Body Dysmorphic Disorder — MCQs

10 questions

Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?

Which of the following is not a characteristic feature of personality disorders?

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?

A 15-year-old boy feels that dirt has clung to him whenever he passes through a dirty street. This repetitive thought causes much distress and anxiety. He knows that there is actually no such thing after he has cleaned once, but he is not satisfied and feels compelled to clean repeatedly. This has led to social withdrawal. He spends much of his time thinking about the dirt and contamination and performing cleaning rituals. This has also affected his studies. The most likely diagnosis is:

In psychoanalytic terms, obsessive-compulsive disorder is fixed at -

Fear of contamination, counting behaviours, and having to check and recheck are features characteristic of -

In obsessive-compulsive disorder, which medication is NOT used for treatment?

Porencephaly is due to -

A muscle biopsy shows 'moth-eaten' fibers. Which histochemical finding would confirm mitochondrial myopathy?

Q10

Barr body is NOT seen in:

Body Dysmorphic Disorder Indian Medical PG Practice Questions and MCQs

Question 1: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?

A. Fluoxetine
B. Carbamazepine (Correct Answer)
C. Cognitive Behaviour Therapy
D. Clomipramine

Explanation: ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder. - It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**. *Fluoxetine* - **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD. - SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**. *Cognitive Behaviour Therapy* - **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD. - It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**. - It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.

Question 2: Which of the following is not a characteristic feature of personality disorders?

A. Starts in childhood.
B. Behavior is maladaptive.
C. Disorder results in personal distress.
D. Ego dystonic symptoms (Correct Answer)

Explanation: ***Ego dystonic symptoms*** - Personality disorders are characterized by **ego-syntonic** traits, meaning the individual perceives their thoughts, feelings, and behaviors as consistent with their self-image and acceptable. - **Ego-dystonic symptoms**, conversely, are experienced as alien, inconsistent with one's self-concept, and distressing (e.g., in OCD or major depressive disorder), which is **definitively NOT** a feature of personality disorders. - This is the key distinguishing feature: personality disorder traits are not perceived as problematic by the individual themselves (ego-syntonic), unlike neurotic disorders. *Starts in childhood.* - While personality traits and vulnerabilities may emerge in childhood, **formal diagnosis** of personality disorders is made in **late adolescence or early adulthood** (typically after age 18). - Per DSM-5 and ICD-11, the enduring pattern must be evident by early adulthood. - However, this option is less definitive as some underlying patterns do appear earlier, making "ego dystonic" the better answer. *Behavior is maladaptive.* - A **core diagnostic feature** of personality disorders is a pervasive pattern of **maladaptive behaviors** and inner experiences that deviate from cultural expectations. - These behaviors lead to distress, impairment in social, occupational, or other important areas of functioning. - This IS characteristic of personality disorders. *Disorder results in personal distress.* - Despite ego-syntonic symptoms, individuals with personality disorders frequently experience **significant personal distress**, often arising from consequences of their behaviors, interpersonal conflicts, or functional impairment. - This distress IS characteristic, though it may be indirect rather than from the symptoms themselves. - This IS a feature of personality disorders.

Question 3: 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?

A. Behavior therapy (Correct Answer)
B. SSRI
C. Atypical antipsychotics
D. Allow her to have surgery

Explanation: ***Behavior therapy*** - This patient presents with **body dysmorphic disorder (BDD)**, characterized by preoccupation with a perceived defect in appearance that is not observable to others, leading to significant distress and impairment. - **Cognitive behavioral therapy (CBT)**, specifically **CBT-BDD with exposure and response prevention (ERP)**, is the **first-line treatment** with the strongest evidence base for BDD. - CBT-BDD addresses the core cognitive distortions, reduces checking behaviors, and provides sustained long-term improvement without medication side effects. - **Most appropriate management** involves CBT as primary treatment, often combined with pharmacotherapy for optimal outcomes. *SSRI* - **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line **pharmacotherapy** for BDD, often requiring higher doses than those used for major depressive disorder. - SSRIs are highly effective and can be used as monotherapy or preferably in combination with CBT. - While SSRIs are appropriate, CBT has superior evidence as the primary intervention for BDD. *Atypical antipsychotics* - **Atypical antipsychotics** may be considered as an augmentation strategy for BDD in cases that do not respond to SSRI monotherapy, especially with significant delusional features or severe functional impairment. - They are not first-line pharmacological treatment. *Allow her to have surgery* - Allowing plastic surgery is **contraindicated** in patients with BDD because it rarely alleviates distress and often leads to dissatisfaction with surgical outcomes, potentially worsening symptoms or causing further unnecessary procedures. - The core problem is distorted perception of self, not an actual physical defect that can be remedied surgically.

