Obsessive-Compulsive Disorders in Neurosis and Psychosis

It is a psychiatric tradition to attribute obsessive-compulsive disorders to endogenous psychosis and its subdivisions schizophrenia and manic depression. In this context, it is interesting to note the nosological classification of the so-called “Wolfman,” who was categorized and analyzed as an obsessional neurotic by Freud (1918). In regard to this patient, who 6 years after the completion of his second analysis with Freud, developed a hypochondriacal delusions. Binswanger (1945) had no doubt that one was dealing with a “schizophrenia simplex.” Before this patient came to Freud in Vienna, he had already been treated in Munich by Kraepelin. Kraepelin, who had already treated the patient's father for manic depression, gave the same diagnosis to the son. This is not surprising, as Kraepelin had the tendency to classify the so-called “obsessional insanity” under manic depression, whereas Eugen Bleuler, the founder of the term “schizophrenia,” still classified obsessional neurosis under schizophrenia in his psychiatry textbook of 1943.

Already a phenomenological point of view can demonstrate that such a “psychotization” of obsessional behavior is not possible to maintain. Obsessional behavior can be found universally and not only in psychosis. Ever since Freud, we understand obsessional behavior primarily as an obsessional neurosis, whether it appears as a single symptom, or whether it appears in connection with other symptoms, such as phobias. Obsessional symptoms can also be associated with psychosomatic disorders or brain diseases. Even healthy persons may show tendencies for obsessional behavior in certain situations, especially when a so-called obsessional-compulsive personality structure exists. Here obsessional symptoms are generally regarded as part of the personality, as ego-syntonic, so that the person concerned does not believe himself to be ill.

The question arises: What is obsessional behavior in its own