Obsessions

(obsessive states; anankastic state), ideas, memories, fears, and tendencies that arise persistently and irresistibly in human beings and are often distressing to the individual but are not accompanied by loss of ego. Actions, as well as thoughts, may be obsessive.

Obsessions are observed with neuroses and other diseases, but they are also encountered in healthy persons suffering from fatigue, for example. The patient acknowledges the pathological character of these phenomena, relates to them critically, and strives to rid himself of them. This distinguishes obsessions from delirium, which completely dominates the personality.

Patients often engage in fruitless arguments on banal topics (for example, why theearth is round), indulge in worthless philosophizing, or “rumination,” or spend time on purposeless counting (for example, of the steps of a staircase, the number of steps walked, or the number of street lights). Obsessional personalities frequently have thoughts that are in conflict with their actual feelings—for example, a loving mother may be obsessed with thoughts of harming children. They may experience torturous doubts concerning the correctness of their actions (for example—Did I turn off the gas? Did I lock the door?). As a result, they are driven to repeated verification of their actions. Fear is common in obsessive personalities (for example, fear of blushing in company, of forgetting a prepared speech, of falling ill, of dying, and even “fear of fear”—that is, fear that fear will arise). Patients are often drawn to but do not as a rule carry out absurd actions, such as plunging into water.

Often the patient seeks to overcome his obsessions by elaborating stereotypical “incantations” and preventive actions that are sometimes extremely complex (rituals). Basically, these only enrich the patient’s catalog of obsessions. The vocabulary of obsessions (anthropophobias, bacteriophobias, manias, and so forth) is extremely rich and includes more than 400 terms. There is no single point of view on the origin of obsessions. Treatment involves psychotherapy, especially when there is neurosis. Medication and general restorative treatment are also prescribed.