Definition of Obsession in OCD
Option A is correct: An obsession is defined as recurrent or persistent thoughts, impulses, or images that are experienced as intrusive and unwanted. 1, 2
Core Definition from DSM-5 Criteria
According to the formal diagnostic criteria, obsessions are specifically characterized by:
- Recurrent and persistent thoughts, urges, or impulses that are experienced as intrusive and unwanted, causing marked anxiety or distress in most individuals 1, 2, 3
- The individual attempts to ignore, suppress, or neutralize these thoughts with some other thought or action (typically by performing a compulsion) 1, 2
Why Other Options Are Incorrect
Option B describes compulsions, not obsessions:
- Repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) are the defining features of compulsions 1
- Compulsions are performed in response to obsessions or according to rigid rules 1, 2
Option C describes flashbacks or re-experiencing symptoms:
- This characterizes post-traumatic stress disorder (PTSD), not OCD 1
- The DSM-5 criteria explicitly distinguish OCD from trauma-related disorders 1
Option D describes perceptual disturbances:
- This refers to hallucinations or other sensory distortions, which are not features of obsessions 1
- While individuals with OCD may have poor or absent insight, obsessions remain thoughts/urges/images, not perceptual disturbances 2
Clinical Context and Common Pitfalls
Key distinguishing features of obsessions:
- They are ego-dystonic (unwanted and inconsistent with the person's values), unlike delusions which are ego-syntonic 1, 4
- Common themes include contamination concerns, harm to self or others, intrusive aggressive or sexual thoughts, and symmetry concerns 1
- Most adults can recognize and describe their obsessions, though children may have difficulty articulating them 1, 2
Avoid confusing obsessions with:
- Normal intrusive thoughts (which don't meet the time-consuming >1 hour daily or significant distress criteria) 2
- Worries in generalized anxiety disorder (which are typically about real-life concerns rather than irrational fears) 2
- Delusional beliefs in psychotic disorders (where insight is completely absent, versus OCD where insight typically varies) 2