OCD History can be found in the ancient world, Hippocrates made the first recorded effort to explain symptoms of the obsessive-compulsive disorder (OCD). His theory was that imbalances between and among four body humors, blood, black bile, yellow bile, and phlegm, caused physical or mental abnormalities. He postulated that a fear or dejection that persists for a long time has a depressive effect. Recurrent OCD rituals and obsessive thoughts would have been in this category. For the more than 2,000 years that followed Hippocrates, scientific understanding of OCD made little progress.
In the 19th Century, psychiatry started to study many mental conditions systematically, removing OCD from the realms of the philosophers and theologians who had considered the disorder previously. Faculty psychology of the time perceived the mind as divided into distinct faculties of emotion, volition, and intellect. There was no psychological consensus, however, on which of these three divisions best classified OCD.
Modern concepts of OCD evolved during the 19th Century, when the term “neurosis” implied a neuropathological condition. Psychiatrists struggling to understand the mentally ill gradually distinguished obsessions, in which insight was present, from delusions, in which it was not. Compulsions they distinguished from “impulsions,” which they saw as various forms of stereotypical and involuntary behavior. Influential psychiatrists argued about whether OCD was a disorder of the will, the emotions, or the intellect.
In 1805, Jean-Étienne Esquirol published in Paris a thesis assuming that mental illnesses are disorders of the soul with no effect on patient intellect. Esquirol characterized OCD as a monomaniacal condition in which a patient otherwise sane and rational becomes preoccupied with one thought. He could not determine, however, whether the disorder was volitional or intellectual in nature.
In the 1850s, French psychiatrists downgraded monomania as a scientific concept and studied OCD by applying diagnostic categories. Some spoke of obsessions as impulsive follies acting on irresistible urges driving both obsessions and compulsions. As patients could not control such impulses, they considered OCD a volitional disorder. Others preferred to classify OCD as emotional for its frequent anxiety symptom.
The German psychiatrist Westpahal saw OCD as an intellectual disorder with symptoms in both thoughts and actions. His term, “Zwangsvorstellung,” for the condition translated into English as “compulsion” in America and as “obsession” in Britain, coining the modern compound term. However, once so identified, OCD soon became categorized under neurasthenia, a term now no longer in technical use, meaning nervous debility or exhaustion. American neurologist George Beard described the condition as an enervation of the central nervous system under the stresses of urbanization and overly competitive business practices with symptoms of anxiety, fatigue, headaches, sexual dysfunction, and depression treated by methods ranging from rest to electrotherapy. Although still a diagnosis in China and other parts of Asia, neurasthenia is no longer part of the Diagnostic Statistical Manual published by the American Psychiatric Association.