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Heinz Weiss. (2017). Neuere Überlegungen zur Psychodynamik zwanghafter Mechanismen (Contemporary reflections on the psychodynamics of compulsive mechanisms). Psyche: Zeitschrift fur Psychoanalyse und Ihre Anwendungen, 8.71: 663–732.
The author begins with the observation that, in contrast to other therapeutic schools, psychoanalysis views obsessions and compulsions not only as symptoms that manage anxiety, but also as expressions of and attempts to deal with longstanding unconscious conflicts. Psychoanalysis possesses the deepest clinical understanding of compulsive phenomena, which it has gained through long-term and high frequency treatments. However, such clinical evidence stands in contrast to empirical-statistical evidence. We now have increasingly empirical evidence about the effectiveness of psychodynamic and psychoanalytic treatments of these conditions (Dörr 2003, Leichsenring and Steinert 2016, Leuzinger-Bohleber 2017).
Weiss argues that, historically, according to Freud and Abraham, anxiety and guilt about unconscious aggressive and sexual impulses was considered central to the development of obsessive-compulsive neurosis. These unconscious conflicts are expressed in obsessive thinking and compulsive behaviors. Typical defense mechanisms include intellectualizing, isolation of affect, rationalization, reaction formation, undoing, and displacement. The presence of pre-genital characteristics especially anal preoccupations, were considered to be central, in addition to the repetition compulsion, which is a central dynamic in all compulsive behaviors.
We have since come to understand that obsessive-compulsive phenomena occur in a great variety of psychiatric disorders. Compulsions can serve to fend off depressive affects such as loss and guilt conflicts and also paranoid-schizoid anxieties in borderline and psychotic states. They also occur in patients with psychosomatic illness. Rather than focusing on drive-conflicts, later clinicians, especially Melanie K