Complaints & connections · borters.ch
The thoughts create pressure, the action briefly relieves — exactly this circle can be broken.
Also known as: OCD · obsessive-compulsive disorder · obsessions · compulsions
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Obsessions are intrusive, distressing thoughts that force themselves in against one’s will — often about contamination, harm to others, order, or forbidden content. Compulsions are what one does in response: washing, checking, counting, arranging. Tension drops in the short term, the compulsion grows in the long term. Crucial to understand: sufferers usually know the thoughts are excessive and feel ashamed — which is why treatment takes years on average to begin. And: having such thoughts does not mean wanting them; the fear they cause is precisely the hallmark. OCD responds well to treatment, above all a particular form of behavioural therapy (exposure with response prevention).
In very severe obsessive-compulsive disorder that has resisted treatment for years, deep brain stimulation is considered in a few centres. That stands at the end of a long line — behavioural therapy and medication come far before it.
Behavioural therapy with exposure and response prevention: facing the situation and deliberately not carrying out the action. The tension rises and then falls by itself — that is the experience it is about.
Relatives who keep confirming that the stove is off mean well and keep the compulsion running. Agreeing together on a wording that does not answer and yet stays warm relieves both sides.
In this illness the usual drugs often work only at a higher dose and after eight to twelve weeks. Giving up too early is the most common reason for the statement that nothing helps.
A notebook with time, trigger, tension from zero to ten and what was done. It makes visible the progress that gets lost in the experience, and it is the basis of the therapy.
Someone who likes tidying feels something good doing it. Here there is fear at the start and relief for minutes at the end. That distinction matters, because it explains why good advice does not help.
SSRIs work differently in obsessive-compulsive disorder than in depression: higher doses and eight to twelve weeks are needed before anything shows — stopping too early is the most common reason for concluding that they do not help. They lower the pressure by about thirty to fifty per cent, they do not remove the thoughts. Exposure with response prevention works at least as well in comparisons and lasts longer.
About two to three in a hundred people are affected. From the first signs to treatment, seven to ten years pass on average — one of the largest gaps in psychiatry. A treatment is judged after eight to twelve weeks, with SSRIs at a higher dose than in depression. Success is defined as a thirty-five per cent fall on the usual scale, not the disappearance of the thoughts.
Images or thoughts that force themselves in and are experienced as alien and unwanted — often exactly those that contradict one’s own nature. That they are felt as repellent belongs to the picture.
Checking, washing, counting, ordering, seeking reassurance: the tension drops for minutes and then comes back stronger. It is exactly this brief easing that keeps the circle going.
From about an hour a day, or when work, relationships and everyday life suffer from it, one speaks of a disorder. Before that it is a quirk — and many people know individual rituals without being ill.
Not every compulsion is visible. Counting inwardly, repeating prayers, going over events in the mind, checking one’s own character — these are compulsions too and are never noticed from outside.
Relatives answer the questions, check along, take over errands, keep to the rules. That is well meant and makes the day easier in the short run — and keeps the compulsion alive.
No value makes this diagnosis. An overactive thyroid does strengthen inner restlessness and tension and belongs checked once.
In children whose compulsions appear suddenly after a throat infection, the infection belongs considered too.
A lack causes exhaustion, problems concentrating, low mood and forgetfulness — and it is one of the few causes that can be found and put right with a single blood draw.
Low values are common with low mood. Whether correcting it lifts the mood is not settled; that it makes sense in winter at our latitudes is.
An empty store causes tiredness, lack of drive and problems concentrating long before any anaemia becomes visible. In women of childbearing age the most common single reason.
A building block of the cell coverings in the brain. The studies on mood are inconsistent; as part of a good diet it belongs there anyway.
Needed for making the messengers in the brain. It runs short with alcohol and under certain medicines — and it is always judged together with B12.
Studied for compulsions, hair pulling and skin picking: 1200–2400 mg a day over 12 weeks. The results are mixed; something showed most clearly with hair pulling.
Studied in the 1990s at 18 g a day over 6 weeks — a very large amount that few tolerate. The studies were small and were never convincingly repeated.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
The medicines that work here all act on serotonin — and they need higher doses and more patience than in depression: 10 to 12 weeks before it can be judged whether they help.
Intrusive thoughts about the baby occur in many mothers after birth — more often than is spoken about. They are tormenting and not dangerous; saying them out loud is the step that helps.
High caffeine amounts increase restlessness and with it the urge. A direct link with compulsions is not established — the tension they sit on is.
Studied as an addition to behavioural therapy, with small extra effects. Exposure with response prevention remains the treatment with the best evidence.
Regular movement reduced the intensity of obsessive thoughts in small studies. The effect is smaller than that of therapy, but it adds up.