Which of the following best distinguishes obsessions in OCD from the intrusive thoughts experienced in normal individuals?

• A Normal intrusive thoughts are always pleasant, while OCD obsessions are always violent
• B Obsessions in OCD are exclusively about contamination, while normal intrusive thoughts cover many topics
• C Normal individuals never experience intrusive thoughts about harm or aggression
• D In OCD, obsessions are experienced as ego-dystonic, cause marked distress, and the individual attempts to neutralise them with compulsions or mental acts ✓

Explanation

Research shows that the content of intrusive thoughts in OCD and in the general population is largely similar, covering themes of contamination, harm, sex, and religion. What distinguishes OCD is the degree of distress, the appraisal of the thought as highly significant or dangerous (cognitive model), and the compulsive attempts to suppress or neutralise the thought. Ego-dystonicity (the thought is experienced as alien and contrary to one's values) drives distress. Normal intrusive thoughts are readily dismissed and cause minimal disruption.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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