You are on page 1of 16

ABNORMAL AND NORMAL OBSESSIONS

S. RACHMAS and P. DE SILVA


Psychology Department. lnstttute of Psychmtry. De Crespigny Park. London. SE5 YAF

Summary-Three related. e.xploratory studies were carrted out in order to ascertatn the occur-
rence and nature of normal obsesstons. and to relate them to abnormal obsessions. The subjects
included S obsessional patients, and up to 121 non-chnical SubJectS.
Broadly. the findings were that normal obsessions are a common experience and they resemble
the form of abnormal obsessions. They also show some notable similarittes of content. However.
normal and abnormal obsessions differ in several respects. includin g frequency. duration. inten-
sity and consequences. among others.
With repeated practice, the frequency. duration and discomfort of obsessions are observed
to decrease. Overall. the findings are considered to be consistent with the noxious stimulus
cum habituation theory.

In the course of developing a theory to account for obsessions it became necessary


to assume that all people experience a phenomenon akin to ‘clinical’ or ‘abnormal’
obsessions (Rachman, 1971). The first aim of the present investigation was to test this
assumption.
Secondly, we set out to determine the similarities and differences between normal
and abnormal obsessions. And finally, we attempted to gather some preliminary experi-
mental data pertinent to that part of the theory which postulates that obsessions are
subject to an habituation-like process.
In the earliest form of the theory it was proposed that obsessional material should
be construed as (largely internal) noxious stimuli to which the person has failed to
habituate. Such failures to habituate were assumed to be the result of a combination
of factors including mood disturbance, pre-disposing hyper-sensitivity, specially signifi-
cant material. heightened arousal and in a majority of cases, a precipitating event. Habi-
tuation to potentially or actually disturbing material was (presumably) facilitated by
lowered arousal, stable mood, repeated presentations of evoking stimuli, prolonged expo-
sures. The subsequent elaborations of the theory (Rachman, 1977; Rachman and Hodg-
son. 1978) are of marginal relevance to the present experiment and will not be taken
up here.
The first study, which aimed to find out whether non-psychiatric subjects experience
obsessions, consisted of a simple questionnaire survey. The second study. in which we
sought to discover the similarities and differences between clinical (abnormal) and non-
clinical (normal) obsessions, consisted of standardized interviews of obsessional patients
and non-clinical subjects with obsessions. The third study, in which we tested whether
obsessions can be formed to instruction and whether they show signs of habituation,
consisted of a simple experiment carried out on clinical and non-clinical subjects.
For purposes of the investigations, obsessions were defined as repetitive, unwanted,
intrusive thoughts of internal origin. A full discussion of this definition and its conceptual
justification is provided elsewhere (Rachman, 1978, and Rachman and Hodgson, 1978).

STUDY I-NORMAL OBSESSIONS


A simple questionnaire was given to 124 normal people, inquiring about the presence
or otherwise of intrusive, unacceptable thoughts and impulses, their frequency, and about
whether or not these could be easily dismissed. The questionnaire inquired about
thoughts and impulses separately.
The sample was not random. but was determined by easy availability. Most were
students-postgraduate, undergraduate or professional-and some were employed as

233
research workers. nurses. clinicians etc. Fifty-seven of the sample were males. and 67
were females. Their age ranged from 16 to 51. with a mean of 17.7 years. The average
age of the males was 38 vears (range 19-51) and that of the females 27.5 years (range
I&15).
Respondent’s characterljtlcs

\lalr Female Total

\lCln age 2Y 27.5 27.7


RXlge Ii)-51 I6A.s 16-51
Number 57 67 171

Of the 12-t respondents, 99 reported that they had either thoughts or images. Twenty-
five responded negatively-i.e. they had neither thoughts nor impulses. In other words,
79.8-l of the total sample of normals were positives. and 20.16 were negatives. This
substantially confirms the first hypothesis of this investigation-vi:. that non-psychiatric
subjects commonly experience obsessions. There were no age or sex-related differences
in presence or absence of obsessional experiences.
/Vryari~ rrspo~tler~rs. No systematic study was made of the negative respondents.
However. some of them made unsolicited comments and observations on the question-
naire forms and verbally. Five subjects emphasized that they did have obsessions of
the type given in the examples in the questionnaire. but did not consider them to
be unacceptable: they had therefore responded in the negative. Of these five, three
admitted to having both thoughts and impulses of this sort. one to having thoughts
only. and the other impulses only. One of the positive respondents, a female who had
responded positively to impulses only. also indicated she had some of the thoughts
in question. but did not consider them to be unacceptable.
The conclusion from these unsystematic data seems to be that people vary in the
level of tolerance. or criterion. of what is an acceptable thought or impulse, and what
is not. One subject stated that: ‘My criterion of what is unacceptable is high’. Another
subject observed that: ‘I do not consider these unacceptable. But they are by ethical
standards of society.’
For the present purposes. it must be noted that 5 out of a total of 25 negatives
in the sample would have been classed positives, if not for the problem of unacceptabi-
lity. If the present frequency data are revised. by re-classifying these 5 subjects as positive.
then 104 out of 124 (i.e. 844;) would be positives. The explanation of why 16% have
no obsessions is unknown.

Positike 37 57 IOA
(S2.5)’ (35. I ) (93 91
Negative 20
(,:.:I $9, (16.1)
Total 57 67 124

* Figures within brackets show the


number in ths cell 3s a percentage of the
total in category-mats. female. total.

