اختلال وسواس فکری _ عملی چیست؟

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خصیصه اصلی اختلال وسواسی- جبری(OCD) وجود وسواس‌های فکری یا عملی مکرر و چندان شدید است که رنج و عذاب قابل ملاحظه ای را برای فرد به بار می‌آورند. این وسواس‌های فکری یا عملی سبب اتلاف وقت می‌شوند و اختلال قابل ملاحظه ای در روند معمولی و طبیعی زندگی، کارکرد شغلی، فعالیتهای معمول اجتماعی، یا روابط فرد ایجاد می‌کنند. بیمار مبتلا به اختلال وسواسی- جبری ممکن است فقط وسواس فکری، فقط وسواس عملی، و یا هر دوی آنها را با هم داشته باشد.

بيماري وسواسي جبري سه بخش اصلي دارد:

-افكاري كه شما را بيمناك مي كنند
-اضطرابي كه شما احساس مي كنيد.
-اعمالي كه انجام مي دهيد تا اضطرابتان كاهش يابد

ویژگی افکار و اعمال وسواسی

بیمار مبتلا به اختلال وسواسی- جبری از غیر منطقی بودن وسواس‌هایشان آگاهی (یعنی به صورت یک رفتار ناخواسته).هر چند عمل وسواسی ممکن است در تلاش برای کاستن از اضطراب همراه با وسواس فکری انجام شود، همیشه به کم شدن این اضطراب منجر نمی‌گردد. ممکن است پس از کامل شدن انجام عمل وسواسی، اضطراب فرقی نکرده باشد و یا حتی بیشتر شده باشد. وقتی فرد در مقابل انجام وسواس عملی مقاومت خرج می‌دهد نیز اضطراب افزایش می‌یابد.

میزان شیوع مادام العمر اختلال وسواسی- جبری(OCD) در جمعیت عمومی حدود دو تا سه درصد است. طبق تخمین برخی از پژوهشگران، اختلال وسواسی- جبری در بسیاری از بیماران سرپایی مطبها و درمانگاههای روانپزشکی یعنی در ده درصد از آنها یافت می‌شود. با توجه به ارقام مذکور، اختلال وسواسی- جبری چهارمین بیماری روانپزشکی است. اختلال وسواسی- جبری می‌تواند در نوجوانی، کودکی وحتی در برخی موارد در دو سالگی هم شروع شود. افراد مجرد بیشتر از متأهلها به این اختلال مبتلا می‌شوند که البته این یافته می‌تواند نشانه مشکلی باشد که بیماران مبتلا به اختلال وسواسی- جبری در حفظ روابط خود دارند.

علایم بیش از نصف بیماران دچار اختلال OCD به طور ناگهانی شروع می‌شود. از آنجا که خیلی از این بیماران می‌کوشند که علایم خود را از دیگران پنهان نگه دارند، اغلب بیماران با پنج تا ده سال تاخیر به روانپزشک مراجع می‌کند.

ویژگی های اصلی وسواس

اختلال وسواس چیست؟

چه عاملي باعث ادامه OCD مي شود؟

تعجب آور اينكه برخي راههايي كه شما از طريق آنها سعي در كمك به خودتان داريد در واقع به تدوام بيماري كمك مي كند.

  • تلاش در بيرون راندن افكار از ذهنتان- اين كار معمولاً باعث مي شود افكار بازگردند. يك دقيقه سعي كنيد به يك فيل صورتي فكر نكنيد. شما احتمالاً متوجه مي شويد مشكل است به چيز ديگري فكر كنيد.
  • اعمال تكراري – چك كردن- اجتناب و تاييد خواستن   از ديگران باعث مي شود براي مدت كوتاهي اضطرابتان كمتر شود. بخصوص اگر حس كنيد اين مي تواند از بروز حادثه اي بد و ناخوشآيند جلوگيري كند، اما هر بار كه شما اينگونه عمل مي كنيد، باور خود كه آنها از وقوع حوادث بعد جلوگيري مي كنند را قدرت مي بخشيد و بنابراين شما فشار بيشتري براي انجام آنها حس مي كنيد و الي آخر …
  • انديشيدن به افكار خنثي كننده، شما زمان صرف اصلاح افكار مضطرب كننده با فكر ديگري مثل شمارش تا ده يا تصوير (خوشايند) (مشاهده فردي زنده و سالم) مي كنيد سپس متوقف شده و منتظر مي مانيد تا اضطراب از بين برود.

