Obsessive-Compulsive and Related Disorders Practice Questions

Q: A 22-year-old woman presents with excessive preoccupation with a perceived defect in her physical appearance. What is the first-line management?

Cognitive-behavioral therapy (CBT). ***Cognitive-behavioral therapy (CBT)*** - **CBT** is considered the **first-line psychotherapy** for Body Dysmorphic Disorder (BDD) because it directly targets maladaptive thoughts and behaviors related to appearance concerns. - It helps patients identify and challenge their **negative thought patterns** about their appearance and develop healthier coping mechanisms. - **Note**: SSRIs (at higher doses) are the first-line **pharmacological treatment** for BDD, and combined treatment (CBT + SSRI) is often most effective. *Antipsychotic medication* - Antipsychotics are typically reserved for cases where there is a **significant psychotic component** or severe delusions, which is not implied as first-line for BDD. - They are often used as an **adjunct** to SSRIs in severe, treatment-resistant cases with delusional features. *Interpersonal therapy* - **Interpersonal therapy (IPT)** focuses on improving interpersonal relationships and social functioning. - While helpful for some disorders like depression, it is **less effective than CBT** for directly addressing the specific cognitive distortions and compulsive behaviors seen in BDD. *Exposure and response prevention* - **Exposure and response prevention (ERP)** is a specific CBT technique that is actually a **core component** of CBT for BDD, not a separate treatment. - In BDD treatment, ERP involves exposing patients to feared situations (e.g., looking in mirrors, being seen in public) while preventing compulsive behaviors (e.g., mirror checking, reassurance-seeking, camouflaging). - While highly effective, ERP is used **within a comprehensive CBT framework** that also includes cognitive restructuring, perceptual retraining, and relapse prevention.

Q: What is the difference between obsessions and compulsions in obsessive-compulsive disorder (OCD)?

Obsessions are thoughts, compulsions are behaviors. ***Obsessions are thoughts, compulsions are behaviors*** - **Obsessions** are defined as intrusive, recurrent, and persistent **thoughts, urges, or images** that are experienced as unwanted and cause significant anxiety or distress. - **Compulsions** are repetitive **behaviors** (e.g., handwashing, checking) or mental acts (e.g., praying, counting) that an individual feels driven to perform in response to an obsession or according to rigid rules. *Obsessions are voluntary, compulsions are involuntary* - Both obsessions and compulsions are generally experienced as **involuntary** or difficult to control by the individual. - Individuals with OCD often feel compelled to engage in these thoughts and behaviors despite their efforts to resist them, highlighting their involuntary nature. *Obsessions are linked to reality, compulsions are delusional* - Neither obsessions nor compulsions are typically delusional; individuals with OCD usually have **insight** that their obsessional thoughts are irrational or excessive. - While they may recognize the unreasonableness of their fears, the anxiety associated with unfulfilled compulsions nonetheless drives the behaviors. *Obsessions are behavioral, compulsions are cognitive* - This statement reverses the correct definitions: **obsessions are cognitive** (thoughts), and **compulsions are behavioral** (actions or mental acts). - OCD involves a cycle where intrusive thoughts (obsessions) lead to anxiety, which is then temporarily relieved by performing ritualistic behaviors (compulsions).

Q: A 28-year-old woman presents with a history of intrusive, distressing thoughts about contamination, which lead her to wash her hands excessively. These symptoms have been present for over a year. What is the most appropriate initial treatment?

