A Flaw in the Fabric

There appears to be a broad impression that an explicitly psychoanalytic framework of obsessive–compulsive disorder (OCD) is outdated and obsolete. However, interpersonal dynamics and experiences within the family during childhood and their intrapersonal sequelae in particular, may have substantial bearing on the early stages of the development of OCD. The author presents a set of observations about obsessional thoughts based on case material from research projects, psychometric assessments and psychotherapy with these patients. Freud’s contributions to understanding the internal world of the patient are discussed, suggesting a need to extend beyond the crucible of emerging affects and their regulation and into the wider stage in which the most profound struggle exists around relating to the other. We place the individual’s experience of others at the centre of our theories of the aetiology of OCD. We need to expand our understanding of OCD, particularly in how we locate the individual’s internal struggles within the context of the social environment in, and perhaps out of, which they have emerged.