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Obsession

Obsession

BIBLIOGRAPHY

The term obsession is used quite liberally in current popular vernacular to indicate an intense interest in or preoccupation with a subject. Despite the prevalence of this connotation, psychologists generally use the term to indicate a more severe disturbance in cognition. As defined by the American Psychological Associations Diagnostic and Statistical Manual of Mental Disorders, obsessions are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress (2004, p. 457). This definition indicates that obsessions are identified in part by their effect on the thoughts and feelings of afflicted individuals. That is, obsessions are cognitive in content and result in negative emotions. Furthermore, obsessions are involuntary in nature and may intrude into ones consciousness unexpectedly. Therefore, true obsessions exert a measure of control over the individual that nonpathological obsessive thoughts do not. Obsessions can have a profound impact on ones ability to form and nurture interpersonal relationships and can lead to conflict with friends, coworkers, and family.

Delineations between normative behavior and abnormal obsessions can be somewhat difficult to ascertain. Showing an enthusiastic interest in a particular activity, topic, or person need not reflect psychopathology. Likewise, persistent worries about realistic problems do not qualify as obsessions. However, when such a thought occurs at a very high rate and is associated with significant distress to oneself or others, it is more likely to be considered an obsession. Differentiating obsessions from normative behavior also requires that one consider the developmental stage of the individual. For example, although it is not uncommon for young children to develop intense preoccupations with or fears of specific objects or interests, such behavior would be more worrisome in older individuals. Landmark studies by researchers in the 1970s and 1980s demonstrated that many people experience intrusive thoughts in the absence of any psychological impairment (e.g., Rachman and de Silva 1978). Therefore, the presence of unwanted thoughts alone neither qualifies as obsession nor confers a risk factor for mental disorder. Furthermore, marked emotional distress must accompany the thoughts in order for them to be considered obsessions. These emotional reactions can range, though many people report feeling anxious when confronted with obsessive thoughts.

Among the psychiatric disorders most relevant to obsessions are obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), eating disorders, and delusional disorder. Individuals with obsessive-compulsive disorder usually have both obsessions and behavioral symptoms called compulsions, though an obsession-only subtype exists as well. Compulsions are ritualistic actions performed to neutralize the anxiety and distress created by obsessions. For example, a patient with obsessions about contamination may exhibit compulsive hand washing, and a patient with obsessions about harm may exhibit compulsive checking behavior. Individuals with body dysmorphic disorder have persistent unwanted thoughts about a perceived defect in their physical appearance. Common obsessions include concerns about parts of ones body being misshapen, abnormally sized, or otherwise unattractive. Like obsessive-compulsive individuals, people with BDD also exhibit compulsions, such as repetitive grooming behavior. Researchers have linked obsessions to psychotic disorders such as schizophrenia and delusional disorder. A key feature of such disorders is that the afflicted individual suffers a severe impairment of his or her ability to experience rational thoughts and perceptions. If these irrational thoughts become intrusive and persistent, then one can be said to be experiencing obsessions. Eating disorders have been associated with obsessions, in that afflicted individuals often have persistent uncontrollable thoughts about food, dieting, body image, and exercise.

Obsessions can also affect ones propensity to pursue and maintain social relationships via maladaptive means, such as stalking. Stalking is defined as the deliberate following and harassing of others, and victims are most commonly former intimate partners or celebrities. Although many individuals experience a desire to maintain contact following the dissolution of an intimate relationship, those who do so by threatening means or who act on uncontrollable thoughts about the loved one may meet criteria for stalking behavior.

The treatment of obsessions differs based upon the specific disorder in which the obsessions are couched. Psychotherapeutic techniques are often augmented by medication, as in the case of OCD and BDD, or may serve as a primary means of treatment, as in psychotic disorders. For individuals with OCD, cognitive-behavioral therapy has proven to be more effective than other forms of talk therapy. The primary technique used in this therapy as it pertains to OCD is called exposure and response prevention. In this method, individuals are exposed to stimuli that raise anxiety and provoke obsessions. They are instructed to tolerate this anxiety and distress without performing any neutralizing compulsive behaviors. Although patients may experience a greater deal of distress at the onset of treatment, over time obsessions wane as individuals learn that they can tolerate the anxiety without performing a compulsion. Ideally, the obsessions themselves lose potency and become less impairing. This technique is also used to treat BDD in that patients are exposed to their obsessive body concerns and prevented from performing behaviors that combat anxiety. For example, one might be prevented from applying makeup, checking mirrors, or skin-picking if these are repetitive and anxiety-reducing strategies used by the patient.

