Two elements of Freud’s theory about obsessive-compulsive neurosis are contradictory: the first is the regression of the interpersonal concept toward an anal-retentive source personality, and the second is the interpretation of obsessive-compulsive neurosis as a defect in the structure of the ego. If we focus on obsessive-compulsive behavior, we understand that the interpersonal factor is the primary point that causes the abnormal behavior: the person with OCD lacks the ability to self-assess; in turn, self-assessment requires another person as part of the ego to accept and support the ego’s behavior. The following clinical case illustrates the narcissistic function of obsessive-compulsive impulses and the changes produced by applying a psychodynamic orientation to them. unlike the DSM-classification of obsessive-compulsive disorders, which includes atypical symptoms that appear in neurosis, schizophrenia, psychotic depression, and organic psychosis, this article focuses on specific symptoms that are discriminatory in obsessive-compulsive neurosis. Liu Huaqing, Department of Child Psychology, Huilongguan Hospital, Beijing Freud pointed out in his exposition of “repression, symptoms and anxiety” as early as 1926 that obsessive-compulsive symptoms give narcissistic satisfaction to the patient; “the system constructed by obsessive-compulsive neurosis makes him feel superior to others because he is particularly clean or cautious. feel better than others, and by doing so appeals to his self-interest.” The secondary benefits of obsessive-compulsive disorder sustain the struggle of the ego in assimilation and consequently the formation of symptoms as part of personality traits. According to Freud, traits like neatness, cleanliness, politeness, precision, and economy are actually reactions built to resist the urge to anal desire. These personality traits are not what they appear to be, but rather have an underlying unconscious or intra-mind conflict. Most scholars of the kinetic orientation have since adopted such a view. For example, Hoffmann commented on obsessive-compulsive neurosis thus, “Few new books reflect phenomenology, disease taxonomy, and psychodynamics, and what is common knowledge is repeated again and again.” In a book on the psychodynamics of obsessive-compulsive neurosis, Benedetti says: “Freud’s model has always been at the root of all psychodynamic thought. The only thing that can be found in a glance at those works is how mediocre they are compared to the brilliance of Freud’s writings.” Benedetti comments that although Freud’s successors did not recognize Freud’s value, they accepted his theory without the slightest question and passed it on. I. Freud’s theory of mind The Oedipus conflict is at the heart of Freud’s thought. Once the genital phase is reached, the ego’s defensive struggle begins, inspired by the repressed castration complex. Using a set of defense mechanisms – such as isolation, denial, fantasy (magic thinking), rationalization and rationalization – the ego regresses to the level of the former anal lust period. Repression then becomes a successful defense mechanism for a mature and stable ego structure. From a structural dynamics point of view, the repression of the ego leads to an increasing seriousness and lack of love from the superego, and more and more of the ego’s impulses are blocked away. These impulses are anal-sadistic (antisocial, aggressive), anal-sexual (anal-sadistic) (defilement fetish) and genital (masturbation, homosexual and heterosexual tendencies) impulses. The ego gradually submits to the superego and identifies itself with the above-mentioned objects of emotional attachment. Compulsive symptoms become a symbolic means of compromise adopted by the ego to resolve the conflict between the superego and the ego. Thus, Freud believed that as far as forms of compulsive behavior are concerned, “masturbation is a more satisfying form of repression.” In 1996, Joraschky described the symbolism of washing mania in terms of “washing one’s hands, on the one hand, washes away seemingly magical guilt, and on the other hand, washing one’s hands can become a new form of masturbation that does not draw conscious attention to itself.” Because Freud was concerned with the structure and conflict within the psyche, his theory emphasized the internal dependence of neurosis on the superego rather than the later prevalent view of external dependence on those around us. Because psychoanalysts have maintained a psychological view of the individual, they have tended to ignore the interpersonal and interactive processes in OCD, although Freud described these aspects in his introduction to Rat–Man therapy, although this description was not sufficiently detailed and in-depth. The first note of Freud’s initial analysis of the patient was as follows: he told me that he had a friend of whom he had a particularly high opinion; he said that he used to go to this friend when he was tormented by