Zwangsstörung (Obsessive-Compulsive Disorder, OCD) – Erfahren Sie in der MSD Manuals Ausgabe für Patienten etwas über die Ursachen, Symptome. Übersetzungen für OCD im Englisch» Deutsch-Wörterbuch von PONS Online: OCD, obsessive-compulsive disorder. Tics und Zwänge bei OCD. Zwischen Tics und Zwangsstörungen besteht ein klarer und enger Zusammenhang. Etwa 30–60% der Patienten mit dem.
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Whether or not behaviors are compulsions or mere habit depends on the context in which the behaviors are performed. For example, arranging and ordering DVDs for eight hours a day would be expected of one who works in a video store, but would seem abnormal in other situations.
In other words, habits tend to bring efficiency to one's life, while compulsions tend to disrupt it. In addition to the anxiety and fear that typically accompanies OCD, sufferers may spend hours performing such compulsions every day.
In such situations, it can be hard for the person to fulfil their work, family, or social roles. In some cases, these behaviors can also cause adverse physical symptoms.
For example, people who obsessively wash their hands with antibacterial soap and hot water can make their skin red and raw with dermatitis.
People with OCD can use rationalizations to explain their behavior; however, these rationalizations do not apply to the overall behavior but to each instance individually.
For example, a person compulsively checking the front door may argue that the time taken and stress caused by one more check of the front door is much less than the time and stress associated with being robbed, and thus checking is the better option.
In practice, after that check, the person is still not sure and deems it is still better to perform one more check, and this reasoning can continue as long as necessary.
Good or fair insight is characterized by the acknowledgment that obsessive-compulsive beliefs are or may not be true. Poor insight is characterized by the belief that obsessive-complsive beliefs are probably true.
Some people with OCD exhibit what is known as overvalued ideas. In such cases, the person with OCD will truly be uncertain whether the fears that cause them to perform their compulsions are irrational or not.
After some discussion, it is possible to convince the individual that their fears may be unfounded.
It may be more difficult to do ERP therapy on such people because they may be unwilling to cooperate, at least initially. There are severe cases in which the person has an unshakeable belief in the context of OCD that is difficult to differentiate from psychotic disorders.
A meta-analysis reported that people with OCD to have mild but wide-ranging cognitive deficits; significantly regarding spatial memory , to a lesser extent with verbal memory , fluency , executive function, and processing speed, while auditory attention was not significantly affected.
Specific subtypes of symptom dimensions in OCD have been associated with specific cognitive deficits.
Risk factors include a history of child abuse or other stress -inducing event. There appear to be some genetic components with identical twins more often affected than non-identical twins.
In cases where OCD develops during childhood, there is a much stronger familial link in the disorder than cases in which OCD develops later in adulthood.
The relationship between OCD and COMT has been inconsistent, with one meta analysis reporting a significant association, albeit only in men,  and another meta analysis reporting no association.
It has been postulated by evolutionary psychologists that moderate versions of compulsive behavior may have had evolutionary advantages.
Examples would be moderate constant checking of hygiene, the hearth or the environment for enemies. Similarly, hoarding may have had evolutionary advantages.
In this view OCD may be the extreme statistical "tail" of such behaviors, possibly due to a high amount of predisposing genes. A controversial hypothesis  is that some cases of rapid onset of OCD in children and adolescents may be caused by a syndrome connected to Group A streptococcal infections , known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections PANDAS.
A review of studies examining anti-basal ganglia antibodies in OCD found an increased risk of having anti-basal ganglia antibodies in those with OCD versus the general population.
Functional neuroimaging during symptom provocation has observed abnormal activity in the orbitofrontal cortex , left dorsolateral prefrontal cortex , right premotor cortex , left superior temporal gyrus , globus pallidus externus , hippocampus and right uncus.
Weaker foci of abnormal activity were found in the left caudate , posterior cingulate cortex and superior parietal lobule.
Affective tasks were observed to relate to increased activation in the precuneus and posterior cingulate cortex PCC , while decreased activation was found in the pallidum, ventral anterior thalamus and postetior caudate.
Observed similarities include dysfunction of the anterior cingulate cortex , and prefrontal cortex , as well as shared deficits in executive functions.
Generally two categories of models for OCD have been postulated, the first involving deficits in executive function, and the second involving deficits in modulatory control.
The first category of executive dysfunction is based on the observed structural and functional abnormalities in the dlPFC, striatum, and thalamus.