Much of the research on the biology of obsessions has been conducted by examining individuals with OCD. Basal ganglia abnormalities are the most commonly reported structural correlates of the disorder. More specifically, the head of the caudate nucleus and the orbital gyrus may play a prominent role in the dysfunction. These structures are deep below the cerebral cortex and are implicated in the regulation and coordination of movement. In terms of neurotransmitter dysfunction, both the serotonin and dopamine systems have been implicated in OCD. Pharmacological treatments for obsessions include drugs that target the serotonin system and increase the amount of this neurotransmitter available in the brain. Serotonin reuptake inhibitors, such as clomipramine or fluoxetine, have been associated with both symptom reduction and improved quality of life for patients with both OCD and body dysmorphic disorder (McDonough and Kennedy 2002; Phillips 2002). About 40 to 60 percent of obsessive-compulsive patients report significant improvement from using a drug of this type. Combining these drugs with antianxiety drugs or neuroleptics may also be beneficial for patients, depending upon the initial response to serotonin reuptake inhibitors.

BIBLIOGRAPHY

American Psychological Association. 2000. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision ( DSM -IV-TR). Washington, DC: American Psychiatric Publishing.

McDonough, M., and N. Kennedy. 2002. Pharmacological Management of Obsessive-Compulsive Disorder: A Review for Clinicians. Harvard Review of Psychiatry 10 (3): 127137.

Phillips, Katherine A. 2002. Treating Body Dysmorphic Disorder Using Medication. Psychiatric Annals 34(12): 945953.

Rachman, Stanley, and Padmal de Silva. 1978. Abnormal and Normal Obsessions. Behavior Research and Therapy 16 (4): 233248.

Amy Mariaskin

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Obsession

OBSESSION

The term obsession refers to images, ideas, or words that force themselves into the subject's consciousness against their will, and which momentarily deprive them of the ability to think and sometimes even to act. The term is derived from the Latin obsidere, which means "to sit before," "to lay siege to," and figuratively "to control an audience." From this is derived the noun obsidio, which means "detention," or "captivity," and figuratively "a pressing danger."

Classical psychiatrists had described the experience of a person whose consciousness was besieged by an intrusive thought and who, although lucid and in possession of his faculties, was incapable of stopping it. Philippe Pinel (mania without delusion), Jean-Étienne Esquirol (affective monomania), and Jules Baillarger (madness accompanied by conscious awareness) all distinguished this pathology from mental alienation in the strict sense. But it was Bénédict-Augustin Morel (emotional delusion) and Jean-Pierre Falret (the madness of doubt and the delusion of touch) who described a clinical picture that was closest to what would later be referred to as obsessional neurosis.

It was Sigmund Freud, however, in his description of obsessional neurosis in "Heredity and Aetiology of the Neuroses" (1896a), who considered obsession to be a symptom that is part of a larger clinical picture, a symptom that serves as a compromise and has an economic function. "Obsessive ideas . . . are nothing but reproaches addressed by the subject to himself because of anticipated sexual pleasure, but these reproaches are disfigured by an unconscious psychic process of transformation and substitution."

For Freud the notion of Zwang (compulsion) assumed a much broader and more fundamental meaning than that which he gave it in the clinical picture of obsessional neurosis. It reflects what is most radical in the drive: "In the mental unconscious, we can recognize the supremacy of a repetition compulsion arising from libidinal emotions that are most likely dependent on the most intimate nature of drives that are sufficiently powerful to place themselves above the pleasure principle, lending certain aspects of psychic life their demoniacal character" (1919h).

In his article on the case of the "Rat Man" (1909d) Freud writes, "The definition I gave in 1896 of compulsive ideas, namely that they are 'reproaches that have been repressed but now return transformed, always related to a sexual act from childhood that brought pleasure when carried out,' seems to me today to be arguable in formal terms. . . . In fact it is more correct to speak of 'compulsive thinking' and to emphasize the fact that compulsive structures may be equivalent to the most diverse psychic actions. These may be defined as wishes, temptations, impulses, reflections, doubts, commands and prohibitions."

