Perseveration is a phenomenon that is characterized by a psychological, mental or neuropathological disorder of human behavior and speech. Perseveration manifests itself through the constant repetition of an action, phrase, idea, idea or experience. This constancy sometimes turns into an annoying, uncontrollable form; the person himself does not even notice it or is not aware of the phenomenon happening to him.

Such behavior in actions or speech is possible not only with mental or neurological disorders. There are often cases when perseveration was noted in a person due to overwork or distraction.

Perseveration most often occurs when physical impact on the brain. In this case, a person experiences difficulties in switching attention from one object to another or from one action to another. The main neurological causes of perseveration are:

What psychological problems lead to perseveration?

In addition to neurological reasons that are associated with physical damage to the brain or the influence of diseases on it, there are also psychological reasons for the occurrence of perseveration.

Perseveration should be distinguished from other diseases or stereotypical human actions. Repetitive actions or words can be a manifestation of sclerosis, OCD (obsessive-compulsive disorder), regular habit, subjective obsessive phenomena. With obsessive phenomena, patients realize that their behavior is a little strange, ridiculous, and senseless. With perseveration there is no such awareness.

Symptoms

Depending on how perseveration manifests itself, experts distinguish motor and mental (intellectual) forms.

With motor perseveration, a person constantly repeats the same movement. Sometimes you can see a whole system of repetitive actions in a patient. Such actions have a certain algorithm that does not change for a long time. For example, when having difficulty opening a box, a person constantly hits it on the table, but this leads to nothing. He understands the pointlessness of such behavior, but repeats these actions. Children may constantly call a new teacher by the name of the previous one, or look for a toy where it was stored before, but its storage location has long been changed.

Intellectual perseveration is characterized as an abnormal stuckness of ideas and judgments. It is expressed through the constant repetition of phrases or words. This form of the disease is easily diagnosed when the specialist asks several questions, and the patient answers everything with the very first answer. In a mild form, perseveration can be observed when a person constantly returns to the discussion of a long-resolved issue, the topic of conversation.

Doctors draw the attention of parents to the need to monitor their child’s behavior to see if he has any even the most minor perseverations.

The Positive Side of Persistent Repetition

It is believed that obsessive repetitions of thoughts or actions characterize a person as sick or abnormal. But almost every one of us has been subject to perseveration at least once in our lives. But in people without additional neurological or psychiatric dysfunctions, this state is called careful analysis, worry, perseverance.

Sometimes repetition of thoughts or actions helps people adapt to a particular situation. Perseveration is useful or at least not pathological when:

• a person needs to understand something in detail;
• pacify strong emotions and overcome psychological trauma;
• a person tries to remember something for a long time;
• you need to see something new in an already known fact;
• take into account all the probabilities of the phenomenon.

Persistent repetition is useful during learning when it does not interfere with achieving goals. In other cases, this phenomenon requires correction or treatment.

Treatment

It is a known fact that perseverations accompany some mental or neurological diseases, such as Alzheimer's disease, arteriosclerosis, genetic epilepsy, organic dementia, Down syndrome, OCD, autism. If you have a history of such diseases, then you first need to treat the root cause of frequent recurrences with medication.

Medicines for perseveration

As a symptom, perseveration cannot be treated, but thanks to drug therapy of the underlying disease, its intensity is reduced. Neuroleptics are often used for the above diseases. This is a group of drugs that have a calming effect.

With their constant use, a person does not react to external stimuli in the same way, that is, excessive experience of situations goes away, which can cause annoying repetition of actions or thoughts. Decreasing psychomotor agitation, aggressiveness is weakened, the feeling of fear is suppressed. Some antipsychotics are used as sedatives, while others, on the contrary, are used when it is necessary to activate mental functions. Each drug is selected individually by the doctor.

Along with the use of drugs, it is important to provide psychotherapeutic support to the person, especially if perseverations are caused by stress and other psychological factors.

Psychotherapeutic assistance

Before conversations and the use of psychotherapy, psychological tools are used to diagnose the patient’s condition. This is a technique that includes 7 subtests that help assess the degree pathological manifestations in the patient's behavior and thoughts. After this, the need is determined medication assistance and directions in psychotherapeutic work with him.

