Obsessions and compulsions

An Obsession is a recurrent thought/image/impulse which the patient cannot get rid of. It occurs repeatedly, and dominates the patient's consciousness, although the patient realizes it is senseless and tries to resist it. There is a subjective sense of struggle -the patient resists the obsession, but it intrudes into his awareness. The patient is also aware that the obsession are his own thoughts. If the delusion and an obsession were compared, it is clear that unlike in a delusion, a patient with an obsession does not believe his thoughts is true; and unlike in a deluded patient, the patient with obsessions tries to resists his obsessive thoughts.

For example, a patient gets the recurrent obsessive thoughts that her skin will become dirty and leads to disease. She is aware that this is a senseless thought, and tries to resist it, but she gets this thought again and again and this causes her distress.

A compulsion can be described as an obsessional motor act. Here the patient carries out a stereotyped motor act repeatedly, and feels a strong urgent to do so. At the same time, he knows that the act is senseless, it causes him distress and he tries to resist it unsuccessfully. A compulsion might be secondary to an obsessive idea/image. For example the woman who has recurrent obsessive thoughts of becoming contaminated might also have a compulsion to wash.

Often these compulsions or motor acts are carried out in stereotypic ritualistic ways-hence they are often referred to as compulsive rituals. For example if the compulsion is to wash, the patient may have a ritualistic way of washing, such as pouring water five times, applying soap twice, and pouring water 15 times and so on. The ritual is usually individualistic to each patient. Compulsive acts are of many kinds; the commoner kinds are checking rituals, washing rituals, counting rituals and dressing rituals.

Obsessions and/or compulsions are the key feature of obsessive compulsive disorder. Obsessive phenomena may also form part of the symptomatology of other disorders such as depression, schizophrenia and some post encephalitic states. Obsessive traits are also often seen in healthy people where it does not account to a disorder.