Obsessions and Compulsions

Question 1

OBSESSION

- Involuntary thoughts, images, or impulses with following characteristics:

Answer 1

1. Recurrent and intrusive, experienced as unpleasant and distressing.
2. Enter the mind against conscious resistance
3. Patients recognize these thoughts as being products of their own minds despite being involuntary and distasteful.

Question 2

COMPULSION:

- repetitive mental operations or physical acts with following characteristics:

Answer 2

1. Feel compelled to perform these in response to own obsessions.
2. Performed to reduce anxiety through belief that it will prevent a dreaded event although they are not realistically connected to the event or are ridiculously excessive.

Question 3

OCD(ICD-10):

Answer 3

1. Obsessions/compulsions present for ≥2 successive weeks and are a source of distress/interfere with patient’s functioning.
2. Acknowledged to come from patient’s own mind.
   3, Obsessions are unpleasantly repetitive
3. ≥1 thought is resisted unsuccessfully *in chronic cases, some symptoms may no longer be resisted.
4. Compulsive act is not in itself pleasurable(excluding the relief of anxiety)

Question 4

DDx:

1. Obsessions and compulsions
2. Mainly obsessions
3. Mainly compulsions

Answer 4

1. a) OCD
   - ≥2w genuine obsessions and compulsions
   b) Eating disorders
   - Over-valued idea/morbid fear of fatness
   - Ego-syntonic thoughts and actions
   - Thought do not necessarily provoke distress.
   c) Obsessive-compulsive(anankastic) personality disorder
   - Ego-syntonic
   - Enduring behaviour pattern
2. a) Depressive disorder
   - Simultaneous or after onset of depression which resolves with treatment.
   - Mood-congruent obsessions.
   - >20% patients with depression have obsessive-compulsive symptoms
   - >2/3 patients with OCD experience depressive episode in their lifetime. Symptoms are present before and can persist after treatment of depression.
   - OCD is also a chronic disabling illness so patients can have chronic, mild depressive symptoms.
   b) Phobias
   - provoking stimulus is an external object/situation, not from patient’s own mind.
   c) Generalised anxiety disorder
   - excessive concerns about real-life circumstances
   - absence of genuine obsessions and compulsion.
   d) Hypochondriacal disorder
   - Obsessions related to fear of having serious disease or bodily disfigurement.
   e) Schizophrenia
   - Thought insertion along with other symptoms.
   - Lack of insight.
3. Mainly compulsions
   a) Habit and impulse-control disorders
   - eg: pathological gambling, kleptomania, trichotillomania
   - Repetitious impulses and behaviours with no other unrelated obsessions/compulsions
   - Ego-syntonic
   b) Giles de la Tourette’s syndrome
   - Motor and vocal tics, echolalia, coprolalia
   * 35-50% of patients with Tourette’s meet diagnostic criteria but only 5-7% of patients with OCD have Tourette’s

Question 5

OBSESSION VS DELUSION

Answer 5

1. Key differential is insight
2. For an obsession, patient is aware that the thought is a product of their own mind.
3. In a delusion, the patient believes the thought to be true and representative of the external reality.