When working psychotherapeutically with a patient, it is important to teach him new mental and motor skills, as well as create rational attitudes and support existing ones. positive characteristics person to overcome constant repetition in actions, conversation and thoughts. For this purpose they can be used following methods and techniques (their use can be carried out in sequence or alternated).

Persistent and annoying repetitions often interfere with a person’s life. In this case, you need the help of a specialist who will determine the need to use medications and also help you get rid of such a phenomenon as perseveration with the help of psychotherapeutic methods.

Timely and qualified assistance with persistent repetition of actions, ideas, thoughts and phrases, it will help a person to better adapt to the reality around him.

Perseveration is a phenomenon of a psychological, mental or neuropathological nature, characterized by obsessive, frequent repetition of a physical action, word or whole phrase in written or oral speech, as well as certain emotions.

Depending on the nature of the manifestation, there are:

• Perseveration of thinking. It is characterized by anchoring in a person’s mind a specific thought or a simple, uncomplicated idea, which often manifests itself in verbal communication. With a perseverative phrase or word, a person can answer questions that have absolutely nothing to do with it, speak it out loud to himself, and so on. A classic manifestation of perseveration of thinking is the constant return to a topic of conversation that has already been closed and is considered resolved,
• Motor perseveration. The etiology of motor perseveration is associated with physical damage to the premotor nuclei of the cerebral cortex and motor subcortical layer. This type of perseveration is expressed in the repetition of one physical movement many times - elementary motor perseveration or a whole complex of movements with a clear algorithm - systemic motor perseveration.

Motor speech perseveration, when a person repeats the same word or writes it, can also be classified as a separate subtype of motor perseveration. This type of deviation is characterized by damage to the lower parts of the premotor nuclei of the cortex of the left hemisphere in right-handers and the right - in left-handers.

Fundamental factors and features of the genesis of perseverative deviations

The neurological etiology of perseveration is the most common, it is characterized by a wide range of atypical personality behavior due to physical damage to the cerebral hemispheres, which causes dysfunction in switching from one type of activity to another, changing the train of thought, the algorithm of actions for performing some task, and so on. when the perseverative component dominates objective actions or thoughts.

The causes of perseveration against the background of neuropathology include:

• traumatic brain injury with predominant damage to areas of the lateral orbitofrontal cortex or its prefrontal convexity,
• (aphasia - pathological condition, in which deviations occur in a person’s speech, which was already formed earlier. Occurs due to physical damage to the speech centers in the cerebral cortex as a result of traumatic brain injuries, tumors, encephalitis),
• transferred localized pathologies in the area frontal lobes cerebral cortex, similar to aphasia.

Perseveration in psychology and psychiatry reflects the course of deviation against the background of psychological dysfunctions in a person and, as a rule, is additional feature complex syndromes and phobias.

The occurrence of perseveration in a person who has not suffered traumatic brain injury and severe stress can serve as the first sign of the development of not only psychological, but mental disorders.

The main etiological factors of psychological and psychopathological directions in the development of perseverative manifestations may be:

• obsessiveness and high selectivity of individual interests, which is most typical for persons with autism spectrum disorders,
• a feeling of lack of attention against the background of hyperactivity can stimulate the manifestation of perseveration as a protective compensatory phenomenon aimed at attracting attention to oneself or one’s type of activity,
• insistence on constant learning and the desire to learn new things can lead gifted individuals to become fixated on a particular judgment or type of activity. The line between persistence and perseveration is very blurred,
• the complex of symptoms of obsessive-compulsive disorder often includes the development of perseverative deviations.

Obsessive-compulsive disorder is an obsession that causes a person to perform certain physical actions (compulsions) due to obsessive thoughts (obsessions). A striking example obsessive-compulsive disorder is frequent hand washing in fear of getting infected infectious disease or reception different drugs in order to prevent possible diseases.

