It all starts with a few drops of blood. Rather, it all begins with the description of blood in the book.
I was reading a classic children’s book about a girl Molly who died of leukemia. There is a passage that describes her nosebleeds, which can’t be stopped. Since then, every time I get a nosebleed, I’m sure I’m going to die soon. I would compulsively examine my extremities for abnormal ecchymosis—one of the symptoms of leukemia. As a child, I was obsessed with thinking about the finiteness of life, perhaps more than some dying people. I was so obsessed with it that I ended up having to throw away that dazzling book.
Real OCD is a disease | Figure Worm
A dozen years later, I wasn’t at all surprised when the doctor said I had Obsessive Compulsive Disorder (OCD), and I clearly saw my obsessive-compulsive disorder running through my life like a red thread. When I was diagnosed, my symptoms were on the extreme end of the OCD spectrum, and like many others, I met the criteria for a diagnosis of OCD.
No whitewash: true OCD is a disease. It keeps you from living your normal life – my own experience can attest to it.
What is OCD?
When it comes to obsessive-compulsive disorder, most people think of someone who tucks the corners of their sheets neatly, or who washes their hands constantly to get rid of germs. I don’t fit that profile at all – I’m even a bit lazy. The most hallmark symptom of OCD is intrusive thoughts.
Being a writer, I’ve struggled with intrusive thoughts that popped out of nowhere: Remember your old article about dinosaurs? You’d better read it word for word to make sure you didn’t make a typo or miss a source of information. Almost every obsessive thought that roared in my head repeatedly cried out: You made a mistake, you made a mistake. And all the compulsions are in vain after all, and the voice is still incessant.
Actually, research shows that everyone has intrusive thoughts. Most people are able to dismiss intrusive thoughts that might have adverse effects on the mind and body when they arise. However, people with OCD cannot ignore these thoughts. They overinterpret these thoughts and mistake them for who they are: What if I hurt myself? What if I am a villain?
OCD is a terrifying endless cycle | Figure Worm
Intrusive thoughts can trigger anxiety, so people with OCD force themselves to do something to relieve the anxiety, such as washing, looking up, counting, repeating a phrase, praying , rumination (remembering something), or other coping mechanisms.
These behaviors may be external or completely internal. Intrinsic compulsions are invisible to anyone but the patient.
When a patient engages in a compulsive behavior, it has a temporary effect on themselves. In a short period of time, another thought will sprout, and the patient will re-engage in compulsive behavior in order to calm the anxiety. It’s a horrific endless loop where the slightest bit of carelessness can get out of hand. People with OCD are 10 times more likely to commit suicide than healthy people.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) states that OCD is characterized by the presence of obsessive thoughts and/or Most individuals with OCD have both obsessive thoughts and obsessive behaviors.
Obsessions are repeated and persistent thoughts, impulses (such as stabbing others), representations (such as scenes of violence or terror) that are felt as intrusive and unwanted; Whereas compulsions are repetitive behaviors or mental activities in which the individual feels driven to respond to obsessive thoughts, or has to follow rules very mechanically.
Figure | Giphy
It is important to note that OCD is not the same as intrusive thoughts or repetitive behaviors in the general population. For example, the fact that we sometimes check repeatedly after locking the door may not be due to OCD, but rather a common accidental behavior. So in order to distinguish between the two, one of the diagnostic criteria of the DSM-5 emphasizes that the obsessive thoughts and obsessive behaviors of OCD must be time-consuming or cause significant clinical distress or impairment.
OCD also needs to be distinguished from a number of other mental disorders: Trichotillomania, for example, is the repetitive plucking of one’s own hair – a somatically focused repetition Sexual behavior, while repetitive behavioral patterns are also present in autism spectrum disorders, and ritualized eating behaviors are present in eating disorders.
The brain overpredicts the threat
Biological research finds that humansthe human brain is born with a mechanism that promotes obsessive thoughts.
