Obsessive compulsive disorder (OCD) affects 1 to 2% of the population. As explained by Professor Antoine Pelissolo, head of service in the psychiatry center of the CHU Henri-Mondor in Créteil, in Without an appointment, on Europe 1, these “obsessions” or “compulsions”, which alter everyday life, can, in most cases, be taken care of by specialists. OCD is both “the disease of doubt” and “the disease of hypercontrol”, with “something that is imposed on you, which can take control of your actions” and “a risk perceived as serious not to do it “, explains the doctor.
There are thus three main categories of OCD, explains Antoine Pelissolo:
– Washing obsessions: rewashing something that has already been washed, ten or twenty times, with above all “the fear of becoming contaminated”.
– The obsessions of error, “linked to risks of misfortune” which could happen in case of forgetting.
– Obsessions “linked to bad thoughts: a fear of having bad thoughts towards others, which pushes to constantly monitor one’s thoughts”.
Added to this is “impulse phobia: being afraid of an impulse with a violent outcome, such as hurting yourself with a knife, physically or sexually assaulting someone”, a phenomenon turned towards you or towards other. But as the professor specifies, “these are people who never act out”.
Majority of patients have normal lives
OCD affects either 1% or 2% of the population, with “normal” personalities. As Professor Pelissolo explains, “We don’t know a single cause of OCD, we know where it happens in the brain, but not exactly why”. In addition to this favorable terrain, “the effects of stress”. Events can also trigger OCD, “like pregnancy for women”.
In children, they can appear “between 5 and 10 years old”, but it is important to “not confuse them with rituals, mania, as long as it does not cause anxiety”, warns the psychiatrist. A TOC “it is a compulsion which is essential. There is a magic thought, as for the superstitions, which are much weaker. Certain figures, arbitrary, will thus have a reassuring value”.
These disorders can become truly disabling in everyday life. “If the majority of patients have a normal life, some are sometimes disabled to the point where they can no longer carry out their usual activities.” For example, “people who have a contact phobia will end up not touching anything anymore or spending their time cleaning themselves”, specifies Antoine Pelissolo. Beyond these physical constraints, there is a strong psychological effect. “The person, in general, realizes that what he is doing is not rational. The adults find it absurd, ridiculous, but feel obliged to do it,” adds the doctor. OCD also exposes to depression: “There is a form of wear and tear after years of struggle”.
What treatments for OCD?
If treatments for OCD exist, this is not the silver bullet for Professor Pelissolo. “We can make the pathology progress a lot, rarely make it disappear 100%. There are half of the people suffering from OCD that we can improve,” he explains. The first reflex for a practitioner with his patient is to inform him, to explain the process to him and to make him admit that it is a real disease. “Receiving the family in consultation to understand how it happened and helping them understand what OCD is” is also an important part of this information work.
Then comes the time for behavioral and cognitive therapy, “the only ones that work,” says the psychiatrist. The goal is to “change behavior, because giving in to OCD will make it worse. The more things you do artificially, the more you create the need to do it again.” It is therefore necessary “to expose patients to what they fear, to bear the stress that this causes, gradually”, edicts the doctor.
Heard on europe1:
The only secret for the habituation phenomenon to happen is to repeat it at home every day
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One of the usual exercises will be to “touch and then touch something that is not completely disinfected to identify the level of anxiety and offer suitable and graduated exercises”. For example, “move from the table to the sink, to the public space”. The sessions are three quarters of an hour, but “the only secret for the phenomenon of habituation to take place is to repeat it at home every day”. To hope for stabilization in “six months”, anticipates Antoine Pelissolo.
Psychotherapy “is essential first and when it is too hard, that it does not work, we go to drug treatment”, he continues. It is “including serotonergic antidepressants, well supported and easy to implement. But it is a treatment that should not be taken lightly. It is over several months, rather followed by a psychiatrist and it can be decisive enough, “warns the doctor.
Today, virtual reality is gradually arriving in the field of treatment. “We are starting to have visual environments that are offered to people. What is complicated is that there is this tactile dimension in OCD. We are doing it more and more, but it is more difficult in terms of technical “, explains the professor again.
For so-called “resistant” OCD, research continues and is currently exploring “deep brain stimulation, with electrodes in the brain. By continuously stimulating certain regions of the brain, we can reduce the impact of severe OCD”. A promising practice but not without risk.
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