Psychoanalysis and General Psychiatry: Obsessive-Compulsive Disorder as Paradigm

Abstract

To certain areas once dominated by psychoanalytic conceptualizations of psychopathology and pathogenesis, general psychiatry has in recent years made significant contributions. The obsessive-compulsive disorder is cited as an example, and illustrations of such contributions are described and discussed. Some implications for psychoanalytic theory and research are suggested.

Psychotherapy and Pharmacotherapy: A Contemporary Perspective

“…But dynamic psychiatry has reconnected to its biological roots, becoming aware of the various ways in which the ego, as Freud said, is first and foremost a body ego. Efforts have been made to integrate and revise psychoanalytic theories of illness to accommodate advances in biological science (Esman, 1989;Willick, 2001) as well as consider combining medication and psychotherapy in thoughtful ways (Busch & Sandberg, 2007).…”

A Psychodynamic Clinician’s Foray into Cognitive-Behavioral Therapy Utilizing Exposure-Response Prevention for Obsessive-Compulsive Disorder

“…In this model, OCD, which today is widely accepted as a largely neurobiological disorder, can be understood as the result of an underlying deficit. The intrapsychic-conflict understanding of OCD as initially posited, while facilitative in certain cases, has generally not been helpful in the amelioration of OCD symptoms (2,10,24).…”

“…Because OCD symptoms often are characterized by concerns about aggression, sex, and control, it is very intriguing and tempting for psychoanalytic practitioners to try to help the patient understand the meaning of the symptoms and gain mastery of the intrapsychic conflicts in the hope that such understanding will yield eventual symptom remission. Unfortunately, psychoanalytic ap-proaches to OCD (earlier referred to as "obsessional neurosis") to date have yielded disappointing outcomes (10). Though the psychoanalytic theories of OCD are interesting, I found it difficult to make a compelling case for expressive psychoanalytic treatment as a first-or second-line approach in the face of much stronger outcome data for CBT and pharmacotherapy.…”

Zwangsstörung

“…Psychoanalytiker wissen um die Begrenztheit der Wirksamkeit des psychoanalytischen Verfahrens als Monotherapie bei Zwangsstörungen (Esman 1985;Gabbard 1992;Malan 1979). Eine vorsichtige Indikation für eine psychoanalytische Behandlung erscheint allenfalls bei akuter Manifestation von leichteren bis mäßigen Zwangssymptomen sowie bei anankastischen Persönlichkeiten vertretbar (Kaplan 1987;Sarwer-Foner 1987).…”