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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.

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