Disorder of Possession of Thought

Has to do with issues with the feeling of possession or mental control.
Typical experience: Being aware of and in charge of one's thoughts. It is possible for psychiatric disorders to cause a person to lose control or ownership of their thoughts.

Patterns Of Disorders Of Possession Of Thought

Obsessions and Compulsions

Obsessions: Reluctant but unacceptable ideas that the patient feels helpless to control. Definition (Schneider): The incapacity to purge the mind of mind-numbing or overpowering stuff that is acknowledged as illogical.

• Characteristics (ROSIE pneumonic):
  • Repetitive
  • Own Intrusive
  • Senseless
  • Irresistible

Also Read: Formal Thought Disorders

Thought Alienation (Passivity of Thought)

 Often referred to as delusions of power over one's own ideas, the sensation that one's thoughts are influenced by outside forces rather than oneself.  A diminished sense of control over ideas that are ascribed to outside influences.

Rigid Control of Thought and Intolerance for Variation

Linked to a stoic or fixation-driven mentality. Distinguished by inflexible commitment to ideas and intolerance for change.

Obsessions in Psychiatry

• Subjective Compulsion: People who are obsessed often feel pressured or driven from within to act in a specific way or think in a certain way.
• Resistance: In spite of the compulsion, there is frequently resistance to these ideas or actions, which suggests a psychological battle for the person.
• Preservation of Insight: People who experience obsessions usually continue to be aware of the absurd or illogical nature of their ideas or urges, in contrast to certain other mental processes.

Differentiating Obsessions from Other Symptoms

• Loss of Contact with Reality: People with obsessions are still aware of reality even when their ideas are intrusive, in contrast to people with delusions who completely lose contact with reality.
• Distinguishing Obsessions from Hallucinations and Delusions: Unlike hallucinations and delusions, obsessions are regarded as real and people frequently try to resist or control them.
• Lack of Compulsive Behavior: Unlike compulsions or cravings, which can be a symptom of disorders like substance abuse or sexual abnormalities, obsessions are not motivated by these feelings. It's possible that the sufferer doesn't like himself.

Forms Of Obsessions

1. Obsessional Thoughts
   • Simple Thoughts: Repetitive ideas, which might be simple, complicated, or even ritualistic, that people find bothersome and reject.
   • Contrasting Thoughts: When someone has an obsession, they may feel forced to think in opposition to ideas or assertions that are put out.
2. Obsessional Images
   • Vibrant Mental Imagery: People may encounter obtrusive, frequently recurring mental images that are recognized as mental creations.
   • Distinguishing Between Pseudo-Hallucinations: Unlike hallucinations, which take place in objective outer space, vivid, obsessional visions happen in the mind's eye and are somewhat controlled.

Types Of Obsessional Images (Remembered As OCD2)

1. Obsessional Images: Recurrent, unwanted, and intrusive thoughts, such as pictures of wounds or blood.
2. Compulsive Images: Show obsessive actions intended to correct obsessional images, such as seeing the living dead.
3. Disaster Images: Exaggerated catastrophes are linked to obsessive-compulsive checking, which breeds anxiety of dire situations like home fires.
4. Disruptive Images: Images that are bothersome and interfere with compulsive rituals, forcing people to repeat compulsions in order to feel better. 

3. Obsessional Impulses

Strong desires to act—which can range from insignificant to aggressive or socially disruptive—are referred to as obsessional impulses.
Patients may feel compelled to touch, count, organize objects, or engage in antisocial behavior, but it's rare that they will follow through on these urges. People who suffer from severe depression are more likely to act on impulses, such as obsessions with suicide or violence.

4. Obsessional Rumination

Pseudo-philosophical concepts that are repetitious and needless are a feature of obsessional rumination; they frequently don't result in any novel insights. Patients may think about philosophical issues repeatedly without coming to a meaningful conclusion, such as the presence of God, the color of the sky, or the form of the Earth.

5. Obsessional Fear or Phobias

These obsessions are made up of unfounded concerns that control the person's thinking and have no apparent reason. People can have phobias or anxieties, such as the fear of talking about intimate relationship problems in public, even though they don't want to.

6. Obsessional Doubts

The tendency to doubt if a task has been sufficiently finished, which results in a pattern of checking, is known as obsessional doubts.
OCD sufferers frequently question whether they've finished activities like locking doors or turning out lights, which causes them to check things over and over again. 

7. Miscellaneous Obsessions

Miscellaneous obsessions is the category for obsessions that do not fall into any other recognized category. This grouping of obsessions highlights the diversity of obsessive thoughts and impulses because different types of obsessions cannot be classified in any other category.

Also Read: Thought Disorder: Causes, Types, Symptoms, Risk Factors, Diagnosis And Treatment

Content And Forms Of Obsessions And Compulsions

Content of Obsessions

Themes associated with obsessions include filth and pollution, violence, injury to oneself or others, impersonal worries, sexual ideas, religious obsessions, and other unrelated material. While there used to be a higher prevalence of sexual obsessions, current trends indicate a rise in worries about hurting other people, which reflects anxieties about aggressiveness in the modern world. 

The subject matter of obsessions is important because it can cause a great deal of worry in people, especially when it covers taboo topics like religion or sexuality. Since the content can affect a patient's symptom severity and related suffering, clinicians should carefully evaluate it while diagnosing and treating patients.

Obsessions in Various Disorders

• Relationship with OCD: Although obsessions are frequently linked to obsessive-compulsive disorder (OCD), they can also arise in other mental health diseases, including post-encephalitic syndrome, depression, schizophrenia, and psychotic illnesses.
• Difficulties with Differential Diagnosis: It can be difficult to distinguish obsessions from delusions and hallucinations, particularly when they co-occur with OCD or other illnesses. Accurate diagnosis and patient treatment depend on careful evaluation.

Forms of Compulsions

• Obsessional Motor Actions: Compulsions are the result of obsessional motor actions, which can be triggered by an obsessional impulse and result in action directly or through the mediation of obsessional ideas or mental images.
• Yielding Compulsions: Despite being aware of the irrationality of their acts, people with these compulsions nonetheless act to satisfy underlying obsessional needs, such as easing worries or averting perceived harm.

Controlling Compulsions

These aim to divert or suppress obsessions without directly acting.

Hope you found this blog helpful for your Psychiatry residency Basic Sciences preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.