Obsessive-Compulsive Dis­orders.

When compulsions dominate daily life.

The symptoms consist of an inner compulsion to perform or think certain things. With compulsive actions, these may be compulsions to wash or check, or compulsions to carry out certain (ordering) rituals in a specific sequence or with a specific frequency. With obsessive thoughts, there are usually threatening ideas — for example, fear of becoming contaminated (through germs on objects), which subsequently (in 75 % of those affected) leads to corresponding compulsive actions (cleaning door handles). However, obsessive thoughts can also involve ideas of an aggressive nature, or a ritualised circular thinking that is supposed to prevent something bad from happening. In any case, those affected are aware that their compulsions impose themselves with an irresistible inner force but are fundamentally rather distorted and 'absurd.' This distinguishes compulsions from delusions, in which there is no inner critical distance from the symptom. Considerable distress arises when daily life is so severely affected that carrying out the compulsions causes a permanent lack of time and professional and private obligations can no longer be met. Compulsive collecting (and the 'inability to let go') of objects up to the level of hoarding disorder can also be understood as a subtype of obsessive-compulsive conditions.

Treatment at Sanima Klinik.

In the therapy of obsessive-compulsive disorders, alongside approved and effective antidepressants, cognitive-behavioural interventions are of decisive importance. The essential and indispensable therapeutic element consists of stimulus confrontation and response prevention. The aim here is to face the unpleasant feelings, inner restlessness and tension, and catastrophising thoughts, and to endure them without neutralising them in the habitual way through compulsions. Only in this way can the concrete experience be gained that unpleasant feelings and affects (e.g. anxieties and inner restlessness) subside again, even when the habitual avoidance behaviour (in this case compulsions) is dispensed with. This increases the expectation of self-efficacy and self-esteem, while reducing the sense of powerlessness of being a victim of one's own compulsions.

In psychodynamic therapy, we focus on work aimed at understanding the compulsions in the context of existing relational and behavioural patterns (e.g. inhibition of aggression, conflict avoidance, limited ability to set boundaries, etc.), inner conflicts, and their biographical references (early existential insecurities, controlling or anxiously overprotective relationship experiences, the experience of conflict culture in the family of origin, experiences of loss of control, and much more). The goal is to defuse inner patterns connected with the symptoms and ultimately to have corrective relationship experiences — in the therapeutic relationship, in the patient community, and later in everyday life.

At Sanima Klinik, we pursue a two-pronged cognitive-behavioural and psychodynamic therapeutic approach, as outlined above.