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强迫症:病因,症状,病理

Obsessive compulsive disorder (OCD) - causes, symptoms & pathology

再次核查事物是一种很常见的人类行为
Double-checking things is a pretty common human behavior,
比如 我刚才关车库门了吗?
like—did I shut the garage-door?
最好再检查一下
Better double-check.
前门锁了吗?
How about locking the front door?
再检查一下吧
Double-check.
煤气灶和烤箱关了吗?
Gas-stove and oven off?
再检查一下
Double-check.
我们都会这样做
We all do it.
但如果你觉得迫不得已要检查三遍
But what if you feel compelled to triple-check it,
甚至觉得需要四遍五遍地检查 会怎样呢
or even quadruple check it, or quintuple check it even,
那么 这种想法可以被看作强迫意念
then it might be considered an obsession.
如果你必须在每次出门前对煤气灶及烤箱
Now, what if you have to do a certain ritual with the gas-stove and oven
进行程式化例行检查会怎样呢 比如
before leaving the home each time, like:
确保煤气灶关了
make sure the gas-stove is off,
把煤气灶擦干净
wipe down the gas stove to clean it,
再次检实燃烧器关掉了
double-check that the burners are off,
确保烤箱关了
make sure the oven is off,
把烤箱擦干净
wipe down the oven to clean it,
然后打开烤箱门确认没有热气冒出来
and then open the oven door to make sure no heat is coming out,
然后你才可以离开家
and then you can leave the house.
那么这种程式化行为可能是一种强迫行为
Then that might be a compulsion.
强迫症 或称OCD
Obsessive compulsive disorder, or OCD,
是一种特殊类型的焦虑症
is a specific type of anxiety disorder
这种焦虑症以强迫意念或强迫行为为特征
characterized by these obsessions or compulsions.
强迫意念是反复出现的侵入性想法
Obsessions are recurrent and intrusive thoughts
这些想法你通常不想要却在脑海中挥之不去
that are typically unwanted and tough to get out of your brain.
像“我家不安全”这些不必要的想法造成了焦虑
These unwanted thoughts, like “ my house is unsafe ”, cause anxiety,
而这些强迫意念会导致强迫行为
and usually they lead to compulsions,
人们试图执行强迫行为
which are actions that might be performed
是为了尝试减轻与强迫意念相关的焦虑
to try and reduce the anxiety associated with obsessions.
你可以想象
As you might imagine,
这些想法和习惯会严重影响一个人的日常生活
these thoughts and rituals can have a serious impact on someone’s daily life.
强迫症影响了大约3%的人口
OCD affects around 3 % of the population,
男女发病率相同
and affects both men and women equally
通常开始于童年或者青少年时期
and usually starts in childhood or in the teen years.
据悉 大卫·贝克汉姆 霍伊·曼德尔等名人也患有强迫症
Celebrities like David Beckham and Howie Mandel are known to be affected by OCD,
另一个更严重的强迫症实例是霍华德·休斯――
and a more severe example is that of Howard Hughes,
别的头衔先不说 他是商业大亨和企业家
business tycoon and entrepreneur, among other things,
他在晚年患上了强迫症 严重影响了生活
who was affected by relatively incapacitatingOCD later in his life.
虽然强迫症包括强迫意念和强迫行为
Although obsessive-compulsive includes both obsessions and compulsions,
诊断强迫症不必同时具有强迫意念和强迫行为
one doesn’t need both obsessions and compulsions for a diagnosis,
有些人也许只有强迫意念 或只有强迫行为
some individuals might have just obsessions or just compulsions,
但大多数患者二者兼具
but the majority of patients have both,
患者常常会执行强迫行为来缓解强迫意念
often where the compulsion is performed to alleviate an obsession.
一个非常常见的强迫行为是清洁
A very common compulsion is cleaning,
这种强迫行为来自于对病菌或污染物的强迫意念
which often stems from an obsession with germs or contamination.
另一个常见的强迫行为是检查
Another common compulsion is checking,
往往因为他们有“总有些事物不安全”的强迫意念
usually because they have obsessions that something’s unsafe,
所以他们会打开锁 再锁上 有时候重复几次检查
so they’ll check to make sure that something’s definitely safe
来确保这些东西的确安全
by unlocking and re-locking it, sometimes several times.
但一般而言 重复本身就是强迫行为
More generally though, repeating is a compulsion on its own,
比如多次重复某个动作或者短语
where an action or phrase is repeated several times,
之所以这样做
And usually this is done
