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Letter to the Editor

Sensory Phenomena, "Just-Right"and "Not Just-Right" Experiences

in OCD Patients:Looking for a Consensus

To the Editor: October 10,2006

Several studies have addressed the subjectiveexperiences that might precede or accompanyrepetitive behaviors, such as tics and/or compul-sions, in obsessive-compulsive disorder (OCD)andTourette's syndrome (TS) patients.

Janet1 described feelings of imperfection andincompleteness preceding or accompanyingcompulsive behaviors. He wrote, "the patientsfeel that actions they perform are incompletelyachieved, or that they do not produce thesought-for satisfaction."1 Rasmussen and Eisen2

reported that OCD patients had "an inner drivethat is connected with a wish to have thingsperfect, absolutely certain, or completely undercontrol" Leckman and colleagues3 used theterm "Just-Right" as a need to perform com-pulsive acts until feeling "Just-Right." Leckmanand colleagues4 later proposed the term "pre-monitory urges" to define sensations, as wellas mental or physical awareness, normallydescribed by the patients as an itch, discom-fort, or pressure that make them do the tics asa response to these premonitory urges. Colesand colleagues5 and Coles and colleagues6 havedescribed the experiences of "Not Just-Right"in OCD patients. Summerfeldt7 defined the term"Incompleteness" as "the troubling and irreme-diable sense that one's actions or experiencesare not just-right''

This inconsistency in definitions makes thestudies' results difficult to interpret and discour-age more comprehensive investigations of thesesubjective experiences. Our group has proposedthe term "sensory phenomena."811 Under "sen-sory phenomena," we have incorporated all previ-ous descriptions of these subjective experiences,including physical sensations (uncomfortable sen-

sations in the skin, muscles-joints, or body sensa-tions, that come before or along with some of therepetitive behaviors); just-right perceptions (innerfeelings and/or perceptions of discomfort thatmakes the patient do things until feeling just-right.These perceptions might be accompanied by sen-sory stimuli, such as the visual just-right); and/orenergy (generalized inner tension or energy thatbuilds up and needs to be released by doing somerepeated movement or action).

We would like to emphasize the need for aconsensus on how to define these subjectiveexperiences. Considering that the term sensoryphenomena unites previous definitions, we pro-pose its use in studies assessing these experi-ences. We would also like to emphasize the needfor the development of an instrument capable ofproperly assessing these sensory phenomena.Our group has recently developed the Universityof Sao Paulo Sensory Phenomena Scale (USP-SPS), which is currently being validated and isavailable upon request.

Being able to better investigate these sensoryphenomena is of extreme relevance. Not onlysome do OCD patients refer that these sensoryphenomena are more troublesome than theobsessions or compulsions, but some studieshave also reported that the presence of thesesensory phenomena can enhance the patient'sability to suppress tics; that pharmacologic treat-ment can alter these sensations; and that theyhave different frequencies between patients withOCD alone, OCD+TS, andTS alone.9

Sincerely,Helena da Silva PradoMaria Conceigao do Rosario, MD, PhDRoseli Gedanke Shavitt, MD, PhDEurfpedes Constantino Miguel, MD, PhD

CNS Spectr 12:2 95 February 2007

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Letter to the Editor

REFERENCES1. Janet P. Les Obsessions et La Psychasthenie [French]. Paris, France: Bailliere: 1903.

2. Rasmussen SA, Einsen JA. The epidemiology and clinical features of obsessive-

compulsive disorder. Psychiatr Clin North Am. 1992;15:743-758.

3. Leckman JF, Walker DE, Goodman WK, Pauls DL, Cohen DJ. "Just-Right" per-

ceptions associated with compulsive behaviors in Tourettes's syndrome. Am J

Psychiatry. 1994:51:675-680.

4. Leckman JF, Walker BE, Cohen DJ. Premonitory urges in Tourette's syndrome. Am J

Psychiatry. 1993:150:98-102.

5. Coles ME, Frost RO, Heimberg RG, Rhe"aume J. "Not just right experiences": perfec-

tionism, obsessive-compulsive features and general psychopathology. Behav Res

Ther. 2003:41:681 -700.

6. Coles ME, Heimberg RG, Frost RO, Steketee G. Not just-right experiences and

obsessive-compulsive features: experimental and self-monotoring perpspectives.

Behav Res Ther. 2005:43:153-167.

7. Summerfeldt LJ. Understanding and treating incompleteness in obsessive-compul-

sive disorder. J Clin Psychol. 2004:60:1155-1168.

8. Miguel EC, Coffey BJ, Baer L, et al. Phenomenology of intentional repetitive behav-

iors in obsessive-compulsive disorder and Tourette's syndrome. J Clin Psychiatry.

1995:56:246-255.

9. Miguel EC, Baer L, Coffey BJ, et al. Phenomenological differences appearing with

repetitive behaviours in obsessive-compulsive disorder and Gilles de la Tourette's

syndrome. Br J Psychiatry. 1997:170:140-145.

10. Miguel EC, do Rosa"rio-Campos MC, Prado SH, et al. Sensory phenomena in patientswith obsessive-compulsive disorder and Tourette's syndrome. J Clin Psychiatry.2000:61:150-156.

11. Rosario-Campos MC, Leckman JF, Mercadante MT, et al. Adults with early-onsetobsessive-compulsive disorder. Am J Psychiatry. 2001:158:1899-1903.

Ms. Prado is a psychologist and post-graduate student, Dr. Shavittis a fellow researcher, and Dr. Miguel is associate professor, allin the Department of Psychiatry at the University of Sao PauloMedical School in Brazil. Dr. do Rosario is associate professorin the Department of Psychiatry at the Federal University of SaoPaulo Medical School and a fellow researcher in the Departmentof Psychiatry at the University of Sao Paulo Medical School.

Disclosure: The authors report no affiliation with or financial interestin any organizations that may pose a conflict of interest.

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