He Pure obsessive disorder Is one in which both obsessions and rituals occur covertly (Barajas Martínez, 2002).
He human brain It naturally creates nonsensical thoughts that can be uncomfortable and strange. We have all had an intrusive thought of a violent, immoral or sexual type, however, this becomes a problem when they become recurring obsessions that cause the individual to suffer.
Also called primarily obsessive compulsive disorder or pure obsessive OCD, this disorder is a subtype of TOC In which the person primarily experiences obsessions, but does not exhibit observable compulsions typical of OCD such as washing his hands repeatedly or checking several times if the door has been closed.
Rather, they frequently present obsessions that appear as Intrusive thoughts , Unpleasant and unwanted that are considered violent, immoral, or sexually inappropriate for the person.
In general, obsessions have a theme centered on the fear of not controlling and doing something improper of oneself that can bring very negative consequences for itself or for the others (OCD Center of Los Angeles, 2016).
These thoughts are lived as if it were a nightmare and can be very tortuous for the person as it goes against their values , Religious beliefs, moral or social habits. It has been considered one of the most difficult and distressing forms of OCD.
One difference with traditional OCD is that people with the obsessive subtype suffer more and experience thoughts with great dread; While in the typical form the subject is more concerned with carrying out his compulsive behaviors, managing to avoid unpleasant and obsessive thoughts on a temporary basis.
As obsessives do not usually show compulsions (or do so much less) they try to turn the subject around (rumination) to try to neutralize that thought or to avoid it, by asking themselves questions like:"Would you be able to actually do it?"Or" If it really happens?"
This functions as a vicious circle in which thoughts appear and the person will try to neutralize them by giving them even more turns because he believes that this will solve the problem or a conclusion will come. But what they achieve is to reinforce these obsessions and become more important, becoming more likely to appear again.
Those affected know that the things they fear are very unlikely to occur, 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 reasons for concern.
These thoughts are closely associated with numerous cognitive biases such as giving thought a great importance, the need to attempt to control and manage them, and to believe that thought is the same as action.
For example, someone may have the intrusive thought that he could accelerate and run over a pedestrian while driving, and that makes him start to look for a source for that thought; May even believe that it could To be psycho And start monitoring yourself by continually looking for tests to tell you if it really is or is not.
Curiously, everything is a product of oneself and indeed people with pure obsessive disorder never get to perform the acts they fear, nor do they fulfill their fears as they had thought.
Frequent Topics in Pure Obsessive Disorder
Usually obsessions are focused on:
- Violence: It is about the fear of hurting yourself or other persons important to the person such as physically assaulting or killing your parents, a child, a partner, etc.
- Responsibility: They worry greatly about one's well-being, because they feel guilty or believe that they hurt (or they will) hurt others.
- Sexuality: A very common obsession is to doubt about their own sexuality, orientation and desires: whether they are homosexual or heterosexual, and may even begin to think that they will become pedophiles.
- Religion: Intrusive thoughts of blasphemous character and that go against the religion of that person, like thinking that one wants to obey the devil.
- Health: Obsessions about the occurrence of illnesses, mistrust of the indication of the doctors or thinking that they are going to contract illnesses of improbable or impossible forms (like to have touched an object that is of a sick person). They are always experiencing symptoms that they attribute to a disease when they do not really matter. Obsession on the other hand, may be centered somewhere on the body. It is different from hypochondria.
- Social relations: For example, a person who is in a relationship can ask himself continuously if Still in love , If you have really found the right partner, if the relationship is real love, etc.
How does it manifest?
It seems that these individuals do not show compulsions because at first sight they are not detected and must be explored more deeply to find them.
These patients very rarely manifest a single obsession or more than four, but are usually around 2 or 3 at the same time; This condition being associated with depression .
An adequate evaluation will uncover numerous compulsive behaviors, avoidant behaviors and search for tranquility, and above all mental compulsions. For example:
- Avoid those situations where you think that unpleasant thoughts can appear.
- They repeatedly ask themselves if they have actually carried out or would carry out the behaviors they fear to do (such as murder, rape or going crazy, etc.)
- Check your own feelings, symptoms, or experiences seeking to verify your obsessions as being aware of if you feel desires for someone of the same sex when you fear To be homosexual , Or if you feel the symptoms of any illness you think you might get.
- Repeat concrete sentences or pray silently, to mask unpleasant thoughts.
- Performing superstitious behaviors such as touching wood compulsively in order to try to prevent bad things from happening.
- Confess to everyone, even strangers, who has had thoughts that he considers unacceptable.
- Constantly rush obsessions trying to prove to himself that all is well and has done nothing wrong or is not to blame for certain events.
How is it diagnosed?
Diagnosis of this particular subtype is complicated to perform, and most are diagnosed as generalized anxiety , Hypochondria or traditional OCD.
This is because apparently these people seem to lead a normal and healthy life and normally do not interfere significantly with their daily functioning. However, behind everything hide constant obsessions trying to answer the questions that your thoughts pose.
