When was obsessive-compulsive disorder (OCD) discovered?

A history of OCD

Obsessive-compulsive disorder (OCD) has been recognized as a psychological condition for over a century now, although it wasn’t always understood or classified as a distinct disorder. The modern understanding of OCD emerged gradually over time. Below is a timeline highlighting the development of OCD:

Scrupulosity in the 14th to 18^th century

Early historical descriptions of symptoms of OCD can be traced back to the 14^th century, when they were thought of as elements of scrupulosity. ^[1]

In present day, scrupulosity is a sub-type of OCD referring to a person’s obsessive concerns with their own sins and compulsions specifically related to religious devotion. In earlier centuries, ‘scrupulosity’ encompassed all varieties of obsessions and compulsions. ^[1]

The German theologian, Johanes Nider wrote of scrupulosity as a life-threatening affliction that could give rise to the lethal sin of despair. ^[1]

The obsessions that people used to feel were thought of as spiritual maladies, rather than medical issues, underlined by the 17^th century concept of ‘religious melancholies’ ^[1] [2]. John Moore, the bishop of Norwich, described religious melancholies to Queen Mary II as ‘the anti-Christian thoughts’ that overwhelmed people despite their best efforts to push them away.

He described those afflicted as possessing a ‘fear, that what they do, is so defective and unfit to be presented unto God, that he will not accept it. Naughty, and sometimes blasphemous thoughts, start in their minds, while they are exercised in the worship of God, despite all their endeavors to stifle and suppress them, the more they struggle with them, the more they increase.’ ^[1]

The similarities between the obsessions and compulsions endured by people with OCD in present day, notwithstanding the religious context, can be inferred from Moore’s quote.

It makes sense that obsessions and compulsions centered on religion pre-18^th century. Religion was the cornerstone of everyday life and OCD generally impacts what is important to sufferers. ^[1]

19^th century – French and German psychiatrists make progress in comprehending obsessions and compulsions.

Modern concepts of OCD began to take shape in the 19^th century as scientific disciplines developed and research into neuropathological conditions was undertaken. ^[1]

In 1838, French psychiatrist, Jean Esquirol, referred to OCD as a form of monomania. He said that while sufferers may be impaired in one area, the rest of their body and mind remained intact. ^[1] Thus, Esquirol was among the first to recognize that OCD patients were able to function in many areas of life despite their obsessive-compulsive symptoms. ^[1]

Esquirol also introduced the term ‘obsessions’, who described them as the persistent intrusive thoughts experienced by individuals. ^[3] Other terms like “compulsion” and “compulsive behavior” also started to emerge during this period.

By the 1850s, French psychiatrists had the concept of monomania, with a range of thinkers proposing different theories regarding the nature of OCD. Terms such as ‘impulsive insanity’ and ‘disease of the emotions’ were banded around, as psychologists attempted to nosologically categorize obsessions and compulsions. ^[2]

While emotive origins held sway in France, German psychiatry believed obsessions and compulsions related to an intellectual disorder.

In 1877, Karl Freidrich Otto Westphal attributed obsessions to damaged intellectual function. ^[2] His term, ‘Zwangvorstellung’ was etymologically important for our current term of OCD. In the UK, ‘zwangvorstellung’ was translated as ‘obsessions’, while in the USA it was translated as ‘compulsions’. The English-speaking powers compromised on the term ‘obsessive-compulsive disorder’. ^[2]

20^TH century and Sigmund Freud

Sigmund Freud furthered the public understanding of OCD by drawing on his theories of mental structure, mental energies, and defense mechanisms. ^[2] His ideas can be summarized as follows:

1. The Role of Unconscious Conflicts: Freud believed that OCD symptoms stemmed from conflicts between unconscious impulses or desires and the individual’s conscious moral standards. According to his theory, the person experiences anxiety due to the conflict and uses compulsive behaviors as a defense mechanism to manage that anxiety.
2. Anal Stage and Obsessive Traits: Freud associated certain traits observed in individuals with OCD with unresolved conflicts from the anal stage of psychosexual development. The anal stage, occurring between 18 months and 3 years of age, is characterized by the child’s focus on bowel control. Freud theorized that fixation or unresolved conflicts during this stage could contribute to obsessive traits later in life.
3. Reaction Formation: Freud proposed that individuals with OCD engage in reaction formation, a defense mechanism in which they express opposing responses to their unconscious desires and feared responses.

As such, Freud’s psychoanalytic stance buttressed our knowledge of OCD, leading us to our present day understanding of the disorder.

Present day understandings of OCD

During the 1950s, the classification of OCD as a distinct disorder gained more recognition. The Diagnostic and Statistical Manual of Mental Disorders (DSM) was published, and it included OCD as a specific psychiatric diagnosis.

This led to OCD being widely recognized as a neurobiological disorder characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). It is categorized under the Obsessive-Compulsive and Related Disorders section of the DSM-5, the current edition of the diagnostic manual for mental health conditions, having previously being categorized under the Anxiety and Related Disorders section.

Significant advancements were made in the understanding and treatment of obsessions and compulsions. Comprehensive amounts of research have enhanced therapeutic methods, with cognitive behavior therapy and/or medication comprising the front-line treatments for OCD.

The development of selective serotonin reuptake inhibitors (SSRIs) in the 1980s and 1990s provided effective pharmacological treatment options for OCD.

If you believe you, or a loved one, may be struggling with OCD, consult a doctor as soon as possible. They will assess your symptoms and if you are diagnosed with OCD, you can work on a treatment plan that best suits your needs and requirements and live as unencumbered a life as possible.