Die Geschichte der Zwangserkrankung: Ihre Stellung im Wandel der psychiatrischen Formenlehre bis Anfang des 20. Jahrhunderts

Abstract

Influenced by French psychiatry, the first German works on obsessive-compulsive phenomena were published in the second half of the 19th century. First they were seen as one form of the unitary psychosis, later they became involved in the dispute about the concept of paranoia. The first German definition, proposed by Carl Westphal in 1877 and of crucial importance in the conceptual history of obsessive disorders as an illness (OCD) ever since, stood in this tradition. Still the adequate nosological classification of obsessive phenomena was still heavily disputed. As more and more varied forms of obsessive disorders were described, the highly unspecific concept of neurasthenia gained importance. Then degeneration theory was a widespread aetiological concept to integrate the large number of obsessive phenomena. Towards the end of the 19th century, when psychoanalysis emerged, psychological aspects started to interest psychiatrists and psychoanalytical suggestions like Sigmund Freud's concept of obsessional neurosis were discussed. However, none of these different nosological suggestions, nor any of the proposed definitions, found general approval. Above all the question to what extent affects were involved and whether certain phenomena were compulsive in nature or not remained the subject of (ongoing) controversy. This led to a variety of highly inconsistent aetiopathogenetic concepts being proposed.

Comorbid Obsessive-Compulsive Symptoms in Schizophrenia: Insight into Pathomechanisms Facilitates Treatment

“…In general, nosological concepts of OCD substantially changed during the history of psychopathology. French and German pioneers of psychiatry published very divergent theories in the 19th and 20th century [ 100 ]. The relationship between OCD and the delusional spectrum and the so-called unitary psychosis was a major matter of discussion.…”

“…Here authors assume a complex association of primary OCD with schizotypal personality disorder, which meets DSM related criteria. This subgroup of primary OCD patients presents beliefs, which can be classified on a spectrum between obsessions and delusions [ 100 ]. They are emphasizing the similarities as being irrational thoughts, the first with insight and the latter lacking insight.…”

The creator of the term ‘anancasm’ was Hungarian: Guyla Donáth (1849–1944)

“…A recent study analysed what Donáth proposed to refer to as 'anancasm' (Steinberg, 2014). This has also been mentioned in a recent conceptual idea of obsessive-compulsive disorders (OCD) (Oberbeck, Stengler and Steinberg, 2013). Defining obsessive-compulsive processes and conditions as a 'clearly circumscribed type of illness' (Donath, 1897: 213), Donáth took a clear position Figure 1.…”

Kraepelin’s views on obsessive neurosis: a comparison with DSM-5 criteria for obsessive-compulsive disorder

“…This process of nosological changes mirrors the historic discussion led in the 19th century about the role of affect, which has remained central throughout the history of OCD. 11 The fact that today's DSM-5 OCD criteria closely resemble Kraepelin's description of obsessive neurosis reveals a great deal about the development of psychiatric nosology overs 100 years. Today's classification systems do not differentiate psychiatric disorders by causes or etiologies, but mostly by phenomenological (i.e., purely descriptive) criteria.…”

“…So far, only a few general chronological overviews about the early conceptualization of OCD (up to the early 1900s) have been published. [9][10][11][12] These suggest that during the first decades of the 19th century, French psychiatry categorized obsessive-compulsive phenomena among the range of monomanias. Jean E. D. Esquirol (1772-1840) had defined monomanias as partial impairments of mental functions while mind and reasoning were unaffected or healthy.…”