The nature of normal obsessions. Of the 99 positive respondents, 32 had only obses-
sional thoughts. 1-I had only impulses. while 53 admitted to having both. The male-
female breakdown for these data is as follows:

Thoughts only Impulses only Both Total

?&IS: IS (40)’ 5 (I 1.1) ‘1 (4S.9) 45


Female: I-l (75.9) 9 116.7) 31 (57.1) 5-l
Total 32 (32.3) 14 (II.11 53 (53.5) 99

* Figures within brackets show number in cell as a percent-


age of the total position in the catrgor)-male. female. total.
-\bnormal and normal obsesstonj 235

The following figures are for positives for thoughts and impulses separately. irrciudiny
in each category those u-ho had both.

Thoughts Impulses Total

Xf&: 40 (59.7)’ 27 (10.3) 67


Female: 4.5 (52.9) JO (17. f 1 S5
Total: Y5 (55 9) 67 WI) 152

* Figures within brackets show number in cell


as 3. percentage of total in category-male.
female. total.

(Note that the tot& here exceed the total casrs, as some subjects had both thoughts
and impulses, as indicated above). Evidently obsessional thoughts are somewhat more
common than impulses.
The frequency of the occurrence of thoughts is given below. Also indicated in the
table is the respective number of cases who found it was easy to dismiss the thought
or not, including a ‘doubtful’ category.

Frequency and dismissability of obsessional thoughts

Easily Not easily


dismissed dismissed Doubtful Total

IO+,day I z 0 3
IO+ week 13 3 0 16
IO+ ‘month 25 4 1 33
Less 27 4 2 33
Total 69 13 3 85

Frequency and dismissability of obsessional impulses

Easily Not easily


dismissed dismissed Doubtful Totat

IO+,day 1 0 0 I
IO+,week 5 0 0 5
IO+/month 22 4 0 26
Less 31 4 0 35
Total 59 8 0 67

The patterns of frequency. and ease of dismissal, are similar for the two sexes. Impulses
tend to be slightly less frequent in that, in the majority, they occur less than 10 times
a month. Also. people seem to find impulses very easily dismissible, and obsessional
thoughts easily dismissible. We were unable to identify any individual factors determin-
ing ease of dismissal. Cases positive for both, who found it difficult to dismiss thoughts
did not necessarily find it difficult to dismiss impulses-or vice versa. The general tend-
ency is for impulses to be more easily dismissible even in these cases, although numbers
are too small to draw any firm conclusions,
To conclude Study I, obsessions (thoughts andior impulses) are a very common experi-
ence. There are no sex or age-related differences in occurrence, and most thoughts
and impulses are easily dismissed. There are individual variations in the threshold of
acceptability of obsessional thoughts or impulses.

STUDY II-SIMILXRITIES TO ABNORMAL OBSESSIONS


The second stage of the investigation consisted of standardized interviews of a sample
of the positive respondents. and a sample of clinical obsessionals-i.e. patients who
had come for psychiatric help for their obsessions. Our aim was to coliect detailed
information about their obsessions and related matters, and to test the short-term effects
of repeatedly provoking the obsessions. It was planned to compare the two groups
236 S. RACHMAL 2nd P. DE SILL%

so that similarities and diffrrrnces between them. with regard to the obsessions and
their response to repeated evocation, could be explored.
The interview sessions were carried out by the same experimenter (P. de S.) for all
subjects, clinical and non-clinical. The interview was a structured one. using a prepared
schedule and a set of agreed guidelines for its use. After recording the essential back-
ground data and relevant data on the target obsession s, the repeated evocation tests
were given.
If a subject was unable to produce the obsession on request in one session. another
session was arranged wherever possible. No subject was seen for this purpose more
than thrice.
T/W ~KXI-clinicnl sample. A total of 40 subjects chosen from the positive respondents
to the questionnaire. comprised the non-clinical sample. Although it was originally in-
tended to choose the sample from among those whose obsessions had a frequency
of at least 10 per vveek. the final sample was determined mainly by availability. It
had the following composition :

The clinical sample consisted of eight subjects, as follows:

MZllC Female Total

hlcan 3gt’ 42.S 38.3 41.1


Number 5 3 8

They were all obsessional patients who had come for psychiatric treatment and in whom
the obsessions were either the sole complaint or one of the major complaints. They
were from the Maudsley. Bethlem Royal, Guy’s. and Queen Elizabeth II Hospitals.
C’o~tte~~t analr;sis. The contents of the obsessions are reported below. Only current
obsessions of the subjects have been included. Verbatim descriptions are given when
the obsession concerned takes a particular. invariant verbal form. The presence of im-
agery is noted only when the image constitutes an essential and/or prominent part
of the obsession. Circumstances of occurrence, and the specific target person or object.
are given only when the content is inextricably bound up with them.
An obsession has been considered as a single, independent one, on the basis of the
judgement of the subject himself. Sometimes, common themes with slightly varying
details were reported; in such cases. the obsession has been considered as WIT. On
the other hand. certain subjects reported more than one obsession with an underlying
theme (e.g. violence). where the individual obsessions were reported to be independent
and specific in terms of target person, object, circumstances etc. despite the common
theme. These have been considered as individual units. The total number of obsessions
exceeds the number of subjects as some of them reported several obsessions.
The obsessions of the clinical sample are given below. There is a total of 23, elicited
from 8 subjects.
to attack, or strangle, cats or kittens
to strangle children, sometimes adults
to jump out of window
to attack and harm someone, especially own son, with bat. knife or heavy
object
Thought of ‘disgusting’ sexual acts with males (male subject)
Itnpulsr to look at buttocks of boys and youths (male subject)
Thoqht whether he has been poisoned by chemicals
Thought that his eyes will be/are harmed
Abnormal and normal obsessions 237