One proposed model suggests that dysfunction in the OFC leads to improper valuation of behaviors and decreased behavioral control, while the observed alterations in amygdala activations leads to exaggerated fears and representations of negative stimuli.
Due to the heterogeneity of OCD symptoms, studies differentiating between symptoms have been performed. Symptom specific neuroimaging abnormalities include the hyperactivity of caudate and ACC in checking rituals, while finding increased activity of cortical and cerebellar regions in contamination related symptoms.
Another model proposes that affective dysregulation links excessive reliance on habit based action selection  with compulsions. This is supported by the observation that those with OCD demonstrate decreased activation of the ventral striatum when anticipating monetary reward, as well as increase functional connectivity between the VS and the OFC.
Furthermore, those with OCD demonstrate reduced performance in pavlovian fear extinction tasks, hyper responsiveness in the amygdala to fearful stimuli, and hypo-resonsiveness in the amygdala when exposed to positively valanced stimuli.
Stimulation of the nucleus accumbens has also been observed to effectively alleviate both obsessions and compulsions, supporting the role of affective dysregulation in generating both.
Studies of peripheral markers of serotonin, as well as challenges with proserotonergic compounds have yielded inconsistent results, including evidence pointing towards basal hyperactivity of serotonergic systems.
Despite inconsistencies in the types of abnormalities found, evidence points towards dysfunction of serotonergic systems in OCD. Although antipsychotics, which act by antagonizing dopamine receptors may improve some cases of OCD, they frequently exacerbate others.
Antipsychotics, in the low doses used to treat OCD, may actually increased the release of dopamine in the prefrontal cortex, through inhibiting autoreceptors.
Further complicating things is the efficacy of amphetamines, decreased dopamine transporter activity observed in OCD,  and low levels of D2 binding in the striatum.
Abnormalities in glutaminergic neurotransmission have implicated in OCD. Findings such as increased cerebrospinal glutamate, less consistent abnormalities observed in neuroimaging studies, and the efficacy of some glutaminergic drugs such as riluzole have implicated glutamate in OCD.
Formal diagnosis may be performed by a psychologist, psychiatrist, clinical social worker, or other licensed mental health professional.
The Quick Reference to the edition of the DSM states that several features characterize clinically significant obsessions and compulsions.
Such obsessions, the DSM says, are recurrent and persistent thoughts, impulses or images that are experienced as intrusive and that cause marked anxiety or distress.
These thoughts, impulses or images are of a degree or type that lies outside the normal range of worries about conventional problems. Compulsions become clinically significant when a person feels driven to perform them in response to an obsession, or according to rules that must be applied rigidly, and when the person consequently feels or causes significant distress.
Therefore, while many people who do not suffer from OCD may perform actions often associated with OCD such as ordering items in a pantry by height , the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD must perform these actions, otherwise they will experience significant psychological distress.
These behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these activities are not logically or practically connected to the issue, or they are excessive.
In addition, at some point during the course of the disorder, the individual must realize that their obsessions or compulsions are unreasonable or excessive.
Moreover, the obsessions or compulsions must be time-consuming taking up more than one hour per day or cause impairment in social, occupational or scholastic functioning.
With measurements like these, psychiatric consultation can be more appropriately determined because it has been standardized. OCD is sometimes placed in a group of disorders called the obsessive—compulsive spectrum.
OCD is egodystonic , meaning that the disorder is incompatible with the sufferer's self-concept. OCPD, on the other hand, is egosyntonic —marked by the person's acceptance that the characteristics and behaviours displayed as a result are compatible with their self-image , or are otherwise appropriate, correct or reasonable.
As a result, people with OCD are often aware that their behavior is not rational, are unhappy about their obsessions but nevertheless feel compelled by them.
A form of psychotherapy called " cognitive behavioral therapy " CBT and psychotropic medications are first-line treatments for OCD.
The specific technique used in CBT is called exposure and response prevention ERP which involves teaching the person to deliberately come into contact with the situations that trigger the obsessive thoughts and fears "exposure" , without carrying out the usual compulsive acts associated with the obsession "response prevention" , thus gradually learning to tolerate the discomfort and anxiety associated with not performing the ritualistic behavior.
At first, for example, someone might touch something only very mildly "contaminated" such as a tissue that has been touched by another tissue that has been touched by the end of a toothpick that has touched a book that came from a "contaminated" location, such as a school.
That is the "exposure". The "ritual prevention" is not washing. Another example might be leaving the house and checking the lock only once exposure without going back and checking again ritual prevention.
