Obsessive Compulsive Disorder
- Epidemiology
- Comorbidity
- OCD and Tic Disorder
- OCD and Depression
- OCD and Other Anxiety Disorders
- OCD and Phobia
- OCD and OCPD
- OCD and Schizophrenia
- Course and Prognosis
- Etiology
- Specific Clinical Response
- Serotonin Antagonists
- Pharmacological Challenges
- Dopamine
- Immune Factors
- Brain Imaging Studies
- Genetics
- Other Biological Data
- Behavioral Factors
- Psychosocial Factors
- Treatment of OCD
- Efficacy of Serotonergic vs Adrenergic Antidepressants
- Long Term Treatment of OCD
- Drug Dosage
- Psychological Approaches
- Treatment Resistant OCD
- Switching Medications
- Augmentation
- Risperidone
- Pindolol
- Other Options
- Intravenous Clomipramine
- Monoamine Oxidase Inhibitors
- Last-line Therapies
Psychosocial Factors for OCD
The dynamic aspects of OCD were first described by Sigmund Freud, who coined the term ‘‘obsessional neurosis’’. The disorder was thought to be the result of a regression from the oedipal to the anal phase, with its characteristic ambivalence. The coexistence of hatred and love towards the same person was believed to leave the patient paralyzed with doubt and indecision. Freud originally suggested that obsessive symptoms result from unconscious impulses of an aggressive or sexual nature. These impulses, he maintained, cause extreme anxiety which is avoided via the defense mechanisms. One of the striking features amongOCDpatients is the degree to which they are preoccupied with aggression or cleanliness (anal phase), either overtly in the content of their symptoms or in the underlying associations. Freud described three major psychological defense mechanisms that are important in OCD: isolation, undoing and reaction formation.
According to the psychoanalytic formulation,OCD develops when these defenses fail to contain the anxiety. Isolation is the separation of the idea and the affect that it arouses, when the patient is only aware of the affectless idea. Undoing is a secondary defense in order to combat the impulse and quiet the anxiety that its imminent eruption into consciousness arouses. Undoing is a compulsive act, performed in order to prevent or undo the results that the patient irrationally anticipates from a frightening obsessional thought or impulse. Reaction formation is related to the production of character traits rather than symptom formation (characteristic of the above defenses). This trait seems highly exaggerated and inappropriate (i.e. the transformation of anger and hate into exaggerated love and dedication).