علل اختلال وسواس فكري-عملي

بدليل اينكه انواع مختلفي از آن وجود دارد بسيار مشكل مي باشد. به عنوان مثال، عواملي كه باعث به وجود آمدن علايم ونشانه‌هاي جمع آوري اشيا در فرد مي شوند با عواملي كه ترس از آلودگي را به وجود مي آورند متفاوت هستند.

وسواس همانند ساير بيماريهاي رواني نتيجه تركيب عوامل مختلف زيستي، رواني و اجتماعي مي باشد. با اين حال، افراد مختلف با علائم و نشانه‌هاي متفاوت مي توانند تركيب گوناگوني از عوامل را داشته باشند و همين امر،  شناخت و مشخص كردن علت بيماري را بسيار پيچيده مي كند.

 عوامل زیستی

تحقیقات بالینی بسیاری که بر روی انواع و اقسام داروها انجام شده، مؤید این فرضیه است که نوعی کژ تنظیمی سروتونین و کژکاری دستگاه نورآدرژنیک در ایجاد علایم وسواس فکری و عملی در این اختلال دخیل است. (کاپلان و سادوک،2007؛ ترجمه، فرزین رضاعی).

وراثت پذیری

داده‌های وراثتی موجود درباره اختلال وسواسی- جبری با این فرضیه همخوانی دارد که اختلال مذکور مؤلفه وراثتی قابل توجهی دارد.

 عوامل روانی- اجتماعی

دوسوگرایی

دو سوگرایی نتیجه مستقیم تغییر در حیات تکانشی فرد است. تعارض بین احساس‌های متضاد را می‌توان در الگوی رفتاری انجام– ابطال و شک ناتوان کننده فرد در انتخاب بین گزینه‌ها به خوبی دید.
تفکر جادویی

ویژگی ذاتی تفکر جادویی، احساس قدرت مطلق (همه کار توانی) در فکر است. بنابراین فرد فکر می‌کند به صرف اندیشیدن به یک موضوع بدون دخالت فیزیکی در جهان واقعی رخ می‌دهد و همین احساس است که باعث می‌شود  افکار پرخاشگرانه فرد مبتلا برایش بیم آور و ترساننده باشد.

نظریه شناختی- رفتاری OCD

مفهوم سازي رفتاري اختلال وسواسي – جبري

آيزنك، راچمن و همكارانشان نظريه پردازي كردند كه اختلال وسواسي- جبري ممكن است از نظريه‌ دو مرحله‌اي ماورر براي شكل گيري و تداوم ترس پيروي كند. در اين نظريه، اضطراب با رخداد هاي ذهني (مانند افكار يا تصاوير) شرطي مي‌شود (شرطي سازي كلاسيك) و اجبارها در تلاش براي كاستن از درماندگي ناشي از اين افكار انجام مي‌شوند. اجبار، در طي زمان، به علت توانايي‌اش براي كاستن از درماندگي ايجاد شده توسط وسواس، تقويت منفي مي‌شود (شرطي سازي كنشگر). مثلاً فردي كه وسواس آلودگي دارد ممكن است وقتي قرار باشد در يك توالت عمومي را لمس كند، احساس درماندگي كند. اين درماندگي باعث ايجاد ميلي شديد در او براي شستن دستانش مي شود (اجبار). اگر به اين اجبار عمل شود، كاهش درماندگي متعاقب آن، به همان شكل كه پاداش مي تواند باعث تقويت رفتار پيش از خود شود، سبب تقويت آيين‌هاي شستشوي دست مي‌شود (توکلی و قاسم‌زاده،1385).

منابع:

  1. کتاب راهنمای تشخیصی و آماری اختلالات روانی(DSM5)
  2. کتاب خلاصه روانپزشکی کاپلان و سادوک
  3. کتاب غلبه بر وسواس نویسنده: دکتر لی بائر
  4. کتاب رهایی از وسواس نویسنده:بروس، م. هایمن، چری پدریک

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