Obsessive Compulsive Neuroses | Mental Illness

After reading this article you will learn about the obsessive compulsive neuroses in humans.

It is a particular personality disorder of a specific nature which the person concerned recognizes to be irrational, but over which he has little or no control. Obsession is used for thoughts and compulsion for actions, obsession compulsions are very much self realized.

In both obsessions and compulsions the patient is well aware of the irrational nature of his thought and action. But in-spite of persistent resistance, he is compelled to think about something which he does not wish to think or undertake activities which he does not intend to perform.

These ideas and actions are very much unwelcome and unpleasant. But they recur again and again in-spite of the best effort of the patient to avoid them.

In actual practice, obsession compulsion neuroses are very much related and go side by side. Obsessional neuroses in fact, cannot be separated from compulsive neuroses. Obsessive ideas frequently lead to compulsive acts and compulsions are based on insistent mental ideas.

To add to this, usually both the symptoms are present in most cases, However, sometimes obsessive symptoms predominate while in other times compulsive behaviour dominates and in some cases we may get a balance of both these symptoms.

Coleman (1981) views that these irrational obsessive compulsive reactions are many and varied and appear to constitute some 20 to 30 per cent of all psychoneurotic disorders. In DSM-II (1968) obsessive compulsive neuroses has been described in the following manner.

“In this reaction the anxiety is associated with the persistence of unwanted ideas and repetitive impulses to perform acts which may be considered morbid by the patient. The patient himself may regard his ideas and behaviour as unreasonable but nevertheless is compelled to carry out his rituals”.

CD-9 (1979) has also defined obsessive compulsive neuroses in a similar way. Obsessive compulsive neuroses are a common type of disease found in common population. In all walks of life obsessive compulsive neurotics are found. The disease develops very slowly. In the early period, the patient becomes very religious, thoughtful and philosophical.

The symptoms in the childhood are mostly showiness, strong conscience and morality. In-spite of their relationship and unseparatedness, some authors have tried to describe obsessions and compulsions separately.

Obsessive reactions:

Page (1976) comments that obsessions are spontaneously recurring ideas, images and thoughts over which the individual has no voluntary control. He is forced to tolerate their presence and domination of his consciousness although they are disturbing to his mental peace.

In obsession generally three essential elements are present:

(i) Feeling of subjective compulsion,

(ii) The resistance to it and     

(iii) The strong desire to repeat it over and over again.

In short, the obsessive patient understands the irrationality of the thought coming to his mind persistently, and tries to resist them, but fails miserably and finally becomes a prey to that thought or idea.

According to Duke and Nowicki (1979) “In contrast to the hysteric person, who either, compartmentalizes or converts anxiety in attempts to control it, the obsessive person intellectualizes in what may be seen as an attempt to think the anxiety away”. They further hold that obsessive neuroses are the diagnoses in about 5 per cent of all psychoneurotic patients.

The investigations of Nemaciah (1975) show that though sex does not seem to have a significant effect on the incidence, of obsessive reaction, it has been observed that many obsessive people are unmarried and come from the middle and upper classes.

Compulsive reactions:

As already pointed out, in compulsive reactions, the patient feels compelled to do some action which seems irrational, absurd, and strange to him. Popular examples of obsessive reactions are washing hands 11 times before eating, praying God 5 times each and every time before going out, looking at the time piece every time before entering the toilet, counting the steps each time while proceeding for the office etc.

Such actions reduce anxiety and give satisfaction to the ego of the individual.But the moment he tries to check such activity and withdraws from it realising its absurdity, he is overshadowed with terrible anxiety and tension.

The washing compulsion of Lady Macbeth arising out of the guilt of murder may serve an example here. Similarly compulsive reactions may arise out of guilt about sex. Some compulsive behaviours are very often found in normal people, but the persistent nature of the action found in the neurotics is absent in the normal people.

According to Duke and Nowicki (1979) a compulsion may be viewed as a felt need to carry out certain admittedly senseless sequences of actions or to think certain peculiar and magical thoughts as a way to reduce anxiety.

