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P. DE SILVA
De Crespigny Park. London. SE5 YAF
related. e.xploratory studies were carrted out in order to ascertatn the occurrence 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. intensity 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 experimental 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 significant material. heightened arousal and in a majority of cases, a precipitating event. Habituation to potentially or actually disturbing material was (presumably) facilitated by lowered arousal, stable mood, repeated presentations of evoking stimuli, prolonged exposures. The subsequent elaborations of the theory (Rachman, 1977; Rachman and Hodgson. 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 nonclinical (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
1) 124 * Figures within brackets show the number in ths cell 3s a percentage of the total in category-mats.11 * Figures within brackets show number in cell as a percentage of the total position in the catrgor)-male.5 I6A. The explanation of why 16% have no obsessions is unknown.e.16 were negatives. if not for the problem of unacceptability. and 20. 67 IOA (93 91 20 (16. The malefemale breakdown for these data is as follows: Thoughts ?&IS: Female: Total only Impulses only Both ‘1 (4S. one to having thoughts only. three admitted to having both thoughts and impulses of this sort. Respondent’s \lalr \lCln RXlge Number age 2Y Ii)-51 57 characterljtlcs Female 27. 1-I had only impulses. If the present frequency data are revised. or criterion. of what is an acceptable thought or impulse.5)’ (. The average age of the males was 38 vears (range 19-51) and that of the females 27. by re-classifying these 5 subjects as positive.1) 53 (53. 844.:.9) 31 (57.8-l of the total sample of normals were positives. In other words.e. that non-psychiatric subjects commonly experience obsessions.) would be positives. total. while 53 admitted to having both.7 years.1) 9 116.research workers. There were no age or sex-related differences in presence or absence of obsessional experiences. Another subject observed that: ‘I do not consider these unacceptable. I ) $9.s 67 Total 27. clinicians etc. 99 reported that they had either thoughts or images. and the other impulses only. Five subjects emphasized that they did have obsessions of the type given in the examples in the questionnaire. they had neither thoughts nor impulses. female. a female who had responded positively to impulses only. 79. nurses. and 67 were females. One subject stated that: ‘My criterion of what is unacceptable is high’. but did not consider them to be unacceptable: they had therefore responded in the negative. and what is not.3) 5 (I 1. Twentyfive responded negatively-i. then 104 out of 124 (i. But they are by ethical standards of society. Of the 99 positive respondents. also indicated she had some of the thoughts in question.’ For the present purposes. . The nature of normal obsessions. Fifty-seven of the sample were males. /Vryari~ rrspo~tler~rs. some of them made unsolicited comments and observations on the questionnaire forms and verbally. with a mean of 17. However. Their age ranged from 16 to 51. One of the positive respondents.7) 14 (II.7 16-51 171 Of the 12-t respondents. No systematic study was made of the negative respondents. This substantially confirms the first hypothesis of this investigation-vi:. female.5 years (range I&15).:I 57 57 (35.5) Total 45 5-l 99 IS (40)’ I-l (75. Of these five. it must be noted that 5 out of a total of 25 negatives in the sample would have been classed positives. total. but did not consider them to be unacceptable.9) 32 (32. 32 had only obsessional thoughts. Positike Negative Total 37 (S2. The conclusion from these unsystematic data seems to be that people vary in the level of tolerance.
STUDY II-SIMILXRITIES TO ABNORMAL OBSESSIONS The second stage of the investigation consisted of standardized interviews of a sample of the positive respondents. patients who had come for psychiatric help for their obsessions. for thoughts and impulses separately.e. obsessions (thoughts andior impulses) are a very common experience. There are no sex or age-related differences in occurrence. people seem to find impulses very easily dismissible. total. (Note that the tot& here exceed the total casrs. The frequency of the occurrence of thoughts is given below. Also. in the majority.day IO+. The general tendency is for impulses to be more easily dismissible even in these cases. show number in cell in category-male. who found it difficult to dismiss thoughts did not necessarily find it difficult to dismiss impulses-or vice versa. as indicated above). they occur less than 10 times a month. To conclude Study I. Also indicated in the table is the respective number of cases who found it was easy to dismiss the thought or not. percentage female. and ease of dismissal.3) JO (17. We were unable to identify any individual factors determining ease of dismissal. There are individual variations in the threshold of acceptability of obsessional thoughts or impulses.5 (52. although numbers are too small to draw any firm conclusions. f 1 67 WI) Total 67 S5 152 * Figures within as 3. Impulses tend to be slightly less frequent in that. and a sample of clinical obsessionals-i. It was planned to compare the two groups . including a ‘doubtful’ category.7)’ 4.-\bnormal and normal obsesstonj 235 The following figures are for positives in each category those u-ho had both. and obsessional thoughts easily dismissible. and to test the short-term effects of repeatedly provoking the obsessions. Our aim was to coliect detailed information about their obsessions and related matters. Frequency and dismissability of obsessional thoughts Easily dismissed IO+.day IO+ week IO+ ‘month Less Total Not easily dismissed Doubtful Total 3 16 33 33 85 I 13 25 27 69 z 3 4 4 13 0 0 1 2 3 Frequency and dismissability of obsessional impulses Easily dismissed IO+. Evidently obsessional thoughts are somewhat more common than impulses. are similar for the two sexes. and most thoughts and impulses are easily dismissed. Cases positive for both.week IO+/month Less 1 5 22 31 59 Not easily dismissed 0 0 4 4 8 Doubtful 0 0 0 0 0 Totat I 5 26 35 67 Total The patterns of frequency. irrciudiny Thoughts Xf&: Female: Total: 40 (59. as some subjects had both thoughts and impulses.9) Y5 (55 9) brackets of total Impulses 27 (10.
