Neuroses in adolescents. What is it, why does it occur and what to do?

One of the most common psychological disorders today is neurosis.
This disease can be a constant concern or be episodic, but in any case, neurosis greatly complicates a person’s life. If you do not seek qualified medical help in a timely manner, this disorder can lead to the development of more complex mental illnesses. Neuroses are reversible psychogenic disorders that arise due to internal or external conflicts, emotional or mental stress, as well as under the influence of situations that can cause mental trauma in a person. Obsessive-compulsive neurosis occupies a special place among neurotic disorders. Many experts also call it obsessive-compulsive disorder (OCD), but some doctors separate the two pathologies.

Why is this happening? The fact is that in Russian medicine, for a long time, obsessive-compulsive disorder and OCD were indeed considered different diagnoses. But the international classification of diseases ICD-10 used today does not contain such a disease as obsessive-compulsive disorder; this list of diseases only mentions obsessive-compulsive disorder. That is why recently these two formulations have begun to be used as a definition of the same mental pathology.

A person in this state suffers from intrusive, disturbing or frightening thoughts that arise involuntarily. The main difference between this disease and schizophrenia is that the patient is aware of his problems. He tries to get rid of anxiety through obsessive and tiresome actions. Only a qualified psychotherapist who has experience working with patients who suffer from this form of mental disorder can cure obsessive-compulsive disorder.

Reasons for development

Among the reasons for the development of obsessive-compulsive neurosis are usually cited stressful situations and overwork, but obsessive-compulsive disorder does not occur in all people who find themselves in a difficult life situation. What actually provokes the development of obsessive states has not yet been precisely established, but there are several hypotheses regarding the occurrence of OCD:

1. Hereditary and genetic factors. Researchers have identified a pattern between the tendency to develop obsessive-compulsive disorder neurosis and unfavorable heredity. Approximately every fifth patient with OCD has relatives with mental disorders. The risk of developing this pathology increases in persons whose parents abused alcoholic beverages, suffered from a tuberculous form of meningitis, and also suffered from migraine attacks or epilepsy. In addition, obsessive-compulsive disorder may occur due to genetic mutations.
2. A fairly large number of people (approximately 75%) suffering from obsessive-compulsive neurosis have other mental illnesses. The most likely accompaniments of OCD include bipolar disorder, depression, anxiety neurosis, phobias and obsessive fears, attention deficit hyperactivity disorder, and eating disorders.
3. Anatomical features can also provoke obsessive-compulsive neurosis. Biological reasons also include a malfunction in some parts of the brain and the autonomic nervous system. Scientists have drawn attention to the fact that in most cases, with obsessive-compulsive neurosis, there is a pathological inertia in the excitation of the nervous system, accompanied by lability in the inhibition of ongoing processes. OCD can occur against the background of various dysfunctions of the neurotransmitter system. Neurotic level disorders arise due to a failure in the production and metabolism of gamma-aminobutyric acid, serotonin, dopamine and norepinephrine. There is also a version about the relationship between the development of obsessive-compulsive disorder neurosis and streptococcal infection. People who have had this infection have antibodies in their bodies that destroy not only harmful bacteria, but also the body’s own tissues (PANDAS syndrome). As a result of these processes, the tissues of the basal ganglia can be damaged, which can lead to the development of OCD.
4. Constitutional-typological factors include special character traits (anancaste). Most patients are prone to constant doubts and are very cautious and cautious. Such people are very concerned about the details of what is happening, they are prone to perfectionism. Ananscasts are conscientious and very diligent people who strive to scrupulously fulfill their obligations, but the desire for perfection very often prevents them from completing the work they have started on time. The desire to achieve high results at work does not allow for the establishment of full-fledged friendships, and also greatly interferes with personal life. In addition, people with this type of character are very stubborn; they almost never compromise.

Treatment of obsessive-compulsive disorder should begin with identifying the causes of the disorder. Only after this will a treatment regimen be drawn up and, if necessary, medication prescribed.

