Reflections on the Obsessive-Compulsive Disorders: A Psychodynamic and Therapeutic Perspective

Since the founding of the psychoanalytic movement over a century ago, the psychiatric disease entity of obsessive-compulsive disorder (OCD) has not received anywhere near the attention that other entities have received. Presumably, this may be due to the seemingly intractability, to the psychoanalytic process, of the illness. Freud (1907, 1909, 1913, 1926; 1966) devoted much attention to this subject but this endeavor has not, for the most part, been continued in any elaborate manner by psychoanalysts since then. There is no published study that I am aware of that documents a complete cure for OCD through the psychoanalytic process. Some modification of symptoms can, occur but complete cure will elude us for a long while. Freud's (1909) famous case of The Rat Man shed much light on the underlying emotional conflicts of OCD, but the lasting, positive therapeutic effect of his analysis could not be established as the patient was killed during World War I. Transference phenomena must have played some role in the positive result that Freud seemingly noticed in the patient.

Unfortunately, since Anna Freud's 1966 review of the subject, virtually nothing has appeared in the psychoanalytic literature that has added to our understanding of the disorder or enhanced the very limited therapeutic influence of psychoanalysis in such cases. Meanwhile there has been an avalanche of contributions from biological psychiatry and behavioral psychology that have propounded different theories of pathogenesis and have laid claim to significant effectiveness. (Esman, 2001, p. 145)

Several decades ago it was a given that the statistical incidence of OCD ranged from 0.5% to 1% of the general population, almost