By Forman S. Acton
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How might such a patient's thoughts and images of what she thinks is going to happen to her be distinguished from such obsessions as the following? (a) images of horribly mutilated dead bodies (b) blasphemous thoughts (c) unacceptable insults concerning, for example, the appearance or conduct of the patient's partner or close relatives (d) number sequences and nonsense phrases that continually run through the patient's mind The crucial difference between such experiences as these and phobic thinking seems to be that the latter refers to objective states of affairs that the patient fears she will have to encounter, and/or things that she fears may happen - often her fear will concern situations she knows she will have to encounter very soon, as in the foregoing example of the agoraphobic.
Attempts are made to ignore or suppress them" (p. 234). This passage is slightly modified in DSM-III-R, which states that obsessions need only be initially experienced as "intrusive and senseless" (p. 245). The DSM-III/III-R criteria add that a person must recognise his thoughts, impulses, and so on, to be the product of his own mind if these are to be symptomatic of OCD. Rachman and Hodgson (1980, p. 2) similarly suggest that the diagnostic criteria for obsessions are "intrusiveness, internal attribution, unwantedness and 6 Theoretical approaches to obsessive-compulsive disorder difficulty of control".
5). By contrast, three remaining examples of OCD symptoms can indeed be satisfactorily described as fears of, or discomfort about, external objects or situations. Thus, consider those symptoms exhibiting characteristic (iii), which involve concerns about bizarrely unlikely outcomes - concerns, as mentioned in earlier examples, such as whether or not people will come to serious harm 20 Theoretical approaches to obsessive-compulsive disorder through tripping on small stones or having books fall on them from household shelves.