Obsessive-compulsive neurosis - symptoms and treatment

Psychoanalytic theory. According to Freud, obsessive thoughts arise from the suppression of aggressive and sexual drives. These symptoms develop as a result of regression to the anal stage (the second stage of psychosexual development according to S. Freud, which begins at the age of 18 months and ends by three years) [7]. Regression depends on one of the following factors or a combination of them:

• defensive ego;
• residual phenomena of the anal-sadistic stage of development;
• phallic organization [3].

There was no objective evidence in the stated theory, so only some scientists consider it possible to consider it as an explanation for the cause of OCD.

Neurochemical theory. This theory was put forward by I.P. Pavlov; it is based on the role of acetylcholine and adrenaline metabolism [14]. Further, the occurrence of OCD has been described as a result of disturbances in serotonin metabolism.

The evidence was a comparison of the effectiveness of serotonin reuptake inhibitors, non-serotonergic drugs and placebo tablets in OCD. Strong correlations between plasma levels of clomipramine (an antidepressant) and reduction in OCD symptoms further supported the role of serotonin in the development of this disorder. However, the study of serotonin metabolism in OCD patients has not yet been sufficiently effective. Contrary to this theory, clomipramine is in some cases better at reducing OCD symptoms than selective serotonin reuptake inhibitors such as fluoxetine, fluvoxine and sertraline [4].

Neuroanatomical theory. Based on the results of special studies, neuroanatomical justifications for OCD were obtained. Frontal lobe dysfunction has been identified in many patients with OCD, but only a few researchers have been able to confirm this. Additional evidence for the involvement of the frontal lobe in the development of OCD has been the use of effective psychosurgical techniques such as capsulotomy and cingulotomy (targeted damage to brain structures whose activity causes the disease).

Evidence of neurobiological disorders in OCD is the connection of this disorder with another pathology, which is based on processes in the basal ganglia (lethargic encephalitis, Sydenham's chorea and Gilles de la Tourette's syndrome). Also, based on the results of four studies that assessed the metabolic activity of the brain using positron emission tomography, it was proven that metabolism in this disorder is increased in the prefrontal cortex [4].

Symptoms of the disorder

A doctor will be able to diagnose obsessive-compulsive disorder in a patient and prescribe appropriate treatment only if the main symptoms of the disorder have been observed for a long period of time (at least two weeks). OCD manifests itself like this:

• presence of obsessive thoughts. They can be regular or occur periodically, remaining in the head for a long time. Moreover, all images and attractions are very stereotypical. A person understands that they are absurd and ridiculous, but nevertheless perceives them as his own. The OCD patient also realizes that he cannot control this flow of thoughts, as well as control his own thinking. During the thought process, a person suffering from obsessive-compulsive disorder periodically has at least one thought that he tries to resist. Someone's first and last names, names of cities, planets, etc. may persistently come to mind. A poem, quote, or song may be replayed in your brain over and over again. Some patients constantly talk about topics that have nothing to do with reality. Most often, patients are worried about thoughts of panic about infectious diseases and pollution, about painful loss or the predetermination of the future. Patients with obsessive-compulsive disorder may experience a pathological desire for cleanliness, a need to maintain a special order or symmetry;
• Another important symptom of obsessive-compulsive neurosis is the desire to perform any actions that reduce the intensity of anxious thoughts. This behavior is called compulsive, and regular and repeated actions of the patient are called compulsions. The patient's need to perform specific actions is a conditional “obligation.” Compulsions rarely bring moral pleasure to a sick person; such “ritual” actions can only make one feel better for a short time. Among such obsessive actions one can note the desire to count specific objects, commit immoral or illegal acts, repeatedly check the results of one’s work, etc. A compulsion is the habit of squinting your eyes, sniffling, licking your lips, winking, licking your lips, or twirling long strands of hair around your finger;
• Doubts that constantly plague the patient can also indicate the presence of obsessive-compulsive disorder. A person in such a state is not confident in himself and his own abilities, he doubts whether he has performed the necessary action (turned off the water, turned off the iron, gas, etc.). Sometimes doubts reach the height of absurdity. For example, a patient can repeatedly check whether the dishes have been washed, and at the same time wash them every time;
• Another symptom of obsessive-compulsive neurosis is the patient’s fears that are groundless and devoid of logic. For example, a person may be terribly afraid of speaking in public; he is afraid of the thought that he will definitely forget his speech. The patient may be afraid to visit public places; it seems to him that he will definitely be ridiculed there. Concerns may relate to relationships with the opposite sex, inability to sleep, fulfilling work obligations, and the like.