3 3 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. The presence of imagery is noted only when the image constitutes an essential and/or prominent part of the obsession. circumstances etc. No subject was seen for this purpose more than thrice. MZllC hlcan 3gt’ Number 42. the final sample was determined mainly by availability. to attack. clinical and non-clinical. knife or heavy object Thought of ‘disgusting’ sexual acts with males (male subject) to look at buttocks of boys and youths (male subject) Itnpulsr whether he has been poisoned by chemicals Thoqht Thought that his eyes will be/are harmed . The interview was a structured one.1 8 Female 38. and Queen Elizabeth II Hospitals. despite the common theme. Only current obsessions of the subjects have been included. RACHMAL 2nd P. common themes with slightly varying details were reported. on the basis of the judgement of the subject himself. in such cases. It had the following composition : The clinical sample consisted of eight subjects. certain subjects reported more than one obsession with an underlying theme (e. C’o~tte~~t analr. Sometimes. where the individual obsessions were reported to be independent and specific in terms of target person. invariant verbal form. There is a total of 23. Guy’s. The contents of the obsessions are reported below. If a subject was unable to produce the obsession on request in one session.236 so S. After recording the essential background data and relevant data on the target obsession s. These have been considered as individual units. T/W ~KXI-clinicnl sample.g. with regard to the obsessions and their response to repeated evocation. The total number of obsessions exceeds the number of subjects as some of them reported several obsessions. On the other hand. sometimes adults to jump out of window to attack and harm someone.S 5 as follows: Total 41. A total of 40 subjects chosen from the positive respondents to the questionnaire. The interview sessions were carried out by the same experimenter (P. An obsession has been considered as a single. Circumstances of occurrence. elicited from 8 subjects. Bethlem Royal. and the specific target person or object. object. with bat. The obsessions of the clinical sample are given below. the repeated evocation tests were given. Although it was originally intended to choose the sample from among those whose obsessions had a frequency of at least 10 per vveek. They were from the Maudsley. cats or kittens to strangle children. comprised the non-clinical sample. are given only when the content is inextricably bound up with them.) for all subjects. could be explored. DE SILL% that similarities and diffrrrnces between them.sis. independent one. the obsession has been considered as WIT. another session was arranged wherever possible. using a prepared schedule and a set of agreed guidelines for its use. de S. especially own son. Verbatim descriptions are given when the obsession concerned takes a particular. or strangle. violence).
A total of 7 have been omitted in this way (the second obsession of three subjects.Abnormal and normal obsessions 237 Thought that he will get. from 40 subjects. mainly own dog. when reading or hearing reports of crime Thought that he may become insane. but also to some extent other dogs Impulse to harm children with physical violence The obsessions of the non-clinical sample are given below. had occurred to a loved one Impulse of violence towards objects Impulse to buy unwanted things Though? identifying himself with person executed. 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. with reference to persons close and dear. especially smaller ones to crash car. also others Thought of swear words. or bus Thouglir of harm befalling her children. throw things-to disrupt peace in a gathering Impulse to jump in front of tube train. religious persons Thoughr that she might harm someone Thought ‘I wish heishe were dead. in relation to people ‘misbehaving’ Impulse to attack and violently punish some0ne-e. There is a total of 58. with large.g. or be violent towards children. of a violent form. 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. 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.e. Impulse to hurt or harm someone Thought ‘what is the calorie content of that food?’ Impulse to jump on to rails.g. especially car accident. there was failure to record the content of a second (or third) obsession of the subject. when reading or hearing reports of executions--‘How would I feel at that moment if I were him?‘. when tube train is approaching Thought of intense anger towards someone. and the second and the third of one subject). 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. relatives. to throw a child out of bus Thought whether any harm has come to his wife . the third of two subjects. clear images of the words in print Impulse to utter swear words Thought ‘Did I commit this crime?‘. shout. to ‘good’ people-i. family. In a very few cases.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’. her husband and baby (due) would be greatly harmed because of exposure to asbestos. also clear image sequence Thought that she. when driving Impuse Thought ‘Why should they do that? They shouldn’t do that’. or death of. 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.
