Musical obsessions: a comprehensive review of neglected clinical phenomena

J Anxiety Disord. 2014 Aug;28(6):580-9. doi: 10.1016/j.janxdis.2014.06.003. Epub 2014 Jun 16.


Intrusive musical imagery (IMI) consists of involuntarily recalled, short, looping fragments of melodies. Musical obsessions are distressing, impairing forms of IMI that merit investigation in their own right and, more generally, research into these phenomena may broaden our understanding of obsessive-compulsive disorder (OCD), which is phenomenologically and etiologically heterogeneous. We present the first comprehensive review of musical obsessions, based on the largest set of case descriptions ever assembled (N=96). Characteristics of musical obsessions are described and compared with normal IMI, musical hallucinations, and visual obsessional imagery. Assessment, differential diagnosis, comorbidity, etiologic hypotheses, and treatments are described. Musical obsessions may be under-diagnosed because they are not adequately assessed by current measures of OCD. Musical obsessions have been misdiagnosed as psychotic phenomena, which has led to ineffective treatment. Accurate diagnosis is important for appropriate treatment. Musical obsessions may respond to treatments that are not recommended for prototypic OCD symptoms.

Keywords: Earworms; Intrusive musical imagery; Involuntary musical imagery; Musical obsessions; Obsessive-compulsive disorder; Orhwurms.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antipsychotic Agents / therapeutic use
  • Avoidance Learning
  • Child
  • Cognitive Behavioral Therapy / methods
  • Diagnosis, Differential
  • Fear
  • Female
  • Hallucinations / diagnosis
  • Hallucinations / psychology
  • Humans
  • Imagination
  • Male
  • Middle Aged
  • Models, Psychological
  • Music*
  • Obsessive Behavior / diagnosis*
  • Obsessive Behavior / psychology
  • Obsessive Behavior / therapy
  • Obsessive-Compulsive Disorder / diagnosis*
  • Obsessive-Compulsive Disorder / psychology
  • Obsessive-Compulsive Disorder / therapy
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Young Adult


  • Antipsychotic Agents
  • Serotonin Uptake Inhibitors