those criminal impulses; that this friend often gave him moral support and believed that he was a person whose behavior was beyond reproach; that it was probably the habits inherited from his childhood that made him lose his life. At the beginning of the meeting, he also talked about another student of nineteen years old (he was fourteen or fifteen at the time) who had a similar experience to his. He said that that student resembled him, was so conceited that he thought he was a genius. In this example, we can clearly see the interpersonal element in the compulsive impulse. quint describes in the behavioral disorder of obsessive-compulsive neurosis its kinetic background: compulsive personalities cannot rely on either their own behavior or their own thoughts, because they lack the ability to self-assess and they need to rely on the recognition and acceptance of others to confirm their behavior. Clinically, this usually manifests itself in the patient’s incessant questioning of the most important people. For example, in the case of scrubaholics, they keep washing their hands because they cannot confirm that their hands are really clean because they are afraid of being contaminated or soiled by others (who may not have touched them at all), and they suffer constantly from such thoughts. With the help of others, they attempt to transform this unbelievable experience into a reality that is usually acceptable. In this process, the “other” functions as the self-object. In interpersonal terms, it is narcissism that longs for others to accommodate its own imperfect neurosis, and for their approval and respect to correct the defects of the ego structure. Regarding the origin of the disorder, we believe that neurotypicals fail to experience their parents as part of themselves in childhood, and thus fail to experience their own worth and acquired abilities. In a similar way, Janssen describes the dynamics of obsessive-compulsive symptoms as a way of coping with symbiotic and dissociative conflicts, that is, the symptoms attempt, on the one hand, to prevent the mixing with the original object and, on the other hand, to compensate for the threats received when the object is lost. It fears the disintegration and destruction of all object relations above. From this point of view, in order to have access to exclusive sensations, but at the same time to be able to rebel against them covertly, the OCD patient strives to hide and control others, to make them part of themselves. They attempt to establish the narcissistic symbiosis in which maturity is possible. According to Mahler, a good mother-child symbiotic relationship is a basic prerequisite for the acquisition of a sense of self-identity, while Winnicott argues that the infant’s experience of control over the mother and access to the mother as part of him or her is a prerequisite for the full distinction of the future object, a view complemented by the clinical findings of Quint and Lang. The following case study is intended to illustrate the theory and treatment of psychodynamics as applied to obsessive-compulsive neurosis. Ms. A did not shake hands with the therapist, partly because she felt pain from shaking hands due to excessive hand washing and partly because she was afraid of soiling herself by touching others. She sat there with her mouth half open, like a child with a disability. She was slow to speak and later became increasingly nervous. Ms. A. first said that her mother insisted that she come to the clinic because she felt she could not stand to be home with her. at age 11, she always came home dirty from playing. Her mother scolded her, calling her dirty and a nuisance. These words triggered her compulsive hand washing and cleaning. Ms. A. could no longer know when her hands and kitchen were definitely clean. She needed her mother to make sure everything was clean. Ms. A. says that her mother is the most important person in her life, even though she has never done anything to make her happy. Whenever her mother went out for the weekend, she felt awful. She would sanitize and wash her hands until they started to bleed. When her mother was not home, she always felt anxious that someone outside the house noticed and was very concerned about her. She kept checking all the doors for fear of being murdered. She could not live without her mother. She tried out-of-hospital psychotherapy five times, but no form of treatment was effective. 