Thought that he will get;has got cancer


Thotcght whether he has been affected by radiation
Thought ‘These boys when they were young’-a mechanically-repeated phrase
Thoughr of ‘bad’ people doing ‘all sorts of harm’. of a violent form. to ‘good’
people-i.e. family. relatives, religious persons
Thoughr that she might harm someone
Thought ‘I wish heishe were dead. with reference to persons close and dear. also
others
Thought of swear words. with large, clear images of the words in print
Impulse to utter swear words
Thought ‘Did I commit this crime?‘. when reading or hearing reports of crime
Thought that he may become insane, and end up in an institution
Thought that he may go berserk all of a sudden
Thought that he might push someone under a bus or train
Impulse to harm girl-friend with physical violence
Impulse to physically attack and harm dog, mainly own dog, but also to some extent
other dogs
Impulse to harm children with physical violence
The obsessions of the non-clinical sample are given below. There is a total of 58.
from 40 subjects. In a very few cases, there was failure to record the content of a
second (or third) obsession of the subject. A total of 7 have been omitted in this way
(the second obsession of three subjects; the third of two subjects; and the second and
the third of one subject).
Impulse to hurt or harm someone
Thought ‘what is the calorie content of that food?’
Impulse to jump on to rails, when tube train is approaching
Thought of intense anger towards someone, related to a past experience
Thought of accident occurring to a loved one
Impulse to say something nasty and damning to someone
Thoughr of harm to, or death of, close friend or family member
Thought of acts of violence in sex
Thought that something is wrong with her health
Impulse to physically and verbally attack someone
Impulse to do something--e.g. shout, throw things-to disrupt peace in a gathering
Impulse to jump in front of tube train, or bus
Thouglir of harm befalling her children, especially accidents
Thought that probability of air-crash accident to herself would be minimised if a
relative had such an accident
Thought whether an accident, especially car accident, had occurred to a loved one
Impulse of violence towards objects
Impulse to buy unwanted things
Though? identifying himself with person executed, when reading or hearing reports
of executions--‘How would I feel at that moment if I were him?‘, also clear
image sequence
Thought that she, her husband and baby (due) would be greatly harmed because
of exposure to asbestos, with conviction that there are tiny asbestos dust
particles in the house
Thought whether any harm has come to his wife
Impulse to shout at and abuse someone
Impulse to harm, or be violent towards children, especially smaller ones
Impuse to crash car, when driving
Thought ‘Why should they do that? They shouldn’t do that’, in relation to people
‘misbehaving’
Impulse to attack and violently punish some0ne-e.g. to throw a child out of bus
Thought whether any harm has come to his wife
738 s. RACHMA\ and P DE SILL h

Thoughr with clear visual image sequence. of walking along a crowded passage. and
suddenly discovering that he is naked
Thought with image sequence. of the details of an accident that she had experienced
ltnpulsr to say rude things to people
Thought about accidents or mishaps, usually when about to travel
It?7pLilsr to push peopls away and OK in a crowd-e.g. a queue
Impulse to attack certain persons
Ti7ought of being aggressive tokvards some persons
Itnp1rlw to say inappropriate things--‘wrong things at wrong place’
Thougi7t of hurting someone by doing something nasty, not physical violence-
‘Would I or would I not do it’?’
ltr7plrlsr to hurt someone by saying something nasty. or deliberately shaming him.‘her
It1rp7rl.w sexual impulse towards attractive females. knoivn and unknown
Thoughr wishing that someone disappeared from the face of the earth
Itnpulsc of violence towards a person
ThougIlt that harm would have befallen to someone near and dear
Thoughr of ‘unnatural’ sexual acts
Thought wishing and imagining that someone close to her was hurt or harmed
Impulse to hurt. or harm, someone
Itt7plclsr to shake someone hard and shout at him/her
Tl7ougl7 t of experience/s many years ago when he was embarrassed. humiliated, or
was a failure
Implrl.%~ to violently attack and kill a dog
It?7plrlsr to violently attack and kill someone
Thoughr that she might do something dramatic like trying to rob a bank
It?lplrls~~ to jump from top of a tall building or mountain/‘cliff
T17oughr of being violent towards a known person. causing harm, in revenge
ln7p1rlsr to sexually assault a female, known or unknown
Itt7pdsr to say rude and unacceptable things
Tl7oughr of an embarrassing or painful experience he has had, with visual image
sequence
I tl7plclsr to engage in certain sexual practices which involve pain to the partner
Impulse to be rude and say something nasty to people
ltt7pulse to jump off the platform when a train is arriving
Thought of physically punishing a loved one
T17oright that she might commit suicide
Clit7ical cs non-clinical. In an attempt to examine the similarity between the two
types, a small sub-study was carried out to determine whether the obsessions of clinical
and non-clinical subjects are discriminable on the basis of the content alone. For this
purpose. the 81 obsessions were printed on cards, giving only the content (as summarised
above). These were shuffled and given to six judges (five psychologists and one psychia-
tric nurse) who had clinical experience with obsessional patients. along with instructions
to sort the 81 obsessions into 2 piles-normal and abnormal-in terms of whether
they came from patients or non-patients. The number of correctly identified ‘clinical’
obsessions were 10, 13. 13. 10. 13 and 18 for the six judges. Their response as ‘clinical’.
were as follows:

Judg .A B c D E F

Correct positive guesses


(out of 23 clinical
obsessions)

SS Non-clinical
obsessions judged to
be clinical
Abnormal and normal obsessions 239

It appears that the judges were not able to identify the clinical obsessions too well.
but on the other hand they were moderately good at identifying non-clinical obsessions.
From this we can conclude that clinical obsessions are not as readily discernible-even
to experienced clinicians-as might be expected.

DIFFERENCES BETWEEN THE CLIKICAL AND


NON-CLINICAL SAMPLE

(a) Number oj obsessions at present

Clinical sample Non-clinical sample

Range I-7 l-3


Mean 2.9 I.45
.\ s 40

(b) Time since onset*

Clinical sample Non-clinical sample

Range I yr-46 yr 3 m-24 yr


Mean I5 9.4 yr
IV 8 40

+ In cases where more than one obsession was


present. the duration given is that for the one
of which the duration was longest. It must also
be noted that there is a difficulty in comparing
the two samples on this, as the clinical sample
was considerably older.

(c) Ocert compulsions unrelated to obsessions

In the clinical sample, five (5/S) reported having compulsive behaviour (e.g. checking,
washing), while in the non-clinical sample. eleven (1 l/40) reported having them.

Other rituals No other rituals Total

Clinical 5 3 8
Non-clinical II 29 40

(d) Other problems

In the clinical sample, one (l/8) also had a social phobia. but none of the other
7 had psychiatric complaints (other than obsessional behaviour noted above). In the
non-clinical sample none had any such condition.

(e) Family
Only one (l/S) person in the clinical sample said a parent was obsessional. One
had an aunt who was obsessional. In the non-clinical sample nine (9/40) had parents
described as obsessional. Three others had a close relative who was obsessional.

Parent Other close relative No relative


obsessional obsessional obsessional Total

Clinical 1 I 6 8
Non-clinical 9 3 28 40

CHARACTERISTICS OF THE OBSESSIONS


Data were obtained in detail from every subject on one obsession. In cases of multiple
obsessions, although it was hoped to obtain data on another obsession as well, in
practice it was not possible to do this in detail. Thus, full data are available only
on one obsession for each subject; and this was the one the subject considered to
be his her current obsession. The form and content of all current obsessions were how-
eher recorded.
Clinicul. The relevant data for the eight clinical subjects are given belobv.
Form. Three were impulses. and 5 were thoughts. Three (2 thoughts and 1 impulse)
had invariant and clear visual imagery associated with them.
Oct~rc~il ci~atiori. Mean of 15 years. range 1-46 yr.
011st~r. Four subjects had a clear idea as to the onset. One had a vague and uncertain
association Lvith a certain event (father’s death) with the onset of the obsession, and
the other three had no idea as to the specific onset. Of the four who did claim clear
memory of onset. in one it was change of residence and associated reservations and
doubts (leading to impulses to harm son). In another. it was the death of known co-
workers due to suspected radiation effects (leadin g to thought he may have been poi-
soned by chemicals); in one, it was a common sight of some children in a certain
place at a certain time in his life (leading to a senseless thought about the same children);
and in the other, the death of a kno\vn person which the patient’s mother kept secret
from her for some time (leading to the thought that she wished death to others).
Dctrariotl. Reported duration of each obsession varied from 2 XC to 5 min. with a
mean of 80.7 sec. In five cases. the duration was 20 set or less.
Frrqrtencr~. Frequency of occurrence varied from 3 per day to 150 times per day.
with a mean of 27. Five reported frequencies of 10 or more per day. Most said the
frequency varied. especially in relation to mood (see below).
Rrpetiri~nrss. Only three described a tendency for the obsession to return immedi-
ately, or almost immediately. having occurred and gone away.
R~sisra~lcr. Four reported high resistance to the obsession, three moderate resistance,
and one low resistance. Two of those reporting moderate resistance and the one report-
ing low resistance stated that initially they had resisted strongly, but now they were
‘used to it’. This decline in resistance over time has also been independently observed
among other types of obsessional-compulsive patients (Rachman and Hodgson. 1976).
Pro~~ation. Five said their obsessions occurred with no identifiable external provoca-
tion; one said that subjective anxiety was the provoking factor. Interestingly. all rhesejce
bvere rhortghrs, as against impulses. In the case of the three impulses. sight of the target,‘s
(e.g. children) or associated stimuli (e.g. bats or heavy objects, bvhere impulse was to
attack child with such object). that is external stimuli. inrariclb/y rriggereri the impulse.
Of these three subjects, one would also sometimes get the impulse without provocation,
and another would also sometimes get the impulse at the thought of going out.
Senselrssness. Only two subjects had obsessions that they considered senseless. One
of these was the mere mechanical repetition of a string of words (‘these boys when
they were young’). The other was not senseless so much as vague.
Persotlnl it7mlretmwt. Five had direct personal involvement. one had no personal in-
volvement at all (one referred to in the above paragraph). and in two the involvement
was indirect (harm coming to people known; harm being wished by self to others).
Intrnsit~l. Subjectively felt intensity was high in six, and moderate in two. The latter.
hoivever. reported it was high initially but had weakened over time.
:\iemity. All except one (whose obsession was a string of words), said it had meaning
for him/her. (However. this variable proved to be difficult to assess properly. particularly
as senselessness was also inquired into--see above).
Alietwess to selj: Six felt the obsession was quite contrary to their normal self. In
one. it was in keeping with his nature-he \vas prone to worry and anxiety about
everything, mainly his health. and his obsession was whether he had been poisoned
by chemicals. The eighth felt her obsession (wishing death of others) was not entirely
alien to herself; however, the thought aroused guilt.
Discomfort. The felt discomfort/anxiety/uneasiness. on a O-100 scale, varied from 10
to 90, with a mean of 63. One (whose rating of discomfort was 10). reported that
somatic reactions (palpitations. pain at back of neck) accompanied the obsession. She
also said the subjective discomfort was 100 initially, but it had come down.
-\bnormal and normal obsessions 241