Regardless of the etiological factors, perseveration must be differentiated from obsessive-compulsive disorder, normal human habits, and also from sclerotic memory disorders, when a person repeats the same words or actions due to forgetfulness.

Features of perseverative deviations in childhood

Manifestation of perseverations in childhood is a very common occurrence due to the characteristics of child psychology, physiology and a fairly active change in the child’s life values ​​at different stages of growing up. This creates certain difficulties in distinguishing perseverative symptoms from the child’s intentional actions, and also camouflages the manifestation of signs of more serious mental pathologies.

In order to early identify mental disorders in their child, parents should be more attentive to the manifestation of perseverative signs, the most common of which are:

• regular repetition of the same phrases, regardless of the situation and the question posed,
• the presence of certain actions that are repeated regularly: touching some place on the body, scratching, narrowly focused play activity and so on,
• drawing the same objects, writing the same word repeatedly,
• regularly repeated requests, the need for fulfillment of which is questionable within a specific situation.

Help with perseverative deviations

The basis for the treatment of perseverative deviations is always a comprehensive psychological approach with alternating stages. Rather, it is a trial and error method than a standardized treatment algorithm. In the presence of neurological pathologies of the brain, treatment is combined with appropriate drug therapy. Among the drugs used are groups of weak sedatives central action, with the mandatory use of nootropics against the background of multivitaminization.

The main stages of psychological assistance for perseveration, which can either alternate or be applied sequentially:

1. Waiting strategy. The fundamental factor in psychotherapy is perseveration. It consists of expecting any changes in the nature of the deviations due to the use of any therapeutic measures. This strategy is explained by the resistance of symptoms of deviation to disappearance.
2. Prevention strategy. Often, perseveration of thinking gives rise to motor perseveration, and these two types begin to exist together, which makes it possible to prevent such a transition in a timely manner. The essence of the method is to protect a person from the physical activity that he talks about most often.
3. Redirection strategy. A physical or emotional attempt by a specialist to distract the patient from obsessive thoughts or actions by abruptly changing the topic of conversation at the moment of the next perseverative manifestation, changing the nature of actions.
4. Limitation strategy. This method allows you to consistently reduce perseverative attachment by limiting a person in his actions. The limit allows obsessive activity, but in strictly defined volumes. A classic example is access to a computer for a strictly designated time.
5. Abrupt termination strategy. Aimed at actively eliminating perseverative attachments using the patient’s shock state. An example would be unexpected, loud statements “That's it! This is not the case! It doesn't exist! or visualizing harm from obsessive actions or thoughts.
6. Ignoring strategy. An attempt to completely ignore perseverative manifestations. The method is very good when etiological factor the violation was caused by a lack of attention. Without getting the desired effect, the patient simply does not see the point in his actions,
7. Understanding strategy. An attempt to find out the patient’s true train of thought at the time of deviations and in their absence. Often this helps the patient himself to put his actions and thoughts in order.

Perseveration refers to psychological, mental and neuropathological phenomena in which there is an obsessive and frequent repetition of actions, words, phrases and emotions. Moreover, repetitions appear both in oral and written form. Repeating the same words or thoughts, a person often does not control himself when communicating verbally. Perseveration can also manifest itself when nonverbal communication based on gestures and body movements.

Manifestations

Based on the nature of perseveration, the following types of its manifestation are distinguished:

• Perseveration of thinking or intellectual manifestations. It is distinguished by the “settling” in the human creation of certain thoughts or its ideas, manifested in the process of verbal communication. A perseverative phrase can often be used by a person when answering questions to which it has absolutely nothing to do. Also, a person with perseveration can pronounce such phrases out loud to himself. A characteristic manifestation of this type of perseveration is constant attempts return to a topic of conversation that has long been stopped talking about or the issue in it has been resolved.
• Motor type of perseveration. Such a manifestation as motor perseverations is directly related to physical impairment in the premotor nucleus of the brain or subcortical motor layers. This is a type of perseveration that manifests itself in the form of repeating physical actions repeatedly. This can be either the simplest movement or a whole complex of different body movements. Moreover, they are always repeated equally and clearly, as if according to a given algorithm.
• Speech perseveration. It is classified as a separate subtype of the motor type perseveration described above. These motor perseverations are characterized by constant repetition of the same words or entire phrases. Repetition can manifest itself in oral and written form. This deviation is associated with lesions of the lower part of the premotor nucleus of the cortex human brain in the left or right hemisphere. Moreover, if a person is left-handed, then we are talking about damage to the right hemisphere, and if a person is right-handed, then, accordingly, to the left hemisphere of the brain.

