Musical obsession: Repeated auditory imagery of a cell phone
Provigilant
Letters to the Editor
Musical obsession: Repeated
auditory imagery of a cell phone
ring tone
doi:10.1111/j.1440-1819.2009.01986.x
MUSICAL OBSESSIONS (the repetition of songs in the
head) have only sporadically been reported as single
cases or very small case series in the literature.1–4 Whereas
previous reports focused on music per se, the present report is
different in that it involves a more limited obsessional phrase:
a cell phone ring tone.
The patient, a 22-year-old college student, had been diagnosed
with obsessive–compulsive disorder (OCD; DSM-IV) at
age 19 years. His symptoms included counting, checking, and
cleaning compulsions. The patient went into almost complete
remission on 3–4 months of fluoxetine (40 mg/day). He
stopped medication after a further month and remained reasonably well
until his index presentation, at which time he
reported a 4-month history of a preoccupation with cell phone
ring tones.
He had been using a cell phone regularly during the previous
5 years and was excessively fond of downloading and
changing cell phone ring tones, sometimes as often as every
2–3 days; this was a hobby rather than a symptom of OCD
because, although the behavior occupied 2–3 h per day, he
enjoyed what he was doing, and there was no disturbance in
social and academic activities.
At the index presentation, however, he complained that he
had begun to experience cell phone ring tones running repeatedly
through his mind. The phenomena were intrusive and anxiety-provoking;
he attempted to cope by keeping his cell
phone in the silent mode, by asking others to follow suit, by
wearing earplugs, by grinding his teeth, and by thinking of
other tunes to rid his mind of the obsessive tunes. He also
avoided places where he might hear the ringing of cell phones
owned by others; consequently, he avoided peer interactions
and places of public congregation. He had full insight into
the dysfunctional nature of his experiences and recognized
them to be part of his own thought processes. The only other
obsessive–compulsive phenomenon also present was occasional
checking.
His symptoms interfered with his ability to study and
he began to feel depressed. During the month before
presentation, the ring tones preoccupied him for 6–8 h per
day. The symptoms were graded as severe on the Yale–Brown
Obsessive–Compulsive Scale (total score 27).
He was prescribed fluvoxamine 200 mg/day and clomipramine
75 mg/day, with which combination he reported
90% subjective improvement and no residual functional
impairment at 3-month follow up.
To the best of our knowledge, this is the only report in the
literature of a musical obsession occurring as a mobile phone
ring tone. Most common psychological symptom associated
with mobile phone users is ringxiety (http://en.wikipedia.org/
wiki/ringxiety). It is defined as a nagging sense that you can
hear your mobile phone ringing when actually it is not. The
experience of common jingles and tunes running through
one’s head is so common that it is puzzling that patients with
OCD may not report musical obsessions more frequently. In
the present case, the clinical presentation does not fit that
of musical hallucinations because hallucinations cannot be
obsessional because they are not experienced as ego-alien, nor
is there an attempt to get rid of them. Further, this patient had
developed OCD in the past.
Awareness of this interesting phenomenon may be necessary
because the mobile phone is the fastest growing market
and it is one of the forms of social revolution throughout the
world.
Dattatreya N. Mendhekar, MD, DPM1 and
Chittaranjan Andrade, MD, DPM2
Neuropsychiatry and Headache Clinic, Pratap Nagar Metro
Station, Delhi and 2Department of Psychopharmacology, National
Institute of Mental Health and Neurosciences, Bangaluru, India
Email: dnmen...@vsnl.net
Received 8 December 2008; revised 15 February 2009;
accepted 4 March 2009.
REFERENCES
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Obsession of hearing music: From the viewpoint of Morita
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2 Pfizer N, Andrade C. Isolated musical obsessions. Indian J.
Psychiatry
1999; 41: 77–78.
3 Zungu-Dirwayi N, Hugo F, van Heerden BB, Stein DJ. Are
musical obsessions a temporal lobe phenomenon? J. Neuropsychiatry
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4 Matsui T, Matsunaga H, Ohya K et al. Clinical features in two
cases with musical obsessions who successfully responded to
clomipramine. Psychiatry Clin. Neurosci. 2003; 57: 47–51.