As pointed out by Duke, besides repeated single behaviour like washing, there are also serial compulsions in which anxiety is handled by specific ordering procedures and the more is the anxiety, the more widespread, pervasive and complex is the ordering procedure. For example arrangement of clothes, beds, drawing room, where every-thing must be put in their proper place, in a certain typical way.

Any change or disorganization in the typical arrangements cannot be tolerated by the patient at any cost and until and unless the things are not placed in their respective places and typical orders he cannot rest in peace and do his normal work.

The author knows a girl who wastes most of her time in the day by taking out the belongings of the house every day, sweeping the dust and then putting them in order again. By the time she has kept everything in order, her energy is exhausted; a lot of time is wasted and she is unable to do any other work.

Compulsive neuroses thus characteristically consume more and more time of a person, his energy and behaviour. Compulsive magical behaviours are also seen in compulsive neurotics.

Duke and Nowicki (1979) view that it may be related in some ways to superstition. There is similarity they say in the behaviour of the compulsive neurotic arranging his clothes in a certain manner and the basketball player who has to wear the same lucky socks (unwashed) for every game.

The author knows many students who wear the same dress and use the same pen for every examination they appear because these have proved themselves lucky for the concerned individual.

A prominent film producer of India produced all pictures with the title beginning with ‘A’ as ‘A’ happened to bring luck and success to his films. At least that is what he believed. In-spite of the similarities between compulsive neurotics and superstitious people, there are some obvious differences between the two.

The superstitious people have firm belief that they will succeed in their rituals by using a particular dress or so. The compulsive neurotic in contrast is never quite sure that his rituals will succeed and this very feeling forces him to increase his rituals. Thus, Duke concludes, “More than any-one else, the compulsive neurotic person is usually aware of the frailty of people and of the imperfection of their behaviour.”

To add to this Coleman comments, “Most of us resort to minor obsessive compulsive patterns under severe pressure or when trying to achieve goods which we consider of critical importance”. They may be necessary for adjustment under particularly difficult stress situations.

Symptoms of obsessive compulsive neuroses:

Having its beginning in adolescence, or early adulthood; the most important symptom of obsessive reactions is persistence and unshakable, rigid thoughts and sexual and aggressive impulses of an unpleasant or unwanted characteristic. Such thought not only come to the mind over and over again, they also stand on the way of his normal day to day behaviour.

Obsessive thoughts may resolve around varieties of subjects and ideas, such as the strong desire to repeat a particular line of a particular song, the repeated thought to commit suicide, the obsession to count 12 before starting an auspicious work, the obsession to touch every lamppost on the way back home and the obsession to proceed to the railway station every afternoon at 5.30 P.M. etc.

Some people are haunted by the thought whether or not they have locked their rooms, though they know they have locked it and things of the sort.

Obsessive symptoms may be expressed in severe forms of phobias, intrusive ideas or images, such as the fear of killing one’s own son, the fear of the wife of killing her own husband with poison, the fear of the mother of strangling her daughter and the like. Though such fears appear irrational to the patient, they recur in-spite of best effort to resist them.

Coleman opines that on many occasions these thoughts are in the nature of fantasies rather than impulses to action on the part of the patient, the patient may find himself persistently wishing that his mother would die.

To the patient such thoughts may appear not only irrational but also immoral disgusting and horrifying. In obsessional phobia, the fear persist constantly. The more he tries to get rid of such fears, the more they persist.

In all cases obsessive ideas may not be carried out to action. For instance, a person sometimes may have the obsession to go necked in public but he may not have the compulsion to convert it into practice.

However, obsessive ideas torment the patient all the while and the patient may experience some amount of anxiety because of the antisocial and immoral nature of the thoughts. So much so that he may feel that he is going mad, unfit to live or his life is utterly useless etc.

One patient reported “If I keep trying to my mind to forget about them, I seem to remember them all the more.” A middle aged woman tortured herself day and night with the question as to whether she really loved her husband. Self accusing obsessive symptoms mostly remain in the form of fantasy rather than impulse to action.

An undergraduate college student who had a brilliant academic record complained to the author that he is not able to concentrate on his studies, read and write because he is always haunted by the morbid desire to wash his hands. The moment he stops washing his hand, considering it irrational and sits for studying, he is driven by terrible anxiety.