2. Personal history Ms. A. was born a year after her sister. She said she was an unwanted child, that she should have been a boy and should have been born two years later. In her mother’s eyes, she was a disruptive child who never lived in peace. Her father had no place in the family and would not handle anything in the house. When there were arguments in the family, she snuck into the garden to hide. All in all, Ms. A’s growth was delayed by two years. Because of bedwetting, she did not go to daycare until she was five and started first grade at seven. In her opinion, no one at school could tolerate her. After she left school, she was never integrated into society because she could not accept criticism. So her mother was the only person she could get along with. When her mother came to the meeting, she was worried and didn’t know what to do. She blamed herself for not raising her daughters properly. She said her second daughter came out so soon after her oldest daughter was born and it was just too much for her to handle. Even now, she can still feel her daughter washing her hands constantly, asking questions, and making stubborn demands that she can’t tolerate. Her daughter once begged her for hours on end to lend her her car, only to finally let her have it even though she needed it herself. 3. Narcissistic functioning in symbolism, fantasy (magic thinking), and sadism Compulsive behavior is characterized by failure to ensure success despite multiple repetitions. Since self-perception and self-assessment skills are not sufficiently developed, the compulsive neurotic needs the approval of another person. Therefore Ms. A. cannot judge the success of hand washing or cleaning, nor can she decide independently on various issues concerning clothes. She was too dependent on her mother. The importance of her mother’s presence was demonstrated by an obsessive-compulsive episode at the age of 11: Ms. A. could not face her mother’s criticism of her dirty appearance, so she started compulsive washing. The purpose of the compulsive impulse is precisely to get rid of this defect in appearance. This is not symbolic, but rather the intention to bond. When left alone by her mother for the weekend, Ms. A. kept washing her hands until she started to bleed, and she was afraid of being killed. When asked about the meaning of her hand washing, she did not talk about therapeutic guilt, pleasure or masturbation, but only about her fear of dirt, germs and poisons that could invade her body and kill her. Thus, rather than being symbolic, compulsive sexual behavior is a concrete manifestation of paranoia. Moreover, in Ms. A.’s case, the potentially fragile boundary between the ego and the outside world is clearly visible, both in the “tactile taboo” that Freud first described in 1913 when he described neurosis, and in her belief that her fears attracted the killer. The illusion (magic thinking) clearly illustrates the illusory narcissistic attachment to the object. While Freud’s conception of neurosis views the child as a clear and coherent self, fantasy thinking is characterized by a lack of clear demarcation between self and object. These magical thinking concepts acquire independence and materiality against the patient’s wishes. In terms of occurrence, it is possible to establish a link between the loss of magical power to control one’s thinking and Winnicott’s developmental stage of narcissistic omnipotence, in which infants believe they can control their environment, such as their mother, but in fact they cannot. Because their narcissistic system is fragile, the ill-considered part of attachment to the mother leads to a situation in which the connection between the internal environment and the external reality is not established or is not sufficiently established. On the contrary, a successful symbiotic relationship is a necessary precondition for the separation of self and non-self, and for the establishment of “bridging” between mother and child as a symbol of difference. The life history supplemented by her mother’s recollections shows that Ms. A. was an unwanted child. She was a burden to her mother from birth and therefore did not have sufficient interaction and symbiosis. The full experience of the feeling of “control over the object” was lacking for her, and Ms. A. remained completely attached to her mother, who represented security. The establishment of symbiotic relationships is related to the fear of self-disintegration. Self-will, aggressiveness, spontaneity, sexuality and abusive tendencies would have to be suppressed. In general, families that produce neurosis are harsh and stereotypical; authoritative parents demand absolute obedience from their children. The compulsive impulse changes from the initial external to the internal impulse, the “cruelty to others” shifts from external to internal, and the punitive superego becomes the main form of internal “cruelty to others”. The corresponding alternative to the superego becomes a sadistic, authoritarian, and antisocial ego impulse. As for interpersonal relationships, there is a contrary view that the harsh superego is not the primary factor that suppresses the ego and causes it to become sadistic. The sadistic impulse is the primary factor that reactively fights the harsh superego in order not to jeopardize the vital object relationship. in Ms. A’s case, the mother was not actually tough and cruel, but was highly adaptive. However, the second daughter, Ms. A., was too much for her to handle. Since