Correspondence (letter to the editor): Obsessive-Compulsive Neurosis in Psychoanalytical Terms

It seems odd that with regard to the causes of obsessive-compulsive disorders in children and adolescents and obsessive-compulsive disorder in general, only neurobiological and cognitive-behavioral findings and models are deemed to exist. The behavioral analysis and diagnostic evaluation set out in the review article described as an obsessive-compulsive neurosis precisely the pathological entity that psychoanalysis has defined and described as an obsessive-compulsive neurosis for a long time. The interpretational pattern that is presented as dysfunctional in the article is also found in psychoanalytical ideas, where it is further differentiated, right down to the term “conflict.” Any further therapeutic approach depends exactly on whether this is done or not.

Cognitive-behavioral, pharmacological, and neurosurgical methods want to eliminate the dysfunctional interpretational pattern in its entirety, but in doing so they run the risk of also eliminating parts that are really normal and healthy or suppress these owing to the risk of symptom displacement.

However, psychoanalytic therapy—which was not mentioned in the review article—aims to (dis)solve the entire complex of the dysfunctional interpretation by enabling its actual constituents:

• Normal but intrusive negative thoughts, and

• accompanying unhappy emotions including fears, which are themselves accompanied by

• other intrusive thoughts, sto become fully expressed in such a way that that one category of thoughts come to the fore while the other moves into the background, and the conflict with its symptoms of compulsion, resistance, and discomfort resolves by itself.

In a scenario where all approaches mentioned are identical in terms of understanding and therapy of the obsessive-compulsive disorder down to the last item—which relates to the therapeutic objective—why does a review article not mention psychoanalysis, at least in one word? Might professional and educational reasons and economic-therapeutic considerations hamper the scientific, unprejudiced, and disinterested perspective?