Obsessive-Compulsive and Related Disorders Practice Questions

Q: Most common symptom associated with adult OCD?

Pathological doubt. ***Pathological doubt*** - **Pathological doubt** is one of the most common symptom dimensions in adult OCD, affecting approximately 25-30% of patients. - This manifests as persistent, overwhelming uncertainty that drives **checking compulsions** (e.g., repeatedly checking locks, appliances, switches). - Patients experience intense anxiety about potential mistakes or harm, leading to time-consuming verification rituals. - Often coexists with responsibility obsessions and is a core feature underlying many OCD presentations. *Need for symmetry* - While **symmetry and ordering obsessions** are characteristic of OCD, they affect a smaller proportion of patients (approximately 10-15%). - These manifest as urges to arrange objects symmetrically or perform actions in a balanced, "just right" manner. - Less common than contamination fears and pathological doubt in epidemiological studies. *Sexual* - **Sexual obsessions** involve intrusive, unwanted thoughts or images of a sexual nature that are ego-dystonic. - These occur in approximately 10-15% of OCD patients and are highly distressing but not the most prevalent symptom type. *Aggressive* - **Aggressive obsessions** involve intrusive thoughts of harming oneself or others, occurring in roughly 10-15% of cases. - Patients fear they might act on violent impulses, though they never do, as these thoughts are ego-dystonic. - Less common than contamination and doubt-related symptoms in adult OCD populations.

Q: Which of the following types of OCD has the poorest response to Exposure and Response Prevention therapy?

Hoarding. ***Hoarding*** - While previously classified as a subtype of OCD, **hoarding disorder** is now recognized as a distinct disorder in the **DSM-5**. - Its unique phenomenology and underlying neurobiology often lead to a **poorer response to traditional ERP therapy** compared to other OCD presentations. *Magical thinking* - This type of OCD involves beliefs that one's thoughts or actions can influence unrelated external events, which is typically well-addressed by **ERP targeting the specific rituals** and avoidance behaviors. - Patients can be exposed to situations that trigger the magical thoughts while preventing the associated compulsions. *Contamination* - **Contamination fears and washing compulsions** are among the most common and treatable forms of OCD with ERP therapy. - Patients are systematically exposed to feared contaminants and prevented from engaging in washing rituals. *Pathological doubt* - This type involves persistent and intrusive doubts (e.g., whether a door is locked, an appliance is off), leading to repetitive checking behaviors. - ERP for pathological doubt focuses on **reducing checking rituals** and increasing tolerance for uncertainty.

Q: An irresistible desire to set fire is called

Pyromania. ***Pyromania*** - **Pyromania** is an impulse control disorder characterized by an **irresistible urge to set fires**. - Individuals with pyromania often experience tension or arousal before setting a fire and feel pleasure, gratification, or relief afterward. *Mutilomania* - **Mutilomania** is a term used to describe a compulsive desire to **mutilate oneself** or others. - This is a distinct impulse control issue that does not involve fire-setting. *Nymphomania* - **Nymphomania** refers to an excessive or uncontrollable sexual desire in women. - This disorder primarily involves an overwhelming sexual drive, which is unrelated to fire-setting. *Dipsomania* - **Dipsomania** is a historical term used to describe an **irresistible craving for alcohol**. - It is a form of alcohol use disorder, distinct from the impulse to set fires.

Q: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?

Systematic desensitisation. ***Systematic desensitisation*** - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where avoidance is a key feature and a clear, single trigger can be identified. - While it involves exposure, the gradual hierarchy and relaxation training are less effective for the complex, intrusive thoughts and compulsive rituals characteristic of **OCD**. *Cognitive behavioral therapy* - **CBT, particularly Exposure and Response Prevention (ERP)**, is considered the gold standard psychotherapy for OCD. - It directly addresses the **obsessions** by exposing the individual to feared thoughts or situations and then preventing the ritualistic responses. *SSRIs* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the availability of **serotonin** in the brain. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant (TCA) with potent **serotonergic effects**, making it highly effective in treating OCD, often when SSRIs are partially effective or not tolerated. - It is specifically approved for OCD and is sometimes considered a second-line or augmentation strategy.