Cognitive-behavioral therapy. ***Cognitive-behavioral therapy*** - **Exposure and response prevention (ERP)**, a component of CBT, is considered a **first-line treatment** for OCD alongside SSRIs, with excellent efficacy in reducing symptoms. - CBT/ERP helps patients identify and challenge **distorted thought patterns** and gradually confront feared situations without engaging in compulsive rituals. - **Advantages of CBT as initial treatment**: no medication side effects, durable long-term benefits, and particularly effective for contamination-related OCD. - ERP has **robust empirical support** and produces lasting changes even after treatment ends. *Antipsychotic medication* - **Antipsychotics** are typically reserved for **treatment-refractory OCD** or as augmentation when patients show inadequate response to first-line treatments (SSRIs with or without CBT). - They are not considered an initial treatment due to potential side effects and lower efficacy compared to CBT and SSRIs. *Psychoanalysis* - **Psychoanalysis** focuses on exploring unconscious conflicts and past experiences, which is **not an evidence-based treatment** for OCD. - It has **limited empirical support** for effectiveness in treating OCD compared to CBT and pharmacotherapy. *SSRI medication* - **SSRIs are also a first-line treatment** for OCD with equivalent efficacy to CBT when used as monotherapy. - Common SSRIs used include fluoxetine, fluvoxamine, sertraline, paroxetine, and clomipramine (a TCA with serotonergic properties). - **Combination of CBT/ERP and SSRIs** is often more effective than either treatment alone. - In this clinical scenario, **CBT is preferred as the single best answer** because: (1) the patient has a specific contamination phobia ideal for ERP, (2) avoids medication side effects, (3) provides durable long-term benefits, and (4) many guidelines recommend offering CBT first when available.

Q: A patient has recurrent intrusive thoughts of contamination and engages in excessive handwashing to relieve distress. This is characteristic of:

Obsessive-Compulsive Disorder. ***Obsessive-Compulsive Disorder*** - Patients with **OCD** experience persistent, unwanted thoughts (**obsessions**) and repetitive behaviors or mental acts (**compulsions**) that they feel driven to perform in response to an obsession or according to rigid rules. - In this case, the **intrusive thoughts of contamination** are typical obsessions, and the **excessive handwashing to relieve distress** is a characteristic compulsion. *Generalized Anxiety Disorder* - Characterized by **persistent and excessive worry** about various areas of life, often not specific to a single theme like contamination. - While it involves anxiety, it does not typically manifest with the specific pattern of intrusive obsessions and ritualistic compulsions seen here. *Panic Disorder* - Involves recurrent, unexpected **panic attacks** characterized by intense fear and physical symptoms like palpitations, sweating, and shortness of breath. - It does not primarily present with recurrent intrusive thoughts and specific ritualistic behaviors to alleviate distress. *Post-Traumatic Stress Disorder* - Develops after exposure to a **traumatic event** and is characterized by intrusive memories, avoidance, negative alterations in cognitions and mood, and hyperarousal. - While it can involve intrusive thoughts, these are directly related to the trauma, and the compulsive, ritualistic behaviors described are not typical features.

Q: Obsessions are best defined as:

Recurrent, intrusive thoughts. ***Recurrent, intrusive thoughts*** - Obsessions are defined as **recurrent** and persistent **thoughts**, urges, or images that are experienced as intrusive and unwanted. - These thoughts often cause significant anxiety or distress, and the individual attempts to ignore or suppress them, or neutralize them with some other thought or action (a compulsion). *Repetitive behaviors* - Repetitive behaviors are known as **compulsions**, which are typically performed in response to an obsession or according to rules that must be applied rigidly. - Compulsions are actions (e.g., hand washing, checking) rather than thoughts, although mental acts can also be compulsions (e.g., praying, counting). *Sudden mood changes* - **Sudden mood changes** are characteristic of mood disorders, such as **bipolar disorder**, where individuals experience shifts between manic and depressive episodes. - This symptom does not primarily define obsessions, which are cognitive in nature. *Auditory hallucinations* - **Auditory hallucinations** are perceptions of sounds that are not actually present, often associated with psychotic disorders like **schizophrenia**. - While disturbing, they are perceptual experiences, distinct from the thought-based nature of obsessions.

Q: Which of the following is a poor prognostic factor for Obsessive-Compulsive Disorder (OCD)?

