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The term obsession refers to [[images]], [[ideas]], or [[words ]] that force themselves into the [[subject]]'s [[consciousness ]] against their will, and which momentarily deprive [[them ]] of the ability to [[think ]] and sometimes even to act. The term is derived from the [[Latin ]] obsidere, which means "to sit before," "to lay siege to," and figuratively "to [[control ]] an audience." From this is derived the noun obsidio, which means "detention," or "captivity," and figuratively "a pressing [[danger]]."

Classical psychiatrists had described the [[experience ]] of a person whose consciousness was besieged by an intrusive [[thought ]] and who, although lucid and in possession of his faculties, was incapable of stopping it. Philippe Pinel (mania without [[delusion]]), Jean-Étienne Esquirol ([[affective ]] monomania), and Jules Baillarger ([[madness ]] accompanied by [[conscious ]] [[awareness]]) all distinguished this [[pathology ]] from [[mental ]] [[alienation ]] in the strict [[sense]]. But it was Bénédict-Augustin Morel (emotional delusion) and Jean-Pierre Falret (the madness of [[doubt ]] and the delusion of touch) who described a [[clinical ]] picture that was closest to what would later be referred to as [[obsessional ]] [[neurosis]].

It was Sigmund [[Freud]], however, in his description of [[obsessional neurosis ]] in "Heredity and Aetiology of the [[Neuroses]]" (1896a), who considered obsession to be a [[symptom ]] that is part of a larger clinical picture, a symptom that serves as a compromise and has an [[economic ]] function. "Obsessive ideas . . . are [[nothing ]] but reproaches addressed by the subject to himself because of anticipated [[sexual ]] [[pleasure]], but these reproaches are disfigured by an [[unconscious ]] [[psychic ]] [[process ]] of transformation and [[substitution]]."

For Freud the [[notion ]] of Zwang ([[compulsion]]) assumed a much broader and more fundamental [[meaning ]] than that which he gave it in the clinical picture of obsessional neurosis. It reflects what is most radical in the [[drive]]: "In the mental unconscious, we can recognize the supremacy of a [[repetition ]] compulsion arising from [[libidinal ]] emotions that are most likely dependent on the most intimate [[nature ]] of [[drives ]] that are sufficiently powerful to [[place ]] themselves above the pleasure [[principle]], lending certain aspects of psychic [[life ]] their demoniacal [[character]]" (1919h).

In his article on the [[case ]] of the "[[Rat Man]]" (1909d) Freud writes, "The definition I gave in 1896 of compulsive ideas, namely that they are 'reproaches that have been [[repressed ]] but now [[return ]] transformed, always related to a sexual act from [[childhood ]] that brought pleasure when carried out,' seems to me today to be arguable in [[formal ]] [[terms]]. . . . In fact it is more correct to [[speak ]] of 'compulsive [[thinking]]' and to emphasize the fact that compulsive [[structures ]] may be equivalent to the most diverse psychic actions. These may be defined as wishes, temptations, impulses, reflections, doubts, commands and prohibitions."

Obsessions must be distinguished from phobias. A [[phobia ]] is the [[fear ]] of an [[object ]] in the [[outside ]] [[world ]] whose [[absence ]] or avoidance is sufficient, in principle, to avoid [[anxiety]], while an obsession involves a mental [[representation ]] that the subject cannot escape. Although the [[distinction ]] had little meaning for Pierre Janet when he described "psychasthenia," it was essential for Freud. Phobias are associated with the qualities of [[objects]], whereas obsessions are concerned with the characteristics of mental representations. Obsessions must also be distinguished from idées fixes and prevalent ideas: "The latter are integrated in the subject's [[personality ]] and are not recognized as unhealthy. A claimant can be constantly preoccupied with the [[idea ]] of an injustice suffered; he suffers from it, tries to obtain [[satisfaction ]] by any means, but never thinks that the object of his preoccupations is absurd or without grounds" (Guiraud, 1956). As for the impulsive act, it [[lacks ]] the [[hesitation ]] and [[internal ]] [[struggle ]] typical of obsession, which, even resolved, always entails a period of uneasiness and indecision.

There would be little point in making a [[list ]] of obsessions by type. They can be [[religious]], metaphysical or [[moral]]; they might concern purity or [[physical ]] protection, or protection against [[external ]] dangers; or follow questions of precision and [[completeness]], [[order ]] and symmetry, or the flow of [[time ]] (Green, 1965).

It would almost be possible to retrace the evolution of [[psychiatry ]] from the classical period to the [[present]]-day by following the status of obsessions within the clinical groupings provided by various authors. We have seen how Freud, by giving obsession its status as a symptom, something that is both a compromise and has an economic function, enabled [[dynamic ]] psychiatry to become thoroughly modern. The description of obsessional neurosis served as a [[model ]] for all [[psychoanalytic ]] [[theory]]. This is why Freud, throughout his [[work]], constantly returned to the economic, [[topographical]], and metapsychological problems presented by this [[concept]].

Innovations in the [[United States ]] (DSM III and IV—Diagnostic and Statistical Manual of Mental Disorders) have expanded the framework of clinical [[concepts ]] and brought [[about ]] the near [[disappearance ]] of the [[science ]] of [[psychopathology]]. As a result, new groups of [[symptoms ]] have been introduced, based on a statistical approach, and new entities created, such as the compulsive obsessional disturbances. These revisions have expanded the clinical spectrum by including somatic obsessions ([[hypochondria]], dysmorphophobia), physical obsessions (eating disorders like [[anorexia ]] and [[bulimia]]), sexual obsessions (paraphilia), and pathological [[jealousy]]. In this way we have come [[full ]] circle, back to a prepsychoanalytic era, back to the origins of classical psychiatry itself.

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