# 29 - Possession Control of thought

# Possession /Control of thought:

© SPMM Course 
Possession /Control of thought: 
Obsessions are unwanted, intrusive, repetitive, senseless thoughts experienced by patients as 
troublesome and resisted; though the appearance of the thoughts themselves is appreciated to be beyond 
their control, they are not claimed to be due to external agency. Patients often regard them to be the 
products of one's own mind but against their values and needs; therefore they are termed as ego-alien. 
Intrusive thoughts occur before motor (compulsive) acts. But it is not necessary that every compulsion is 
preceded by an obsession or vice versa. Often during the course of OCD primary obsessions fade while 
compulsions dominate clinical picture; some compulsions can be mental compulsions like praying, 
counting, etc. Obsessional slowness can occur either when obsessional thoughts occur as part of a 
depressive illness or in cases of severe OCD where primary obsessional slowness ensues. Still another 
pattern is the obsession with symmetry or precision, which leads to a compulsion of slowness. Patients 
take hours to eat a meal or shave, in an attempt to do things ‘just right’. Unlike other patients with OCD, 
these patients do not resist their symptoms! 
The most common obsession is the fear of contamination, followed by pathological doubt, a need for 
symmetry, and aggressive obsessions. The most common compulsion is checking, which is followed by 
washing, symmetry, the need to ask or confess, and counting. Children with OCD present most 
commonly with washing compulsions, which are followed by repeating rituals. 
Thought alienation is a general term used to describe the experience that one’s thoughts are under the 
control of outside influences or that others participate in one’s thinking. This term is often confusing and 
better replaced with components of first rank symptoms – thought insertion, withdrawal and broadcast.