Question
A 40-year-old male says, “he feels that his feet are dirty but knows that it’s not true. This gives him discomfort, and hence he has to wash them again and again.” This is a disorder of thought __________?
| A. | Possession |
| B. |
Flow |
| C. |
Form |
| D. |
Content |
|
Correct Answer » D Explanation |
 |
The patient has:
- A recurrent, intrusive thought that his feet are dirty.
- Insight that the thought is irrational (“I know it is not true”).
- Significant anxiety because of the thought.
- A repetitive washing ritual performed to reduce anxiety.
These are the classic features of Obsessive-Compulsive Disorder (OCD).
The diagnosis is based on:
- Obsession: Recurrent, intrusive, unwanted thought that is recognized as one’s own and is ego-dystonic.
- Compulsion: Repetitive behavior (washing) performed to relieve anxiety caused by the obsession.
According to the traditional classification of psychopathology, obsessions are disorders of thought content, because the abnormality lies in what the patient is thinking rather than the organization or flow of thought.
Why Other Options are Incorrect
A. Thought Possession
Disorders of thought possession involve an abnormal experience regarding the ownership or control of thoughts.
Examples include:
- Thought insertion
- Thought withdrawal
- Thought broadcasting
These are Schneider’s first-rank symptoms of schizophrenia.
Although some recent teaching resources categorize obsessions under thought possession because they are experienced as intrusive, the patient recognizes the obsessive thoughts as his own, unlike true disorders of thought possession.
B. Thought Flow
Thought flow refers to the speed and continuity of thinking.
Examples:
- Flight of ideas
- Retardation of thought
- Thought block
The patient has no abnormality in the rate or continuity of thought.
C. Thought Form
Thought form refers to the organization and logical structure of thinking.
Examples:
- Loosening of associations
- Tangentiality
- Circumstantiality
- Neologisms
- Word salad
The patient’s thoughts are coherent and logical.