Q: Which of the following represents the behavioral component that distinguishes OCD from pure anxiety disorders?

compulsive behaviors. ***Compulsive behaviors*** - **Compulsive behaviors** (or mental acts) are the defining **behavioral component** of OCD that distinguish it from other anxiety disorders - These are repetitive behaviors (e.g., hand washing, checking) or mental acts (e.g., counting, praying) performed in response to obsessions - According to **DSM-5**, compulsions are aimed at reducing distress or preventing a dreaded event, though they are either excessive or not realistically connected to the feared outcome - The presence of these **time-consuming ritualistic behaviors** is what clinically distinguishes OCD from generalized anxiety disorder or other anxiety conditions *Intrusive thoughts* - Intrusive thoughts (obsessions) are indeed the cognitive component of OCD - However, intrusive thoughts alone can occur in many anxiety disorders, depression, and even normal populations - What makes OCD distinctive is the **behavioral response** (compulsions) to these thoughts, not just the thoughts themselves *Anxiety* - Anxiety is present in OCD and motivates the compulsive behaviors - However, anxiety is a feature of **all anxiety disorders** and many other psychiatric conditions - It is not the distinguishing feature that separates OCD from other anxiety-related disorders *Depression* - Depression is a **common comorbidity** with OCD (occurring in 25-50% of OCD patients) - It is a separate condition that frequently co-occurs but is **not a defining feature** of OCD - Depression does not distinguish OCD from other psychiatric disorders

Q: The psychiatric disorder that has been found to be associated with PANDAS is :

OCD. ***OCD*** - **PANDAS** (**Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections**) is a condition where **streptococcal infections** trigger or worsen neuropsychiatric symptoms, most notably **Obsessive-Compulsive Disorder (OCD)** and **tic disorders** [1]. - The sudden onset or exacerbation of **OCD symptoms** in children following a strep infection is a hallmark of PANDAS [1]. *ADHD* - While children with PANDAS may exhibit symptoms like hyperactivity or inattention, these are generally secondary to the primary **OCD** or tic symptoms, not the core presentation of **ADHD** itself [1]. - **ADHD** is often a chronic condition with an earlier onset and a different underlying neurobiological basis compared to the infection-triggered acute onset of PANDAS [1]. *Schizophrenia* - **Schizophrenia** is a severe psychiatric disorder characterized by psychosis, delusions, and hallucinations, which are not typical features of **PANDAS**. - Its etiology involves a complex interplay of genetic and environmental factors, distinct from the autoimmune response seen in PANDAS. *Depression* - While children with **OCD** or chronic illness may experience **depressive symptoms** due to distress or functional impairment, **major depressive disorder** is not the primary or defining psychiatric disorder directly associated with the onset of **PANDAS** [1]. - The acute, dramatic onset of mood changes following a strep infection is more likely to be part of the broader neuropsychiatric presentation, rather than isolated clinical **depression** [1].

Q: Irresistible desire to pull out hair

Trichotilomania. **Trichotilomania** - This term precisely describes the **irresistible urge to pull out one's own hair**, often leading to noticeable hair loss. - It is classified as an **obsessive-compulsive and related disorder** in the DSM-5. *Dipsomania* - This refers to an **uncontrollable craving for alcoholic drinks**, characterized by periodic bouts of excessive drinking. - It is related to **alcohol use disorder** but specifically highlights intermittent, intense cravings. *Satyriasis* - This term denotes **excessive or uncontrollable sexual desire in a man**. - It is the male counterpart to nymphomania. *Nymphomania* - This term describes **excessive or uncontrollable sexual desire in a woman**. - It specifically refers to hypersexuality in females.

Q: The most common major symptom of obsessive-compulsive disorder is:

Compulsive checking. ***Compulsive checking*** - **Compulsive checking** is the most common major symptom in OCD, affecting 50-60% of patients with the disorder. - This typically involves **repeatedly checking locks, appliances, switches**, or other safety-related concerns driven by obsessions about harm or danger. - The repetitive nature significantly impairs daily functioning and causes marked distress, fulfilling the core criteria for OCD compulsions. *Compulsive washing of hands* - **Contamination obsessions with washing compulsions** are very common in OCD (affecting 20-40% of patients) but are less prevalent than checking behaviors. - This compulsion can lead to dermatological issues due to excessive washing and significant functional impairment. - While highly visible and well-recognized, it is not the single most common major symptom. *Obsessive precision* - This refers to **symmetry, ordering, and arranging compulsions**, which represent another common OCD subtype. - While significant, these behaviors are less prevalent than checking compulsions as the primary presenting symptom. - Often co-occurs with other OCD symptoms rather than being the predominant feature. *Compulsive thinking about the same thing* - This describes **obsessions** (intrusive, unwanted thoughts), which are the cognitive component of OCD rather than the behavioral compulsion. - While obsessions are core to OCD diagnosis, the question specifically asks about the most common major *symptom*, which in clinical practice refers to the observable compulsive behaviors. - Checking compulsions remain the most prevalent behavioral manifestation.

