Safety, Harm and Violent Obsessions
- Fear of harm due to carelessness. Exclude contamination obsessions.
- Fear might harm self on impulse. This involves unwanted impulses or inexplicable acts. Examples: fear of stabbing self with a knife, jumping in front of a car, leaping out an open window, or swallowing poison. (Distinguished from suicidal ideation secondary to depression.)
- Fear might harm others because not careful enough. Examples: parked car rolling down hill, hit a pedestrian because not paying attention, customer gets injured because you gave him wrong materials or information.
- Fear might harm others on impulse. Examples: physically harming loved ones, stabbing or poisoning dinner guests, pushing stranger in front of a train. (Distinguished from homicidal intent.)
- Fear of being responsible for terrible events. Examples: fire, burglary, flooding house, company going bankrupt, pipes freezing.
- Fear of blurting out obscenities or insults. Examples: shouting blasphemies in church, yelling fire in the movie theatre, writing obscenities in a business letter.
- Fear of doing something else embarrassing. Examples: taking off clothes in public, walking out with unpaid merchandise. (Distinguished from Social Phobia.)
- Violent or horrific images. Examples: intrusive and disturbing images of car crashes or disfigured people.
Hoarding/Saving Obsessions
- Need to hoard or save things. Examples: afraid that something valuable might be discarded with recycled newspapers even though all valuables are locked up in the safe. (Distinguished from hobbies and concern with objects of monetary or sentimental value. Hoarding can be present in OCPD, but if pronounced it is usually better explained by OCD.)
- Fear of losing objects or information.
- Fear of losing people. Example: otherwise rational man feared “losing” his 5-year old daughter when mailing envelopes.
- Fear of losing something symbolic. Example: patient concerned that her “essence” would be left behind when getting up from a chair.
Other Obsessions
- Pathological doubting. Examples: after completing a routine activity patient wonders whether he performed it correctly or did it at all; may not trust his memory or his own senses (i.e., “his mind doesn’t trust what his eyes see.”).
- Pathological indecisiveness. Examples: continual weighing of pros and cons about nonessentials like which clothes to put on in the morning or which brand of cereal to buy. Differentiate from worries about real-life decisions characteristic of GAD.
- Excessive concern with functioning of, or injury, to a body part. Examples: protecting face or eyes from damage; obsessed with mechanical functioning of feet. In most cases of preoccupations with physical appearance, BDD is most appropriate diagnosis.
- Colors with special significance. Examples: black connected with death, red associated with blood and injury.
- Superstitious fears. Examples: black cats, breaking mirror, stepping on side walk cracks, spilling salt, omens.
- Lucky or unlucky numbers. Example: the number 13.
- Intrusive meaningless thoughts or images.
- Intrusive nonsense sounds, words or music. Examples: songs or music with no special significance played over like a broken record.
Last reviewed: By John M. Grohol, Psy.D. on 17 Feb 2006