His mind travels to the persistent desire to wash his hands again and again. When he washed his hands, he felt relieved of anxiety. But the moment he gives up, he is tormented by the terrible anxiety that his hands are dirty and hence inauspicious.

Many people count their steps, words in sentences, the number of lamp posts they cross, street they pass and so on. A person was so much obsessed by the digit 9 that the utterance of this digit led to terrible shock. He was wasting so much time to avoid the number that he could not do any other work.

In short, when the individual is engaged in obsessive compulsive behaviour, he is a peaceful and normal person without any anxiety or tension. But otherwise he is haunted by terrible anxiety. Persistent doubting and suspicion is another symptom of obsessive thinking. The individual is never sure that he has completed a particular action and he may have to go back repeatedly to assure himself that he has done so.

For example, the patient may not be sure that he has locked the door or turned off the water tap or gas cylinder and that thought brings painful anxiety in him. Intellectual capacity is not at all disturbed or deteriorated.

Aetiology:

Coleman is of opinion that “either obsessive thoughts or compulsive actions may predominate in a given case, but both are parts of total reaction pattern and their dynamics are essentially the same”. Coleman has described the following dynamics of obsessive compulsive neuroses.

Substitutive thoughts and activities:

Earlier repressed drives and memories give symbolic representation in the symptoms. The patient may defend himself from anxiety by continuously thinking or doing something else each time the dangerous impulses or thoughts appear. Repression, displacement and substitution are the most important mental mechanisms playing their role in the causation of obsessive compulsive neuroses.

There is regression to the anal sadistic stage of libido development in case of obsessive compulsive neuroses. The memories of early traumatic experience are intolerable and hence the ego tries to keep them away from the consciousness by developing substituted activities. So substitution of thoughts and activities are mainly found in obsessive compulsive neuroses.

In some cases of safe obsessive thoughts leading to constructive activities are substituted for more unpleasant or dangerous ones. By developing the substituted activities, he keeps himself busy and away from the original traumatic experience.

Reaction formation:

In certain cases the obsessive compulsive patients may think or behave in a way which are just the opposite of their thoughts or impulses. Thus, original hatred and hostility may be represented by love and sympathy.

Excessive desire to kill someone may be avoided by excessive concern for one’s safety and security. Thus, the individual may think or act in ways which are directly contradictory to his dangerous thoughts or impulses.

Isolation of fantasy from affect:

According to Coleman (1981) “in some cases, the dangerous desires may become conscious but the individual is not aware that they represent fulfilment of his own wishes.”

The repressed hostility of a person towards his son was expressed in the obsessive thoughts to kill his own son over the head with a hammer, though the patient himself was never aware of the fact that these thoughts represent his original feeling for his son.

This was possible by the mechanism of denial. Thus the patient knows the content of his obsession but they can never appear to him to be his own thoughts. Guilt and fear of punishment.

The guilt feelings connected with infantile sexuality sometimes leads to obsessive compulsive reactions. Feeling of guilt and self condemnation arising out of socially and morally unacceptable activities and thoughts of aggressive and sexual nature lead to fear of punishment also. As a result, the patient develops obsessive compulsive behaviour like hand washing, cleaning etc.

There is the constant balancing between the forces of the id urges of an anal sadistic sort and the strongly developed but not properly integrated super ego in the obsession neurotic. The compulsive acts which normally follow obsessions help in neutralizing this guilt feeling and self devaluation.

Undoing or counter-acting forbidden desires:

By means of compulsive activities the individual may try to counteract or face the unacceptable or forbidden desires. A man who repressed his extreme hostility towards his son (and which threatened to come to the conscious level) tried to face it by developing excessive love and praying God to save his son. But he never was aware of that fact that he actually had dangerous hostility towards his son.

Washing mania may symbolize the desire to cleanse on-self from the guilt feeling arising out of sex and other immoral behaviour. Thus, by means of compulsive rituals, he may undo his guilt arousing fantasies. In this way, however injurious they are to the individual, they prove safe for the person and are not carried out in anti-social action.

