Obsessional symptoms and obsessional personality traits in patients with depressive illnesses.

The relationship between obsessions and depression has been the subject of many studies and several facts are well established. Depressive mood swings are common in patients with obsessional neuroses and, conversely, obsessional symptoms are common in depressive illnesses. Gittleson (1966) found 152 patients with obsessional symptoms in a retrospective study of 398 psychotic depressives, and obsessional symptoms were present in 14 of the 61 patients described by Lewis (1934) in his study of the symptomatology of melancholia. Usually these obsessional features develop during the depression and fade away again afterwards, or, if they were present beforehand, they get worse during the depression and revert to their original intensity afterwards. But this is not invariably the pattern. Obsessional fears may become transformed into delusions at the height of the illness; sometimes obsessions persist after the depression has lifted instead of fading away again; and occasionally they may even disappear as a depression develops. The form of these obsessions is identical with that of the compulsive acts and obsessional ruminations developing in other settings, but the content, as Lion (1942) and Stengel (1945) have pointed out, tends to be restricted to aggressive themes. The patient fears he may kill himself, or that some harm may befall his relatives or loved ones; or perhaps he takes elaborate precautions to avoid knives and scissors or other dangerous objects.