Understanding Obsessive Neurosis Symptoms and Care

Obsessional Neurosis

Obsessive Character

• Organization of Personality Pathology: Marked by particular mental fatigue at symptomatic and psychological levels. This state is often associated with feeling mentally drained and ineffective in practical matters.
• Compulsive System: Essential for controlling anxiety, often manifesting through thoughts resembling magical rites.
• Behavioral Traits: Exhibits traits of anal-retentive regression and egotistical behavior. There is often a fondness for order, such as libraries, yet they react strongly to disorder, leading to tendencies toward sorting, cleaning, and maintaining propriety.

Apparent Symptoms

• Obsessions: Involuntary emergence of anxiety-provoking thoughts or images that are pathogenic to the self.
• Identical Obsessions: Intellectual phenomena linked to specific events, often absurd, aimed at reducing anxiety.
• Impulsive Obsessions: Expressions of terror regarding committing offensive acts against others.
• Phobic Ideas: Anxiogenic in nature, often disorganized fears concerning dirt, the unknown, and similar subjects.
• Obsessive Rites: Automatic internal thoughts and external rituals (behaviors).
• Compulsion: A perceived necessity to perform an action (e.g., running) to continue daily activities without generating anxiety.
• Rigidity: Strict adherence to routines and events.

Clinical Forms

According to Severity:

• Asymptomatic Form: Characterized by stubbornness, meticulousness, aggression, greed, neatness, and cleanliness, with crises appearing around specific events.
• Symptomatic Form: Involves psychasthenia (mental fatigue), leading to near-nonexistent activity. May present with sadistic character traits (aggressive, selfish, phobic drive).

Psychopathology:

• Ambivalence: The simultaneous existence of intense positive and negative feelings toward the same person, often describing very intense feelings of love.
• Thought Control: Order in thought is used to neutralize anxiety and aggressiveness, helping to avoid feeling affection (love or hate) toward real things, focusing instead on phobic ideas.
• Positional Control: Aggressiveness is controlled, often resulting in behavior that is polite, distant, and perpetually doubtful.

Differential Diagnosis

Distinguished by rich ritualistic behaviors that do not subside with symptoms. When depression is present, it can manifest as a lack of zest for life, making existence wearisome, increasing the likelihood of suicide attempts. Paradoxically, just before the final moment, the individual may attempt to settle affairs, showing no prior indication of intent.

Treatment Considerations

Depression Aspects:

Depressive states involve a fundamental lack of will to live. Neurotic depression specifically involves a lack of recognition and zest for life, leading to suicidal ideation as a perceived salvation.

Immediate Action:

When these characteristics are present, it is crucial to inquire immediately about past or present suicide attempts (when, where, and under what circumstances). If attempts are confirmed, seek immediate medical consultation for medication and ensure the environment provides constant support, ensuring the person is never left alone.

General depressants should be managed through consultation; they should not be requested independently.