may not manifest in its full form in ancestors. Childhood development - particularly feelings of insecurity and lack of security - also has a significant impact. Over-controlling or frightening parents may also play a role. Freud's theory spoke, for example, of the influence of a period of training in hygiene habits, when there can be a conflict between the need for autonomy and environmental pressures. Today we know that there are more causes and that they combine - biological, psychological and social.
Can OCD be combined with other disorders?
Yes, it is quite often found together with other anxiety disorders, mood disorders and borderline personality disorder (BPD). Probably the most complex to experience is the combination with borderline personality disorder. In our Centre, we see this combination in about one fifth of our patients. The manifestations of both disorders overlap and in many ways influence each other. We have patients in the community from both of these diagnostic categories, and some have symptoms of both. Therefore, we often work with these patients together - we feel that it allows them to understand each other better.
In what sense do these groups of patients understand each other?
OCD patients often struggle to gain a sense of security through control, whereas people with borderline disorder are more likely to struggle with intense emotions that sometimes completely overwhelm them. They have sensitivity to rejection, mood swings, insecurity in relationships and low self-esteem. Their interpersonal relationships tend to be intense but also hurtful - they crave closeness but fear abandonment. Often these are women who are genuinely trying to have a fulfilling relationship, but are facing internal obstacles that make it difficult.
What about self-harm?
Self-harm is a common response to internal tension in BPD patients. Physical pain can bring relief for a while because it distracts from the unpleasant emotional experience of subjectively unbearable tension. Unfortunately, habits can form on this way of coping, which are then difficult to abandon. In therapy, we look for safer and more sustainable ways to work with emotions.
Where do the causes of BPD lie?
A child's temperament and genetic makeup play a large role, but early developmental experiences have the greatest influence. Emotionally unstable environments, lack of acceptance, humiliation, physical or emotional abuse, but also, for example, misunderstanding a child's emotions and being spoiled - all of these can affect personality development. In addition, in recent years we have seen that changes in the way children spend their time are also having an impact - they are now spending less time in direct contact with their parents, but also with their peers, which is essential for healthy emotional development.
How do you work with these patients at the Centre for Mental Rehabilitation?
Our treatment is intensive and takes place over a six-week period. Each day we focus on different areas - from emotions and thinking to relationships, communication, ability to understand self and others, and problem-solving skills. Many patients make significant progress during the program. To support and maintain the results, we offer some patients a follow-up year-long program with weekly attendance to help stabilize them in their daily lives.
What therapeutic methods do you use?
For OCD, the primary method is exposure with ritual prevention - i.e., conscious exposure to the anxiety trigger without subsequent relieving behavior. Although this initially causes a lot of tension, repetition leads to a gradual decrease in anxiety and learning that there is no need to perform rituals. With borderline disorder, the focus is primarily on working through past traumas and changing internal beliefs. We help patients learn to manage their emotions, build healthy relationships and better understand themselves. This is a deeper process, but it produces long-term results.
What role does medication play in treatment?
For OCD, antidepressants can be very helpful - they reduce the intensity of symptoms and make it easier to start psychotherapy. If the patient arrives early, pharmacotherapy can help significantly. In borderline personality disorder, medication does not usually have a direct effect on the core of the problem - rather it is used for co-occurring conditions such as depression or anxiety. The key to recovery is psychotherapy, which leads to inner change and improved quality of life.