Question 4: A 15-year-old boy feels that dirt has clung to him whenever he passes through a dirty street. This repetitive thought causes much distress and anxiety. He knows that there is actually no such thing after he has cleaned once, but he is not satisfied and feels compelled to clean repeatedly. This has led to social withdrawal. He spends much of his time thinking about the dirt and contamination and performing cleaning rituals. This has also affected his studies. The most likely diagnosis is:

A. Obsessive compulsive disorder (Correct Answer)
B. Conduct disorder
C. Agoraphobia
D. Adjustment disorder

Explanation: ***Obsessive compulsive disorder*** - The presence of **recurrent, intrusive thoughts** (obsessions) about dirt and contamination, coupled with **repetitive cleaning rituals** (compulsions) performed to alleviate distress, is characteristic of **Obsessive-Compulsive Disorder (OCD)**. - The patient has **insight** (recognizes thoughts are irrational after cleaning once) but cannot resist the compulsion to continue cleaning. - The significant amount of time spent on these obsessions and compulsions, along with their impact on daily functioning (academic decline) and social withdrawal, confirms the diagnosis. - **DSM-5 criteria met:** obsessions causing anxiety, compulsions to reduce anxiety, time-consuming (>1 hour/day), and causing functional impairment. *Conduct disorder* - **Conduct disorder** is characterized by a persistent and repetitive pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. - It usually presents with **aggression to people and animals**, **destruction of property**, **deceitfulness or theft**, and **serious violations of rules** none of which are described in the clinical vignette. *Agoraphobia* - **Agoraphobia** is an anxiety disorder characterized by fear and avoidance of situations that might cause panic, helplessness, or embarrassment, especially in public spaces or situations where escape might be difficult. - The patient's symptoms are centered around contamination obsessions and cleaning compulsions, not fear of open spaces or situations where escape is difficult. *Adjustment disorder* - **Adjustment disorder** is an emotional or behavioral reaction to an identifiable stressor that develops within 3 months of the onset of the stressor, and resolves once the stressor is removed. - While the patient is experiencing distress, the symptoms are specific to obsessions and compulsions rather than a generalized reaction to a life stressor; the chronic nature and specific symptom pattern do not align with an adjustment disorder.

Question 5: In psychoanalytic terms, obsessive-compulsive disorder is fixed at -

A. Oral stage
B. Genital stage
C. Anal stage (Correct Answer)
D. Oedipal stage

Explanation: ***Anal stage*** - In psychoanalytic theory, **obsessive-compulsive disorder (OCD)** is often conceptualized as a fixation at the **anal stage** of psychosexual development. - The anal stage (ages 1-3) is associated with issues of **control, orderliness, cleanliness, and defiance**, which parallel many symptoms seen in OCD, such as excessive neatness, rigid routines, and fear of contamination. *Oral stage* - The oral stage (birth to 1 year) is associated with behaviors like **smoking, overeating, nail-biting, and dependency**, stemming from unmet oral needs. - Fixation at this stage typically leads to issues related to **dependency** and **trust**, not the control and orderliness seen in OCD. *Genital stage* - The genital stage (puberty onwards) represents mature sexual interests and healthy psychological functioning, where conflicts from earlier stages are hopefully resolved. - Fixation at this stage is not typically associated with specific neurotic disorders like OCD but rather with overall difficulty in forming mature relationships. *Oedipal stage* - The Oedipal stage refers to the **phallic stage** (ages 3-6), characterized by the **Oedipus complex** (or Electra complex for girls), where children develop sexual desires for the opposite-sex parent and rivalry with the same-sex parent. - Fixation at this stage is linked to issues of **gender identity, authority problems**, and **sexual inhibition**, not the specific symptoms of OCD.

Question 6: Fear of contamination, counting behaviours, and having to check and recheck are features characteristic of -

A. Panic attacks
B. Generalized anxiety disorder
C. Agoraphobia
D. Obsessive-compulsive disorder (Correct Answer)

Explanation: ***Obsessive-compulsive disorder*** - **Fear of contamination** and the need to **check and recheck** are classic **obsessions** and **compulsions** seen in OCD. - **Counting behaviours** are a common type of compulsion, where individuals engage in repetitive mental acts to reduce anxiety. *Panic attacks* - Characterized by sudden, intense episodes of fear accompanied by **physical symptoms** like heart palpitations, shortness of breath, and chest pain. - They do not typically involve specific **obsessions** or **compulsions** like fear of contamination or repetitive checking. *Generalized anxiety disorder* - Involves **persistent and excessive worry** about various everyday events or activities, often for at least six months. - While it involves anxiety, it lacks the specific **obsessions** and **compulsions** seen in OCD. *Agoraphobia* - Involves intense **fear and avoidance of situations** where escape might be difficult or help unavailable, such as crowded places or open spaces. - The core feature is **situational avoidance**, not contamination fears or repetitive rituals.

