Obsessive-Compulsive and Related Disorders Practice Questions

Q: Compulsive hair pulling that produces bald spots is called:

Trichotillomania. **Explanation:** **Correct Answer: A. Trichotillomania** Trichotillomania is a psychiatric disorder characterized by the recurrent, irresistible urge to pull out one's own hair (scalp, eyebrows, or eyelashes), resulting in noticeable hair loss or bald spots. Under the DSM-5 and ICD-11, it is classified under **Obsessive-Compulsive and Related Disorders (OCRD)**. Patients often experience a sense of tension before pulling and a sense of relief or gratification afterward. **Analysis of Incorrect Options:** * **B. Kleptomania:** An impulse control disorder characterized by the recurrent failure to resist urges to steal objects that are not needed for personal use or monetary value. * **C. Pyromania:** An impulse control disorder involving deliberate and purposeful fire-setting on more than one occasion, driven by an internal tension or affective arousal. * **D. Dipsomania:** An older term used to describe an uncontrollable craving for alcohol, often occurring in periodic paroxysms (binge drinking). **High-Yield Clinical Pearls for NEET-PG:** 1. **Trichobezoar (Rapunzel Syndrome):** A classic surgical complication where patients with Trichotillomania also ingest the hair (Trichophagia), leading to a hairball in the stomach that can cause intestinal obstruction. 2. **Gender Ratio:** It is significantly more common in females (approx. 10:1 ratio). 3. **Treatment:** The behavioral therapy of choice is **Habit Reversal Training (HRT)**. Pharmacologically, **SSRIs** (like Fluoxetine) or **Clomipramine** are often used. 4. **Histopathology:** On scalp biopsy, "Trichomalacia" (distorted, fragmented hair shafts) and "pigment casts" are characteristic findings.

Q: Obsessive Compulsive Disorder is NOT associated with which of the following?

Thought insertion. **Explanation:** **Obsessive-Compulsive Disorder (OCD)** is characterized by recurrent, intrusive thoughts (obsessions) and repetitive mental or physical acts (compulsions) that the individual feels driven to perform. **Why "Thought Insertion" is the correct answer:** Thought insertion is a **First Rank Symptom (FRS)** of Schizophrenia, not OCD. In thought insertion, the patient believes that thoughts are being put into their mind by an external agency. Crucially, in OCD, the patient recognizes that the obsessions are **products of their own mind** (ego-dystonic but internal). If a patient believes thoughts are coming from an outside source, it indicates a loss of reality testing, pointing toward a psychotic disorder rather than an anxiety-related disorder like OCD. **Analysis of other options:** * **Repetitive behavior:** This is a hallmark of OCD (Compulsions). These are performed to reduce the distress caused by obsessions (e.g., hand washing, checking). * **Anxiety:** OCD was historically classified as an Anxiety Disorder. While now in its own category, intense anxiety or "psychic tension" is the primary driver that leads to compulsive rituals. * **Paranoid behavior:** While not a core diagnostic criterion, patients with OCD often exhibit avoidant or "paranoid-like" guardedness regarding their rituals or contamination fears. However, compared to the pathognomonic nature of thought insertion for psychosis, it is considered associated with the clinical spectrum of OCD. **Clinical Pearls for NEET-PG:** * **Ego-dystonic:** OCD symptoms are recognized by the patient as irrational and unwanted (Insight is usually preserved). * **Most common obsession:** Contamination. * **Most common compulsion:** Checking. * **Treatment of choice:** SSRIs (High dose) and Exposure and Response Prevention (ERP) therapy. * **Neurobiology:** Associated with hyperactivity in the **Orbitofrontal Cortex (OFC)** and Anterior Cingulate Cortex.

Q: Kleptomania means?

