Obsessive-compulsive disorder with bizarre content of obsession

ABSTRACT Obsessive thoughts are known for their irrationality, however, they are not impossible in physical domains. A ”thought” is considered bizarre when it is impossible and implausible, i.e., difficult to comprehend from ordinary life experiences, and is always diagnosed as psychotic as it is markedly detached from reality. We present a case of a 47-year-old male teacher who reported repetitive irresistible thoughts that he might have swallowed metal objects such as sharp objects, large objects like tin sheets/sheds, and buildings for the past 8 years though he was fully aware that it is not physically possible. The patient had significant distress and took up alcohol to overcome the anxiety. The patient was diagnosed with obsessive-compulsive disorder and improved only with fluvoxamine and risperidone combination. Bizarre content of thought in the absence of psychosis needed highlighting. Bizarre thoughts can be placed on a continuum from obsessions to psychosis.