A phenomenological analysis of symptoms in obsessive-compulsive neurosis

Obsessive-compulsive symptoms in childhood and adolescence

We investigated 61 patients (38 boys and 23 girls) under 18 years of age with obsessive-compulsive symptoms seen in the Department of Psychiatry, Nagoya University Hospital, from 1982 until 1986. In this period, a total of 1293 patients under 18 years of age visited the clinic. The percentage of patients with obsessive-compulsive symptoms was 5%. The earliest onset of symptoms was at age 3 years, and the average age of onset was 11.6 years. We found no particular tendency in terms of the number of siblings and the birth order of the patients. Obsessive traits were the fundamental personality traits of patients. Moreover, according to the other characteristics of personality, the patients were subdivided into schizothymic, viscous temperament, and cyclothymic. Parents of the patients were more apt than usual to have obsessive-compulsive personalities. Psychiatric disturbances and occupations were also investigated. Incidents related to school situations commonly triggered obsessive-compulsive symptoms. The most frequently noted obsessive thought was dirt phobia, and the most common compulsive behavior was washing. School refusal and violence at home were especially common as associated symptoms of obsessive-compulsive symptoms. We also describe the treatment regimen and the outcomes of the patients.

Animal models of compulsive behavior

A convergence of clinical and pathological evidence points to the basal ganglia as the site of disturbance in compulsive disorders. However, the limbic system may be implicated as well. This article draws upon various lines of animal research in an attempt to explain how disturbances in one or another of these systems may produce compulsive behavior. Possible models include stimulation of the reinforcement mechanism, manipulation of the striatal "comparator" function, production and blockade of displacement behavior, and interference with the hippocampus' modulation of the stereotypy-inducing effect of reward. The common denominator of these models is a relative excess of dopaminergic activity in the basal ganglia. However, this does not necessarily implicate a primary dopaminergic disturbance in all human compulsive behavior.

Three types of obsessive compulsive disorder in a community sample

Until recently, prior estimates of the prevalence of obsessive compulsive disorder (OCD) have been based on clinical data. The present investigation studied point prevalence and demographic data that pertain to three ritual-based forms of OCD in a sample of the adult general population of the greater St. Louis area. Two hundred fifty male and 247 female subjects were administered a structured interview designed to identify the presence of symptoms associated with OCD according to DSM-III criteria. The overall prevalence rate of OCD was 2.8%. The most prevalent form of OCD involved checking (1.6%), followed by a miscellaneous category that included repeating, counting and collecting rituals (1.0%) and, finally, washing compulsions (.8%). Subjects with OCD did not differ demographically from the rest of the sample except that they were more likely to live in the city. Results indicate that OCD is more prevalent than previously supposed and that checking compulsions may be the most common form of ritual in nonclinical samples.

Drug treatment of obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) traditionally has been considered a rare, treatment refractory disorder of psychological origin. However, OCD appears to be much more common than was previously believed. Moreover, in recent years controlled studies demonstrated that clomipramine is more effective than placebo and than other tricyclics for reducing obsessive-compulsive symptoms. Although it has been suggested that clomipramine was effective in treating obsessive-compulsive symptoms by an antidepressant mechanism, the majority of the controlled studies found that its antiobsessional effects occurred whether the patient was depressed or not. The apparent specificity of clomipramine, and, to some extent, newer serotonin selective antidepressants, suggests a serotonergic role in the psychobiology of OCD.

Sociodemographic variables in obsessive compulsive neurosis in India

A retrospective analysis was carried out about sociodemographic data in 412 patients who had received a diagnosis of Obsessive Compulsive Neurosis in the period 1975 to 1984. The patterns which emerged have been discussed. There was a bimodal age of onset in females, the second peak occurring at 35-40 years. Students and housewives were the two largest groups observed.

Gilles de la Tourette syndrome and the neurological basis of obsessions and compulsions

Gilles de la Tourette syndrome (GTS) is a chronic neurological disorder manifested by involuntary motor tics and vocalizations. Many GTS patients also suffer from obsessions and compulsions. The clinical similarities between GTS and obsessive-compulsive disorder (OCD), their occurrence among members of the same families, and the fact that both can be observed as symptoms of known basal ganglia disturbances suggest that GTS and OCD share common neurological mechanisms. It is hypothesized that the tics and vocalizations of GTS are aberrant manifestations of simple motor programs that are spontaneously generated by the basal ganglia and that obsessions and compulsions represent more complex motor plans initiated by similar anomalous activities.

Treatment outlines for the management of obsessive-compulsive disorders. The Quality Assurance Project

The Quality Assurance Project is developing explicit and detailed treatment outlines for each of the major psychiatric disorders. Three sources of information are used: a meta-analysis of the treatment outcome literature, the opinions of a sample of practising psychiatrists, and the views of a panel of nominated experts. The recommendations for the treatment of obsessive-compulsive disorder were as follows: for those patients who have no significant personality disorder, either short-term dynamic psychotherapy or cognitive behaviour therapy is indicated if the illness has lasted less than a year or if obsessions are the predominant symptoms. When compulsions predominate, particularly when they have been present for more than a year, response prevention is the treatment of choice. Tricyclic antidepressants and cingulo-tractomy are also worthy of consideration in patients with persisting symptoms. Psychotherapy or cognitive behaviour therapy are the approaches recommended for compulsive personality disorder.