Reasons for the manifestation of perseveration

There are neuropathological, psychopathological and psychological reasons for the development of perseveration.

Repetition of the same phrase, caused by the development of perseveration, can occur against the background of neuropathological reasons. These most often include:

• Traumatic brain injuries that damage the lateral region of the orbitofrontal cortex. Or is it related to physical types damage to the frontal convexities.
• For aphasia. Perseveration often develops against the background of aphasia. It is a condition characterized pathological abnormalities previously formed human speech. Similar changes occur in the event of physical damage to the centers in the cerebral cortex responsible for speech. They can be caused by trauma, tumors or other types of influences.
• Transferred local pathologies in the frontal lobe of the brain. These may be similar pathologies, as is the case with aphasia.

Psychiatrists and psychologists call perseveration deviations psychological type, which occur against the background of dysfunctions occurring in the human body. Often, perseveration acts as an additional disorder and is an obvious sign of the formation of a complex phobia or other syndrome in a person.

If a person has signs of the formation of perseveration, but at the same time he did not tolerate severe forms stress or traumatic brain injury, this may indicate the development of both psychological and mental forms deviations.

If we talk about psychopathological and psychological reasons development of perseveration, then there are several main ones:

• Tendency to increased and obsessive selectivity of interests. Most often this manifests itself in people characterized by autistic disorders.
• The desire to constantly learn and learn, to learn something new. It occurs mainly in gifted people. But the main problem is that that person may become fixated on certain judgments or his activities. The existing line between perseveration and such a concept as perseverance is extremely insignificant and blurred. Therefore, with an excessive desire to develop and improve oneself, serious problems can develop.
• Feeling of lack of attention. Occurs in hyperactive people. The development of perseverative inclinations in them is explained by an attempt to attract increased attention to themselves or their activities.
• Obsession with ideas. Against the background of obsession, a person can constantly repeat the same physical actions caused by obsession, that is, obsession with thoughts. The simplest, but very understandable example of obsession is the desire of a person to constantly keep his hands clean and wash them regularly. A person explains this by saying that he is afraid of contracting terrible infections, but such a habit can develop into a pathological obsession, which is called perseveration.

It is important to be able to distinguish when one person simply has strange habits in the form of constant hand washing, or whether it is obsessive-compulsive disorder. It is also not uncommon for repetitions of the same actions or phrases to be caused by a memory disorder, and not by perseveration.

Features of treatment

There is no universally recommended treatment algorithm for perseveration. Therapy is carried out based on the use of a whole range of different approaches. One method should not be used as the only method of treatment. It is necessary to take new methods if the previous ones did not produce results. Roughly speaking, treatment is based on constant trial and error, which ultimately makes it possible to find the optimal method of influencing a person suffering from perseveration.

The presented methods of psychological influence can be applied alternately or sequentially:

• Expectation. It is the basis in psychotherapy for people suffering from perseveration. The point is to wait for changes in the nature of the deviations that have arisen against the background of application various methods impact. That is, the waiting strategy is used in conjunction with any other method, which we will discuss below. If no changes occur, switch to other psychological methods of influence, expect results and act according to the circumstances.
• Prevention. It is not uncommon for two types of perseveration (motor and intellectual) to occur together. This makes it possible to prevent such changes in time. The essence of the technique is based on the exclusion of physical manifestations that people most often talk about.
• Redirection. This psychological technique, based on a sharp change in ongoing actions or current thoughts. That is, when communicating with a patient, you can suddenly change the topic of conversation or from one physical exercise, movements move to others.
• Limitation. The method is aimed at consistently reducing a person’s attachment. This is achieved by limiting repetitive actions. A simple but clear example is to limit the amount of time a person is allowed to sit at a computer.
• Abrupt cessation. This is a method of actively getting rid of perseverative attachment. This method is based on exposure by introducing the patient into state of shock. This can be achieved through harsh and loud phrases, or by visualizing how harmful the patient’s obsessive thoughts or movements or actions can be.
• Ignoring. The method involves completely ignoring the manifestations of the disorder in a person. This approach works best if the disorders were caused by attention deficit. If a person does not see the point in what he is doing, since there is no effect, he will soon stop repeating obsessive actions or phrases.
• Understanding. Another relevant strategy with the help of which the psychologist recognizes the patient’s train of thought in case of deviations or in the absence of them. This approach often allows a person to independently understand his thoughts and actions.

Perseveration is a fairly common disorder that can be caused by for various reasons. When perseveration occurs, it is important to choose a competent treatment strategy. Drug effects in in this case does not apply.

Speech stereotypies, also known as speech iterations, verbal tics, are reflexive, meaningless and emotionally indifferent repetitions of sounds, syllables, words and entire phrases in the patient's speech.

The patient’s speech can be either on his own initiative or provoked by questions from people around him.

Types of speech stereotypies

Several types of speech stereotypies are known: persistent repetition of one conclusion or word (perseveration), repetition of the same expression, figure of speech (standing turns), repetition of words or syllables in a certain rhythm or in rhymed form (verbigeration).

Perseveration - we sing odes to the persistence of the stubborn

The term perseveration comes from the Latin word perseveratio, which means “perseverance”, “persistence”. In speech, perseveration manifests itself as repeated reproduction of the same syllables, words or sentences.

A word or thought seems to be “stuck” in the patient’s mind, and he repeats it repeatedly and monotonously when communicating with his interlocutor. In this case, the repeated word or phrase is not related to the topic of the conversation. The patient's speech is monotonous. Perseveration can be expressed both orally and in writing.

Perseveration is the result of associative activity, part of consciousness and does not occur by chance. It should not be confused with obsessive phenomena, since the latter have an element of obsession, and the patient is aware of the absurdity of his actions.

Verbigeration is a common fate of schizophrenics

A mental disorder in which the patient repeats and shouts in a monotonous voice the same interjections, words, and phrases. These repetitions are automatic and meaningless and can last several hours or even days.

The patient rhythmically, often in rhyme, repeats words and combinations of sounds that do not make sense. Verbigeration should be distinguished from perseveration, since with the latter, repetitions depend on neuropsychic states, and disappear with the elimination of these states.

Standing speed

Standing phrases are fragments of phrases, expressions, words, ideas of the same type that the patient repeatedly reproduces during conversations.

At first, the patient pronounces them with the same intonation, and subsequently simplifies, reduces, and the process comes down to a stereotypical repetition of words.

Often the pronounced standing phrases are greatly distorted and it becomes impossible to understand their original meaning and sound.

Palilalia

Palilalia means the patient repeating a phrase, or part of it, a single word or syllable, from a fragment of speech he himself uttered, two or more times in a row.

Repetition occurs at normal voice volume; the volume may gradually decrease and the rate of speech become faster. For example, having given an answer to a question, the patient repeatedly and continuously repeats the answer.

Manifestations of palilalia relate not only to intellectual forms of speech, but also to emotional ones (exclamations, shouts). However, it usually does not refer to mechanically pronounced turns of automated speech. The number of repetitions can reach two dozen or more.

Echolalia

When the patient repeats phrases and words that were said by people around him. Often echolalia is characteristic of young children, and in them it is not a pathology.

This is considered a pathology when echolalia causes delay mental development, or its development is observed in an adult.

Speech stereotypies and psychoneurological diseases

The causes of speech stereotypies often lie in the development of neurological and psychological diseases.

Causes of perseverations

Experts believe that the cause of perseveration is damage to the lower parts of the premotor nuclei of the cortex of the left hemisphere in right-handers, and the right hemisphere in left-handers.

