Abstract:

Objective To characterize the clinical features, diagnosis, differential diagnosis, and treatment of musical obsessions. Methods We report a case of musical obsessions and review the literature to discuss clinical presentation, diagnostic considerations, differential diagnosis, and therapeutic approaches. Results A 15-year-old male presented with a oneyear history of intrusive, uncontrollable songs repeatedly playing in his mind. The phenomenon progressively worsened until musical fragments recurred on an almost continuous loop during wakefulness. The patient experienced persistent, changing sung phrases that he could not suppress, causing severe distress, anxiety, and despair and substantially impairing his academic performance and daily functioning. Physical and ancillary examinations were unremarkable. Based on the phenomenology, he was diagnosed with obsessive-compulsive disorder (OCD) presenting with musical obsessions and was treated with sertraline combined with cognitive behavioral therapy (CBT), resulting in symptomatic improvement. Conclusion Musical obsessions are an uncommon but clinically important manifestation of OCD. Clinicians, especially psychiatrists, should be alert to this presentation to ensure timely recognition and appropriate treatment.

Key words: obsessive-compulsive disorder, diagnosis, differential diagnosis, treatment