Q: Oniomania is a disorder of compulsive:

Buying. ***Buying*** - **Oniomania** is characterized by an uncontrollable urge to buy things, often leading to significant financial and social problems. - It is also known as **compulsive shopping** or **buying disorder**, fitting the description of a compulsive buying behavior. *Gambling* - The compulsion to gamble is known as **pathological gambling** or **gambling disorder**, not oniomania. - This disorder focuses specifically on recurrent problematic gambling behavior. *Stealing* - The compulsive urge to steal is a distinct impulse control disorder called **kleptomania**. - Kleptomania involves repeated stealing of items not needed for personal use or monetary value. *Hair pulling* - Compulsive hair pulling is known as **trichotillomania**, which is a body-focused repetitive behavior disorder. - It involves recurrent pulling out of one's hair, resulting in hair loss.

Q: Obsession is a disorder of:

Thinking. ***Thinking*** - An obsession is defined as a **recurrent and persistent thought, urge, or image** that is experienced as intrusive and unwanted, indicating a primary disturbance in the content of thought. - Individuals typically attempt to **ignore or suppress these thoughts** or to neutralize them with some other thought or action (a compulsion). *Perception* - Disorders of perception involve distortions in how sensory information is interpreted, such as **hallucinations** or **illusions**. - Obsessions are not sensory experiences but rather cognitive events that occur in the mind. *Judgment* - Judgment refers to the ability to make sound decisions and evaluate situations appropriately. - While obsessions can impair judgment by leading to compulsive behaviors, the obsession itself is not primarily a disorder of judgment but rather a disorder of thought content. *Memory* - Memory disorders involve difficulties in recalling or forming new memories, such as **amnesia** or **dementia**. - Obsessions do not represent a failure of memory retrieval or encoding; rather, they are intrusive thoughts regardless of memory function.

Question 1

Most common symptom associated with adult OCD?

Accepted Answer

Pathological doubt

Answer

Sexual

Answer

Aggressive

Answer

Need for symmetry

Question 2

Which of the following types of OCD has the poorest response to Exposure and Response Prevention therapy?

Accepted Answer

Hoarding

Answer

Magical thinking

Answer

Contamination

Answer

Pathological doubt

Question 3

An irresistible desire to set fire is called

Accepted Answer

Pyromania

Answer

Mutilomania

Answer

Nymphomania

Answer

Dipsomania

Question 4

Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?

Accepted Answer

Systematic desensitisation

Answer

Cognitive behavioral therapy

Answer

SSRIs

Answer

Clomipramine

Question 5

Which of the following represents the behavioral component that distinguishes OCD from pure anxiety disorders?

Accepted Answer

compulsive behaviors

Answer

anxiety

Answer

depression

Answer

intrusive thoughts

Question 6

The psychiatric disorder that has been found to be associated with PANDAS is :

Accepted Answer

OCD

Answer

ADHD

Answer

Schizophrenia

Answer

Depression

Question 7

Irresistible desire to pull out hair

Accepted Answer

Trichotilomania

Answer

Dipsomania

Answer

Satyriasis

Answer

Nymphomania

Question 8

The most common major symptom of obsessive-compulsive disorder is:

Accepted Answer

Compulsive checking

Answer

Obsessive precision

Answer

Compulsive thinking about the same thing

Answer

Compulsive washing of hands

Question 9

Oniomania is a disorder of compulsive:

Accepted Answer

Buying

Answer

Gambling

Answer

Stealing

Answer

Hair pulling

Question 10

Obsession is a disorder of:

Accepted Answer

Thinking

Answer

Perception

Answer

Judgment

Answer

Memory

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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