Which feature best distinguishes obsessions in OCD from the worries seen in generalised anxiety disorder?
- A Worries are always more severe and prolonged than obsessions
- B Obsessions are experienced as intrusive and ego-dystonic and are typically followed by compulsive rituals ✓
- C Worries concern imaginary threats whereas obsessions concern real-life issues
- D Obsessions respond only to benzodiazepines
Correct answer: B. Obsessions are experienced as intrusive and ego-dystonic and are typically followed by compulsive rituals
Explanation
Obsessions are intrusive, unwanted, and recognised as excessive or irrational by most patients, and they characteristically trigger compulsions performed to neutralise the distress. Worries in generalised anxiety disorder concern ordinary real-life matters such as finances or health, are experienced as excessive but less alien to the self, and are not relieved by ritualised acts. Option C inverts reality: it is GAD worries that centre on real-life concerns, making it the key distractor to reject.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
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