Okay, let's tackle this question about true statements regarding obsessions. First, I need to recall the DSM-5 criteria for obsessive-compulsive disorder (OCD). Obsessions are defined as intrusive, unwanted thoughts, images, or urges that cause marked anxiety or distress. They are ego-dystonic, meaning they don't align with the person's self-image. The key here is to differentiate obsessions from other similar concepts like compulsions or normal worries.

The correct answer should include statements that align with these criteria. For example, obsessions are persistent and not simply excessive worries about real-life problems, which is a common point of confusion. Also, they are accompanied by attempts to ignore or suppress them, which is a core feature.

Now, looking at the wrong options, I need to think about common misconceptions. One might confuse obsessions with compulsions, which are repetitive behaviors or mental acts aimed at reducing anxiety. Another mistake is thinking that obsessions are the same as normal intrusive thoughts everyone experiences. Also, some might incorrectly believe that obsessions are always about cleanliness or order, but OCD can involve a wide range of themes like fear of harming others or needing symmetry.

The clinical pearl here is to remember that obsessions are ego-dystonic and cause significant distress. It's important for students to recognize that not all intrusive thoughts are obsessions; the distinction lies in the distress and the attempts to suppress them. Also, OCD is often underdiagnosed because people may not seek help if their obsessions are about socially unacceptable topics.

**Core Concept**
Obsessions are defined as recurrent, intrusive, and unwanted thoughts, images, or urges that cause marked anxiety or distress. They are ego-dystonic (conflict with self-image) and are distinct from normal worries or compulsions.

**Why the Correct Answer is Right**
The correct statement aligns with DSM-5 criteria: obsessions are persistent, ego-dystonic, and associated with attempts to suppress or neutralize them (e.g., via compulsions). They are not simply excessive worries about real-life problems (e.g., financial concerns) but are perceived as irrational by the patient. True obsessions often involve themes like contamination, harm, or symmetry.

**Why Each Wrong Option is Incorrect**
**Option A:** Incorrect if it claims obsessions are "pleasurable" or "voluntary"—obsessions are distressing and intrusive.
**Option B:** Incorrect if it equates obsessions with compulsions (repetitive behaviors, not thoughts).
**Option C:** Incorrect if it states obsessions are "ego-syntonic" (aligned with self-image), as they are ego-dystonic by definition.
**Option D:** Incorrect if it suggests obsessions are "infrequent" or "benign"—they are persistent and clinically significant.

**Clinical Pearl / High-Yield Fact**
Remember: **OCD obsessions are ego-dystonic and cause distress**. A classic exam trap is confusing obsessions with normal intrusive thoughts. Use the acronym **OCD = Obsessions, Compulsions, Distress** to recall key features.

**Correct Answer: D. Obsessions are ego-dystonic and cause marked anxiety**

✓ Correct Answer: A. It is the repetitive thoughts or images