OCD: First Steps — Where to Begin So You Don’t Make It Worse

When a person starts being tormented by intrusive thoughts, rechecking, rituals, the natural urge is to get “cured” fast: rush to a specialist, look for the secret, demand action. Dr. Saulitis suggests the opposite first step: stop and figure out where this came from. Because the answer to that question determines the entire treatment strategy that follows.

First — the nature of the obsessions, not the fight against them

Obsessive-compulsive disorder is not uniform. It can appear both in an organic condition and in an endogenous one — and look almost identical on the surface. So the first step is not to attack the symptom, but to understand its origin.

If the obsessions are at a mild, neurotic level, then in over 90% of cases they come “from the organic camp” and respond very well to restoration: sleep, routine, a normal environment and diet, relieving exhaustion.

“If a person has these obsessions, in 90-plus percent of cases they’re from the organic camp and treat very well.”

How to tell: simple questions to yourself

The doctor shows it’s easier to sort out than it seems. Just look honestly at your way of life and your history.

Ask yourself: how did all this begin? People often tell the same story — they “got caught in the grinder,” didn’t sleep, wandered, overloaded themselves, and that’s when the trouble started: hard to remember things, an urge to recheck, and so on. If that’s the picture, it’s an organic neurosis, and you should start with restoring your health.

Separately, recall your parents: were there similar states in your direct relatives. If a genetic component can be ruled out — the path forward is clearer.

Why it matters not to rush

Haste is dangerous. A person whom “life has run over” — had an illness, a head injury, exhaustion — comes in with trembling hands and neurotic syndromes, and is immediately hit with “heavy artillery”: poorly chosen medications, antidepressants. And then the person only gets worse.

“They immediately reach for the drugs without sorting it out — and that’s the moment when you get a vegetable.”

The same mistake, the doctor says, is made by ill-prepared psychologists: a person comes in already carrying his own system of thoughts, and they start to “treat him with willpower” without understanding what’s happening — and nothing works.

Where a lifestyle change helps, and where it doesn’t

If the obsessions are the consequence of an organic neurosis or a mild part, then psychotherapy, restructuring your rhythm, rest, mending relationships, and relieving stress really do work — the doctor speaks of 40–50%.

But if it’s a genetically determined variant, treatment will already require medication support, and routine and rest will play only a smaller role. And in real life there are almost no “pure” variants — everything is interconnected, by the “grid principle,” so such cases are hard to treat and respond poorly when handled in isolation, without a team of specialists.

Separately: obsessions after alcohol

The doctor notes: frightening, intrusive thoughts can indeed intensify after heavy drinking and during a hangover — when, for instance, a person starts removing the knife from the table. This too is a cue to look at your way of life and load, not a reason to panic over the thought itself.

Practice: first steps with obsessions

1. Stop, don’t run to “get cured.” Don’t hunt for an instant “secret” and don’t bury your head in the sand — sort it out wisely.
2. Describe the onset. How did it all start? Was there overload, sleeplessness, illness, getting “caught in the grinder”?
3. Check the origin. Recall direct relatives — did they have similar states. This helps separate organic from endogenous.
4. If the picture is organic — start with restoration: sleep, routine, normal diet, exercise, motivation, relieving exhaustion.
5. Don’t prescribe yourself the “heavy artillery.” Choosing medication is only for a doctor who has taken the time to understand, not in 15 minutes.