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The possibility that obsessions may be transformed into delusions has long been a subject of dispute among psychiatrists. Gordon presents three cases to demonstrate the possible relationships of these conditions. In one, prolonged obsessional ideas that he might harm his family served as a point of departure for delusions of guilt in a melancholic patient who finally committed suicide. In a second case, a woman with long-standing obsessive fears that she had caused injury to children incorporated these ideas into a delusional system when she developed definite dementia præcox. Then she suffered from hallucinatory experiences in which she was reproached by the children or threatened with violence by their parents. Ultimately she heard the voice of the Lord demanding the sacrifice of her parents and herself and contemplated fulfilling both injunctions. A third patient, who had practiced obsessive prayer rituals for many years, developed a melancholic condition with delusions that the prayers were required as penance for sins against God.
Gordon is of the opinion that obsessions imply the existence of a dissociation of personality which predisposes to the development of psychosis. Obsessions may themselves be symptomatic of more serious disorders or a prelude to their development, may exist without further deterioration, or may subside when delusions have become pronounced.