OBSESSIONS & COMPULSIONS OF THOUGHT

- Also termd as rumination

- Thought that persists + dominates one’s thinking :
obsessions - despite one’s awareness
- entirely w/o purpose
- dominates beyond the purpose of relevance and appears against
will

- Content of the obsession is often of a nature as to cause the sufferer great

anxiety and even guilt.
- # prudish person is tormented by the thoughts of sex; mother with an
obsession that she may harm her baby

- Compulsions are merely obsessional motor acts.

- An obsessional impulse or obsessional mental image/ thought may lead to
compulsive behavior.
- # Obsessional fear of contamination may lead to compulsive hand washing

Obsessional images Vivid images that sometimes they are mistaken for pseudo
hallucinations.
# being obsessed abt image of one’s own gravestone that clearly has
his name engraved on it.

Obsessional ideas = ruminations.

Ranging from why the sky is blue to the possibility of committing
fellatio with god.

Contrast thinking Obsessional thoughts take the form of contrast thinking in which the
patient is compelled to think the opposite of what is said.
 This can be seen as COMPULSIVE BLASPHEMY. For example, in the
case of a devout patient who was compelled to make a blasphemous
rhymes so that when the priest said ‘god almighty’ she was compelled
to think and say ‘ sod allshitey’.

Obsessional impulse Obsessional impulses to touch, count, or arrange objects, or impulses

to commit antisocial acts.
Apart from obsessions with suicide and homicide in depressed
patients, it is very unusual for the obsessed patient to carry out an
obsessive impulse.

Obsessional fears or They consist of groundless fear that the ptt realizes is dominating w/o
phobias a cause,

- Obsessions occur in obsessional states | depression | schizo | organic states |

- Compulsive features in post-encephalitic parkinsonism.

- Sometimes there is difficulty in distinguishing OCD from psychosis.

Up to 14% of ptts with OCD may report psychotic phenomenon, such as delusions
and hallcinations of thought dd. These quasi-psychotic symptoms may hv significant
impact on ptt’s ability to think clearly abt their obseesions and compulsions.

THOUGHT ALIENATION
v/s
Obsessions
 In obsessional thoughts,
- ptt knows that they are
compelled to think about
things against their will,
therefore do not associate
such obsessional thoughts with
external force
In thought alienation,
- ptt believes that their thoughts
are under the control of an
outside /external force, or that
others are participating in their
thinking.
Thought insertion
Thought deprivation
Thought broadcasting

- psychoanalytic interpretation :
that the boundary between the
ego and the surrounding world
has broken down.

- Thought alienation is an
important symptom in
diagnosis of schizo according to
ICD-10.

Thought insertion Thought deprivation Thought broadcasting

This term is used to describe a

In pure thought insertion the In this the belief is that range of slightly different
patient knows that thoughts are as they are thinking experiences :
being inserted into their mind their thoughts
and they recognize them as being suddenly disappear Patient believes that as they are
foreign and coming from without. and are withdrawn thinking, everyone else is
from their mind from a thinking in unison with them.
it is primarily associated to foreign influence.
schizophrenia but it’s also found The belief that one’s thoughts
in other psychotic illnesses. Thought deprivation is are quietly escaping from one’s
the subjective mind and that other ppl might
experience of thought be able to access them.
 blocking and
‘omission’. Experience of hearing one’s
thoughts spoken aloud and
believing that as a result other
ppl can hear them too.

Psycho-analytic interpretation
- Experiences of thought alienation breaks the boundary b/w the ego and the
surrounding world.
- Therefore, it is classified as one of the symptom of schizophrenia by ICD-10.

2 imp.phenomenon to consider :

Ego syntonic v/s Ego- dystonicity

- Ego-syntonicity – an experience which is consistent with the goals and needs of

the ego and consistent with the individual’s ideal self-image.
- Ego-dystonicity is the reverse case.

An important thing to note is that as an individual with psychosis develops insight

into their symptoms, the experience of thought alienation may seem increasingly
ego-dystonic and quite distressing to them.

C. DISORDERS OF CONTENT OF THINKING

C.1 DELUSIONS

- Delusion is defined as a false, unshakable belief.

- Another type of false belief is ‘ overvalued idea’ which can occur in individuals
with or w/o mental illness. Overvalued idea is a thought that takes precedence
over other ideas.