The most common cause of perseveration is considered to be neurological diseases resulting from brain damage. physical nature. In this case, it becomes impossible to switch between different activities, changing the train of thought and the order of actions when performing various tasks.

With the neurological nature of the disease, the causes of perseveration are:

1. , in which the lateral orbitofrontal areas of the cortex and its prefrontal convexities are affected.
2. - the appearance of disturbances in speech formed at the previous stage of life. These disorders arise due to physical damage to the speech centers, as a result of traumatic brain injury.
3. Pathologies related to the area of ​​the frontal lobes of the cerebral cortex.

Psychiatry and psychology attribute perseveration to signs of various phobias and anxiety syndromes. The course of this speech stereotypy in the psychological and psychiatric direction can be caused by:

• obsessiveness and selectivity of individual interests, which is most often found in people with autistic disorders;
• lack of attention with hyperactivity, while stereotypy arises as a defense mechanism to attract attention to oneself;
• a steady desire to learn and experience new things can lead to fixation on one conclusion or activity;
• perseveration is often one of the symptoms.

Perseveration should not be confused with obsessive-compulsive disorder, human habits, and sclerotic changes in memory.

Perseverations are more often observed in patients with dementia (), which is caused by, as well as with age-related atrophic processes in the brain. The patient’s intellect is impaired, and he cannot understand the question being asked and, instead of a logical answer, repeats previously used phrases.

What provokes the development of verbigeration?

With verbigeration there is no connection with certain neuropsychic conditions. One of the features of verbigeration is that the patient pronounces words without showing emotion. As a rule, verbal repetitions are accompanied by active facial expressions and motor disturbances.

Most often, these verbal iterations occur in patients with catatonic schizophrenia.

Causes of standing rotations, palilalia and echolalia

The appearance of standing phrases in speech signals a decrease in intelligence and empty thinking. They often appear with this disease such as epileptic dementia. Also, one of the diseases in which standing turns are characteristic is, as well as other atrophic diseases of the brain.

Palilalia is a typical manifestation of Pick's disease. It also often accompanies diseases such as striatal pathology, striopallidal pathology (atrophic, inflammatory, vascular), postencephalic, and schizophrenia.

The occurrence of echolalia is often associated with damage to the frontal lobes of the brain. If the patient has symptoms such as hallucinations, lack of coordination, and forgetfulness, it is necessary to seek advice from a specialist. If brain damage is not diagnosed, then the causes of echolalia may be schizophrenia, autism, or Tourette's syndrome.

Establishing diagnosis

Diagnosis of speech stereotypies involves comprehensive testing. The patient is asked to undergo special testing or answer simple questions (implying “yes” or “no” answers), repeat similar-sounding sounds or sound combinations.

The patient is also asked to name the objects that are in the room, name the days of the week, explain the meaning of the words, and retell the text.

When examining a patient, it is very important to determine whether he understands speech addressed to him. If there is a suspicion of mild forms speech disorders, a defectologist uses other more complex diagnostic methods.

To diagnose speech stereotypies, a technique is used that includes a series of separate tests. The patient is asked to write words in ordinary and reverse order, write words and phrases in upper and lower case letters, read the text in forward and reverse order, write numbers in normal and inverted form, perform multiplication. When making toasts, the doctor assesses the number of correct and incorrect answers per minute.

Therapy and correction

Treatment of patients with speech stereotypies involves the following methods:

• pharmacotherapy;
• physiotherapy;
• psychotherapy;
• psychological correction;
• physiotherapy;
• logotherapy;
• working with defectologists.

It is necessary to begin therapy with treatment of the main provoking disease. It will be possible to restore speech function depend on the main diagnosis.

If the patient has aphasia, the main emphasis is on automated speech, then the patient is gradually taught to comprehend and separate the main from the secondary. If the underlying disease is dementia, during therapy they focus on the semantic meaning of words. Patients with mild form schizophrenia is taught to correctly construct sentences that preserve semantic content.

In Western countries, when treating these disorders, the main emphasis is on medicinal method therapy. The most widely used. They promote change in pathological processes brain function.