Urge to neutrake. The three subjects referred to in the above paragraph reported
distinct neutralizing activities. and rated their urges to do so as 70. 90 and 100 respect-
ively. One (impulse to strange children) patient would be extra nice to the target person
(overt), or. if the obsession arose in the absence of a target person, she would imagine
being extra nice (covert). One (thoughts about ‘good’ people being harmed by ‘bad’
people) would wash his hands (overt). and this was an act to prevent real harm coming
to loved persons. The third (thought wishing death to others) would utter a phrase
(‘I take the curse’) silently (covert). so that the person concerned would not die. Carrying
out the neutralizing activity brought relief. but total relief only in one of the above
cases.
Other coping tnechanims. All the eight subjects had other coping mechanisms to deal
with their obsessions. including the three who had specific neutralizing activities noted
in the above paragraph. One would say ‘stop’ to herself, five would try to distract
themselves (one would sing. another count. another pray aloud). One would leave the
place (escape). and another avoid instruments which would trigger the obsession (avoid-
ance). The success of these. however. was limited.
Fate. The obsession would generally cease after a while. However. in one case it
would sometimes linger on. In three cases. it would return immediately or almost
immediately.
Relation to mood. Except in two, mood was felt to relate to the obsession. Four
said depression led to greater frequency and discomfort, while one of them said depres-
sion led to greater discomfort only. In two, it was generalized anxiety. rather than
depression, which led to greater frequency and greater discomfort.
General cotnmenrs. In general, the subjects were able to talk about their obsessions
without difficulty; in one case, however, the subject was able to describe and articulate
the obsession only with difficulty, and he was somewhat vague in his account. His
general level of anxiety was high.
It was clear that the nature of the problem had undergone some change during
the course of the disorders. As noted above, three reported that their resistance to
the obsession had lessened over time. One of these three, plus another, also reported
the intensity was now moderate-it had been high earlier. Another of these three
reported a reduction of felt discomfort from 100 initially to 10 after one year since
onset, but the somatic correlates remained. All this may be taken to indicate that people
get accustomed to obsessions, without necessarily achieving full relief-is this incomplete
habituation perhaps?
Non-clinical sample. In order to simplify comparisons with the clinical data described
above, the following Tables summarize the main findings. Data for the clinical and
the non-clinical samples are given together under the separate headings to facilitate
comparison. Due to smallness of the clinical sample (N = 8) statistical tests of signifi-
cance are strictly not applicable; all the data are given in raw form.
(a) Fornr
Impulses Thoughts

Clinical
(N = S) 3 5
Non-clinical
(N = 40) 16 24

(b) Durarion o/problem. in yors

Between Between
10 years 5 and I and I year
Range Mean or more 10 years 5 years or less

Clinical
(.V = 8) I-46 I5 5 0 3 0
Non-clinical
(N = 40) f-22 8.6 I6 4 I3 7
S RACHMA~ and P. DE SILLA

Between
10 3K or 10 WC and More thJn
Range llran Ias I min I min

ClInical
(.V = S) J-300 so7 7 3 3
Non-cllnlcal
(.Y = 101 I-300 17.4 2: 6 II

IO or Less th,ln I da). Less


more l-9 but not less than
Range M2,itn d,l) da) than I wk I Lb:,

Cllniclll
(.V = 8) 2-l50d 27d 5 ? 0 0
Non-climcal
20 d-
(.V = -101 l j 2 5 :2 !1

Yes No

Clinical
(.L’ = 8) 3 5
Non-clinical
(:V = 40) I4 16

Strong Moderate Weak Non?