Only way out of a catastrophic situation:

When the situation is very critical and full of stress and tension, the individual may try to face it by taking recourse to obsessive compulsive behaviour. Coleman quotes the case of a lady who, being betrayed by her boy friend on the ground of unfaithfulness tried to convince him by developing an obsession to prove her faithfulness to her boy friend.

Security and predictability:

By becoming excessively or unnecessarily methodical, or systematic and meticulous and thus developing an obsessive compulsion behaviour one may get some security in a world which appears to him dangerous and highly complex.

A rigid way of life helps him in getting some feeling of satisfaction and perfection and hence security in an insecure and ungrateful world. But on the contrary if he gives up his compulsive act, he feels threatened and anxious.

Heredity:

Henderson has suggested heredity to be the main aetiological factor in obsessional neuroses. Obsessional traits and obsessional illness are found in the families of the obsessionals in about 1/3 of the parents and 1/5 of the siblings.

In review of 50 cases of obsessional neuroses Lewis (1935) found that 37 of the parents showed pronounced obsessional traits and in a number of instances both parents were obsessionals. 43 out of 206 siblings showed milder or severe obsessional traits.

Individual’s constitutional factors may also be taken into consideration while considering the role of heredity. It may also be due to learning from the obsessive compulsive parents. It is also viewed that obsessional neuroses may be precipitated by physical illness or long term prolonged fatigue. Emotional stress leading to terrible worry and conflict in some cases may precipitate obsessive compulsive neuroses.

According to the Freudian concept, mainly aggressive instinctual forces arising out of strict and rigid toilet training lead to obsessive compulsive neuroses. The symptoms of obsessive compulsive neuroses arise out of conflict between the id and the defence mechanisms at the unconscious level.

Excessive nearness or cleanliness and the like may be due to the fixation at the anal stage. The desire to soil due to the fixation at an anal stage is resisted by being compulsively neat and clean. Repeated washing may be done to remove the guilt feeling arising out of antisocial and irrational activities of the past.

It is also held that by being engaged in a particular work in a compulsive manner, the ego gets some punishments which provides some degree of satisfaction to the super ego. By bribing the super ego the gratification of id wishes are made symbolically. So it is said that a compulsion obsession neurotic suffers as much from his unconscious morality as from his unconscious criminality.

Personality psychologists have tried to interpret the aetiology of obsession compulsion neuroses from a slightly different angle. People having unhealthy attitude towards sex, rigid conscience, feeling of inadequacy and insecurity, submissive and conventional behaviour in social situations and gatherings and with methodical and perfectionist habit may tend to develop obsessive compulsive neuroses.

Besides, guilty feeling, susceptibility to threat is the other important personality traits of the obsessive compulsive neurotics. All these personality characteristics make them prone to threats both inner and outer. By following rigid discipline, by being perfect, organised, orderly and systematic, neat and clean, he tries to face the threats and gets some security to be free from anxiety.

In the opinion of Eysenck introversion is another characteristic of obsessive compulsive neurotics. Behaviourist psychologists view that obsessive compulsive reactions are learnt and reinforced by the consequences. The onset of consequences leads to the reduction of anxiety. Following Skinnerian conception (1948) obsessive compulsive reaction may be called to be a function of chance reward.

In his concluding statement on the dynamics of obsessive compulsive neuroses Coleman has held that dangerous and unacceptable impulses are suppressed by the concerned person.

But the more he tries to suppress them the more they trouble him, partly because the immediate threat they present to his precariously structured world and partly because of the emotional motive power of sex, guilt and pent up hostility.

The strongly rigid conscience of the person further aggravates the whole situation. Most minor things are given plenty of seriousness, which can be otherwise handled easily by normal people. But the obsessive compulsive neurotics take them too seriously and try to defend themselves from these experiences (which they consider too serious) by mental mechanisms like isolation, undoing and substitution etc.

Coleman (1981) finally remarks “The obsessive compulsive individual pays a high price for his neurotic defences in rigidity, lack of openness, new experience and restriction of his ‘life space’. Although such individuals are likely to remain basically rigid and restricted in their personality make up, psychotherapy can often be of marked assistance in clearing up their more disabling symptoms and removing blocks to long range personal growth.”