738 s.w sexual impulse towards attractive wishing that someone disappeared from the face of the earth Thoughr Itnpulsc of violence towards a person ThougIlt that harm would have befallen to someone near and dear Thoughr of ‘unnatural’ sexual acts wishing and imagining that someone close to her was hurt or harmed Thought to hurt. 10. giving only the content (as summarised above). humiliated. or deliberately shaming him. or Tl7ougl7 t of experience/s was a failure Implrl. in revenge ln7p1rlsr to sexually assault a female. and suddenly discovering that he is naked Thought with image sequence. knoivn and unknown It1rp7rl. In an attempt to examine the similarity between the two types.g. 13. 13. 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. with visual image Tl7oughr of an embarrassing sequence I tl7plclsr to engage in certain sexual practices which involve pain to the partner to be rude and say something nasty to people Impulse to jump off the platform when a train is arriving ltt7pulse of physically punishing a loved one Thought T17oright that she might commit suicide Clit7ical cs non-clinical. The number of correctly identified ‘clinical’ obsessions were 10. known or unknown to say rude and unacceptable things Itt7pdsr or painful experience he has had.A B c D E F Thoughr obsessions) (out of 23 clinical SS Non-clinical obsessions judged be clinical to . 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.%~ to violently attack and kill a dog It?7plrlsr to violently attack and kill someone that she might do something dramatic like trying to rob a bank Thoughr It?lplrls~~ to jump from top of a tall building or mountain/‘cliff T17oughr of being violent towards a known person. RACHMA\ and P DE SILL h with clear visual image sequence. Their response as ‘clinical’. someone Impulse hard and shout at him/her Itt7plclsr to shake someone many years ago when he was embarrassed. not physical violence‘Would I or would I not do it’?’ nasty. of walking along a crowded passage. These were shuffled and given to six judges (five psychologists and one psychiatric nurse) who had clinical experience with obsessional patients. For this purpose. the 81 obsessions were printed on cards. usually when about to travel It?7pLilsr to push peopls away and OK in a crowd-e. causing harm. 13 and 18 for the six judges. of the details of an accident that she had experienced ltnpulsr to say rude things to people Thought about accidents or mishaps. or harm.‘her ltr7plrlsr to hurt someone by saying something females. were as follows: Judg Correct positive guesses . 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.
4 yr 40 + In cases where more than one obsession was present. checking. but on the other hand they were moderately good at identifying non-clinical obsessions. Thus. (e) Family phobia. and this was the one the subject considered to . In the non-clinical sample nine (9/40) had parents described as obsessional. eleven (1 l/40) reported having them. one (l/8) also had a social 7 had psychiatric complaints (other than obsessional non-clinical sample none had any such condition.g. while in the non-clinical sample. Parent obsessional Clinical Non-clinical Other close relative obsessional No relative obsessional 6 28 Total 8 40 1 9 I 3 CHARACTERISTICS OF THE OBSESSIONS Data were obtained in detail from every subject on one obsession. From this we can conclude that clinical obsessions are not as readily discernible-even to experienced clinicians-as might be expected. in practice it was not possible to do this in detail. but none of the other behaviour noted above). (c) Ocert compulsions unrelated to obsessions In the clinical sample. It must also be noted that there is a difficulty in comparing the two samples on this. the duration given is that for the one of which the duration was longest. although it was hoped to obtain data on another obsession as well. In the Only one (l/S) person in the clinical sample said a parent was obsessional. full data are available only on one obsession for each subject. five (5/S) reported washing). In cases of multiple obsessions. Other Clinical Non-clinical having compulsive behaviour (e. No other 3 29 rituals Total 8 40 rituals 5 II (d) Other problems In the clinical sample. One had an aunt who was obsessional. as the clinical sample was considerably older.Abnormal and normal obsessions 239 It appears that the judges were not able to identify the clinical obsessions too well. DIFFERENCES BETWEEN NON-CLINICAL THE CLIKICAL AND SAMPLE (a) Number oj obsessions at present Clinical Range Mean .9 s Non-clinical l-3 I. Three others had a close relative who was obsessional.45 40 sample (b) Time since onset* Clinical Range Mean IV sample yr Non-clinical sample I yr-46 I5 8 3 m-24 yr 9.\ sample I-7 2.