Anxiety is common to all people to one degree or another, and many of us sometimes perform rituals to varying degrees irrationalities designed to keep us out of trouble - banging a fist on the table or wearing a lucky T-shirt on an important event. But sometimes this mechanism gets out of control, causing a serious mental disorder. “Theories and Practices” explains what tormented Howard Hughes, how an obsession differs from schizophrenic delusion, and what magical thinking has to do with it.

Endless Ritual

Jack Nicholson's character in the famous film “As Good As It Gets” was distinguished not only by his complex character, but also by a whole set of oddities: he constantly washed his hands (with new soap each time), ate only with his own cutlery, avoided the touch of others and tried not to step on cracks on the asphalt. All these "eccentricities" - typical signs obsessive-compulsive disorder, a mental illness in which a person is obsessed with obsessive thoughts that force him to repeat the same actions regularly. OCD is a real boon for a screenwriter: this disease is more common in people with high intelligence, it gives the character originality, noticeably interferes with his communication with others, but at the same time is not associated with a threat to society, unlike many others mental disorders. But in reality, the life of a person with obsessive-compulsive disorder cannot be called easy: behind innocent and even funny, at first glance, actions hide constant tension and fear.

It’s as if a record is stuck in such a person’s head: the same unpleasant thoughts regularly come to mind, having little rational basis. For example, he imagines that there are dangerous microbes everywhere, he is constantly afraid of hurting someone, losing something, or leaving the gas on when leaving home. He may be driven crazy by a leaking faucet or an asymmetrical arrangement of objects on the table.

The flip side of this obsession, that is, obsession, is compulsion, the regular repetition of the same rituals that should prevent the impending danger. A person begins to believe that the day will go well only if he reads a nursery rhyme three times before leaving the house, that he will protect himself from terrible diseases if he washes his hands several times in a row and uses his own cutlery. After the patient performs the ritual, he experiences relief for a while. 75% of patients suffer from both obsessions and compulsions at the same time, but there are cases when people experience only obsessions without performing rituals.

At the same time, obsessive thoughts differ from schizophrenic delusions in that the patient himself perceives them as absurd and illogical. He is not at all happy about washing his hands every half hour and zipping his fly five times in the morning - but he simply cannot get rid of the obsession any other way. The level of anxiety is too high, and rituals allow the patient to achieve temporary relief. But at the same time, the love of rituals, lists, or putting things on shelves in itself, if it does not bring discomfort to a person, is not considered a disorder. From this point of view, aesthetes who diligently arrange carrot peelings lengthwise in Things Organized Neatly are absolutely healthy.

The biggest problems for OCD patients are obsessions of an aggressive or sexual nature. Some become afraid that they will do something bad to other people, including sexual assault and murder. Obsessive thoughts can take the form of individual words, phrases or even lines of poetry - a good illustration is an episode from the movie “The Shining”, where the main character, going crazy, begins to type the same phrase “all work and no play makes Jack” a dull boy.” A person with OCD experiences enormous stress - he is simultaneously horrified by his thoughts and tormented by a feeling of guilt for them, tries to resist them, and at the same time tries to ensure that the rituals he performs go unnoticed by others. In all other respects, his consciousness functions completely normally.

It is believed that obsessions and compulsions are closely related to “magical thinking” that arose at the dawn of humanity - the belief in the ability to take control of the world with the help of the right attitude and rituals. Magical thinking draws a direct parallel between mental desire and a real consequence: if you draw a buffalo on the wall of a cave, setting yourself up for a successful hunt, you will certainly be lucky. Apparently, this way of perceiving the world originates in the deep mechanisms of human thinking: neither scientific and technological progress, nor logical arguments, nor sad personal experience, which proves the uselessness of magical passes, does not relieve us of the need to look for relationships between random things. Some scientists believe that it is embedded in our neuropsychology - the automatic search for patterns that simplify the picture of the world helped our ancestors survive, and the most ancient parts of the brain still work according to this principle, especially in stressful situation. Therefore, when elevated level With anxiety, many people begin to fear their own thoughts, fearing that they may become reality, and at the same time believe that a set of some irrational actions will help prevent an undesirable event.

