This document discusses the psychoanalytic treatment of obsessive compulsive disorder (OCD). It provides an overview of OCD based on the DSM-IV criteria and conventional treatments including medications and cognitive behavioral therapy. It then outlines Freud's perspective on "obsessional neurosis" and the contemporary psychoanalytic view of OCD relating to attachment styles, defense mechanisms, and addressing the unconscious meaning behind symptoms through transference in therapy. The conclusion states that psychoanalytic treatment may benefit some individuals with OCD, especially those whose physical symptoms represent unconscious conflicts, and may serve as an alternative for those not helped by traditional approaches.

1. S A S H A A L B R E C H T
Psychoanalytic Treatment of
Obsessive Compulsive Disorder

2. OCD Example
Melvin Udall

3. DSM-IV
•Obsessions or
compulsions
•Individual has at one
point realized that the
obsessions or
compulsions are
excessive or
unreasonable
•Distressful, excessively
time-consuming, or
impairing of normal
functioning
•Symptoms not induced
by a substance or
another medical
condition

4. Conventional Treatments
Psychotropic Medications
• SSRIs
• Effective in about 50%
of cases
• High relapse rates
Cognitive Behavioral
Therapy
• Alter negative meanings
attached to obsessions
• Exposure therapy
• Effective in about 60-
90% of cases
• Although most
continue to experience
mild to moderate
symptoms once
therapy is completed

5. Freud’s Perspective on “Obsessional Neurosis”
 Inappropriate impulses of the id acting out and/or
punishment of a harsh superego
 Origin: fixation at the anal stage of psychosexual development
 ≈ Autonomy vs. Shame/Doubt

6. Contemporary Psychoanalytic Therapy
 Ambivalent attachment styleambivalent sense of
self
 Splitting defense mechanism
 Perfectionism: accentuate the positive aspects of self and hide the
negative
 Therapist: transference/counter-transference corrective
emotional experience
 Accept ambivalence

7. Contemporary Psychoanalytic Therapy (cont.)
 Unconscious
meaning
attached to
symptoms
 Example:
cleaning
obsessed son

8. Conclusions
 Psychoanalytic
treatment can benefit
certain individuals with
OCD, including those
whose symptoms may
be physical
manifestations of
unconscious conflict.
 May be a suitable
alternative for
individuals who are not
benefitting from
traditional treatment
options.