pain at back of neck) accompanied the obsession. in one it was change of residence and associated reservations and doubts (leading to impulses to harm son). as against impulses. Five said their obsessions occurred with no identifiable external provocation. Two of those reporting moderate resistance and the one reporting low resistance stated that initially they had resisted strongly. Most said the frequency varied. harm being wished by self to others). Only three described a tendency for the obsession to return immediately. one said that subjective anxiety was the provoking factor. (However. One (whose rating of discomfort was 10). Rrpetiri~nrss. Five had direct personal involvement. it was the death of known coworkers due to suspected radiation effects (leadin g to thought he may have been poisoned by chemicals). 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). with a mean of 63. Clinicul. Frrqrtencr~. . and moderate in two.be his her current obsession. One had a vague and uncertain association Lvith a certain event (father’s death) with the onset of the obsession. Form. bvhere impulse was to attack child with such object). and another would also sometimes get the impulse at the thought of going out. She also said the subjective discomfort was 100 initially.7 sec. The eighth felt her obsession (wishing death of others) was not entirely alien to herself. Four subjects had a clear idea as to the onset. the thought aroused guilt. Dctrariotl. range 1-46 yr. especially in relation to mood (see below). One of these was the mere mechanical repetition of a string of words (‘these boys when they were young’). 011st~r. In another. children) or associated stimuli (e. and 5 were thoughts. Senselrssness. it was in keeping with his nature-he \vas prone to worry and anxiety about everything. mainly his health. This decline in resistance over time has also been independently observed among other types of obsessional-compulsive patients (Rachman and Hodgson. Of these three subjects.‘s (e. hoivever. all rhesejce bvere rhortghrs. 1976).g. with a mean of 80. Persotlnl it7mlretmwt. In one. Subjectively felt intensity was high in six. on a O-100 scale. Intrnsit~l. sight of the target. Frequency of occurrence varied from 3 per day to 150 times per day. Mean of 15 years. Alietwess to selj: Six felt the obsession was quite contrary to their normal self. this variable proved to be difficult to assess properly. Pro~~ation. that is external stimuli. with a mean of 27. Discomfort. All except one (whose obsession was a string of words). but now they were ‘used to it’. In the case of the three impulses. particularly as senselessness was also inquired into--see above). R~sisra~lcr. Interestingly. reported that somatic reactions (palpitations. but it had come down. one would also sometimes get the impulse without provocation. In five cases. The form and content of all current obsessions were howeher recorded. said it had meaning for him/her. bats or heavy objects.g. Five reported frequencies of 10 or more per day. and the other three had no idea as to the specific onset. Only two subjects had obsessions that they considered senseless. 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). The felt discomfort/anxiety/uneasiness. Four reported high resistance to the obsession. and his obsession was whether he had been poisoned by chemicals. The other was not senseless so much as vague. The latter. having occurred and gone away. reported it was high initially but had weakened over time. and one low resistance. and in the other. Oct~rc~il ci~atiori. the duration was 20 set or less. one had no personal involvement at all (one referred to in the above paragraph). Three were impulses. Of the four who did claim clear memory of onset. in one. varied from 10 to 90. Three (2 thoughts and 1 impulse) had invariant and clear visual imagery associated with them. The relevant data for the eight clinical subjects are given belobv. however. :\iemity. inrariclb/y rriggereri the impulse. Reported duration of each obsession varied from 2 XC to 5 min. three moderate resistance. and in two the involvement was indirect (harm coming to people known. or almost immediately.