Irresistible desire to steal things. **Explanation:** **Kleptomania** is an impulse control disorder characterized by a recurrent failure to resist urges to steal objects. Unlike shoplifting, the theft is not motivated by monetary gain, personal use, or vengeance. Instead, the individual experiences a rising sense of tension before the act and a feeling of gratification, relief, or pleasure immediately after committing the theft. The stolen items are often discarded, given away, or hoarded. **Analysis of Options:** * **Option B (Correct):** Kleptomania specifically refers to the pathological and irresistible urge to steal items that are usually of little value. * **Option A (Incorrect):** This describes **Pyromania**, where an individual has a repetitive, deliberate pattern of starting fires to relieve internal tension. * **Option C (Incorrect):** This describes **Trichotillomania**, now classified under "Obsessive-Compulsive and Related Disorders" in DSM-5, involving the recurrent pulling out of one's own hair. * **Option D (Incorrect):** This describes **Ludomania** (Pathological Gambling), which is now classified as a "Non-Substance Related Addictive Disorder." **High-Yield Clinical Pearls for NEET-PG:** * **Gender Predominance:** Kleptomania is more common in females (3:1 ratio). * **Comorbidity:** It is frequently associated with mood disorders (Depression), anxiety disorders, and eating disorders (especially Bulimia Nervosa). * **Treatment:** The mainstay of pharmacological treatment includes **SSRIs** (e.g., Fluoxetine) and sometimes Opioid antagonists (e.g., **Naltrexone**) to reduce the "rush" associated with stealing. Cognitive Behavioral Therapy (CBT) is the preferred psychological intervention. * **Legal Note:** In forensic psychiatry, Kleptomania is a rare defense; the individual usually feels intense guilt or shame after the act, unlike a typical criminal.

Q: A 25-year-old gentleman has repeated thoughts that he has not locked his car door properly and frequently checks it while driving. He also repeatedly checks locks in his house. What is the most likely diagnosis?

Obsessive-Compulsive Disorder (OCD). ### Explanation **Correct Answer: A. Obsessive-Compulsive Disorder (OCD)** The patient presents with classic symptoms of **Obsessive-Compulsive Disorder (OCD)**. The underlying medical concept involves two components: 1. **Obsessions:** Recurrent, intrusive, and distressing thoughts (e.g., the doubt that the car door is unlocked). 2. **Compulsions:** Repetitive behaviors performed to neutralize the anxiety caused by the obsession (e.g., frequent checking). Crucially, these symptoms are **Ego-dystonic** (the patient recognizes the thoughts as irrational or excessive and finds them distressing), which is the hallmark of OCD. **Why other options are incorrect:** * **B. Obsessive-Compulsive Personality Disorder (OCPD):** Unlike OCD, OCPD is **Ego-syntonic**. Individuals with OCPD are preoccupied with perfectionism, orderliness, and control, but they do not typically have discrete obsessions or compulsions. They believe their way of doing things is "correct" and do not feel the need to resist their behaviors. * **C. Phobia:** This involves an intense, irrational fear of a specific object or situation leading to avoidance. It does not involve the ritualistic "checking" behaviors seen here. * **D. Somatoform disorder:** This involves physical symptoms (like pain or fatigue) that suggest a medical condition but cannot be fully explained by one. It does not involve intrusive thoughts or repetitive rituals. **High-Yield Clinical Pearls for NEET-PG:** * **Ego-dystonic:** OCD (Patient vs. Symptoms). * **Ego-syntonic:** OCPD (Symptoms are part of the patient's "self"). * **First-line Treatment for OCD:** Selective Serotonin Reuptake Inhibitors (SSRIs) at high doses and Cognitive Behavioral Therapy (CBT) using **Exposure and Response Prevention (ERP)**. * **Neurobiology:** OCD is associated with structural abnormalities in the **Orbitofrontal cortex, Anterior Cingulate Cortex, and Caudate nucleus**.

Q: Which of the following is the primary neurotransmitter implicated in the pathophysiology of obsessive-compulsive disorder (OCD)?

Serotonin. ***Serotonin*** - Serotonin (5-HT) is the primary neurotransmitter implicated in the pathophysiology of **OCD**; specifically, a relative deficit or dysregulation is noted, which explains the efficacy of **SSRIs (Selective Serotonin Reuptake Inhibitors)** in treating the disorder. - Dysfunction in the **serotonergic system** is thought to contribute to the repetitive thoughts and behaviors characteristic of OCD. *Dopamine* - Dopamine is primarily associated with the **reward system**, motivation, and movement disorders (e.g., Parkinson's disease), and is the main target in **psychosis** (e.g., Schizophrenia). - While dopamine modulators (e.g., antipsychotics) are sometimes used as augmenting agents in severe refractory OCD, it is not considered the primary neurotransmitter. *Norepinephrine* - Norepinephrine (noradrenaline) plays a major role in the **stress response**, alertness, and mood regulation, being highly implicated in **anxiety disorders** (e.g., GAD) and depression. - Although some SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) are used off-label, they are generally less effective than SSRIs for OCD. *GABA* - **GABA** (**Gamma-aminobutyric acid**) is the main inhibitory neurotransmitter in the CNS, chiefly involved in reducing neuronal excitability and mediating the effects of **anxiolytics** like benzodiazepines. - While dysregulation may contribute to general anxiety often seen comorbidly, it is not the primary mechanism underlying the core obsessive-compulsive cycle.

