Compulsions are thoughts, impulses, and actions that are uncontrollable and cannot be suppressed, even though those affected recognize them as nonsensical. The point prevalence is one to two percent, and the lifetime risk is two to three percent.
The first choice is the cognitive one Behavioral Therapy with exposure and prevention of reactions. For the TP, the following apply: insufficient evidence of efficacy . People with obsessive-compulsive disorder may first consider behavioral therapy. In addition, high doses of selective serotonin reuptake inhibitors (SSRIs) are used over an extended period of time.
In classical compulsion, there is an underlying conflict: frowned-upon impulses—whether sexual, rivalrous, or self-assertive—clash with a conscience that is experienced as alien and directed against one’s own self. Reaction formation and affect isolation— Transformation into its opposite; separation of thought and feeling – as well as denial keep this conflict unconscious. These are defense mechanisms.
The situation is different in cases of severe structural disorders. Here, the ritual provides stability and protects against a sense of inner disintegration. Interpretations that focus on conflict can then have a destabilizing effect. What is needed are supportive interventions that strengthen structure.
This distinction determines the course of treatment, and it also determines the prognosis: The first form can be treated much more successfully using psychodynamic methods than the second.
Obsessive-compulsive disorders begin early in life, are chronic in nature, and are difficult to treat with any method. For many people with the disorder, the neurobiological component is likely greater than the psychoanalytic tradition has long been willing to acknowledge.
Out of shame, compulsions are often kept secret for years. Simply bringing them up is the most important step.