通常是因为他们认为不这样做就会发生坏事
because if it’s not, they think something bad will happen.
患者有时候觉得自己被迫去整理和排列东西
Sometimes patients might feel compelled to order and arrange things,
因为混乱的东西会造成焦虑和不适
because when they’re out of order, it causes anxiety and discomfort.
最后 仪式化的思维也是强迫意念
Finally, mental rituals are also obsessions,
人们这样做是为了抵消侵入性的“坏”想法
these are often done to try to neutralize intrusive or what they think are bad thoughts.
所以他们可能会试着想出
so they might try and call up specific words or phrases
一些较为正面的词汇或短语
they think are good thoughts
以取代不好的想法
to try and replace the bad thoughts.
《精神疾病诊断与统计手册》
Now the diagnostic and statistical manual for mental disorders,
第五版 或简称DSM-V
the fifth edition, or the DSM – V,
给出了强迫症的具体诊断标准
gives specific diagnostic criteria to meet for a diagnosis of OCD.
首先 他们要有强迫意念 强迫行为或二者兼具
First and foremost they need to have the presence of obsessions compulsions or both.
这很合理
Make sense.
强迫理念及(或)强迫行为也得是耗费时间的
The obsessions and/or compulsions need to also be time-consuming,
以至于让他们的社交和工作受到影响
often such that it produces distress with their social life and their work.
比如 每天花两个小时叠衣服和展开衣服
for example, taking two hours every day folding and unfolding clothes
然后上班迟到
and then being late for work.
有一点很重要 强迫性理念和强迫行为
it’s also important that the obsessions and compulsions
不是由某种物质或其他疾病的生理作用产生的
are not due to the physiological effects of a substance or other medical condition.
最后 没有其他精神障碍更好地解释这种明显的焦虑
Finally, the apparent anxiety isn’t better explained by another mental disorder,
比如:像在躯体变形障碍中对个人外表的痴迷
like for example, an obsession with personal appearance, like in dysmorphic disorder.
就像大多数心理障碍一样
Like most mental disorders,
强迫症并没有已知的病因
there isn’t a known cause of OCD,
尽管它被认为是由基因及环境因素共同导致的
though it’s thought to be a combination of genetic and environmental factors.
有的时候强迫症似乎在家庭中传播
Sometimes OCD seems to run in families,
一个重要的线索是
and an important clue is that
同卵双胞胎比异卵双胞胎更容易患病
identical twins are more often affected than non-identical twins.
现在人们认为
It’s now thought that
大脑中的5-羟色胺神经传递不正常起着关键作用
abnormalities in serotonin neurotransmission in the brain plays a key role,
尽管确切的发病机制还不得而知
though the exact mechanism is unknown.
治疗方法包括精神疗法 药物疗法 或二者结合
Treatment usually involves psychotherapy, medications, or both.
在多种精神疗法中 认知行为治疗已有成效
Among psychotherapy options, cognitive behaviortherapy has been effective,
特别是一种叫做暴露和反应疗法的技术
specifically a technique called exposure and response therapy,
治疗中 先把患者置于引发焦虑与强迫行为的情景中
where patients are first exposed the anxiety and compulsion provoking situation.
最终表明当不执行强迫行为时
ultimately showing that the anxiety actually lessens
焦虑实际上得以缓解
when the compulsion is not carried out.
因为病因与5-羟色胺有关
Because the cause has been linked to serotonin,
选择性5-羟色胺再摄取抑制剂 简称SSRIs
selective serotonin reuptake inhibitors, or SSRIs,
已被证明是一种有效的药物治疗方法
have been shown to be an effective drug treatment,
但由于这些药往往带来一些症状和副作用
though they often come with symptoms and side effects
因此病人可能需要接受进一步的药物或心理治疗
that may need to be further treated with medications or psychotherapy.
通过合理治疗
With the right treatment though ,
患者往往可以恢复正常的日常生活和活动
patients often return to normal daily life and activities.

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视频概述

强迫症发病症状,分为强迫思维和强迫行为,或二者兼具,人群发病率,男女发病率,家庭传播情况,发病时期,和治疗方法。

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视频来源

https://www.youtube.com/watch?v=I8Jofzx_8p4

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