Q: A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Behavior therapy. ***Behavior therapy*** - The patient presents with **Body Dysmorphic Disorder (BDD)**, where **Cognitive Behavioral Therapy (CBT)** using **exposure and response prevention** is considered the first-line psychological treatment. - Behavior therapy aims to reduce **compulsive behaviors** like mirror checking and correct the distorted cognitive processing associated with perceived defects. *SSRI* - While **SSRIs** are the first-line **pharmacotherapy** for BDD, behavioral interventions are often prioritized or used in conjunction for better long-term outcomes. - High doses of **SSRIs** are typically required to see clinical improvement in BDD symptoms compared to depression. *Atypical antipsychotics* - These agents are not first-line and are generally reserved as **augmentation therapy** for patients who are non-responsive to SSRIs and therapy. - Even when BDD presents with **delusional intensity** (poor insight), SSRIs and CBT remain the preferred initial treatments over antipsychotics. *Allow her to have surgery* - Cosmetic surgery is **contraindicated** because it does not address the underlying psychiatric pathology and typically leads to **dissatisfaction** or shifts in preoccupation to another body part. - Research indicates that surgical or dermatological procedures often **exacerbate symptoms** and can lead to legal or physical threats against the providing surgeon.

Q: Match the following: 1. Kleptomania 2. Pyromania 3. Mutilomania 4. Dipsomania A. Intense desire to drink alcoholic drinks B. Intense desire to mutilate C. Intense desire to steal items of trivial value D. Intense desire to burn things

1-C, 2-D, 3-B, 4-A. **1-C, 2-D, 3-B, 4-A** - **Kleptomania** is characterized by an **irresistible urge to steal objects** that are often of little value and not needed for personal use or monetary gain. - **Pyromania** involves a **preoccupation with fire** and an overwhelming urge to set fires and witness their effects. - **Mutilomania** is a rare impulse control disorder that involves an **intense desire to self-mutilate**. - **Dipsomania** describes an **uncontrollable craving for alcohol**, leading to recurrent bouts of excessive drinking. *1-C, 2-B, 3-D, 4-A* - This option incorrectly matches Pyromania with an intense desire to mutilate and Mutilomania with an intense desire to burn things. - **Pyromania** is specifically about fire, and **Mutilomania** is about self-harm. *1-D, 2-B, 3-A, 4-C* - This option incorrectly matches Kleptomania with the desire to burn things, Pyromania with the desire to mutilate, and Dipsomania with the desire to steal. - The core definitions of these terms are not aligned in this pairing. *1-D, 2-C, 3-B, 4-A* - This option incorrectly matches Kleptomania with the desire to burn things and Pyromania with the desire to steal. - The defining characteristics of these impulse control disorders are mismatched here.

Q: Which of the following is not classified as OCD as per ICD 11?

PTSD. ***PTSD*** - **Post-traumatic stress disorder (PTSD)** is classified under **disorders specifically associated with stress** in ICD-11, not as an OCD-related disorder. - PTSD involves symptoms like re-experiencing the traumatic event, avoidance, and hyperarousal following exposure to a **traumatic event**. *Hypochondriac disorder* - In ICD-11, **hypochondriac disorder (illness anxiety disorder)** is reclassified under **obsessive-compulsive or related disorders**, focusing on preoccupation with having a serious illness. - This reflects the **compulsive checking** and **obsessive fears** associated with the condition. *Body dysmorphic disorder* - **Body dysmorphic disorder** is classified under **obsessive-compulsive or related disorders** in ICD-11. - It is characterized by **preoccupation with perceived flaws in physical appearance** and repetitive behaviors (e.g., mirror checking) in response to these concerns. *Trichotillomania* - **Trichotillomania (hair-pulling disorder)** is classified as an **obsessive-compulsive or related disorder** in ICD-11. - It involves **recurrent pulling out of one's hair** resulting in hair loss, despite repeated attempts to stop.

