Lecture
The thorough study of obsessive phenomena (obsessions morbides - French) began with the work of P. Morel, who described them under the name delire emotif. Obsessive phenomena, being obligatory symptoms of the obsessive-compulsive syndrome, are characterized by the appearance in consciousness of certain contents that: a) arise against one's will, b) are perceived as imposed, c) are accompanied by the impossibility of freeing oneself from them no matter how much the subject wishes to. Obsessive phenomena are possible only under the condition that mental life is, to a certain degree, under the control of will. Phenomena of mental life become obsessive only if they contain the experience of a certain activity of the "self". Thus, recognizing obsessive thoughts as incorrect, the patient is "forced" to act as if these thoughts were correct, otherwise anxiety and fear arise. For example, when leaving the house, a patient repeatedly checked that the electrical appliances were switched off. But after walking a few blocks, he is tormented by doubts as to whether he left some appliance switched on. And although he clearly remembers his actions, he only calms down when he returns to the apartment and checks everything all over again.
Obsessive phenomena include the following:
fears. Obsessive fears arise against one's will and contrary to real life facts. The most common of them are: agoraphobia - fear of open spaces, crowds, fear of being unable to return to a safe place, claustrophobia – fear of enclosed spaces, closed rooms, social phobia – fear of attracting the attention of others in relatively small groups of people, cardiophobia – fear of dying from a heart attack, mysophobia – fear of contamination, hypsophobia – fear of heights, and so on;
doubts – constant vacillation in making decisions, uncertainty about the correctness of actions performed, repeated, unreassuring rechecking and recalculating;
memories – the intrusive reproduction in memory, most often, of unpleasant, compromising events;
contrasting phenomena. A feeling of antipathy – hostility toward a close person arising against one's will and against one's actual attitude. Blasphemous thoughts – the emergence of cynical, insulting notions toward people for whom the patient feels sincere respect; in religious people – the emergence, at a moment of high emotional intensity (a church service), of thoughts about the desecration of a shrine. Obsessive urges – the appearance, against reason, of impulses to perform senseless or even dangerous actions;
overpowering images – the emergence, contrary to the facts of consciousness, of vivid images based on productive imagination. For example, a mother who had buried her child developed the notion that the child had not died but had woken up and was suffocating and screaming in the coffin
abstract obsessions – obsessive counting, obsessive recall of forgotten names, obsessive ruminations (mental rumination) – involuntary deliberation over trivial alternatives, as a result of which making trivial but necessary everyday decisions becomes impossible or significantly difficult;
compulsive actions – the performance, against one's wishes and despite intact insight, of unnecessary actions - touching the face with the hand, biting nails, pulling out hair (trichotillomania), and the like.
rituals – complex compulsive actions that are secondary in relation to phobias, having the significance of incantations, protection, and leading to relief, a brief release from the obsessive fear.
Clinical variants of obsessive syndrome and its combinations with other syndromes
astheno –phobic, astheno – obsessive, obsessive – asthenic
depression with obsessive phenomena;
hypochondriacal – phobic (nosophobic);
hystero – phobic
+Obsessive – phobic disorder has a close relationship (comorbidity) with recurrent depression, schizophrenia, panic disorder, and Tourette's syndrome. In 80% of patients with obsessive – phobic disorder, depressive symptoms developed after the onset of obsessive manifestations, and these were secondary in nature.
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