Musical obsessions.

Obsessive-compulsive disorder (OCD) is a common psychiatric illness. A case of OCD is presented, in which the chief symptom was recurrent imagery of musical sounds of different instruments experienced by the person. Patient was a musician who played various musical instruments. Such obsessions with predominant musical themes, lyrics, and tunes have not been described in detail in standard textbooks of psychiatry or phenomenology, nor are they considered in the various diagnostic procedures for OCD. These symptoms are rare and may, at times, go unnoticed because of low clinical awareness.

Obsessive thoughts of musical tunes with musical imagery is an obsession, which is seen infrequently. These obsessions, which primarily include repeated intrusive thoughts of musical tunes, lyrics, or even songs, may be more commonly seen in people having an exposure to musical training or people who are themselves distinguished musician. These symptoms find no mention in either classical[1] or contemporary[2] textbooks of psychiatry, in either general textbooks of phenomenology[3] reviews on the phenomenology of OCD[45] in contemporary diagnostic systems,[6] in diagnostic interviews for mental disorders. It finds no mention even in specific rating scales for OCD (e.g. the Obsessive Compulsive Scale, the Maudsley Obsessive -Compulsive Inventory, and other scales.[7] This suggests that obsessions with musical themes are phenomena that are rare. We, therefore, present and discuss a case of “obsessive musical imagery.”

CASE REPORT

A 30-year-old person, married, with a strong inclination to music composing and song writing besides singing most of them himself started to develop intrusive memories of songs that he had composed, and the tunes would keep coming to his mind even when he was resting. He started to become increasingly more anxious when these thoughts became associated with recurrent images of him either humming a new or an old tune. He would keep thinking of the various instruments that he would play to accompany the lyrics and would not be satisfied with any of these thoughts. He realized over the next few months that he was unable to concentrate at his work and knew that these thoughts and images were of his own making. He would experience various songs of melodies that would repeatedly and uncontrollably run through his mind. Certain musical passages were more troublesome than others; these included songs from old and new films or the songs that he had written himself. He recognized his preoccupation with these melodies to be his own thoughts, he found them intrusive and profoundly anxiety provoking. He realized that the experiences were unusual, and possibly not normal, and made attempts to resist them, usually with little success. The characteristics of these unusual preoccupations fulfilled clinical criteria for obsessions. He reported the experience of obsessive verses, in which various lines of poetry or song tunes composed would keep repeatedly running through his mind. He also developed obsessive thoughts of repeated checking, correcting, and maintenance of symmetry compulsions. He did not have a mood disorder.

The symptom and distress would reduce on yielding to compulsions, and the musical obsessions would spontaneously disappear for about 30 minutes after onset, generally in response to some distraction. He was successful in distracting himself by deliberately focusing his attention on other melodies. There was no past, personal, or family history of relevance. There was no history indicative of substance abuse or organicity. He finally came for treatment after being symptomatic for 4 years. He was managed with Tab fluvoxamine 200 mg/day, cap fluoxetine 60 mg OD, and tab lithium 900 mg/day, latter being used as augmentation. He was provided with individual psychotherapy, exposure prevention therapy, and systematic desensitization. He showed subjective response after 4 weeks of therapy, and at the end of 8 weeks, there was significant fall in score on the Yale Brown Obsessive Compulsive Scale. He was followed up over the next 6 months, and he showed near remission of symptoms.

DISCUSSION

An extensive literature survey yielded brief references to musical obsessions. One reference,[8] describing miscellaneous form of obsessions, in which a 23-year-old lady could not “rid her consciousness of a currently popular tune.” The other reference appears towards the end of the Yale-Brown Obsessive Compulsive Symptom Checklist, along with several other entries in the category of ‘Miscellaneous Obsessions’ listed as “Intrusive nonsense sounds, words, or music”(Bech, 1993).

Musical obsessions maybe rare; or, they may be commoner than realized but, because of lack of highlighting in psychiatric literature, are not asked after or during the clinical interview. Hence, specific details need to be specifically sought. Furthermore, experiencing a haunting tune is not an unusual experience; the difference between being haunted and being obsessed by a tune could be a difficult distinction, which would deter the average patient's spontaneous reporting. Some phenomenological issues merit attention. “Musical obsessions” may be considered to be a special form of imagery, presenting more in the auditory rather than in the visual modality. These obsessions may, therefore, warrant classification under the rubric of obsessive images. This leads to the speculation: May obsessional imagery exist in other sensory, modalities as well? The term ‘obsessive images’ may then need to be replaced, by the more appropriate expression, sensory obsessions.

In psychiatry, as seen usually in OCD patients, common themes are preoccupation with dirt, sex, or religion. One is tempted to think about the extent to which individual specific life circumstances may produce individual-specific themes; the experience of musical obsessions by a full-time musician is a case in point as described.