rather than depression. without necessarily achieving full relief-is this incomplete habituation perhaps? Non-clinical sample. which led to greater frequency and greater discomfort. Except in two. it would return immediately or almost immediately. It was clear that the nature of the problem had undergone some change during the course of the disorders. One (impulse to strange children) patient would be extra nice to the target person (overt). and rated their urges to do so as 70. One (thoughts about ‘good’ people being harmed by ‘bad’ people) would wash his hands (overt). while one of them said depression led to greater discomfort only. One would leave the place (escape). in one case. or. Data for the clinical and the non-clinical samples are given together under the separate headings to facilitate comparison. it was generalized anxiety. Carrying out the neutralizing activity brought relief.6 5 I6 0 4 3 I3 . Due to smallness of the clinical sample (N = 8) statistical tests of significance are strictly not applicable. mood was felt to relate to the obsession. however. 90 and 100 respectively. As noted above. Relation to mood. in one case it would sometimes linger on. three reported that their resistance to the obsession had lessened over time. The three subjects referred to in the above paragraph reported distinct neutralizing activities. Fate. the following Tables summarize the main findings. Other coping tnechanims. another count. another pray aloud). the subject was able to describe and articulate the obsession only with difficulty. In order to simplify comparisons with the clinical data described above.V = 8) Non-clinical (N = 40) Mean 10 years or more I year or less 0 7 I-46 f-22 I5 8. One of these three. Four said depression led to greater frequency and discomfort. was limited. she would imagine being extra nice (covert). Another of these three reported a reduction of felt discomfort from 100 initially to 10 after one year since onset. in yors Between 5 and 10 years Between I and 5 years Thoughts 3 16 5 24 Range Clinical (. the subjects were able to talk about their obsessions without difficulty. if the obsession arose in the absence of a target person. One would say ‘stop’ to herself. The third (thought wishing death to others) would utter a phrase (‘I take the curse’) silently (covert). all the data are given in raw form. but the somatic correlates remained. In three cases. The success of these. All this may be taken to indicate that people get accustomed to obsessions. In general. In two. and this was an act to prevent real harm coming to loved persons. including the three who had specific neutralizing activities noted in the above paragraph. also reported the intensity was now moderate-it had been high earlier. however. His general level of anxiety was high. and another avoid instruments which would trigger the obsession (avoidance). (a) Fornr Impulses Clinical (N = S) Non-clinical (N = 40) (b) Durarion o/problem. However. All the eight subjects had other coping mechanisms to deal with their obsessions. The obsession would generally cease after a while. and he was somewhat vague in his account.-\bnormal and normal obsessions 241 Urge to neutrake. but total relief only in one of the above cases. so that the person concerned would not die. General cotnmenrs. five would try to distract themselves (one would sing. plus another.
L’ = 8) Non-clinical (:V = 40) No 3 I4 5 16 Strong Clinical (!V = S) Non-clinical i.ln I da). DE SILLA Range ClInical (.v = 10) Moderate Weak Non? 4 6 3 13 1 12 0 9 External trl_eyrr 0nl> Internal trigger only External or Internal No trtgger v.S RACHMA~ and P.V = S) Non-cllnlcal (.V = -101 IO or more M2.V = 8) Non-clinical (.harevrr Doubtiul Cltnical (.4 7 2: 3 6 3 I-300 II Range Cllniclll (.itn d.t’ = 10) 2 22 I 8 an inrnriuhk I 2 relation 4 1 between 0 1 trigger * This does not mean and obsession. than I wk 2-l50d 20 dl j 27d 5 ? 0 0 2 5 :2 !1 Yes Clinical (. .Y = 101 llran 10 3K or Ias Between 10 WC and I min More I thJn min J-300 so7 17.V = 8) Non-climcal (. Less but not less than I Lb:.l) l-9 da) Less th.
V = 40) No Doubtful 6 I9 I 18 I 3 No.V = 40) No 7 40 I 0 Yes Clinical (. between J&59 NO. less than 20 IO-90 S-90 61 12.V = 401 Nor senseless I 0 7 10 ClInical (. Range Clinical (.V = 8) Son-clinical (V = 10) Moderate Lou 6 II z 20 0 9 Yes Chnlcnl (IV = 8) Son-clinical (.V = 40) Mean with SO or mars NO.V = Y) Non-chnical (. with distinct urge 10 neutralize Cllnical (5 = S) Non-clinical (.V = 40) No with no distinct urgs Range for positives Mean for positives 3 5 5 35 7Sloo IS90 86. bs t~een x-39 No.V = S) Non-clinical (. betiveen 60-79 No.S .V = dl Xon-cllnlcal (.Abnormal and normal obsessions Senseless ClinIcal (Y = 8) Non-chnlcal (.75 I 3 3 6 3 8 0 10 I 7 I 9 No.V = 10) 5 31 2 7 I 2 High Clmical (.1 5O. wth clear somatic correlales NO.