Q: Brain areas involved with obsessive compulsive disorder include all except:

Corpus callosum. ***corpus callosum*** - The **corpus callosum** is primarily involved in **interhemispheric communication**, connecting the two cerebral hemispheres, and is not a core area implicated in the pathophysiology of **OCD**. - While damage to the corpus callosum can lead to neurological deficits, it is not directly associated with the obsessions and compulsions seen in OCD. *Head of caudate nucleus* - The **caudate nucleus**, particularly its head, is part of the **basal ganglia** and is highly implicated in **OCD**, with studies showing abnormal activity and volume. - It plays a crucial role in **goal-directed behavior** and **habit formation**, which are dysfunctional in OCD. *Orbitofrontal cortex* - The **orbitofrontal cortex (OFC)** is consistently identified in neuroimaging studies as being hyperactive in individuals with **OCD**. - It is involved in **decision-making**, **reward processing**, and **emotional regulation**, contributing to the characteristic symptoms of OCD. *Basal ganglia* - The **basal ganglia**, a group of subcortical nuclei including the **caudate nucleus**, **putamen**, and **globus pallidus**, are central to the neurocircuitry of **OCD**. - This region is critical for **motor control**, **habit learning**, and **executive functions**, and its dysfunction is thought to contribute to the repetitive behaviors and cognitive rigidity seen in OCD.

Question 1

Compulsive hair pulling that produces bald spots is called:

Accepted Answer

Trichotillomania

Answer

Kleptomania

Answer

Pyromania

Answer

Diposomania

Question 2

Obsessive Compulsive Disorder is NOT associated with which of the following?

Accepted Answer

Thought insertion

Answer

Repetitive behavior

Answer

Anxiety

Answer

Paranoid behavior

Question 3

A 28-year-old taxi driver is chronically consumed by fears of having accidentally run over a pedestrian. He tries to convince himself that his worries are silly, but his anxiety continues to mount until he drives back to the scene of the "accident" to prove to himself that nobody is lying in the street. This behavior is an example of which of the following?

Accepted Answer

A compulsion secondary to an obsession

Answer

An obsession triggered by a compulsion

Answer

A delusional ideation

Answer

A typical manifestation of obsessive-compulsive personality disorder

Question 4

Kleptomania means?

Accepted Answer

Irresistible desire to steal things

Answer

Irresistible desire to set fire

Answer

Compulsive hair pulling

Answer

Pathological gambling

Question 5

A 25-year-old gentleman has repeated thoughts that he has not locked his car door properly and frequently checks it while driving. He also repeatedly checks locks in his house. What is the most likely diagnosis?

Accepted Answer

Obsessive-Compulsive Disorder (OCD)

Answer

Obsessive-Compulsive Personality Disorder (OCPD)

Answer

Phobia

Answer

Somatoform disorder

Question 6

Which of the following is the primary neurotransmitter implicated in the pathophysiology of obsessive-compulsive disorder (OCD)?

Accepted Answer

Serotonin

Answer

Norepinephrine

Answer

Dopamine

Answer

Gamma-aminobutyric acid (GABA)

Question 7

A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Accepted Answer

Behavior therapy

Answer

SSRI

Answer

Atypical antipsychotics

Answer

Allow her to have surgery

Question 8

Match the following:

1. Kleptomania
2. Pyromania
3. Mutilomania
4. Dipsomania

A. Intense desire to drink alcoholic drinks
B. Intense desire to mutilate
C. Intense desire to steal items of trivial value
D. Intense desire to burn things

Accepted Answer

1-C, 2-D, 3-B, 4-A

Answer

1-C, 2-B, 3-D, 4-A

Answer

1-D, 2-B, 3-A, 4-C

Answer

1-D, 2-C, 3-B, 4-A

Question 9

Which of the following is not classified as OCD as per ICD 11?

Accepted Answer

PTSD

Answer

Hypochondriac disorder

Answer

Body dysmorphic disorder

Answer

Trichotillomania

Question 10

Brain areas involved with obsessive compulsive disorder include all except:

Accepted Answer

Corpus callosum

Answer

Head of caudate nucleus

Answer

Orbitofrontal cortex

Answer

Basal ganglia

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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