Functional Magnetic Resonance Imaging (fMRI) shows that patients with OCD are hyperactive in three key brain regions: orbitofrontal cortex, anterior cingulate gyrus, and basal ganglia . Crucially, we rely on these brain regions to recognize erroneous thoughts in order to correct our thinking. The system responsible for detecting threats in people with OCD is so overactive that it produces a “persistent falsely measured signal”, says UCLA psychiatrist Jeffrey S. Schwartz (Jeffrey Schwartz) said.
Suffice to say, OCD is like a malfunctioning car alarm that keeps ringing no matter how hard you try to disarm it.
OCD patients have overactive threat detection systems | Figure Worm
No one likes the screeching sound of a car immobilizer, but most people are willing to install one just to be on the safe side. From an evolutionary point of view, forcing may arise for similar reasons. “The emotional core of obsessive-compulsive traits is a violent anxiety and tension,” says psychologist Steven Hertler.
This tension, he explains, stimulates us to act necessary to save our lives. Those who are obsessed with potential threats such as intruders, snakes, tigers, etc., although not very flattering, their worrying temperament protects the safety of relatives and friends, and also greatly benefits the survival of future generations. “Of all the avoidance strategies that have evolved,” wrote the German psychiatrist Martin Brüne, “OCD is arguably the most extreme.”
Our brains may also be primed early to go to compulsive extremes during vulnerable stages of life. A study by Northwestern University found that women were about four times more likely to show symptoms of obsessive-compulsive disorder in the postpartum period — a common symptom of constant fear of harming their newborns or exposing them to germs. Researchers believe that some coercion may be an adaptive response after childbirth, keeping mothers in a state of high alertness and meticulously protecting weak and helpless babies.
Highly sensitive threat detection systems provide a survival advantage, which explains why most of our threat detectors are a little too sharp. While only about 1 in 40 people suffer from clinical OCD, as many as 1 in 10 have experienced severe obsessions and compulsions that interfere with daily life. It’s true that most people’s obsessive-compulsive tendencies are innate and there are individual differences, but our current cultural climate promotes and amplifies them.
Most of us have overly sensitive threat detectors | Fabrizio Verrecchia/Unspash
How to deal with OCD?
My OCD returned after my son was born. Although my medical history put me in a high-risk group and postpartum hormonal imbalances made me more prone to flare-ups, I was unaware of it all (perhaps I ignored it) and showed no symptoms for a period of time.
However, the good times didn’t last long, and the obsessional thinking struck again, and it was the hostile type of obsessional thinking. When I was in bed with my son, the sudden tension gripped my body and sent my heart rate soaring. An article I wrote when I was 24, or even a small essay in high school, would trigger my threat detector like a punch. To stem the overwhelming panic, I would go over each article over and over, causing the vicious cycle of compulsion to continue endlessly.
I have no doubt that obsessional traits are in my genes. If Schwartz scanned my brain during my OCD attacks, I’m sure my orbitofrontal cortex would glow like a Christmas tree. However, the vast majority of psychiatric disorders are the product of the interaction of physiological mechanisms and environmental conditions, and the cultural environment I grew up in and my current living conditions were simply designed to induce OCD.
Once your brain understands that life goes on without compulsive behavior, your OCD spikes will become duller | Graphworm
First-line treatments for OCD include selective serotonin reuptake inhibitors (SSRIs) and exposure and response prevention (ERP), which is a cognitive-behavioral therapy. The former includes drugs like Prozac, while the latter requires frantically bombarding you with terrifying stimuli until you get used to them.
At the heart of ERP is total acceptance. If you have a compulsive fear of germs and wash your hands every few minutes to get rid of germs, then you must follow your therapist’s instructions: rub your hands on the floor, lick them with your tongue, and not wash your hands. Or, like me, accept that you may indeed have written a really bad old article, but the desire to check and revise it must be curbed. As for those whose obsessions revolve around the pursuit of perfection, “We usually advise them tomistakes, such as missing commas, wrong capitalization, etc.” and are not allowed to be corrected after they are made, says Eda Gorbis, director of the Westwood Institute for Anxiety Disorders in Los Angeles.