a further production-on-request . as an approximation to brief habituation training. duration. and in meaningfulness. Due to limited time and resources. subjects obtained obsessions to instruction. he/she was also instructed not to carry out any neutralizing ritual. The presence of qualitative differences remains to be demonstrated. the subject was asked to produce. discomfort. and are fairly similar in content. the normal and abnormal obsessions are similar in form. we can state that they are similar in form and content but not in frequency and intensity. Thus far we have been able to identify some quantitative differences between normal and abnormal obsessions. others) were recorded. and used as the pre-intervention baseline. effects of such activity. STUDY III-REPEATED-PRACTICE EFFECTS As noted earlier. I 7 I 0 0 1 0 17 which * Of these. They have lower acceptability. more intense and more frequent. meaning. one of the main aims of the present study was to investigate the effects of repeatedly forming and holding the obsession. Then.4vold Other Non? I 7 0 5 0 0 5 12” as well (I ‘stop’. are more alien. After the basic descriptive data were obtained and recorded. urge to engage in specific neutralizing ritual. intensity. The details of this (latency. or in their consequences. until asked to stop at the end of the 4-min period. in this preliminary study. Here the subject had to obtain the obsession upon instruction and keep it. They are more often and more strongly resisted. In order to investigate the effects of repeated formations. a target obsession. clinical obsessions last longer both in general and in particular. DE SILLA s3’* ‘Stop’ to self ClInIcal (. After the three trials.S RACHMA\ and P. 2 ‘self-reassurance’) Related Chnical (IV = ?I) Non-clinical (‘L’ = JO) Unrelated Doubtful 6 17 1 3 0 20 11~ surnr~lar~. it was decided to study short-term effects only. with a I-min inter-trial interval. in expressed relation to mood.\’ = 8) Non-clinical (:V = 40) Reassurance self Reassurance from others Distract Escxpr . upon instruction. At risk of over-generalizing. They differ in that abnormal. the subject went through three obsession-formation (habituation) trials of 4 min each. 3 had other coping mechanisms have also been listed under these headings. are more discomforting. provoke more urges to neutralize and are more likely to be of known onset. and are harder to dismiss.
e. and Urge: 56 to 0%. p > 0. and the total time within a trial that the subject was able to keep the obsession. it was possibfe to calculate for each trial the number of times the obsession ‘slipped away’. Regrettably. intensity and meaning were recorded for each trial. found it dihicult to get the obsession on request with the same quality as it would normally occur. ‘Meaning’ proved to be a difficult category to assess. duration decreased. On this information. p just fails to reach significance at p = 0. discomfort decreased. the longest time he was able to keep the obsession continuousIy within a triat was recorded. p > 0.. Duratim. urge (where relevant). In addition. one-tailed. Three had neutralizing rituals. the first three were in quantitative form. triggering material were provided for the subjects (knives. In order to facilitate the production of the obsession. it was intended to carry out the experimental trials for each subject with two target obsessions-one experimental (procedure as above). EXPERIMENTAL DATA: THE CLINICAL SAMPLE AI1 8 patients were able to produce a target obsession on request.9 set). Records were also kept of the three repeated trials themselves. one-tailed. Some subjects. Discomfort. In a small number of cases. for which the obsession was present or absent was also recorded. (Mean: pre 9 set. Because of the small numbers. and the findings are therefore incomplete and omitted.72. Laretlc~. instead of the three trials. mainly. In both types of trials. r = 0. t = 1. A comparison of pre. it was hoped that this would enable the testing of the effects of repetition against a control. Latency: In 6. It must be stressed that these were only short-term effects of the repeated trials. cutting instruments.05 level. the time. latency increased. Many failed to get the obsession altogether (see below). df = 7. There were similar effects in the post-intervention sessions (Mean Discomfort: 53% down to 13%. Duration: In 5 duration decreased. respectively). (Mean: pre 41. He was encouraged to close his eyes if he felt it would help. Duration. respectively in the pre-intervention trial). Longterm effects were not investigated in this study. tests of significance may be misleading. particularly in the non-clinical sampie. within the 4 min trial period. This had the effect of lowering intensity and discomfort. a pre-arranged signal (raised index finger) was used for the subject to indicate to the experimenter the presence of the obsession. In addition. wash hands. practical obstacles prevented completion of the plan. post 40%). (Mean: pre 47. which had the effect of bringing down both discomfort and urge to neutralize (Mean Discomfort: 60% down to 23%.and post-intervention production trials gives an idea of the short-term effects of the repeated trials.5%. heavy objects: newpaper reports etc. whenever this was applicable. latency increased. Mean Urge: 75% to 3%. Discomfort and Intensity. in the post-intervention trial. all changes were in the expected directions: i. post 19. there was no control procedure. Using a design balancing order. df= 7.-ibnormal and normal obsesstons 245 trial was carried out. and intensity decreased. or faded. Originally. and in 1 there was no change. t = 1. lif= 7. and the other. Itztrnsity: In 2 there was a decrease and in 6 no change. However. each subject was asked to imagine that he was in the setting and circumstances where it would normally occur. Comparison was possible on the following parameters: Latency.). but was able to obtain his obsession during a second interview a few days later.56. discomfort. post 29. in 1 it increased and in 2 there was no change. Srarisrical tesrs: Of the above. Discomfort: In 6 there was a decrease. One clinical subject failed on one occasion. as a post-intervention trial. one tailed. Further.89. control (where. The rituals were: imagine being extra-nice to target person. and say ‘I take the curse’ silently. .5 see.05. Latency.9 set).05. in 1 it increased. the subject would engage in a neutral activity of comparable duration between the two production-upon-instruction trials). in 1 it decreased and in 1 there was no change. and t tests for non-independent samples were carried out to test if the changes were significant.
