If the content of thoughts or behavioral impulses are always obsessed with, imposed on, and cannot be suppressed or restrained even though one knows that it is pointless or at least unjustified, this symptom is called compulsive symptoms.
These uncontrollable impulses can cause unbearable anxiety. The pathology of obsessive-compulsive symptoms does not lie in their content, but in their “dominant” character and their uncontrolled ability.
Symptoms
Careful examination, repeated verification
Feeling of being emptied of body and mind
Symptoms: Milder obsessive-compulsive phenomena are normal psychological phenomena that sometimes occur in people with an obsessive-compulsive personality structure. For example: always thinking of tones, names, rhymes or word sequences; always counting bells, steps or fresco patterns; being overly neat and organized, not tolerating untidy desks or rooms that are not cleaned; scrutinizing, double-checking, not allowing any mistakes, faults, etc.
Here are also included some compulsive rituals, such as eating, smoking, and the rituals or procedures for going to bed and falling asleep. These fixed habits do not give pain, can be interrupted by distraction or external influence, and are not accompanied by anxiety.
In contrast to the above-mentioned obsessive-compulsive phenomena, pathological compulsions do not differ significantly in content, but in intensity, and importantly, they have an anxiety-dynamic character. The patient cannot get rid of the obsessive-compulsive symptoms, neither can they be eliminated nor avoided, but can only be left to their own devices. Pathological compulsions can be manifested in thinking (obsessive thoughts, obsessive imagination or representations), in sensory, instinctive activity and intentions (obsessive internal drives, obsessive impulses), and in behavior (obsessive behavior, obsessive actions).
Compulsive thoughts are determined by anxiety and can be a fear of what is happening, such as a plane crash, a driving accident, etc. Such obsessive thoughts are less often directed against the person (as in the case of phobias), but mostly about others, imagining that something may happen to a relative, or that something has already happened to him, and that he himself is responsible for this misfortune (pathological guilt).
Compulsive impulses
Aggressive in nature
Compulsive impulses are characterized by the desire to do more harm to others than to oneself, e.g., the desire to throw one’s child out of a window; to see a knife and think of hurting or killing someone with it; to speak obscene or denigrating words about God, or to think and do things that are usually forbidden. Accordingly, the compulsive impulse has an aggressive character.
Healthy people can also have brief episodes of such impulses, for example, seeing an abyss and thinking that I could jump or push someone down, but these thoughts are transient and are immediately suppressed by “normal” thinking: not to harm oneself or others. Although the patient does not act out the compulsive impulses and no corresponding behavior occurs, the patient’s experience is involuntary. The emergence of obsessive aggressive impulses increases the guilt of these mostly moral patients and causes further anxiety (conscience anxiety).
Compulsive behaviors, such as compulsive counting: the patient always counts over and over again, regardless of the quantity of anything (train cars, forms, etc.); compulsive checking: the patient always checks repeatedly whether the lights are turned off, whether the gas switch is turned off, whether the door is locked, whether the letter is posted correctly, etc.; compulsive order: the patient always has to organize the closet or desk repeatedly in a certain order, or must do things in a certain order every day; compulsive washing: the patient must do things in a certain order. Compulsive washing: The patient must keep washing his hands, other parts of his body or his whole body until his skin is damaged and he can’t wash anymore, and then he goes to do anything else.
Anxiety
Nonsensical compulsive behavior
Inability to resist
The patient resists these meaningless compulsions with no apparent effect, if he does not check and verify, if he does not organize or wash in order, etc. This anxiety can only be eliminated, at least temporarily, by the repetition of the compulsive behavior.
Particularly painful for the patient is the opposition between the obscene and the “sacred”, or the persistent confrontation between taboo, repulsive impulses and social morality and etiquette.
The obsessive-compulsive symptoms tend to expand gradually, starting with checking a locked door once or twice, and ending up with countless checks on everything; initially with obsessive-compulsive anxiety about bread knives, but later with obsessive-compulsive symptoms about all sharp objects. Hands may be washed 50 times a day, or more.