Lesson 2 of 6 · Two things that look identical from outside
Tell them apart by what they do
Six differences, and every one of them is about behaviour rather than content.
Where it comes from. A question is something you went and got. A symptom arrives uninvited, and it tends to arrive at prayer or at night.
How it feels. A question is interesting, sometimes uncomfortable. A symptom is alarming, urgent, and repellent to the person having it.
What you want. An answer, or relief.
What happens when you get a good answer. You are satisfied and you move on, or you get an hour and then the but what if arrives.
Whether it repeats. A question rarely returns in exactly the same form. A symptom returns in the same words, sometimes for years.
What you do about it. Read, ask, think, and stop. Or check, reassure, avoid, repeat, confess, ask again.
The list of six is this course's own arrangement. What is not ours is the principle underneath it, which is that these are told apart by what they do and not by what they say.
What the research says
Patients' obsessions could not be told apart from ordinary intrusive thoughts by their content. What separated them was frequency, duration, distress and how hard they were resisted. The content was never the tell.
The obsessions of patients were largely indistinguishable in content from the intrusive thoughts of people with no diagnosis. What separated the two was frequency, duration, distress and resistance. The content was never the tell.
Rachman S, de Silva P (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16(4), 233 to 248 doi
Across 683 students in 13 countries, nearly everyone reported unwanted intrusive thoughts, with content that mirrors what patients report. Having the thought is ordinary. What happens next is not.
683 students at 15 sites in 13 countries. Nearly all of them reported unwanted intrusive thoughts, with content that mirrors what patients report. Having the thought is ordinary. What follows it is not.
Radomsky AS, Alcolado GM, Abramowitz JS, and 16 others (2014). Part 1. You can run but you can't hide: intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269 to 279 doi