but firm conclusions are not narrantzd. as in the clinical sample.e.31 sec. The experimental procedure was tried on all 30 subjects who were inrerviewed. two failed to complete the session. the initial (pre-) levels were too low to show any significant reduction. Urge: 60 d 0 and 60 -+ 0). harder to get). IS”. with some tendency for increased latency (i.) D~~r~ltiQ~i~ In 7. post Ii. IY = 13. the changes Lvere in the expected direction. df‘ = 13. On latency. but 12 failed to obtain the obsession upon instruction. on discomfort (30the same. (Mean: pre 13. harder to maintain).AL SAiMPLE The data for the non-clinicaI sample of 13 subjects are given beloiv. Felt discomfort and intensit) were thus generally low.ention trials (Discomfort: 10 --+ 0 and IO--+ 0. and intensity (mi --t mo.. The di~ctilty many had in producing the obsession to request.) Sr~z~~srjcfil resr. one showed shorter latency while the other remained 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. (Mean: pre 12. duration. the pre. in 2 it decreased.Due to small numbers it was not possible to examine whether there were significant changes trial b? trial in these measures. . Comparison of pre.) Irl!rrlsiry: In 3 there was a decrease. The data indicated a trend for the obsession to become increasingly hard to form and maintain.and post-intervention trials on latency. and in 2 remained same. (In six of these 8. Although the differences were not statistically significant. no downward change was possible. The data do not warrant further analysis. duration (30 --+ 45: 15 --) 35).. Of the 13 whose data have been used in the analysis reported in the sequel.5: r tests for non-independent samples were carried out to test the significance of the pre. Carrying this out led to reduction of discomfort and urge to neutralize in both preand post-inter~. latency increased. EXPERIMENTAL D.. the results of the experimental study are consistent with the hypothesis that obsessions are subject to an habituation process.ATA: THE NO&-CLIVUIC. one-tailed. in Z an increase. inspection indicated unsystematic variation. there was no change.05 sec. only one had a neutralizing ritual (mentally counting calories of food taken in the day). The data are of course insufficient but as far as they go. 1 were omitted as their discomfort upon production of the obsession. mo--+ hi). one-tailed . most felt it \vas ‘artificial’ or -unreal’. However.04. In the case of discomfort. With repeated practice. Also. p > 0.I5 set: post 15.scor?ljkt: In 9. Records of the changes occurring during repeated practice were kept for the non-clinical sample as well. This “sensitizing” effect was not observed in any of the other subjects. (Mean: pre 3 I. was noted above. and in S no chanpe. and increased number of ‘slippages’ (i. Of the 15 CYSTS thus left. as they were ‘mild’ in the pre-trial. In 9. and decreased discomfort. and in 2 there was no change. and longest time obsession held. ~‘as zero. discomfort and intensity provides an indication of the efYects of the repeated trials procedure.47. 20 -+ 40). in Z it increased.post differences with regard to latency. Perhaps most telling of all if it can be confirmed with more practice triais. To summarize.97?. the duration decreases. This left I3 subjects in the non-clinical sample. data for 9 were omitted from the analysis as the frequency of their obsessions \vas less than I per week. In two subjects. Data on two others had to be rejected due to faulty procedure. duration decreased. p > 0. duration and discomfort. Even of those \vho were able to form it. and in 4. they follow the predicted pattern.post differences were consistsntly in the opposite direction 60. decreased total time of obsession. the intensity of the obsession may decrease-our data are unconvincing on this point. in :! it increased. kterlcy: r = 0. Of the others.) Di. Some found external triggers useful.. They showed unsystematic variations.e. Lnter~c~.05. the latency to form the obsession increases. and similarly the attendant discomfort decreases. post 16. Discm~brt: t = I . discomfort decreased. Of the rest. clinical or non-clinical..05.31 SK.