Parents of patients with obsessive-compulsive disorder

Family histories obtained from 27 patients with obsessive-compulsive disorder failed to find a single parent with the disorder. To augment the family history data the Leyton Obsessional Inventory was completed by a subset of 10 patients and by their 20 parents. Although as a group parents showed lower Leyton Obsessional Inventory symptom scores than their obsessional offspring, 3 parents who had not been identified by family history were distinguished by high symptom scores in the absence of significant resistance or interference.

Regional differences in obsessionality and obsessional neurosis

The Leyton Obsessional Inventory was administered to 69 orthopaedic patients in Glasgow, and their responses were compared with those of 77 similar subjects in London and 73 in Cork. The responses of the Scots and the English did not differ, but both of these groups were significantly less obsessional than the Irish subjects, who were particularly likely to regard cleanliness and tidiness as virtues in themselves. Obsessionality was unrelated to age, sex, social class, family size and birth order, but higher Leyton scores were found among bachelors, and among women living in the country and without outside employment. It is suggested that the common factor among these 3 subgroups is emotional or geographic isolation, and that this may enhance any tendency to obsessional ruminations and routines. This could also account for the higher Leyton scores and greater incidence of obsessional neurosis in the Irish.

[Phenomenology of obsessions and compulsions. Experimental diagnosis of obsessive compulsive neurosis. I (author's transl)]

Obsessive-compulsive phenomena occur in 'normal,' neurotic and psychotic individuals. Operational definition, quantitative assessment, and diagnostic evaluation are still unsatisfactory, particularly with regard to differentiation of obsessive-compulsive phenomena (phenomenology), differentiation of trait and symptom factors, and evaluation of different obsessive-compulsive factors in the various kinds of neuroses. Our investigation of phenomenology differs from previous similar ones in basically two aspects: The newly developed obsessive-compulsive checklist covers the whole range of obsessions and compulsions, and questionnaire items of the checklist are operationally difined without reference to constructs from theories of personality or from psychopathology. Results include: Two-thirds of all patients suffer from combined obsessions and compulsions; factorial analysis reveals five symptom factors which are quite different from factor analytic results of previous studies; depression and phobias constitute a factor by themselves; checklist ratings and factor analytic results show the necessity for and basis of a new self-rating questionnaire to substitute for those currently in use. Implications of these results for future research in psychopathology as well as treatment evaluation are discussed.

Hostility and guilt in obsessive-compulsive neurosis

The enquiry relates to the investigation of 30 cases of obsessive-compulsive neurosis with special reference to the phenomena of hostility and guilt as revealed through Foulds' Five Punitive Scales and the Thematic Apperception Test. Controls consisted of an equal number of subjects suffering from neurotic depression. Analysis reveals acting-out hostility and extrapunitive tendency in the experimental group. No significant difference was found in terms of guilt scores.

The Leyton Obsessional Inventory: an analysis of the responses of 73 obsessional patients

The Leyton Obsessional Inventory was administered to 73 obsessive-compulsive neurotics, and their responses compared with those of 100 normal subjects. The ratio of the mean patient to normal scores ranged from 2.4:1 for obsessional traits and 3.2:1 for symptoms to 6.2:1 for resistance and 12.5:1 for interference with other activities. A principal components analysis on the patients' replies produced 3 unitary components (household order, personal contamination, and doubting) plus 2 bipolar components (checking/parsimony and desire for closure/unpleasant ruminations). These appeared to be more definitive representations of components identified from a similar analysis on normal subjects, suggesting that obsessional neurotics differ from normal subjects quantitatively rather than qualitatively. A cluster analysis on the patients' responses produced 3 subgroups. Thirty-two patients were predominantly hesitant and indecisive ('doubters'), 30 were concerned with bodily and clothing contamination ('contaminators'), and 7 were preoccupied with checking ('checkers').

Socio-cultural and clinical determinants of symptomatology in obsessional neurosis

Eighty-two obsessional neurotics were studied from a phenomenological viewpoint in order to unmask the clinical and socio-cultural determinants of symptom-choice in this disorder. The form of obsessions and compulsions seemed to be affected primarily by intrinsic factors (age, sex, I.Q.) while their content was affected equally, if not more, by extrinsic factors (religion, locality, social class). Patient's age at the onset of illness seemed to be an extremely relevant factor insofar as it affected both the form and the content of symptoms. Some socio-cultural explanations have been offered these findings. The data is important insofar as it provides a baseline for cross-cultural studies of the phenomenology of obsessional illness.

The phenomenology of severe obsessive-compulsive neurosis

The case histories are examined of 41 patients who were admitted to hospital for the first time with a diagnosis of obsessive-compulsive neurosis. Aspects of the phenomenology are reported which presented between the first appearance of obsessive-compulsive symptoms and discharge from the first admission. The mean age for admission was 31-6 years (SD 14-3) and 68 per cent of the sample were women. The women showed significantly higher incidences of contamination phobia and of compulsive cleaning behaviour than did the men. Cleaning behaviour and avoidance of feared stimuli were the most frequently encountered manifestations of compulsive behaviour.