Once your brain understands that life goes on without compulsions, your OCD spikes will dull a bit.
For those who are strong enough to endure these discomforts, EPR works wonders. By confronting my worst fears, rather than trying to drive them away with compulsive behavior, I was able to contain my worst compulsive episodes within days or even hours.
A UCLA experiment found that after patients received ERP-focused treatment, if symptoms improved, their previously overactive brain regions also “cooled off” down; this means that therapy can really help change the brain’s physiological circuits. People with OCD also showed reduced activity in the orbitofrontal cortex after taking antidepressants such as Prozac. Drugs and behavioral therapy may go the same way.
Excessive self-protection leads to self-destruction | Doğukan Şahin/Unsplash
Don’t give in to OCD
However, for many patients, including myself, treatment reduces the compulsion, not eliminates it. The goal of treatment is to limit those annoying symptoms and help the patient focus on their lives, not to eradicate obsessive-compulsive tendencies altogether, Gobis said.
“There should be a clear distinction between the two conditions,” she said. “If you have obsessive thoughts for more than an hour a day and they are causing a lot of distress, then you are definitely sick. But if it happens occasionally and doesn’t make you feel bad, then it’s not a disease.”
While my symptoms have eased to a tolerable point, my obsessive nature has not gone away, and I don’t think I would be the writer I am today without it. Another thought I’m too embarrassed to say: I need compulsive tendencies, because it balances out my equally serious laziness.
However, I am also determined not to succumb to the central paradox of OCD: Excessive self-preservation leads to self-destruction. In other words, I have always held on to the red thread, but I no longer let it lead me by the nose. My awakening also eased my pain: I finally realized that my obsessive tendencies were inseparable from the “collective obsessive-compulsive disorder” that prevailed in contemporary culture.
I was therefore able to ask myself if I wanted to obey the dictates of the culture, or in what way. If I could cut the red thread completely, would I do it? I’m not sure, but the question is really pointless: because I can’t. So I had to hold onto it, believing it would continue to lead me out of the maze.
Five common misconceptions about OCD
A person with OCD washes their hands frequently?
Repeated hand washing is a form of compulsive behavior, but only seen in about 25% of patients. Similar behaviors include repeatedly checking faucets, locks, light switches, etc., and these behaviors are only seen in 30% of people with OCD. In other words, not everyone who washes their hands frequently suffers from OCD.
Figure | Giphy
A person with OCD has a cleanliness addiction?
Many people often equate OCD with a “love of neatness and cleanliness.” In fact, OCD is an anxiety disorder that is often accompanied by frequent, disturbing, and unfounded thoughts. People with OCD sometimes seek tidiness or symmetry, and this behavior is further reinforced by unbearable underlying anxiety.
Doing the same thing repeatedly is OCD?
Not all compulsions are visible to the naked eye. About 25% of people with OCD, their obsessive-compulsive behavior is a completely hidden “inner drama”. These behaviors include ruminating, praying, suppressing or rationalizing compulsive behavior, mentally counting, or avoiding certain situations or places.
Obsessive-compulsive disorder helps in work and life?
Don’t think that having OCD makes people pay attention to detail and meticulousness in work and life. In fact, OCD is no fun at all: The World Health Organization once listed OCD as one of its “ten debilitating diseases.” People with obsessive-compulsive disorder may lose income due to the illness, resulting in a reduced quality of life. At least one-third of people with OCD also suffer from anxiety disorders.
OCD only affects adults?
The average age of onset of OCD is 20, but teens and even toddlers as young as 4 can develop OCD. Diagnosing young children can be difficult because repetitive behaviors can be a normal part of a child’s development.
By Elizabeth Svoboda, James Lloyd
Compile: Ear, Olli
Edit: EON, odette
 Aeon, The red thread of obsession
 Science Focus, I still remember the day my brain broke
Diagnostic and Statistical Manual of Mental Disorders (5th Edition)
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