High levels of comorbidity. ***High levels of comorbidity*** - The presence of **multiple co-occurring psychiatric disorders** (e.g., major depression, personality disorders, substance use disorders, other anxiety disorders) significantly complicates treatment and consistently predicts worse outcomes in OCD. - Comorbidity **interferes with treatment adherence**, reduces response to both pharmacotherapy and CBT, and is associated with greater functional impairment and longer time to remission. - This is particularly significant when comorbid depression or personality disorders are present, as these conditions can **complicate the therapeutic alliance** and treatment planning. *Poor insight* - **Poor insight** (overvalued ideation) is also a well-established poor prognostic factor and strongly predicts reduced treatment response, particularly to cognitive-behavioral therapy. - However, in the context of overall prognosis, the complexity of managing **multiple comorbid conditions** often has broader impact on treatment trajectory and functional outcomes compared to insight alone. - The DSM-5 includes a "with poor insight" specifier precisely because of its clinical significance. *Chronic course* - A **chronic course** indicates persistent, long-standing symptoms and is associated with poorer prognosis, particularly when treatment has been delayed. - However, this describes the temporal pattern of illness rather than a distinct prognostic factor, and many chronic cases can still achieve significant improvement with appropriate intervention. *Early onset* - **Early onset** (childhood or adolescent onset) is associated with a more chronic course, greater comorbidity, and generally poorer long-term outcomes compared to adult-onset OCD. - However, early identification and intervention can modify prognosis, and the impact of early onset is often mediated through other factors such as illness duration and comorbidity burden.

Q: Which of the following is the core feature of obsessive-compulsive disorder (OCD)?

Intrusive thoughts. ***Intrusive thoughts*** - Intrusive thoughts (obsessions) are the **core cognitive feature** of OCD, defined as unwanted, recurrent, and distressing thoughts, images, or urges that are typically **egodystonic**. - According to **DSM-5**, OCD diagnosis requires the presence of **obsessions and/or compulsions**, with intrusive thoughts representing the primary obsessive component. - These thoughts are **involuntary** and cause significant anxiety that the person attempts to neutralize through compulsions. *Pathological doubts* - While pathological doubts are a **common manifestation** in OCD, they represent a specific **type of obsession** rather than the core feature itself. - They typically lead to **checking compulsions** but are a subset of obsessive thoughts. *Contamination* - Contamination fears are a **common thematic content** of obsessions but represent one of many possible obsession themes. - Other themes include symmetry, harm, religious/moral concerns, making contamination a **specific presentation** rather than the defining feature. *Compulsions* - Compulsions are the **behavioral component** of OCD and equally important diagnostically, but the question asks for the cognitive/mental core feature. - Compulsions are typically performed to **reduce anxiety** generated by obsessions.

Q: Which of the following is a symptom of Obsessive-Compulsive Disorder (OCD)?

Pathological doubt. ***Pathological doubt*** - **Pathological doubt** is a cardinal and core symptom of OCD, where individuals experience persistent and intrusive uncertainty about routine actions, decisions, or safety. - This pervasive doubt drives repetitive checking behaviors, as patients struggle to achieve certainty that tasks have been completed correctly or that dangers have been averted. - Among the options, this represents the most fundamental and characteristic symptom of OCD. *Magical thinking* - **Magical thinking** can occur in some OCD patients, particularly involving beliefs that certain thoughts or rituals can prevent harm or influence unrelated events. - However, it is not a universal or defining feature of OCD and is more commonly associated with other conditions or normal childhood development. - It represents a cognitive distortion rather than a core diagnostic symptom. *Hoarding* - **Hoarding disorder** was separated from OCD in DSM-5 and is now classified as a distinct disorder within the "Obsessive-Compulsive and Related Disorders" category. - While some OCD patients may have hoarding behaviors, hoarding itself is not considered a primary symptom of OCD. - Hoarding involves persistent difficulty discarding possessions due to perceived need to save them, with distinct underlying mechanisms. *Dirt contamination* - Fear of **dirt contamination** is a common *theme or content* of obsessions in OCD, not a symptom itself. - The actual symptoms would be the obsessive thoughts about contamination and the compulsive washing/cleaning behaviors that follow. - This option confuses the content of an obsession with the symptom structure (obsession + compulsion).

Q: Pyromania is characterized by an irresistible urge to engage in which of the following behaviors?

