OCD, OCPD: Acronyms Do Not Make a Disease

Obsessive Compulsive Disorder (OCD) and perhaps Obsessive Compulsive Personality Disorder (OCPD) are increasingly coming to be viewed as brain diseases treatable by psychopharmacological agents and behavioral therapy. The point of this paper is to illustrate that these conditions probably are on a complemental series, with the proportion of contribution from organic and psychogenic causes variable in each case. The ego of the patient who develops these conditions has always labored badly, whether from psychogenic, constitutional, or neurophysiological factors or a combination of these, and under stress there is a tendency to regression and primitive forms of thinking and wishing. These protect the patient in a magical fashion from a fear of annihilation and dissolution of ego boundaries.

A dramatic long-term case is presented to illustrate the vicissitudes of the development of these conditions along with a whole variety of other symptomatology. This represents a continuing variation in ego functioning as the ego attempts to deal with the vicissitudes of life and perhaps various biological factors. None of these sets of symptoms can be isolated out as a specific “brain disorder” or “disease.” Expert psychopharmacological

intervention was of little help in this long-term psychotherapy case. In spite of the contentions of those who decry long-term psychoanalytic psychotherapy, this patient would have ended up in a psychotic state without it. Because of the long-term psychotherapy, she was and is able to function reasonably well at her job, and have some sort of self-esteem and autonomy. Psychoanalysis still has much to contribute to our understanding and treatment of so-called OCD and OCPD, and psychoanalytic psychotherapists are urged to continue working with these conditions.