Obsessive depression is manifested by the predominance of phobic or obsessive-compulsive experiences, which are combined with a melancholy, anxious affect, fussiness, and vegetative-asthenic symptoms.
1) Involuntary, irresistible appearance;
2) Stereotyped repetition;
3) The incomprehensibility of the content;
4) The feeling of anxious expectation of trouble.
Patients, as a rule, are aware of the morbid nature of obsessions. Obsessions get more intense when an individual tries to get rid of them.
– Ideatorial (actually obsessions);
– Emotional (phobias);
– Motor (compulsions).
– Hypochondriacal phobias: a variety of nosophobia, including cardiophobia, carcinophobia, speed phobia, obsessive fear of death, and insanity.
– Isolated phobias: fear of open spaces (agoraphobia) or closed spaces (claustrophobia), fear of heights, or airplanes, and many others.
– Social phobias consists of the fear of being in the center of attention and manifests itself in various fears: answering at exams, losing consciousness in a public place, for example, in transport, etc.
– Obsessive representations of a traumatic situation: quarrels with children, spouses, conflicts at work or at home.
– Contrasting obsessions (thoughts, drives, and/or ideas) that are contrary to the moral and ethical attitudes of the individual. They are often combined with ideas of self-blame. Their content is different, for example, the desire for death or injury to a loved one, the desire for unacceptable sexual contacts, various blasphemous thoughts.
– Obsessive doubts, consisting of uncertainty about the correctness and completeness of the performance of this or that action. Fear of contamination is often combined with obsessive doubts. Such patients wash their hands, boil dishes, or experience doubts about the purity of their own bodies. Obsessive doubts are more often than other obsessions combined with depression.
Initially, obsessions occur as a minor traumatic experience or as an asthenizing factor. Later, they are actualized in a situation of “expectation” of a traumatic factor. And, finally, they arise in the patient spontaneously.
In the overwhelming majority of cases, the depressive-obsessive syndrome is formed in individuals with anankastic features. Such people are characterized by uncertainty, suspiciousness, and distrustfulness. They fear everything new and are gripped by constant agonizing doubts. In many cases, they grievously experience the lack of fullness of life, are prone to constant self-control, self-observation, and pessimism. Often they are tormented by thoughts of their own inferiority, unattractiveness. They are usually hypersensitive: they feel an extreme need for their physical safety, shy away from meaningful social contacts, and are overly afraid of criticism, disapproval, and rejection. They also tend to impose their opinions, exaggerate the importance of small, everyday facts, and do not tolerate changes in the usual life stereotype.
The main feature of an anankastic personality is the fear of “pollution”. Everything should be “clean” for them: both the body, and objects, and actions that must be performed correctly, that is, “clean”. If the action is performed “not cleanly” – not exactly, not correctly, then it seems to be completely wrong.
The depressive-obsessive syndrome is characterized by the predominance of obsessions combined with anxious or melancholy affect and ideas of self-blame. Depressive-obsessive syndrome mainly occurs in the framework of neurotic or schizophrenic depression, although its formation is also possible in the structure of endogenous depressive-obsessive disorders.