Set objects on fire. ***Set objects on fire*** - Pyromania is a **mental disorder** characterized by a powerful, **irresistible urge to start fires**. - The individual experiences **tension or arousal** before the act, followed by **pleasure, gratification, or relief** after setting a fire or witnessing its effects. - This is classified as an **impulse control disorder** in psychiatric nosology. *Overeat* - This behavior is characteristic of **eating disorders** such as **binge eating disorder** or **bulimia nervosa**, not pyromania. - While impulses are involved, the specific urge and gratification are linked to food consumption, not fire-setting. *Excessive sleeping* - **Hypersomnia** or **excessive daytime sleepiness** is a symptom of various sleep disorders or medical conditions, not an impulse control disorder. - There is no direct association between the urge to sleep excessively and the diagnostic criteria for pyromania. *Steal items* - This behavior is characteristic of **kleptomania**, another impulse control disorder. - While both pyromania and kleptomania involve irresistible urges, kleptomania specifically involves stealing objects not needed for personal use or monetary value.

Q: What is Trichotillomania?

Compulsive hair pulling. ***Compulsive hair pulling*** - **Trichotillomania** is characterized by an irresistible urge to **pull out one's own hair**, often leading to noticeable hair loss. - It is classified as an **obsessive-compulsive related disorder** in the DSM-5. *Irresistible desire to set fire to things* - This describes **pyromania**, a distinct impulse control disorder. - While both are impulse control disorders, their specific behaviors and focus are different. *Irresistible desire to steal* - This refers to **kleptomania**, an impulse control disorder characterized by recurrent urges to steal objects not needed for personal use or monetary value. - It is distinct from trichotillomania, which involves self-inflicted harm through hair pulling. *Compulsive gambling* - This is known as **gambling disorder**, an addictive disorder involving persistent and problematic gambling behavior. - It involves financial risk and reward and is not related to hair pulling.

Question 1

A 22-year-old woman presents with excessive preoccupation with a perceived defect in her physical appearance. What is the first-line management?

Accepted Answer

Cognitive-behavioral therapy (CBT)

Answer

Antipsychotic medication

Answer

Interpersonal therapy

Answer

Exposure and response prevention

Question 2

What is the difference between obsessions and compulsions in obsessive-compulsive disorder (OCD)?

Accepted Answer

Obsessions are thoughts, compulsions are behaviors

Answer

Obsessions are voluntary, compulsions are involuntary

Answer

Obsessions are linked to reality, compulsions are delusional

Answer

Obsessions are behavioral, compulsions are cognitive

Question 3

A 28-year-old woman presents with a history of intrusive, distressing thoughts about contamination, which lead her to wash her hands excessively. These symptoms have been present for over a year. What is the most appropriate initial treatment?

Accepted Answer

Cognitive-behavioral therapy

Answer

Antipsychotic medication

Answer

Psychoanalysis

Answer

SSRI medication

Question 4

A patient has recurrent intrusive thoughts of contamination and engages in excessive handwashing to relieve distress. This is characteristic of:

Accepted Answer

Obsessive-Compulsive Disorder

Answer

Generalized Anxiety Disorder

Answer

Panic Disorder

Answer

Post-Traumatic Stress Disorder

Question 5

Obsessions are best defined as:

Accepted Answer

Recurrent, intrusive thoughts

Answer

Repetitive behaviors

Answer

Sudden mood changes

Answer

Auditory hallucinations

Question 6

Which of the following is a poor prognostic factor for Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

High levels of comorbidity

Answer

Poor insight

Answer

Chronic course

Answer

Early onset

Question 7

Which of the following is the core feature of obsessive-compulsive disorder (OCD)?

Accepted Answer

Intrusive thoughts

Answer

Pathological doubts

Answer

Contamination

Answer

Compulsions

Question 8

Which of the following is a symptom of Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

Pathological doubt

Answer

Magical thinking

Answer

Hoarding

Answer

Dirt contamination

Question 9

Pyromania is characterized by an irresistible urge to engage in which of the following behaviors?

Accepted Answer

Set objects on fire

Answer

Overeat

Answer

Excessive sleeping

Answer

Steal items

Question 10

What is Trichotillomania?

Accepted Answer

Compulsive hair pulling

Answer

Irresistible desire to set fire to things

Answer

Irresistible desire to steal

Answer

Compulsive gambling

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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