- True delusions / Apophany / Autochthonous delusions

- P.D are those delusions which cannot be deduced from any other morbid
phenomenon.
- P.D is a diagnostic symptom of schizophrenia ; certain organic states;
de[ression ; personality dd

1.
Primary
delusions
 -Are those delusions that are secondary to depressive moods and
psychogenic stress reactions. Therefore, unlike primary delusions they arise
2. from some other morbid phenomenon.
secondary
delusions -It has been established that projections play an important role in the
formation of delusions.
Personality also plays important role in the genesis of delusional states.

- According to Freud, delusion of Persecution and Grandeur, is a result of

Latent Homosexuality!!

- a full blown paranoid psychosis that occurs after a stressful event in

schizophrenia is called SENSITIVE BEZIEHUNGSWAHN.
In milder cases Sensitiver beziehungswahn, is an alternate term for ideas of
reference. In this the person thinks as people are talking about him or
observing him or a talk is going on about him on television or radio. Seen
in social phobia, depression, delusional disorder and in schizophrenia where
they are often present up to a delusional extent.
3.
Systematiza In schizo, once primary delusions start, thay are integrated in some
tion ‘delusional system’ = called delusional work. Under this psychologists often
divide delusions into systematized delusions and non-systematized delusions.
In which there is one basic delusion and rest is built logically on this error.

C.2 TYPES OF DELUSIONS

Delusions are unshakable false beliefs held by an individual despite being presented
with rational and logical arguments and evidence to support the contrary. These beliefs
are not shared by the people of the same cultural and religious background and cannot
be accounted for by the individual’s level of intelligence.
1. delusion of persecution o most common type of delusion
(suspicion) o believes that he is going to be harmed by a living or non-
living thing, another person, group, organization or some
force or power despite there being no evidence to support
such belief.
o Injury can be either physical injury or a damage to his
reputation.
# My office colleagues are ganging up against me as I am better than
them; they want to belittle me in front of my boss.
2. delusion of reference

o The individual misrepresents harmless, non-suspicious

events or mere coincidences as being strongly applicable to
him.

Example: an individual believes that the news being read out on TV is

directly referencing him, music being played on the radio is played for
him, and car number plates have a coded message for him.

o Patient knowns that ppl are talking abt him, slandering him or
spying on him.
o Such delusions are not confined to schizo and can occur in
depressive illness and other psychotic illnesses

Ptt.with severe depression may believe that they are

extremely wicked and that other ppl know this and are
therefore quite justifiable spying on them.

3. delusion of guilt
o The individual believes that he is a bad person and has done
something terribly wrong for which he deserves to be punished.
These delusions usually start off by the individual being overly
critical of himself and by feelings of self-reproach. The patient
 feels unworthy of himself. Usually seen in depressed patients
and can lead to suicide or homicide.

o Can be so marked that the person believes that he is about to

be put to death or imprisoned for life. And this alleged
persecution is believed to be fully justified.
o These guilt delusions are often associated with nihilistic ones.
It might also give rise to delusions of persecution.

8. nihilistic delusions Delusions of negation occur when the ptt.denies the existence of
their body, mind, their loved ones, and the world aroundthem.

They may assert that they hv no mind, no intelligence, no body

part, everyone is dead.

Occur in depression, schizo, states of delirium.

Associated with delusions of enormity.

Delusions of being poisoned Or infected are reported by ptts who are morbidly jealous, they
believe that their spouse is poisoning them.

Delusions of influence Are a ‘logial’ result of experiences of passivity in the context of

schizo. And these feelings of passivity may be explained by the ptt
as the result of hypnotism, demon possession, witchcraft, radio
waves, etc.

4. delusion of infedility
5. delusions of love = ‘the fantasy lover syndrome’ = ‘ erotomania’
o Person is convinced that some other person is in love with
them although the alleged love may never have spoken to
them.
o They may pester the victim with letters, unwanted
attention of all kinds.
o And if ther’s no response, they claim that their letters are
being intercepted by someone who is trying to stop them
from being together.
6. grandiose delusions
7. Delusions of ill health
o The individual believes that he or she is very famous, rich,
talented (e.g. performing artist, scientist, inventor), is related to
prominent people, etc. Delusions of grandeur is seen in mania
and schizophrenia.
o In the past it was associated with ‘general paralysis of the
insane’ i.e NEUROSYPHILIS.
o Characteristic feature of depressive illnesses
o Seen in schizo also
o It is a sort of delusion of persecution, believing that they a
serious illness.

Delusional dysmorpho-
phobia
9. Delusions of poverty

Since we depend mostly on speech to reveal thought many terms that end in -lalia
(echolalia), -logia or -phasia (bradyphasia) may reflect thought disorder.