Obsessions must be distinguished from phobias. A phobia is the fear of an object in the outside world whose absence or avoidance is sufficient, in principle, to avoid anxiety, while an obsession involves a mental representation that the subject cannot escape. Although the distinction had little meaning for Pierre Janet when he described "psychasthenia," it was essential for Freud. Phobias are associated with the qualities of objects, whereas obsessions are concerned with the characteristics of mental representations. Obsessions must also be distinguished from idées fixes and prevalent ideas: "The latter are integrated in the subject's personality and are not recognized as unhealthy. A claimant can be constantly preoccupied with the idea of an injustice suffered; he suffers from it, tries to obtain satisfaction by any means, but never thinks that the object of his preoccupations is absurd or without grounds" (Guiraud, 1956). As for the impulsive act, it lacks the hesitation and internal struggle typical of obsession, which, even resolved, always entails a period of uneasiness and indecision.

There would be little point in making a list of obsessions by type. They can be religious, metaphysical or moral; they might concern purity or physical protection, or protection against external dangers; or follow questions of precision and completeness, order and symmetry, or the flow of time (Green, 1965).

It would almost be possible to retrace the evolution of psychiatry from the classical period to the present-day by following the status of obsessions within the clinical groupings provided by various authors. We have seen how Freud, by giving obsession its status as a symptom, something that is both a compromise and has an economic function, enabled dynamic psychiatry to become thoroughly modern. The description of obsessional neurosis served as a model for all psychoanalytic theory. This is why Freud, throughout his work, constantly returned to the economic, topographical, and metapsychological problems presented by this concept.

Innovations in the United States (DSM III and IVDiagnostic and Statistical Manual of Mental Disorders ) have expanded the framework of clinical concepts and brought about the near disappearance of the science of psychopathology. As a result, new groups of symptoms have been introduced, based on a statistical approach, and new entities created, such as the compulsive obsessional disturbances. These revisions have expanded the clinical spectrum by including somatic obsessions (hypochondria, dysmorphophobia), physical obsessions (eating disorders like anorexia and bulimia), sexual obsessions (paraphilia), and pathological jealousy. In this way we have come full circle, back to a prepsychoanalytic era, back to the origins of classical psychiatry itself.

Marc Hayat

See also: Obsessional neurosis.

Bibliography

Freud, Sigmund. (1896a). Heredity and the aetiology of the neuroses. SE, 3: 141-156.

. (1909d). Notes upon a case of obsessional neurosis. SE, 10: 151-318.

. (1919h). The "uncanny." SE, 17: 217-256.

Green, André. (1965). Obsessions et psychonévrose obsessionnelle. In Encyclopédie médico-chirurgicale, Psychiatrie. Paris: E.M.-C., fasc. 37-370-A-10, p. 1-10, B-10, p. 1-5, C-10, p. 1-6, D-10, p. 1-14.

Hantouche,Élie. (1995). Troubles obsessionnels compulsives. In Encyclopédie médico-chirurgicale, Psychiatrie. Paris: E.M.-C., fasc. 37-370-A-10, p. 1-14.

. (1997). Obsession. Les Objets de la psychiatrie (p. 389-390). Paris: L'Esprit du temps.

Lantéri-Laura Georges, and Del Pistoia, Luciano. (1984). Névrose obsessionnelle. In Encyclopédie médico-chirurgicale, Psychiatrie. Paris: E.M.-C., fasc. 37-370-A-10, p. 1-20.

Further Reading

Esman, Aaron. (2001). Obsessive-compulsive disorder: Current views. Psychoanalytical Inquiry, 21, 145-156.

Freud, Anna. (1966). Obsessional neurosis: A summary of Congress views. International Journal of Psychoanalysis, 47, 116-122.

Gabbard, Glen. (2001). Psychoanalytic approaches to treatment of obsessive-compulsive disorder. Psychoanalytical Inquiry, 21, 208-221.

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Obsession

Obsession

An obsession is a persistent (continuous) and recurring thought that a person is unable to control. A person suffering from obsessive thoughts often has symptoms of anxiety (uneasiness or dread) or emotional distress. To relieve this anxiety, a person may resort to compulsive behavior.

A compulsion is an irresistible impulse or desire to perform some act over and over. Examples of compulsive behavior are repetitive hand washing or turning a light on and off again and again to be certain it is on or off.

Although performing the specific act relieves the tension of the obsession, the person feels no pleasure from the action. On the contrary, the compulsive behavior combined with the obsession cause a great deal of distress for the person. The main concern of psychiatrists and therapists who treat people with obsessions is the role those obsessions play in a mental illness called obsessive-compulsive disorder.

Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is classified as an anxiety disorder. A person suffering from an obsession may be aware of how irrational or senseless their obsession is. However, that person is over-whelmed by the need to perform some repetitive behavior in order to relieve the anxiety connected with the obsession.

OCD makes normal functioning and social interactions very difficult because it tends to consume more and more of a person's time and energy. For example, a person obsessed with the fear of being dirty might spend three to four hours in the bathroom, washing and rewashing himself or herself. Fortunately, OCD is a rare disorder, affecting less than 5 percent of people suffering psychiatric problems.

Obsessive-compulsive personality disorder

People who are overt perfectionists or are rigidly controlling may be suffering from obsessive-compulsive personality disorder (OCPD). In this disorder, the patient may spend excessive amounts of energy on details and lose perspective about the overall goals of a task or job. Obsessive personalities tend to be rigid and unreasonable about how things must be done. They tend also to be workaholics, preferring work over the pleasures of leisure-time activities.

OCPD does not involve specific obsessions or compulsions. The obsessive behavior arises more from generalized attitudes about perfectionism than from a specific obsessive thought. A person suffering from OCPD may be able to function quite successfully at work, but makes everyone else miserable by demanding the same excessive standards of perfection.

Words to Know

Compulsive behavior: Behavior that is driven by irresistible impulses to perform some act over and over.

Flooding: Exposing a person with an obsession to his or her fears as a way of helping him or her face and overcome them.

Obsessive-compulsive disorder: Mental illness in which a person is driven to compulsive behavior to relieve the anxiety of an obsession.

Obsessive-compulsive personality disorder: Mental illness in which a person is overtly preoccupied with minor details to the exclusion of larger goals.

Treatments for obsessive-compulsive illnesses

Therapists first try to make patients suffering from obsessive-compulsive illnesses understand that thoughts cannot be controlled. They then try to have patients face the fears that produce their anxiety and gradually learn to deal with them. This type of therapy is called flooding. Once patients begin to modify or change their behavior, they find that the obsessive thoughts begin to diminish.

Most professionals who treat obsessive-compulsive illnesses feel that a combination of therapy and medication is helpful. Some antidepressants, like Anafranil and Prozac, are prescribed to help ease the condition.

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Obsession

Obsession

Definition

An obsession is an unwelcome, uncontrollable, and persistent idea, thought, image, or emotion that a person cannot help thinking even though it creates significant distress or anxiety.

Description

Obsessive ideas seem unnatural or alien to those who have them, but are nevertheless recognized as originating from the person's own thoughtsthey are not seen as delusions sent or controlled by an outside party.

Typical obsessions include fear of contamination as from doorknobs or handshakes, worry about leaving things in their proper order, persistent doubts about one's responsible behavior, scary images involving violent acts, and images of sexual acts. People with obsessions may find themselves acting in compulsive ways in largely futile attempts to relieve the anxiety associated with their persistent, unpleasant thoughts. Others suffering from obsessions may try very hard to control or ignore them. It is important to note that legitimate worries about daily concernspaying bills, studying for exams, keeping a job, interpersonal relationshipsare not obsessions. Although they can occasionally be carried to obsessive lengths, these concerns can change with circumstances and, in most cases be controlled, with planning, effort, and action. Obsessions relate to problems that most people would consider far removed from normal, daily events and concerns.

See also Compulsion; Obsessive-compulsive disorder

Dean A. Haycock, Ph.D.

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obsession

obsession (ŏb-sesh-ŏn) n. a recurrent thought, feeling, or action that is unpleasant and provokes anxiety but cannot be got rid of. Although an obsession dominates the person, he (or she) realizes its senselessness and struggles to resist it, which causes anxiety. Obsessions are a feature of obsessive–compulsive disorder (OCD, formerly known as obsessional neurosis); they can be treated with behaviour therapy and also with psychotherapy and antidepressant drugs. See also neurosis.
obsessional adj.

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obsession

ob·ses·sion / əbˈseshən/ • n. the state of being obsessed with someone or something: she cared for him with a devotion bordering on obsession. ∎  an idea or thought that continually preoccupies or intrudes on a person's mind: he was in the grip of an obsession he was powerless to resist. DERIVATIVES: ob·ses·sion·al / -shənl/ adj. ob·ses·sion·al·ly / -shənl-ē/ adv.

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