The term obsessive neurosisalbeit officially no longer in use in current psychiatric nosography, is still used among mental and non -mental health professionals.
Deepening its evolution, it turns out that the Diagnosis of obsessive neurosis He has a long story behind him.
Historical excursus
Already during the nineteenth century, scholars such as Pinel (1809) and Esquirol (1838) had provided observations in line with the concept of obsession. They described patients besieged by a limited number of content of thought, who tried to face these mental representations through a struggle made of diversion actions (Magnan, 1893).
Between the end of the nineteenth and early twentieth centuries, various authors, in particular Freud, identified a specific morbid entity characterized by so -called “obsessive phenomena” Obsessive neurosis.
Freud, who described his phenomenology in his famous case of “The man of mice” (1909), outlined a picture characterized by ambivalence, fight against “prohibited impulses”, desperate need for emotional control, recurrence of magical thought. Freud’s studies that followed them led to define obsessive neurosis As characterized by specific defense mechanisms (such as, for example, movement and reactive formation), blocks from a drive point of view (maturative arrest and regression to the anal phase) and the presence of a sadistic super-ego.
Some authors, such as Kubie (1937), underlined the distinctive characteristics between the obsessive neurosis and the already existing hysterical neurosis. They observed that the imagination of “dirty” and the “system of duty” prevail in obsessive neurosis while the imagination of “pain” and the “fear system” prevail in hysteria.
It was then Anna Freud in 1965, at the Congress of the Internazional PsychialInatic Association, to speak of the obsessive neurosis reiterating – on the one hand – the centrality of the constitutional factors already supported by Freud, but placing – on the other – also attention to family elements. In particular, the educational methods and maternal unavailability would encourage defense mechanisms and arrests in the psycho-sexual development phases (in this case, the anal one).
Obsessive neurosis in psychiatric nosography
Within the international psychiatric nosography the obsessive neurosis It is described in a concise and non-specific way both in the first and in the second edition of the diagnostic and statistical manual of mental disorders (DSM-I, 1952; DSM-II, 1968).
Starting from the third edition (DSM III, 1980) the traditional distinction between psychosis and neurosis and the Obsessive neurosis termused until the 1980s, gives way to the most recent Diagnostic Diagnostic label of obsessive-compulsive disorder (DOC).
In the subsequent revised edition of the manual (DSM-III-R, 1987) the disorder is described in a specific way with precise diagnostic criteria that consider obsessions and compulsions separately and highlight its mutual relationships. In the DSM-III-R le obsessions They are defined as “ideas, thoughts, impulses or persistent images that are at least initially carried out as intrusive or meaningless. (…). The subject tries to ignore or suppress these thoughts or impulses or to neutralize them with other thoughts or actions”. The compulsions They are defined as “repetitive behaviors, aimed and intentionally performed in response to an obsession, according to certain rules and in a stereotyped way. (…). The individual recognizes that his behavior is excessive or unreasonable”.
The main elements of these definitions are therefore: the distinction of obsessive and compulsive phenomena; the functional bonds and the connection that can intervene between these phenomena; the awareness of the subject about the senselessness or excessiveness of the symptoms.
The most recent classifications
The functional link between Obsessions and compulsions It also seems to inspire the DSM-IV (1994) which underlines how 90% of the compulsions are connected with obsessions. In addition, the DSM-IV and the subsequent revised edition (DSM-IV-TR, 2000) propose the specification “with scarce insight”, allowing to include all those cases in the diagnosis in which the subject is not fully aware of the excess of the symptoms.
Finally, the most recent version of the manual (DSM-5; 2013) leaves the diagnostic criteria of the disorder quite unchanged, also placing the emphasis on the use of the term “discomfort” (wider than the “anxiety” only) as an emotional reaction induced by obsessions. Not surprisingly, in the DSM-5 we have the DOC escape from the category of anxiety disorders, which occupies its nosography separated from other categories by placing itself within the group “Obsessive-compulsive disorder and related disorders“.
In terms of scientific research, the wide amount of studies on the DOC of the last 30-40 years has made it possible to identify and deepen the peculiarities of the specific symptomatological subtypes. Inside the disorder there are in fact a wide range of emotional reactions (anxiety, disgust, discomfort, fear), different obsessive mental contents and the relative functional bonds with compulsive manifestations very different from each other.
It follows that, even within the evidence-based psychotherapy treatments, increasingly specific intervention protocols are also emerging for each subtype of Obsessive-compulsive disorder. This with the aim of increasing the effectiveness of therapies aimed at a problem which, since the dawn of its identification as Obsessive neurosishas always been resistant to treatments and tendentially difficult for therapists.
Bibliography:
- American Psychiatric Association (1952). Diagnostic and Statistical Manual of Mental Disorders, 1st Edition: DSM-I. Washington, DC: American Psychiatric Association.
- American Psychiatric Association (1968). Diagnostic and Statistical Manual of Mental Disorders, 2nd Edition: DSM-II. Washington, DC: American Psychiatric Association.
- American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Dysorders, 3rd Edition: DSM-III. Washington, DC: American Psychiatric Association.
- American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Dysorders, 3rd A reviewer Edition: DSM-III-R. Washington, DC: American Psychiatric Association.
- American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Dysorders, 4th Edition: DSM-IV. Washington, DC: American Psychiatric Association.
- American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Dysorders, 4th Edition, Text Revision: DSM-IV-TR. Washington, DC: American Psychiatric Association.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Dysorders, 5th Edition: DSM-5. American Psychiatric Publishing.
- Dèttore, D. (2002). Obsessive – compulsive disorder. Mcgraw-Hill.
- Ravizza, L.; Bogetto, F.; Maina G. (1997). Obsessive – compulsive disorder. Mason.