Clinical
(!V = S) 4 3 1 0
Non-clinical
i.v = 10) 6 13 12 9

External Internal External No


trl_eyrr trigger or trtgger
0nl> only Internal v.harevrr Doubtiul

Cltnical
(.V = 8) 2 I I 4 0
Non-clinical
(.t’ = 10) 22 8 2 1 1

* This does not mean an inrnriuhk relation between trigger


and obsession.
Abnormal and normal obsessions

Senseless Nor senseless

ClinIcal
(Y = 8) I 7
Non-chnlcal
(.V = 401 0 10

ClInical
(.V = dl 5 2 I
Xon-cllnlcal
(.V = 10) 31 7 2

High Moderate Lou

Clmical
(.V = 8) 6 z 0
Son-clinical
(V = 10) II 20 9

Yes No

Chnlcnl
(IV = 8) 7 I
Son-clinical
(.V = 40) 40 0

Yes No Doubtful

Clinical
(.V = Y) 6 I I
Non-chnical
(.V = 40) I9 18 3

No. wth NO. No.


clear with NO. No. NO. less
somatic SO or betiveen between bs t~een than
Range Mean correlales mars 60-79 J&59 x-39 20

Clinical
(.V = S) IO-90 61 I 3 3 0 I I
Non-clinical
(.V = 40) S-90 12.75 3 6 8 10 7 9

No. with
distinct No with no
urge 10 distinct Range for Mean for
neutralize urgs positives positives

Cllnical
(5 = S) 3 5 7Sloo 86.1
Non-clinical
(.V = 40) 5 35 IS90 5O.S
S RACHMA\ and P. DE SILLA

s3’*
‘Stop’ Reassurance
to Reassurance from
self self others Distract Escxpr .4vold Other Non?

ClInIcal
(.\’ = 8) I 0 0 5 I I 0 0
Non-clinical
(:V = 40) 7 5 0 12” 7 0 1 17

* Of these. 3 had other coping mechanisms as well (I ‘stop’, 2 ‘self-reassurance’) which


have also been listed under these headings.

Related Unrelated Doubtful

Chnical
(IV = ?I) 6 1 0
Non-clinical
(‘L’ = JO) 17 3 20

11~ surnr~lar~. the normal and abnormal obsessions are similar in form, in expressed
relation to mood, and in meaningfulness; and are fairly similar in content.
They differ in that abnormal. clinical obsessions last longer both in general and in
particular, are more discomforting. more intense and more frequent. They have lower
acceptability, are more alien. provoke more urges to neutralize and are more likely
to be of known onset. They are more often and more strongly resisted, and are harder
to dismiss.
At risk of over-generalizing, we can state that they are similar in form and content
but not in frequency and intensity, or in their consequences.
Thus far we have been able to identify some quantitative differences between normal
and abnormal obsessions. The presence of qualitative differences remains to be demon-
strated.

STUDY III-REPEATED-PRACTICE EFFECTS

As noted earlier, one of the main aims of the present study was to investigate the
effects of repeatedly forming and holding the obsession. Due to limited time and
resources. it was decided to study short-term effects only, in this preliminary study.
In order to investigate the effects of repeated formations, as an approximation to
brief habituation training, subjects obtained obsessions to instruction. After the basic
descriptive data were obtained and recorded. the subject was asked to produce. upon
instruction, a target obsession. The details of this (latency. duration, intensity, meaning,
discomfort, urge to engage in specific neutralizing ritual, effects of such activity. others)
were recorded, and used as the pre-intervention baseline. Then. the subject went through
three obsession-formation (habituation) trials of 4 min each, with a I-min inter-trial
interval. Here the subject had to obtain the obsession upon instruction and keep it,
until asked to stop at the end of the 4-min period; he/she was also instructed not
to carry out any neutralizing ritual. After the three trials, a further production-on-request
.-ibnormal and normal obsesstons 245

trial was carried out. as a post-intervention trial. In both types of trials, a pre-arranged
signal (raised index finger) was used for the subject to indicate to the experimenter
the presence of the obsession.
Originally, it was intended to carry out the experimental trials for each subject with
two target obsessions-one experimental (procedure as above). and the other, control
(where. instead of the three trials, the subject would engage in a neutral activity of
comparable duration between the two production-upon-instruction trials). Using a
design balancing order, it was hoped that this would enable the testing of the effects
of repetition against a control. Regrettably, practical obstacles prevented completion
of the plan.
Some subjects. particularly in the non-clinical sampie. found it dihicult to get the
obsession on request with the same quality as it would normally occur. This had the
effect of lowering intensity and discomfort, mainly. Many failed to get the obsession
altogether (see below). One clinical subject failed on one occasion, but was able to
obtain his obsession during a second interview a few days later. In order to facilitate
the production of the obsession, each subject was asked to imagine that he was in
the setting and circumstances where it would normally occur, whenever this was applic-
able. He was encouraged to close his eyes if he felt it would help. In a small number
of cases. triggering material were provided for the subjects (knives, cutting instruments,
heavy objects: newpaper reports etc.).

