A 22-year-old student reports recurrent intrusive thoughts about harming others, which distress him. He has never acted on these thoughts and recognizes them as ego-dystonic. He performs mental rituals (counting) to neutralize the anxiety. According to OCD classification, these intrusive thoughts are BEST described as:
- A Command hallucinations
- B Ego-syntonic delusions
- C Obsessions (ego-dystonic, intrusive thoughts) ✓
- D Overvalued ideas
Explanation
In OCD, obsessions are recurrent, persistent, unwanted intrusive thoughts, urges, or images that cause marked distress and are experienced as ego-dystonic (foreign to the person's sense of self) — the individual recognizes them as products of their own mind. Mental acts performed to reduce distress (counting, praying) are classified as mental compulsions. Command hallucinations are experienced as coming from an external source. Ego-syntonic delusions are consistent with one's self-image. Overvalued ideas are deeply held beliefs with some emotional investment but not completely ego-dystonic.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.