Obsessive neurosis: symptoms, causes and treatments

Obsessive neurosis is a term that defines a mental disorder associated with nervous tension and mental disturbances. It consists of a psychological disorder suggested by psychoanalysis by Sigmund Freud.

The Austrian neurologist defined this disorder as a psychic disorder in which the subject acquires a mental state of constant preoccupation with thoughts in which he is not interested.

The cognitions suffered by an individual with obsessional neurosis have the most frightening content, leading him to commit unwanted behaviors and behaviors. Obsessive neurosis is one of the most complex psychic disorders to be examined and treated. Mainly because the symptoms of the change are difficult to detect.

In general, it can be said that people with obsessional neuroses are perfectionist and meticulous individuals, dominated by their thoughts, which often lead to repetitive and compulsive behaviors to avoid their discomfort.

Although this diagnosis is no longer used in mental health practice. Obsessive neurosis is one of the most relevant psychopathological constructs in the history of psychology and psychiatry.

The objective of the present study is to provide a coherent definition of this complex alteration, as well as to review its characteristics, symptoms and causes. We will also apply the treatments to be carried out for a correct intervention.

Obsessive neurosis definitions

obsessional neurosis

The first difficulty posed by this mental disorder lies in establishing its own defining aspects. In fact, obsessional neurosis is today a complex concept to be defined, as it raises certain doubts in the delimitation of its main aspects. In this sense, in the literature you can find several concepts about this term.

First, Henri Ey defines obsessional neurosis as the compulsive character of feelings, ideas or behaviors, which are imposed on the person and produce an inextinguishable struggle.

From this first definition, the most classic characteristics of obsessions are derived: incoercibility, automatism, struggle and awareness of diseases.

However, these definitions are now notably out of use. In fact, in the manual for the diagnosis of mental disorders (DSM-IV) there are remarkably different specifications of obsessional neurosis.

Firstly, according to current diagnostic manuals, obsessional neurosis is not considered an independent entity, but includes alteration in the pathologies diagnosed as anxiety disorders.

Likewise, in current diagnoses, the term obsessional neurosis has also been modified, which is no longer known as such, but as an obsessive-compulsive disorder.

In this disorder, there are obsessions and compulsions that the sufferer interprets as excessive and irrational. These symptoms generate clinically significant discomfort and lead, in most cases, to the performance of compulsive behaviors.

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Thus, there are notable differences between the disease initially cataloged by psychoanalysis as obsessional neurosis and the current pathology diagnosed under the nomenclature of obsessive-compulsive disorder.


Obsessive neurosis is characterized by a series of attributes and manifestations related to the cognitive alterations that the subject presents.

In other words, obsessional neurosis is defined by a series of thoughts that appear in the person. As the name implies, these thoughts are mainly characterized by being obsessive.

In more detail, the elements that define the alteration known as obsessional neurosis are:

Obsessive cognitions

In the subject’s mind, there arises a high emergence of obsessional phenomena. They can be of different types like cleanliness obsessions, infinity, guilt, verification, etc.

These cognitions refer to a specific idea, representation or situation. And they become a major concern for the matter.

Development of the Defense Mechanism

The person who suffers from this type of obsessive cognition develops a series of defenses against his own obsession.

These mechanisms are characterized by being also obsessive. Likewise, they do not refer to unconscious thought processes, but the subject develops them consciously and with the aim of reducing the discomfort of obsessive thoughts.

The most common defense mechanisms are characterized by being obsessive behaviors. For example, an individual with cleaning obsessions will develop a series of cleaning behaviors to mitigate the psychological disturbances caused by the obsession.

Presence of cognitive and affective changes

Obsessive neurosis is not limited to the appearance of obsessive thoughts and behaviors related to obsession. This alteration usually also presents a series of emotional disturbances.

Abulia, perplexity, a feeling of unreality or strangeness are common elements among subjects with obsessional neurosis.

psychoanalytic features

Obsessive neurosis is a disorder that has its origin in psychoanalysis and dynamic currents. In fact, other types of schools of psychology, such as cognitive behavioral current or humanistic psychology, do not determine the existence of obsessional neurosis.

Instead, they use the diagnosis of obsessive-compulsive disorder, which maintains certain differences with obsessional neurosis.

In this sense, obsessional neurosis presents, in its own definition and characterization, a series of attributes related to the psychoanalysis of alteration. The main ones, as specified by Henri Ey are:

  1. A regression of drive systems to the sadicoanal state.
  2. The ego’s excessive defenses against instinctual drives.
  3. The unconscious imperatives of the superego.

According to psychoanalytic schools and authors, the strength of the unconscious is what constitutes the dynamism of the compulsive thought that bothers. This works on the subject and motivates the emergence of mental and behavioral mechanisms to combat the discomfort of obsession.

