Disturbo ossessivo-compulsivo
Il disturbo ossessivo-compulsivo (DOC) incluso nel DSM 5 esce dal capitolo dei disturbi d’ ansia per guadagnarsi un nuovo capitolo dedicato a un’entità nosografica autonoma. In effetti, questo disturbo ha caratteristiche proprie, come il comportamento bizzarro e la presenza di pensieri intrusivi, per cui è stato a volte considerato come una pallida forma di schizofrenia; esso può presentare inoltre disturbi affettivi associati o sottostanti.
L’età d’inizioè in genere nell’adolescenza o tra i 20 e i 35 anni, con uguale prevalenza nei due sessi. Il disturbo,nella sua forma completa e severa, non sembra molto frequente nella popolazione. Forme lievi sono probabilmente più diffuse.
Ladiagnosi differenzialeva effettuata con disturbi schizofrenici, in cui possono essere presenti ossessioni bizzarre, non criticate dal soggetto come irrazionali, e comportamenti stereotipati, legati però sempre al disturbo delirante. In alcuni casi può comunque coesistere un disturbo schizofrenico. Nel disturbo ossessivo compulsivo è spesso presente depressione.
Ildecorsoè generalmente cronico, lento, con oscillazioni spontanee dei sintomi, in alcuni casi esso risulta gravemente incapacitante l’individuo, mentre in altri, talvolta, si manifesta con periodi di remissione quasi completa.
Il disturbo ossessivo-compulsivo è caratterizzato generalmente dalla presenza di ossessioni o compulsioni.
Ossessioni:
- idee, pensieri impulsi o immagini ricorrenti e persistenticonsiderati almeno inizialmente intrusivi e senza senso (ad esempio il ripetuto impulso di un genitore di uccidere un figlio amato, pensieri blasfemi ricorrente in una persona religiosa).
- la persona cerca diignorare o sopprimere tali pensierio impulsi o di neutralizzarli con altri pensieri azioni.
- la persona riconosce che leossessioni sono il prodotto della sua mente,non imposte dal di fuori.
- se è presente un altro disturbo psichiatrico, ilcontenuto dell’ossessione non riguarda tale disturbo,l’esempio non riguarda il cibo nel caso è un Disturbo Alimentare, sostanze nel caso Disturbo da Sostanze Psicoattive, o pensieri di colpa nel caso di Depressione Maggiore.
Compulsioni:
- comportamenti ripetitivi,senza scopo, intenzionale, messi in atto in risposta ad un ossessione, secondo certe regole in modo stereotipato.
- il comportamento ha lo scopo di neutralizzare o prevenire disagio o qualche situazione o evento temuti; tuttavia, l’attività non è realisticamente connessa con lo scopo di neutralizzare o prevenire o è chiaramente eccessiva.
- la persona riconosce che il suocomportamento è eccessivo e irrazionale(questo può non essere vero per i bambini).
Le ossessioni o compulsioni causano stress, comportano perdita di tempo, più di un’ora al giorno o interferiscono in modo significativo con la normale routine della persona, con le sue occupazioni, inusuali attività sociali e rapporti con gli altri.
Le ossessioni più frequenti sono quelle riguardanti losporco e la contaminazione con germi, escrementi, radiazioni: ad esempio il controllo reiterato della chiusura di serrature, di rubinetti dell’acqua, del gas e di interruttori della luce.
Quelle numeriche riguardanocalcoli matematici o date; le sessuali riguardanoproposte sessuali, impulsi incestuosi, fantasie di stupro, omosessualità; le religiose riguardano paure di commettere peccati e atti sacrileghi; le esistenziali sono relative a dubbi sull’essenza, sul mondo e sulla vita.
I rituali più frequenti riguardano lapulizia e sono spesso associati ad idee di contaminazione. La pulizia può essere personale, come ad esempio lavarsi i denti per ore dopo ogni pasto fino a farsi sanguinare le gengive,oppure lavarsi le mani con prodotti abrasivi e disinfettanti o a procurarsi lesioni.
Nei rituali possono essere interessate anche attività domestiche quali il bucato, rimettendo ad esempio i
panni in lavatrice anche tre/quattro volte di seguito, non convinti che siano sufficientemente puliti.
I rituali di controllo riguardano più frequentemente gesti della vita quotidiana quali controllare ripetutamente
la chiusura diporte e finestre di casa, di interruttori dell’acqua, della luce, del gas.
I rituali di ordine consistono nel ripetere gesti banali comeallineare libri, penne, soprammobili,oggetti da
scrivania e nel mettere in ordine cassetti, armadi e abiti prima di coricarsi.
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