Obsessive (pseudo)hallucinations: a diagnostic dilemma and a visit to descriptive psychopathology

Background

Obsessive-compulsive symptoms are seen in psychotic disorders, and symptoms of psychosis, like hallucinations and delusions, might occur in Obsessive-compulsive Disorder (OCD). Astonishingly, hallucinations that did not respond to conventional treatment of psychosis in a patient prompted us to investigate further and elaborate on the psychopathology. We encountered a rare finding where the hallucinations had an obsessional quality in a background of preserved functionality and cognition.

Case Summary

We present a case of a young man who started hearing unusual voices in clear consciousness, was unable to distract himself, and was distressed by the content of the same. Despite being on treatment (with adequate dose and duration of antipsychotics), he did not find relief, although he kept developing side effects. Descriptive psychopathology (with detailed and repeated mental status examinations) exposed an obsessive component to the voices (“obsessive hallucinations”, a rare entity). It prompted us to reconsider the diagnosis of OCD and treatment with an antiobessive agent, to which the patient responded well.

Conclusion

A thorough elaboration of psychopathology in diagnostically challenging cases remains the gold standard of psychological investigation. Although the debate about the terminology of “pseudohallucinations” is ongoing regarding its validity and utility, cases such as this reignite the curiosity about where and how to place such entities in descriptive psychopathology.