Musical Obsessions: A Brief Narrative Review of an Underrecognized Obsessive-Compulsive Phenomenon

Abstract

This brief narrative review updates and expands upon previous literature on musical obsessions in obsessive-compulsive disorder (OCD) by incorporating new case reports. Musical obsessions are a distressing subtype of involuntary musical imagery (IMI) characterized by persistent, intrusive, and time-consuming musical thoughts that cause significant distress or impairment. Although IMI, commonly known as “earworms,” is widespread, musical obsessions remain under-recognized and understudied in OCD research. This review synthesizes the demographic, clinical, and psychopathological features of musical obsessions, highlighting their frequent underestimation due to inadequate assessment tools, such as the Yale–Brown obsessive compulsive scale. Musical obsessions often co-occur with classic OCD symptoms and share similar comorbidity profiles, including mood and anxiety disorders. However, they differ from phenomena such as musical hallucinations, pseudohallucinations, and palinacousis. Treatment approaches align with standard OCD interventions, including cognitive-behavioral therapy and pharmacotherapy, although distraction techniques show promise as adjunctive strategies. This review acknowledges limitations, such as the reliance on clinical populations and the paucity of controlled treatment studies. This emphasizes the need for validated assessment instruments specific to musical obsessions and calls for future research to elucidate the underlying cognitive and neurobiological mechanisms. A systematic evaluation of treatment modalities, especially those diverging from traditional exposure-based therapies, is critical for advancing clinical care and understanding of this condition.