Professionals usually carry out an incorrect treatment because this disorder is not yet well understood, then the affected person may come to think that he has more serious problems or that he is going completely crazy.
In order to detect it, the patient must comply with the DSM-V or ICD-10 OCD diagnostic criteria and then carry out an exhaustive evaluation with different tests to corroborate whether the compulsions are more internal or more behavioral. If they meet the symptoms mentioned here, it is best to make a specific diagnosis and treatment for pure obsessions and not for OCD in general.
What is its prevalence?
It seems that the percentage of purely obsessive OCD is higher than previously thought. There are studies that have located the percentage between 20% and 25% of patients with OCD, although there are some who have come to estimate that occurs between 50 or 60% of these patients.
This variability may be due to the fact that each professional is identified with different concepts of what an obsession and neutralization means, as well as the evaluation tests; That each investigator uses different tests.
Normally 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 who studied were pure obsessive. In addition, it was 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 about 18.45 years, but may vary. It was also found that their evolution is usually less than four years.
However, the results obtained between the different studies are contradictory. For example, in a research developed by Torres et al. (2013) studied 955 patients with OCD and found that only 7.7% had the pure obsessive subtype.
How can it be treated?
The 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 encounter certain problems. For example, exposure is best in motor rituals, but not so much in covert rituals as is the case. On the other hand, it is difficult to distinguish between anxiety-reducing thoughts (which need to be addressed with response prevention techniques) and those that increase anxiety (which should be treated with exposure).
If the symptoms appear, the best solution is to go to psychological therapy as soon as possible.
The goal of therapy is to stop the patient from feeling the need to ruminate on their obsessions and try to corroborate them or discard them. We remember that the problem of this disorder is that the affected person gives too much importance to harmless and common intrusive thoughts, becoming obsessions.
It is not good technique for this condition to offer tranquility and help the patient to reach the answer of his obsession, because that would further fuel the vicious circle. In addition, it would not be very useful either since pure obsessive people always find a new motive by which to break their tranquility and re-worry if they are not treated properly.
Here are the best treatments for pure obsessive disorder:
- Cognitive-behavioral therapy: In particular, exposure to thoughts that produce fear and anxiety and prevention of response. Cognitive techniques are used mainly in which the affected person is invited to assume the risks of his obsessions and to end them, as the Cognitive restructuring .
For example, instead of thinking all day long if you have cancer or not and being attentive to the possible signs of your own body you could face it and think that you can live with the possibility of cancer or not. These people are very afraid of uncertainty, so it is effective to develop strategies of habituation to uncertainty.
Sometimes the technique of"getting worse"is used, that is, raising the situation that the patient fears to the extreme:"and 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 give him fear and his anxiety power is weakening.
Mental rituals that serve to reduce anxiety must be reduced and abandoned, being careful not to substitute for new rituals. In this way we break the vicious circle because the patient is exposed to the obsessions he fears without the rituals or ruminations that serves to try to avoid them, but these in the background maintain the obsessions and make them grow. For example, eliminate repetition of sentences, counting, praying, asking questions or going to the places you avoided.
In conclusion, the important thing is to expose to the annoying thoughts without realizing mental rituals until they do not produce anxiety.
- Mindfulness Based on cognitive behavioral therapy: Is a form of meditation in which the person with training can learn to accept their thoughts and feelings without judging, avoiding or rejecting them. This diminishes the attempt to control all thoughts, which is what causes discomfort to patients with pure obsessive disorder.
- Accompanying drugs: In some cases, the use of drugs such as Selective Serotonin Reuptake Inhibitors ( SSRIs ) Along with the techniques mentioned above, but do not solve the problem if taken alone.
References
- Hyman, B.M. & Pedrick, C. (2005). The OCD workbook. Oakland, CA: New Harbinger Publications.
- Martínez, S. B. (2002). Subtypes of obsessive-compulsive disorder, differential characteristics of pure obsessive and association with symptoms of anxiety, depression and concerns. Clinical and Health, 13 (2), 207-231.
- McKay, D. (2008). The Treatment of Obsessions. Primary Care Companion to The Journal of Clinical Psychiatry, 10 (2), 169.
- Primarily obsessional obsessive compulsive disorder. (S.f.). Retrieved on July 28, 2016, from Wikipedia.
- Pure Obsessional OCD (Pure O): Symptoms and Treatment. (S.f.). Retrieved on July 28, 2016, from OCD CENTER OF LOS ANGELES.
- Torres, A.R., Shavitt, R.G., Torresan, R.C., Ferrão, Y.A., Miguel, E.C., & Fontenelle, L.F. (2013). Clinical features of pure obsessive-compulsive disorder. Comprehensive Psychiatry, 541042-1052.
- Wochner, S. K. (2012). PURE OBSESSIONAL OCD: Symptoms and Treatment. Social Work Today, 12 (4), 22.