EXPERIMENTAL DATA: THE CLINICAL SAMPLE

AI1 8 patients were able to produce a target obsession on request. Three had neutraliz-
ing rituals, which had the effect of bringing down both discomfort and urge to neutralize
(Mean Discomfort: 60% down to 23%; Mean Urge: 75% to 3%, respectively in the
pre-intervention trial), The rituals were: imagine being extra-nice to target person; wash
hands; and say ‘I take the curse’ silently. There were similar effects in the post-interven-
tion sessions (Mean Discomfort: 53% down to 13%; and Urge: 56 to 0%. respectively).
A comparison of pre- and post-intervention production trials gives an idea of the
short-term effects of the repeated trials. Comparison was possible on the following par-
ameters: Latency, Duration, Discomfort and Intensity. ‘Meaning’ proved to be a difficult
category to assess, and the findings are therefore incomplete and omitted.
Latency: In 6, latency increased, in 1 it decreased and in 1 there was no change. (Mean:
pre 9 set; post 19.9 set).
Duration: In 5 duration decreased, in 1 it increased and in 2 there was no change.
(Mean: pre 41.5 see; post 29.9 set).
Discomfort: In 6 there was a decrease, in 1 it increased, and in 1 there was no change.
(Mean: pre 47.5%; post 40%).
Itztrnsity: In 2 there was a decrease and in 6 no change.
Srarisrical tesrs: Of the above, the first three were in quantitative form, and t tests
for non-independent samples were carried out to test if the changes were significant.
Laretlc~, r = 0.72, df= 7, p > 0.05, one-tailed; Duratim, t = 1.89, df = 7, p just fails
to reach significance at p = 0.05 level, one tailed; Discomfort, t = 1.56, lif= 7, p > 0.05,
one-tailed. Because of the small numbers, tests of significance may be misleading. How-
ever, all changes were in the expected directions: i.e. latency increased, duration de-
creased, discomfort decreased, and intensity decreased, in the post-intervention trial.
It must be stressed that these were only short-term effects of the repeated trials. Long-
term effects were not investigated in this study. Further, there was no control procedure.
Records were also kept of the three repeated trials themselves. Latency, discomfort,
urge (where relevant), intensity and meaning were recorded for each trial. In addition,
the time, within the 4 min trial period, for which the obsession was present or absent
was also recorded. On this information, it was possibfe to calculate for each trial the
number of times the obsession ‘slipped away’, or faded, and the total time within a
trial that the subject was able to keep the obsession. In addition, the longest time
he was able to keep the obsession continuousIy within a triat was recorded.
Due to small numbers it was not possible to examine whether there were significant
changes trial b? trial in these measures. However. inspection indicated unsystematic
variation. The data indicated a trend for the obsession to become increasingly hard
to form and maintain. but firm conclusions are not narrantzd.

EXPERIMENTAL D.ATA: THE NO&-CLIVUIC.AL SAiMPLE


The data for the non-clinicaI sample of 13 subjects are given beloiv. The experimental
procedure was tried on all 30 subjects who were inrerviewed. but 12 failed to obtain
the obsession upon instruction. Of the others. two failed to complete the session. Data
on two others had to be rejected due to faulty procedure. Of the rest. data for 9 were
omitted from the analysis as the frequency of their obsessions \vas less than I per
week. Of the 15 CYSTS thus left. 1 were omitted as their discomfort upon production
of the obsession. ~‘as zero. This left I3 subjects in the non-clinical sample.
The di~ctilty many had in producing the obsession to request. was noted above.
Even of those \vho were able to form it. most felt it \vas ‘artificial’ or -unreal’. Felt
discomfort and intensit) were thus generally low. Some found external triggers useful.
Of the 13 whose data have been used in the analysis reported in the sequel. only
one had a neutralizing ritual (mentally counting calories of food taken in the day).
Carrying this out led to reduction of discomfort and urge to neutralize in both pre-
and post-inter~,ention trials (Discomfort: 10 --+ 0 and IO--+ 0; Urge: 60 d 0 and 60 -+ 0).
Comparison of pre- and post-intervention trials on latency, duration, discomfort and
intensity provides an indication of the efYects of the repeated trials procedure.
Lnter~c~,. In 9. latency increased. in 2 it decreased. and in 2 remained same. (Mean:
pre 13.I5 set: post 15.05 sec.)
D~~r~ltiQ~i~ In 7. duration decreased. in Z it increased. and in 4, there was no change.
(Mean: pre 12.31 SK; post Ii.31 sec.)
Di.scor?ljkt: In 9. discomfort decreased, in :! it increased. and in 2 there was no change.
(Mean: pre 3 I. IS”,;,; post 16.97?;.)
Irl!rrlsiry: In 3 there was a decrease, in Z an increase, and in S no chanpe. (In six
of these 8. no downward change was possible, as they were ‘mild’ in the pre-trial.)
Sr~z~~srjcfil resr.5: r tests for non-independent samples were carried out to test the signifi-
cance of the pre- post differences with regard to latency. duration and discomfort.
kterlcy: r = 0.47. IY = 13. p > 0.05. one-tailed ; Discm~brt: t = I .04, df‘ = 13. p > 0.05,
one-tailed.
Although the differences were not statistically significant. the changes Lvere in the
expected direction, as in the clinical sample. In the case of discomfort. the initial (pre-)
levels were too low to show any significant reduction.
In two subjects. the pre- post differences were consistsntly in the opposite direction
on discomfort (30- 60; 20 -+ 40). duration (30 --+ 45: 15 --) 35). and intensity (mi --t mo;
mo--+ hi). On latency. one showed shorter latency while the other remained the same.
Both these subjects verbally reported that the exposure to the obsession in the three
4-min periods of the repeated practice trials made the obsession affect them more. This
“sensitizing” effect was not observed in any of the other subjects. clinical or non-clinical.
Records of the changes occurring during repeated practice were kept for the non-clini-
cal sample as well. They showed unsystematic variations, with some tendency for in-
creased latency (i.e. harder to get), decreased total time of obsession. and longest time
obsession held, and increased number of ‘slippages’ (i.e. harder to maintain), and de-
creased discomfort. The data do not warrant further analysis.
To summarize. the results of the experimental study are consistent with the hypothesis
that obsessions are subject to an habituation process. The data are of course insufficient
but as far as they go. they follow the predicted pattern. With repeated practice. the
latency to form the obsession increases. Also, the duration decreases, and similarly the
attendant discomfort decreases. Perhaps most telling of all if it can be confirmed with
more practice triais. the intensity of the obsession may decrease-our data are uncon-
vincing on this point.
On all of these measures. the effects of repeated practice are in line with an habituation
process: moreover, we found a similar pattern for normal and abnormal obsessions.
It will be recalled that in the original statement of the theory (Rachman. 1971) it was
postulated that abnormal obsessions present a problem because of their failure to habi-
tuate satisfactorily. A continuation of the present line of investigation will enable us
to test this postulate directly. It is also worth noticing that in part 2 of the present
studies, we obtained information suggestin g that partial habituation had already taken
place in some instances-the subjects had become ‘accustomed’ to their obsessions and
were less disturbed by them.
We are unsure why the non-clinical subjects found it harder to form their obsessions
to instruction than did the patients. Presumably, the intensity and frequency of their
past obsessional experiences enables the patients to re-form or recall the material more
easily-practice makes near-perfect. In a sense, this is a paradoxical finding. Here we
have an example in which obsessional patients demonstrate a greater degree of control
over their intrusive thoughts than do the non-clinical subjects.
If the habituation model is to be developed, we need confirmation on several points.
It has to be shown that the obsession weakens with repeated practice i.e. that it decreases
in intensity and duration. and increases in latency. Further. this process should be
facilitated by low arousal, stable mood. long presentations and frequent repetitions.
The ensuing reductions will recover. in part at least, after an adequate rest period.
Sensitization presumably occurs if the obsessional material has special significance for
the person. if repetitions are limited, if they are too brief, if the person is overly aroused
or experiencing an adverse mood.