Ms. A. could not demand her mother’s love, she pushed herself to at least allow her compulsive symptoms to torment her mother into noticing her. Like many other patients, Ms. A. admitted in therapy that she sometimes deliberately used her obsessive-compulsive symptoms to antagonize her mother. Winnicott believes that antisocial tendencies are actually the child’s attempts to prompt the environment to seek him out. He believes that uncleanliness, washing mania and demanding behavior can be studied from this perspective in Ms. A.’s case. The child wants to get the mother’s attention through coercion. Another important factor here is the already mentioned fantasy of authority and supernatural control and manipulation of the mother, which serves to control and express the fear that initially exists, Winnicott also mentions that here there is no primary narcissism as assumed by Freud, what exists is a primitive dependence on the mother. As Morgenthaler describes, if this step is not well developed, the most important secondary relationships of the individual are held as firmly in the individual’s grip as if they were sealed in order to balance the structural deficits of the ego. This point is also why love and hate are so closely linked in the personality of the OCD patient. The dividing line between good and bad is not sufficient. This fact leads Quint to the hypothesis that OCD patients cannot distinguish well between the good self and the object image, on the one hand, and the bad self and the other object image, on the other hand. This split, in turn, led Janssen to establish a link between obsessive-compulsive neurosis and boundary organization. Indeed, the root of sadism is the desire to be noticed. 4. Results and efficacy The concept of obsessive-compulsive neurosis, proposed by Freud and still widely accepted today, as development should incorporate the concept of interpersonal and narcissistic dimensions. This view is that narcissism does not imply an initial independence from the environment, but rather a need for wholeness that is present in the person from birth. Assuming a lack of symbiotic experience and mediation, OCD cannot rely on their own behavior, but continue to demand others as self – objects. They struggle for narcissistic symbiosis, which is a prerequisite for separation and the establishment of autonomy. Conversely, in a successful symbiotic relationship, the symbol becomes a bridge linking the primary object and the distance it generates. The behavior of OCD does not function as a symbol, but finds an expedient attempt to combine fantasy (magic thinking) and sadism, also in an attempt to achieve control over the object narcissism or at least to attract his attention. This is evident both in Ms. A.’s behavior toward her mother and in therapy: Ms. A.’s initial reluctance to participate in therapy may have been related to a fear of separation from her mother. Her thoughts constantly revolved around home and her disdain for therapy. The therapist tolerated Ms. A.’s disdain, and she began to torment the therapist with endless questions and reports about her obsessive-compulsive symptoms, career prospects, medication history, clothes, etc., the same way she had treated her mother. For example, she secretly changed her medications and tried to add additional treatments. For her, the hidden pleasure stems from the effortful process in which she is noticed and in which she is able to trigger certain things and to generate a different perspective. As in the treatment of borderline patients, the supportive role of the therapist is very important . At the same time, the struggle for clear boundaries that imply safety takes place. Quint points out that there are many cases in which interpretative and confrontational strategies have led to autistic withdrawal, depersonalization, paranoia, severe depression and generalized anxiety. As a result, she developed a great fear of paranoia and fear of being kicked out of the hospital. This suggests that her compulsion to wash her hands was not in fact a symbolic “make-believe” but rather an attempt to combine degenerative repetition with the relief of widespread terror and aggressive tension. Quint uses common terminology to conclude therapeutically that therapists should intervene in such a way as to allow OCD patients to experience the effects of their behavior in empathy, such as the ability to act more effectively. When therapists sense during therapeutic sessions that the OCD patient is in control of feelings, emotions, and affect towards themselves, and they are able to let the patient know through empathy that she/he has been touched, affected, and moved, then this means that 1) repressed instinctual needs are revived in empathy and are closer to consciousness, and 2) these patients experience that they have the ability to make something happen, that they have succeeded. This is the beginning of a new self-understanding and a new narcissistic orientation.