The person fairly quickly habituates to the anxiety-producing situation and discovers that their anxiety level drops considerably; they can then progress to touching something more "contaminated" or not checking the lock at all—again, without performing the ritual behavior of washing or checking.
It has generally been accepted that psychotherapy, in combination with psychiatric medication, is more effective than either option alone.
The medications most frequently used are the selective serotonin reuptake inhibitors SSRIs. SSRIs are a second line treatment of adult obsessive compulsive disorder OCD with mild functional impairment and as first line treatment for those with moderate or severe impairment.
In children, SSRIs can be considered as a second line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects.
Quetiapine is no better than placebo with regard to primary outcomes, but small effects were found in terms of YBOCS score.
The efficacy of quetiapine and olanzapine are limited by the insufficient number of studies. None of the atypical antipsychotics appear to be useful when used alone.
A guideline by the APA suggested that dextroamphetamine may be considered by itself after more well supported treatments have been tried.
Electroconvulsive therapy ECT has been found to have effectiveness in some severe and refractory cases. Surgery may be used as a last resort in people who do not improve with other treatments.
In this procedure, a surgical lesion is made in an area of the brain the cingulate cortex. In the United States, the Food and Drug Administration approved deep-brain stimulation for the treatment of OCD under a humanitarian device exemption requiring that the procedure be performed only in a hospital with specialist qualifications to do so.
Therapeutic treatment may be effective in reducing ritual behaviors of OCD for children and adolescents. In a recent meta-analysis of evidenced-based treatment of OCD in children, family-focused individual CBT was labeled as "probably efficacious", establishing it as one of the leading psychosocial treatments for youth with OCD.
Although the causes of OCD in younger age groups range from brain abnormalities to psychological preoccupations, life stress such as bullying and traumatic familial deaths may also contribute to childhood cases of OCD, and acknowledging these stressors can play a role in treating the disorder.
People with OCD may be diagnosed with other conditions, as well as or instead of OCD, such as the aforementioned obsessive—compulsive personality disorder, major depressive disorder , bipolar disorder ,  generalized anxiety disorder , anorexia nervosa , social anxiety disorder , bulimia nervosa , Tourette syndrome , Asperger syndrome , attention deficit hyperactivity disorder , dermatillomania compulsive skin picking , body dysmorphic disorder and trichotillomania hair pulling.
More than 50 percent of people experience suicidal tendencies, and 15 percent have attempted suicide. Individuals with OCD have also been found to be affected by delayed sleep phase syndrome at a substantially higher rate than the general public.
Reduced total sleep time and sleep efficiency have been observed in people with OCD, with delayed sleep onset and offset and an increased prevalence of delayed sleep phase disorder.
Behaviorally, there is some research demonstrating a link between drug addiction and the disorder as well. For example, there is a higher risk of drug addiction among those with any anxiety disorder possibly as a way of coping with the heightened levels of anxiety , but drug addiction among people with OCD may serve as a type of compulsive behavior and not just as a coping mechanism.
Depression is also extremely prevalent among people with OCD. One explanation for the high depression rate among OCD populations was posited by Mineka, Watson and Clark , who explained that people with OCD or any other anxiety disorder may feel depressed because of an "out of control" type of feeling.
Behaviors that present as or seem to be obsessive or compulsive can also be found in a number of other conditions as well, including obsessive—compulsive personality disorder OCPD , autism , disorders where perseveration is a possible feature ADHD , PTSD , bodily disorders or habit problems  or sub-clinically.
Some with OCD present with features typically associated with Tourette's syndrome, such as compulsions that may appear to resemble motor tics; this has been termed "tic-related OCD" or "Tourettic OCD".
OCD frequently co-occurs with both bipolar disorder and major depressive disorder. OCD is also associated with anxiety disorders. Quality of life is reduced across all domains in OCD.
While psychological or pharmacological treatment can lead to a reduction of OCD symptoms and an increase in QoL, symptoms may persist at moderate levels even following adequate treatment courses, and completely symptom-free periods are uncommon.
In the seventh century AD, John Climacus records an instance of a young monk plagued by constant and overwhelming "temptations to blasphemy" consulting an older monk, : Olika SRI preparat har liknande men ej identisk effekt- och biverkningsprofil.
Om och om och om igen. Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder. Cognitive Domains, Neural Circuitry, and Treatment.
N Engl J Med. The place of and evidence for serotonin reuptake inhibitors SRIs for obsessive compulsive disorder OCD in children and adolescents: Views based on a systematic review and meta-analysis.
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