Reflections on Repetitive Intrusive Thoughts: Diagnostic Dilemmas and Beyond

Journal of the Indian Academy of Applied Psychology

July 2010, Vol.36, No.2, 197-206.

Reflections on Repetitive Intrusive Thoughts: Diagnostic Dilemmas and Beyond

R. Tripathi and S. Mehrotra

National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore

Abstract

Repetitive thoughts (RTs) are normal phenomena; however, these also form essential features of various psychiatric syndromes. This paper describes two unusual adult cases of repetitive thoughts. Both the cases were characterized by emergence of repetitive images and thoughts that were intrinsically pleasurable and were in consonance with developmental concerns in early adulthood. The RTs were not considered irrational by the individuals. The immediate consequences described were that of pleasure and relief. The RTs acquired an intrusive quality overtime. The increasing frequency of intrusions was accompanied by decreasing sense of control, heightened impairment in overall functioning and distress although the RTs continued to be described as giving pleasure during their occurrence. Despite warranting clinical attention, the presentation of the cases was atypical in various ways and did not adequately match the criteria for any diagnosis. The phenomeno\og'ica\ description highlights the evo\ut\on of repetitive thoughts in terms of qualities such as intrusiveness, ego-syntonicity as well as co-occurrence of positive & negative affective tones. Using existing theoretical frameworks, the possible psychological mechanisms underlying these presentations are discussed. The paper raises several questions on repetitive, intrusive thoughts that need to be addressed through further research.