Obsessive-Compulsive Disorder: Neurobiology and the Latest in Treatment

Derick E. Vergne, MD


May 17, 2017

In This Article

Historic Perspective

As with mental illness in general, early historic accounts of obsessive-compulsive disorder (OCD) were filled with religious and moral overtones. Behavior that did not match the expectations of cultural propriety was attributed to the influence of demonic forces. In Europe in the fourteenth to sixteenth centuries, people who experienced blasphemous, sexual, or other obsessive thoughts were believed to be possessed by the Devil, and treatment involved banishing the "evil" from the "possessed" person through exorcism.[1]

In 1838, Jean-Étienne Dominique Esquirol posited that OCD was a type of monomania, or partial insanity,[1] and conceptualized monomania as an illness of the brain that did not cause fever but affected the will and intellect.[2] In 1903, Pierre Janet described three stages in the development of OCD: psychasthenia, forced agitations, and obsessions and compulsions. The term psychasthenia indicated that these patients exhibited an inability to attend to and integrate different aspects of reality (now referred to as executive function).

Emil Kraepelin, best known for coining the term "dementia praecox," also recorded descriptions of obsessive symptomatology, and stated that "the illness fills the whole day and takes up all the attention of the patient."[3] He depicted the prevalent nature of the obsessions as involving "blasphemous pictures," "ideas of disgusting things," "other people having sex," and "buttocks or sexual organs of other people," among other symptoms. Sigmund Freud's view of obsessional neurosis came from his observation of patients possessing an intrapsychic conflict of sexual origin, in which unbearable feelings and emotions are repressed because they provoke guilt and shame and are replaced with traits such as rigidity, exactness, scrupulousness, and heightened morality.[4]


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