The most striking example of obsessive-compulsive neurosis is the fear of getting dirty and contracting a fatal disease after contact with germs. In order to prevent this “terrible” infection, the patient tries in every possible way to avoid public places, he never eats in cafes or restaurants, and does not touch door handles or handrails on stairs. The home of such a person is practically sterile, since he carefully cleans it using specialized means. The same applies to personal hygiene; OCD forces a person to wash their hands for hours and treat the skin with a special antibacterial agent.

Obsessive-compulsive disorder is not a dangerous disorder, but it complicates the life of an individual so much that he himself begins to think about the question of how obsessive-compulsive neurosis can be cured.

Obsessive-compulsive disorder (obsessive-compulsive disorder)

It is possible to effectively treat obsessive-compulsive disorder neurosis only by following the principles of an individual and comprehensive approach to therapy. A combination of medication and psychotherapeutic treatment, hypnotherapy is advisable.

Drug therapy is based on the use of antidepressants (imipramine, amitriptyline, clomipramine, St. John's wort extract). The best effect is provided by third-generation drugs, the effect of which is to inhibit the reuptake of serotonin (citalopram, fluoxetine, paroxetine, sertraline). When anxiety predominates, tranquilizers (diazepam, clonazepam) are prescribed; in chronic cases, atypical psychotropic drugs (quetiapine) are prescribed. Pharmacotherapy for severe cases of obsessive-compulsive disorder is carried out in a psychiatric hospital.

Among the methods of psychotherapeutic influence, cognitive-behavioral therapy has proven itself well in the treatment of OCD. According to it, the psychotherapist first identifies the patient’s existing obsessions and phobias, and then instructs him to overcome his anxieties by facing them face to face. The exposure method has become widespread, when a patient, under the supervision of a psychotherapist, is faced with a situation that worries him in order to make sure that nothing terrible will happen. For example, a patient with a fear of contracting germs who constantly washes his hands is instructed not to wash his hands in order to ensure that no illness occurs.

Part of complex psychotherapy can be the “thought stopping” method, consisting of 5 steps. The first step is to identify a list of obsessions and work psychotherapeutically on each of them. Step 2 is to teach the patient the ability to switch to some positive thoughts when obsessions occur (remember a favorite song or imagine a beautiful landscape). In step 3, the patient learns to stop the obsession by saying “stop” out loud. Doing the same thing, but saying “stop” only mentally is the task of step 4. The last step is to develop the patient’s ability to find positive aspects in emerging negative obsessions. For example, if you are afraid of drowning, imagine yourself in a life jacket next to a boat.

Along with these techniques, individual psychotherapy, autogenic training, and hypnosis treatment are additionally used. Fairytale therapy and play methods are effective for children.

The use of psychoanalytic methods in the treatment of obsessive-compulsive disorder is limited because they can provoke outbursts of fear and anxiety, have sexual overtones, and in many cases obsessive-compulsive disorder has a sexual accent.

Prognosis and prevention

Complete recovery is quite rare. Adequate psychotherapy and drug support significantly reduce the manifestations of neurosis and improve the patient’s quality of life. Under unfavorable external conditions (stress, serious illness, overwork), obsessive-compulsive neurosis may occur again. However, in most cases, after 35-40 years, there is some smoothing of symptoms. In severe cases, obsessive-compulsive disorder affects the patient’s ability to work; disability group 3 is possible.

Considering the character traits that predispose to the development of OCD, it can be noted that a good prevention of its development would be a simpler attitude towards oneself and one’s needs, and living a life that benefits others.