Story

In ancient times, this disorder was often associated with mystical causes: in the Middle Ages, people obsessed with obsessive ideas were immediately sent to exorcists, and in the 17th century, the concept was reversed - it was believed that such conditions arise due to excessive religious zeal.

In 1877, one of the founders of scientific psychiatry, Wilhelm Griesinger and his student Karl-Friedrich-Otto Westphal, found that the basis of “obsessive-compulsive disorder” is a disorder of thinking, but it does not affect other aspects of behavior. They used the German term Zwangsvorstellung, which, having been variously translated in Britain and the US (as obsession and compulsion respectively), became modern name diseases. And in 1905, the French psychiatrist and neurologist Pierre Marie Felix Janet identified this neurosis from neurasthenia as separate disease and called it psychasthenia.

Opinions varied about the cause of the disorder - for example, Freud believed that obsessive-compulsive behavior referred to unconscious conflicts that manifested themselves in the form of symptoms, while his German colleague Emil Kraepelin classified it as “constitutional mental illnesses” caused by physical causes.

Famous people also suffered from obsessive disorder - for example, inventor Nikola Tesla counted steps while walking and the volume of food portions - if he failed to do this, the lunch was considered spoiled. And entrepreneur and American aviation pioneer Howard Hughes was terrified of dust and ordered employees before visiting him to “wash themselves four times, each time using a large amount of foam from a new bar of soap.”

Defense mechanism

The exact causes of OCD are not clear even now, but all hypotheses can be divided into three categories: physiological, psychological and genetic. Proponents of the first concept associate the disease either with the functional and anatomical features of the brain, or with metabolic disorders (biologically active substances, transmitting electrical impulses between neurons, or from neurons to muscle tissue) - primarily serotonin and dopamine, as well as norepinephrine and GABA. Some researchers have noted that many patients with obsessive-compulsive disorder had birth trauma at birth, which also confirms physiological reasons OCD.

Proponents of psychological theories believe that the disease is associated with personal characteristics, character, psychological trauma and incorrect reaction to the negative impact of the environment. Sigmund Freud theorized that obsessive-compulsive symptoms are caused by defense mechanisms psyche: isolation, liquidation and reactive formation. Isolation protects a person from anxiety-causing affects and impulses, displacing them into the subconscious; elimination is aimed at combating the emerging repressed impulses - in fact, the compulsive act is based on it. And finally, reactive formation is the manifestation of patterns of behavior and consciously experienced attitudes that are opposite to emerging impulses.

There is also scientific evidence that OCD is caused by genetic mutations. They were found in unrelated families whose members suffered from OCD - in the serotonin transporter gene, hSERT. Studies of identical twins also confirm the existence of a hereditary factor. In addition, people with OCD are more likely to have close relatives with the same disorder than healthy people.

Maksim, 21 years old, suffers from OCD since childhood

It started for me at about 7-8 years old. The neurologist was the first to report the possibility of OCD; even then there was a suspicion of obsessive neurosis. I was constantly silent, spinning various theories in my head like “mental gum.” When I saw something that caused me anxiety, obsessive thoughts about it began, although the reasons seemed to be quite insignificant and, perhaps, would never have affected me.

At one time there was intrusive thought that my mother might die. I replayed the same moment in my head, and it captured me so much that I could not sleep at night. And when I’m riding in a minibus or in a car, I constantly think that we’re going to get into an accident, that someone is going to crash into us, or that we’re going to fly off a bridge. A couple of times the thought arose that the balcony under me would fall apart, or that someone would throw me out of there, or that I myself would slip and fall in the winter.

We never really talked to the doctor, I just took different medicines. Now I move from one obsession to another and follow some rituals. I am constantly touching something, no matter where I am. I walk from corner to corner throughout the room, straightening the curtains and wallpaper. Maybe I'm different from other people with this disorder, everyone has their own rituals. But it seems to me that those people who accept themselves as they are are luckier. They are much better off than those who want to get rid of it and are very worried about it.