A 22-year-old medical student is plagued by intrusive thoughts that he might harm his family members, despite being a gentle person who is horrified by these thoughts. He spends hours performing mental rituals to 'neutralise' them. He has insight that the thoughts are senseless. Which feature of this presentation SPECIFICALLY distinguishes OCD from violent psychosis?
- A The thoughts involve violence
- B The thoughts cause distress
- C Mental rituals are performed
- D The thoughts are intrusive, unwanted, and ego-dystonic, with full insight and no intent ✓
Explanation
The ego-dystonic nature of OCD obsessions — experienced as intrusive, unwanted, and repugnant to the individual's own values — is the key distinguishing feature from psychotic violent ideation. In OCD, the patient has full insight (recognises the thoughts as products of his own mind, not externally imposed), is horrified by them, and has no actual intent to act. In violent psychosis, violent ideation is typically ego-syntonic, driven by delusional beliefs or command hallucinations, with impaired insight. OCD patients with harm obsessions rarely act on them; the presence of insight and ego-dystonicity is diagnostically and prognostically important.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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