ABSTRACT
Introduction Obsessional disorders are characterised by the occurrence of intrusive and upsetting thoughts which the patient usually regards as senseless, and which are accompanied by the urge to ‘put right’ or neutralise. Compulsive, overt behaviour such as repetitive washing or checking is the most obvious form of neutralising, but neutralising may also take the form of cognitive behaviours, such as thinking a ‘good thought’ whenever an obsessional intrusion occurs. Neutralising behaviour, either cognitive or overt, usually occurs repetitively and is often identified as the principal problem leading to the patient seeking treatment. For example, a patient was referred because of repetitive hand washing. On interview, he reported that two years previously he had read about a toddler dying after drinking from a bottle of domestic bleach. Since that time, he had been troubled by the thought that he had become contaminated by bleach and could harm others as a result. This led him to wash his hands repeatedly, taking up to an hour at a time, several times every day. When he tried to stop, he had the thought, ‘What if I missed some bleach and touched my baby son?’ When this thought occurred, he had a terrifying image of his son’s face, horribly distorted, and his wife reproaching him for his carelessness and the death of their child. He would then have the thought, ‘I can’t risk it, just for the sake of washing for five minutes.’