1971) it was postulated that abnormal obsessions present a problem because of their failure to habituate satisfactorily. If the habituation model is to be developed. if they are too brief. if repetitions are limited. (f) They are more frequent. Sensitization presumably occurs if the obsessional material has special significance for the person. (d) Abnormal obsessions are more intense. in part at least. (h) They are more strongly resisted. A continuation of the present line of investigation will enable us to test this postulate directly. (j) They provoke more urges to neutralize. it is unknown why the small minority fail to do so. There are no age or sex-related differences in occurrence.On all of these measures. I. 7. The ensuing reductions will recover. Despite some similarities of form and content. this process should be facilitated by low arousal. normal and abnormal obsessions are similar in form and content. We are unsure why the non-clinical subjects found it harder to form their obsessions to instruction than did the patients. and increases in latency. 5. It is also worth noticing that in part 2 of the present had already taken studies. (b) Normal obsessions are easier to dismiss. The form. It will be recalled that in the original statement of the theory (Rachman. the effects of repeated practice are in line with an habituation process: moreover. Presumably. if the person is overly aroused or experiencing an adverse mood. (a) The obsessions were formed within less than a minute. 6. overt or covert. (e) And produce more discomfort. 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. (c) Abnormal obsessions last longer-overall.e. (i) They are more likely to be of known onset. we found a similar pattern for normal and abnormal obsessions. normal and abnormal obsessions differ in these respects: (a) The threshold of acceptibility is higher for abnormal obsessions. this is a paradoxical finding. reduces discomfort and urges in both clinical and non-clinical subjects. and to some extent the content as well. So-called ‘normal’ obsessions are also similar to ‘abnormal’ obsessions in their expressed relation to mood and in their meaningfulness to the respondent. A large majority of people report experiencing obsessions. in the form of thoughts and/or impulses. IMost obsessional patients can form their obsessions to instruction. (g) They are more ego-alien. and are (b) more likely to exhibit associated compulsions. some tentative conclusions are permissible. Broadly speaking. long presentations and frequent repetitions. in both groups. we obtained information suggestin g that partial habituation place in some instances-the subjects had become ‘accustomed’ to their obsessions and were less disturbed by them. Further. we need confirmation on several points. 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. intensity and in their consequences. It has to be shown that the obsession weakens with repeated practice i. stable mood. Obsessions. 7. CONCLUSIONS Notwithstanding the exploratory nature of these 3 studies. The execution of neutralizing behaviour. 3. are a common experience. (a) Obsessional patients are more likely to have multiple obsessions. 2. after an adequate rest period. a large number of non-clinical subjects are unable to do so. The need for replications and development of the studies is obvious. but differ in frequency. that it decreases in intensity and duration. and in particular instances. of obsessions reported by non-psychiatric respondents and by obsessional patients are similar. In a sense. 4. .
in 2 of our non-clinical habituation.\/otlrf:.research edge the helpful and L. in press. S.s UI[/ Cwrrprrlsio~~s. B&K. and Hwcso~ R._(M/. de Silva. The findings relative to the habituation postulates of the theory are re-assuring but wholly insufficient at present.-l~~Jlor~/rdyl~1~l~~~lr. This . (1971) Obsessional ruminations. short-term changes were observed: (a) The latency to obsession formation increases. Neti Jersey. S. Nor do we know why non-clinical subjects find it more difhcult to form their obsessions. Thur. the following (statistically non-significant) but predicted. There was evidence. S. Prentice The-.243 S R~CHMA> and P. (b) The duration of the obsession decreases.R. We gratefully acknowlH.ww~ur1.s. (1977) The modification of obsessions: A new formulation. Philips. DE SILVS Y. of sensitization rather than I 1. 14. why some people apparently do not experience obsessions.C. In press.and long-term) of habituation training on normal and abnormal obsessions. subjects. (c) The accompanying discomfort decreases. 9. The obsession produces discomfort: the level is greater in the abnormal instances than in the normal ones. are essential before this part of the theory can develop. abnormal obsessions formed to instruction are moderately intense. Brhar. includln g V. REFERENCES RACHLIAN RACHUAN RACHVAN RACHUAN S. C. . . Rrs. We cannot explain at present. Brhrrr. With repeated trials of 4-min duration. (d) The intensity of the obsession may decrease. normal ones are of mild intensity. 9. Rrs. 10.j. Porklnson. 43743. Hall. . Shackleton oHered by many colleagues. Experimental analyses of the effects (short. but some unexplained pieces must be noted. It can fairly he stated that these findings are generally consistent with the theory. (lY7Y) An anatomy of obsessions. suggestions was supported in part by a grant from the M. Overall. ??!?-?_. (1978) 0h.
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