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A totally different picture of repression is shown, once more, in the third disorder which we shall consider for the purposes of our illustration - in obsessional neurosis. Here we are at first in doubt what it is that we have to regard as the instinctual representative that is subjected to repression - whether it is a libidinal or a hostile trend. This uncertainty arises because obsessional neurosis has as its basis a regression owing to which a sadistic trend has been substituted for an affectionate one. It is this hostile impulsion against someone who is loved which is subjected to repression. The effect at an early stage of the work of repression is quite different from what it is at a later one. At first the repression is completely successful; the ideational content is rejected and the affect made to disappear. As a substitutive formation there arises an alteration in the ego in the shape of an increased conscientiousness, and this can hardly be called a symptom. Here, substitute and symptom do not coincide. From this we learn something, too, about the mechanism of repression. In this instance, as in all others, repression has brought about a withdrawal of libido; but here it has made use of reaction-formation for this purpose, by intensifying an opposite. Thus in this case the formation of a substitute has the same mechanism as repression and at bottom coincides with it, while chronologically, as well as conceptually, it is distinct from the formation of a symptom. It is very probable that the whole process is made possible by the ambivalent relationship into which the sadistic impulsion that has to be repressed has been introduced. But the repression, which was at first successful, does not hold firm; in the further course of things its failure becomes increasingly marked. The ambivalence which has enabled repression through reaction-formation to take place is also the point at which the repressed succeeds in returning. The vanished affect comes back in its transformed shape as social anxiety, moral anxiety and unlimited self-reproaches; the rejected idea is replaced by a substitute by displacement, often a displacement on to something very small or indifferent. A tendency to a complete re-establishment of the repressed idea is as a rule unmistakably present. The failure in the repression of the quantitative, affective factor brings into play the same mechanism of flight, by means of avoidance and prohibitions, as we have seen at work in the formation of hysterical phobias. The rejection of the idea from the conscious is, however, obstinately maintained, because it entails abstention from action, a motor fettering of the impulsion. Thus in obsessional neurosis the work of repression is prolonged in a sterile and interminable struggle.