CONCLUSIONS
Notwithstanding the exploratory nature of these 3 studies, some tentative conclusions
are permissible. The need for replications and development of the studies is obvious.
I. Obsessions, in the form of thoughts and/or impulses, are a common experience.
A large majority of people report experiencing obsessions; it is unknown why the
small minority fail to do so. There are no age or sex-related differences in occurrence.
2. The form. and to some extent the content as well, of obsessions reported by non-psy-
chiatric respondents and by obsessional patients are similar.
3. So-called ‘normal’ obsessions are also similar to ‘abnormal’ obsessions in their
expressed relation to mood and in their meaningfulness to the respondent.
4. Despite some similarities of form and content, normal and abnormal obsessions
differ in these respects:
(a) The threshold of acceptibility is higher for abnormal obsessions.
(b) Normal obsessions are easier to dismiss.
(c) Abnormal obsessions last longer-overall, and in particular instances.
(d) Abnormal obsessions are more intense.
(e) And produce more discomfort.
(f) They are more frequent.
(g) They are more ego-alien.
(h) They are more strongly resisted.
(i) They are more likely to be of known onset.
(j) They provoke more urges to neutralize.
Broadly speaking, normal and abnormal obsessions are similar in form and content,
but differ in frequency, intensity and in their consequences.
5. (a) Obsessional patients are more likely to have multiple obsessions, and are
(b) more likely to exhibit associated compulsions.
6. The execution of neutralizing behaviour, overt or covert, reduces discomfort and
urges in both clinical and non-clinical subjects.
7. IMost obsessional patients can form their obsessions to instruction; a large number
of non-clinical subjects are unable to do so.
7. (a) The obsessions were formed within less than a minute, in both groups.
243 S R~CHMA> and P. DE SILVS

Y. The obsession produces discomfort: the level is greater in the abnormal instances
than in the normal ones.
9. Overall. abnormal obsessions formed to instruction are moderately intense, normal
ones are of mild intensity.
10. With repeated trials of 4-min duration. the following (statistically non-significant)
but predicted, short-term changes were observed:
(a) The latency to obsession formation increases.
(b) The duration of the obsession decreases.
(c) The accompanying discomfort decreases.
(d) The intensity of the obsession may decrease.
I 1. There was evidence. in 2 of our non-clinical subjects. of sensitization rather than
habituation.
It can fairly he stated that these findings are generally consistent with the theory.
but some unexplained pieces must be noted. We cannot explain at present. why some
people apparently do not experience obsessions. Nor do we know why non-clinical
subjects find it more difhcult to form their obsessions.
The findings relative to the habituation postulates of the theory are re-assuring but
wholly insufficient at present. Experimental analyses of the effects (short- and long-term)
of habituation training on normal and abnormal obsessions. are essential before this
part of the theory can develop.

.-l~~Jlor~/rdyl~1~l~~~lr.s-
This research was supported in part by a grant from the M.R.C. We gratefully acknowl-
edge the helpful suggestions oHered by many colleagues. includln g V. de Silva. C. Philips, H. Shackleton
and L. Porklnson.

REFERENCES

RACHLIAN S. (1971) Obsessional ruminations. Brhar. Rrs. Thur. 9. ??!?-?_;j.


RACHUAN S. (1977) The modification of obsessions: A new formulation. B&K. Rrs. The-. 14. 43743.
RACHVAN S. (lY7Y) An anatomy of obsessions. Brhrrr. ._(M/. ,\/otlrf:. in press.
RACHUAN S. and Hwcso~ R. (1978) 0h.ww~ur1.s UI[/ Cwrrprrlsio~~s. In press. Prentice Hall. Neti Jersey.