[The psychopathology of severe obsessive-compulsive disorder: Zwangskrankheit and primary obsessional slowness].

In investigation obsessive-compulsive phenomena, it is important to not only regard them as a kind of symptomatology extending across a variety of diagnostic categories on the basis of faint similarities of symptoms from the cross-sectional point of view, but also to take into account how the psychopathology of a nuclear form of severe obsessive-compulsive disorder (OCD) is different from a neurotic form from the vertical-sectional point of view. In this paper, the psychopathological features of 3 cases of Zwangskrankheit and primary obsessional slowness, which are considered to be nuclear forms of severe OCD, are reported. We suggest that 'obsessive-compulsive pseudophobia' lies behind Zwangskrankheit, and 'obsessive-compulsive depersonalization' lies behind primary obsessional slowness. In both disorders, a peculiar form of avoidance behavior, called 'pathological access to safety signal' was observed in which dangerous situations were avoided by taking no other action other than a determined one. Thus never making a mistake was stressed in their actions which is a feature of adherence to extra-orderliness. Therefore, a patient with Zwangskrankheit lives a restricted life according to strict rules characteristic of ritualization of one's whole life, while a patient with primary obsessional slowness acts according to the principle of miticulousness. Thus we considered that this kind of avoidance behavior is the result of a loss of safety signal not by the existence of a danger signal. In a neurotic form of OCD, patients may attempt to superficially restore the safety signal by avoiding the danger signal. In comparing the psychopathology of OCD with agoraphobia, avoidance behavior involves space in the latter, while it is an act in the former. Obsessive-compulsive pseudophobia and obsessive-compulsive depersonalization are hypothesized to be the background of symptoms of a neurotic form of OCD, but since the patients do not experience them as phenomena and so cannot take them into the field of consciousness, then they are likely to feel them, literally 'obsessive-compulsive.'