Ocd

OCD is

characterized by recurrent obsessions and/or compulsions that cause

marked distress and/or interference in one's life (see March and

Leonard 1996). Such patients often suffer from intrusive and unpleasant

thoughts, which they try to neutralize by performing repetitive

behaviors in order to avoid mounting, at times overwhelming, anxiety.

Children suffering with OCD most often struggle against their symptoms

and know how senseless much of it seems. As Evan tearfully told

me, "You know, most kids don't have to do these things."

Ever since Freud (1909) described his treatment of a patient he

called the "Rat Man," psychoanalysis has been fascinated by obsessive-

compulsive symptomatology. Children suffering from similar

symptoms were reported as early as 1922 (Sokolnicka) and 1924

(Hitschmann). In Freud's attempt to understand the psychic determinants

of the crippling symptoms of the Rat Man, he emphasized the

role of early, perhaps traumatic, sexual exposure and overstimulation;

the failure to resolve oedipal conflicts and the subsequent regression

to anal-sadistic conflicts; the central role of ambivalence; and the

importance of defenses such as reaction formation, intellectualization,

isolation, and undoing (A. Freud 1966).

Freud (1913, 1926) continued