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In this sense, according to the currents of psychoanalysis, the obsessions represented in obsessional neurosis acquire a symbolic character. The demands of the individual’s impulse and libidinal system cause a series of obsessions in his thinking.


With regard to the clinical picture of the disorder, a series of symptoms are postulated that postulate people with obsessional neurosis and that define psychopathology.

These manifestations are also specified from psychoanalytic theories, so they have similarities with the features discussed above. The main symptoms of obsessional neurosis are:

  1. The subject is invaded by obsessive ideas that are imposed despite his will. Thought is compulsive and uncontrollable.
  2. The individual experiences a tendency to aggressive and impulsive acts (compulsive behaviors). Which are especially feared or unwanted by the person.
  3. The person with obsessional neurosis feels forced to perform repetitive acts of a symbolic nature. These behaviors are considered magical thinking rites produced by obsessional neurosis.
  4. The struggle between the individual and the obsessions that appear in his mind constitutes the element that causes the affective symptoms and causes psychosthenia.

Obsessive Neurosis vs. Obsessive-compulsive disorder

Obsessive neurosis is a psychopathology studied, investigated, diagnosed and classified based on psychoanalytic theories.

Currently, both psychoanalysis and dynamic currents have lost weight and prominence in the field of mental health. These are largely relieved by the cognitive behavioral stream.

Today, obsessional neurosis disorder is not found in the diagnostic manuals of psychopathology. Instead, the equivalent disorder postulated by new currents in psychology is specified.

This new disorder is known as obsessive-compulsive disorder. And, despite maintaining close similarities with the alteration initially postulated as obsessional neurosis, it also presents differences in both symptomatology and diagnosis.


Research in obsessional neurosis has shown that there is no single cause for this psychopathology. In fact, it has now been concluded that there is a combination of factors that combine to cause the disorder to develop.

In general, they can be classified into three main types: genetic factors, physical factors, and environmental factors.

genetic factors

As with many other mental illnesses, obsessional neurosis is postulated to have a notable genetic component in its development.

Suffering from this psychopathology is often common in some families. Likewise, people who have a first-degree relative with neurosis have an increased risk of developing the disorder.

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In addition, if there is a family history of other types of anxiety disorders, the person will also be more susceptible to obsessional neurosis.

physical factors

Recent research has shown how the symptomatology of obsessional neurosis correlates with a range of chemical imbalances in the brain. Specific alterations in the functioning of the brain of individuals can lead to the development of the disease.

The first neurochemical hypothesis resides in the dysfunction of the orbito-fronto-caudate circuit as a final common pathway of manifestations of obsessional neurosis.

Likewise, anomalies in the subterranean aspects of the striatum and neurochemicals, such as the facilitation of serotonergic transmission at the orbitofrontal cortex level, are also factors positively related to the development of obsessional neurosis.

environmental factors

Finally, there are certain environmental factors that can motivate and precipitate the onset of obsessional neurosis. People who have had life experiences that they cannot control are at a higher risk of developing the disease.

For example, experiencing trauma, being abused or abandoned, growing up in a dysfunctional home, or being exposed to high levels of chronic stress are all factors that can contribute to the development of pathology.

Obsessional neurosis treatment

Currently, there are two main interventions to address typical symptoms of obsessional neurosis. These are pharmacological treatment and psychotherapy.

With regard to medication, the most effective drugs are tricyclic antidepressants and selective serotonin reuptake inhibitors, the latter being the most used.

These interventions make it possible to improve the clinical picture, but are usually insufficient to minimize the symptomatology of the disorder.

In this sense, cognitive behavioral treatment is usually the type of psychotherapy that should consistently accompany pharmacological intervention. The most used techniques are exposure with response prevention and acceptance and commitment therapy.


  1. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association.
  2. Clifford, CA; Murray, RM; Fulker, DW: Genetic and environmental influences on obsessional characteristics and symptoms. Psychol Med. 1984; 14: 791-800.
  3. BAER, L.; JENIKE, MA: Obsessive-Compulsive Disorders, Theory and Management. PSG Publishing Co, Littletown, 1986.
  4. Freud, S. (1986). «On a Case of Obsessive Neurosis (the « Rat Man »), Complete Works, Volume X, Buenos Aires: Amorrortu Editores.
  5. Freud, S. (1896), “New points about neuropsychosis defence”, in Complete Works, Ed. Amorrortu, Bs. At. 1976, T.III.
  6. Indart, JC (2001), The Obsessive Pyramid, Ed. Tres Haches, Bs. As., 2001.
  7. Lacan, J. (1984). The seminar Book XI: The four fundamental concepts of psychoanalysis, Buenos Aires: Paidós.

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