Obsessional neurosis: symptoms, causes and treatment

A disorder described by psychoanalysis and that today no longer appears in the manuals.

We speak of obsessive neurosis to refer to a mental disorder linked to tensions of nervous type and psychic problems of different nature. It was Sigmund Freud, the famous Viennese psychoanalyst, who described it for the first time.

What is obsessional neurosis?

Freud described obsessional neurosis as a psychic disorder whose sufferers are constantly preoccupied with thoughts that do not interest them. The type of thoughts that these patients suffer from are of a content that generates rejection, which can lead them to engage in undesired behaviors.

Much has been written about the difficult detection and treatment of obsessional neurosis, as its symptoms can go unnoticed in many sufferers. But what are people with this condition like? They are often said to be perfectionists. Their thoughts may dominate their behaviors and moods, so they may engage in repetitive and compulsive behaviors to try to manage their discomfort. and compulsive behaviors to try to manage their discomfort.

This is a term that is no longer used in modern clinical psychology. It does not appear in either the DSM or the ICD. Obsessional neurosis is, however, a construct of great relevance in the history of psychopathology.

In this article we will know the definition of this disorder, as well as its symptoms, causes and possible psychological treatments.

History of the concept

The French psychoanalyst Henri Ey conceptualized obsessional neurosis as the inability to control the compulsiveness of feelings, ideas or behaviors.ideas or behaviors. This causes the affected person to be subjected to the control of this type of neurosis.

Although the DSM-IV does not consider obsessional neurosis as an independent psychopathological entity, the different characteristics of the disorder have been treated, although with very different nuances to those proposed by Freud or those previously described by Henri Ey.

In contemporary diagnostic manuals, obsessional neurosis is integrated among anxiety disorders. Thus, the set of symptoms corresponds to OCD, or obsessive-compulsive disorder. OCD is a disorder in which there are compulsions and obsessive thoughts that the affected person recognizes as irrational and not very adaptive. These symptoms generate a notable uneasiness and the patients usually present compulsive behaviors, rituals, etcetera.

As we can see, there are significant differences between the disorder initially described by psychoanalysis under the term obsessional neurosis and the psychopathology currently described in the manuals under the name of OCD (obsessive compulsive disorder).

Main characteristics

The symptoms and characteristics of obsessional neurosis derive from the psychological and cognitive alterations suffered by the patient. Obsessive thoughts flood the mind of the affected person.

Let us see what types of thoughts suffer those affected by obsessive neurosis.

1. Obsessive cognitions

Obsessive phenomena arise continuously in the psyche of the affected person.. This can take the form of uncontrollable feelings of guilt, verification, obsession with order and cleanliness....

These recurrent ideas usually represent a problem and a constant worry for the patient.

Defense mechanisms

People with obsessional neurosis develop various defense mechanisms to try to minimize their obsession.

However, these defense mechanisms also stem from obsessive thoughts and behaviors. Unlike obsessive cognitions, defense mechanisms can be consciously performed and the subject reproduces them in an attempt to reduce the discomfort of the former.

3. Other psychological and affective disturbances

This disorder is often accompanied by other emotional and affective disturbances.. Symptoms such as abulia, the feeling of unreality, confusion, strangeness or perplexity are very common among those affected by obsessional neurosis.

Symptoms

What are the most common symptoms of obsessional neurosis?

• The affected person presents obsessive ideas that appear in his mind against his will. They are thoughts of compulsive and uncontrollable character.
• The patient has a tendency to perform impulsive and aggressive behaviors, even though they are not desired behaviors.
• They perform repetitive behaviors of symbolic nature. They are defined as magical thinking rites.
• Psychasthenia appears, since the subject maintains a struggle to try to put a stop to his obsessions.

Causes

The studies on obsessional neurosis have revealed that it is a multicausal psychopathology (that is, it can be due to different causes). It seems that there are a number of factors that, together, can lead to the onset of the disorder.

Typically, scholars have classified three types of causes of obsessional neurosis: physical, environmental and genetic factors.

Physical factors

The symptoms associated with obsessional neurosis have been shown to be related to various neurochemical imbalances.

It appears that dysfunction in the orbitofrontal-caudate circuit may be a common factor in the onset of the disorder.

Another hypothesis proposes that certain abnormalities in the striatum and the facilitation of serotonin transmission in the orbitofrontal region may also be risk factors.

2. Environmental factors

There may also be several environmental factors that may be conducive to the emergence of this disorder. Individuals who have experienced situations that they could not control have a greater predisposition to suffer obsessional neurosis.

For example, childhood trauma, having been a victim of abandonment or sexual abuse, living in a broken home and being exposed to high levels of stress can also lead to the emergence of this psychological disease.

3. Genetic factors

As with many mental disorders, obsessional neurosis has also been reported to have a large genetic component.

This has been seen since in some families it is easy to detect several members with this affectation. Likewise, having a family history of obsessional neurosis is a risk factor for developing the same disorder.

Treatments

The usual symptoms of obsessional neurosis can be treated from two different (and often complementary) approaches: pharmacological and psychological treatment.

As regards pharmacological therapy, the most effective drugs are tricyclic antidepressants and selective serotonin reuptake inhibitors. This type of pharmacological intervention stabilizes the clinical picture, although psychotherapeutic support is usually required. In this regard, cognitive-behavioral therapy is the most effective form of psychotherapy and the one that is usually best complemented with inhibitory intervention.

Bibliographical references:

• Freud, S. (1986). "Apropos of a Case of Obsessional Neurosis (the "Rat Man")". Collected Works, Volume X. Amorrortu Editores.
• Jarne, A. and Talarn, A. (2015). "Manual de Psicopatología Clínica". Editorial Herder.
• Indart, J.C. (2001), "La pirámide obsesiva". Editorial Tres Haches.
• Lacan, J. (1984). "The Seminar. Book XI: The four fundamental concepts of psychoanalysis". Editorial Paidós.