Question 7: In obsessive-compulsive disorder, which medication is NOT used for treatment?

A. Sertraline
B. Clomipramine
C. Carbamazepine (Correct Answer)
D. Haloperidol

Explanation: ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for **epilepsy** and **bipolar disorder**. - It does not have a primary role in the treatment of **obsessive-compulsive disorder (OCD)**. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** approved for **OCD** treatment. - SSRIs are considered **first-line pharmacological agents** for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that is a potent **serotonin reuptake inhibitor**. - It is one of the **most effective medications for OCD** and has been historically used as a first-line treatment. *Haloperidol* - **Haloperidol**, an **antipsychotic**, can be used as an **augmentation strategy** for OCD that is **resistant to SSRI treatment**. - It may be particularly helpful in OCD presentations with **comorbid tic disorders** or significant behavioral disinhibition.

Question 8: Porencephaly is due to -

A. Trauma
B. Dandy-Walker syndrome
C. Cerebral infarction (Correct Answer)
D. Fetal alcohol syndrome

Explanation: ***Cerebral infarction*** - **Porencephaly** is a rare neurological disorder characterized by a **cyst or cavity within the cerebral hemisphere** that is usually communicating with the ventricular system. - It results from the **destruction of brain tissue due to a focal cerebral injury**, most commonly caused by **ischemic events** (e.g., cerebral infarction) or **hemorrhage** during fetal development or early infancy [1]. *Trauma* - While trauma can cause brain injury, **porencephaly** specifically refers to tissue destruction and cavity formation, often distinguished from the immediate and direct tissue damage seen in acute traumatic brain injuries [1]. - Trauma typically leads to **hematomas, contusions, or diffuse axonal injury**, rather than the characteristic fluid-filled cysts of porencephaly. *Dandy-Walker syndrome* - **Dandy-Walker syndrome** involves a congenital malformation of the cerebellum and the fluid-filled spaces around it, specifically characterized by **enlargement of the fourth ventricle** and **absence of the cerebellar vermis** [2]. - It is a **developmental brain anomaly**, not typically associated with focal destructive lesions like those seen in porencephaly. *Fetal alcohol syndrome* - **Fetal alcohol syndrome (FAS)** is a group of birth defects caused by maternal alcohol consumption during pregnancy, leading to characteristic facial features, growth deficits, and **central nervous system abnormalities** [3]. - While FAS can cause brain damage including **microcephaly** and **cortical malformations**, the characteristic cysts of porencephaly are not a primary feature. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1260-1261. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 718-719. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 717-718.

Question 9: A muscle biopsy shows 'moth-eaten' fibers. Which histochemical finding would confirm mitochondrial myopathy?

A. Ragged red fibers on MGT (Correct Answer)
B. Type 1 fiber predominance
C. Rimmed vacuoles
D. Nemaline rods

Explanation: ***Ragged red fibers on MGT*** - The presence of **ragged red fibers** on a **modified Gomori trichrome (MGT) stain** is the histological hallmark of **mitochondrial myopathies**. - These fibers represent abnormal accumulation of **dysfunctional mitochondria** beneath the sarcolemma. *Type 1 fiber predominance* - While some myopathies may show type 1 fiber predominance, it is a **non-specific finding** and does not confirm mitochondrial myopathy. - It can be seen in various conditions, including **neurogenic atrophy** or some **congenital myopathies**. *Rimmed vacuoles* - **Rimmed vacuoles** are characteristic of **inclusion body myositis** (IBM) and some **distal myopathies**. - They are not a specific finding for mitochondrial myopathy. *Nemaline rods* - **Nemaline rods** are pathognomonic for **nemaline rod myopathy**, a distinct form of congenital myopathy. - They are composed of **actin filament aggregates** and are unrelated to mitochondrial dysfunction.

Question 10: Barr body is NOT seen in:

A. Marfan's syndrome
B. Turner syndrome (Correct Answer)
C. Down's syndrome
D. Klinefelter syndrome

Explanation: ***Turner syndrome*** - Females with **Turner syndrome** have a **45, X0 karyotype**, meaning they only have one X chromosome [1]. - The **Barr body** is formed by the inactivation of one of the two X chromosomes in females, so its absence indicates only one X chromosome [1]. *Marfan's syndrome* - **Marfan's syndrome** is an autosomal dominant disorder affecting connective tissue, caused by a mutation in the **FBN1 gene** on chromosome 15. - The presence or absence of a Barr body is not directly related to Marfan's syndrome as it affects both males and females, and females would still have a Barr body. *Down's syndrome* - **Down's syndrome** is caused by **trisomy 21**, an extra copy of chromosome 21. - The presence or absence of a Barr body is determined by the number of X chromosomes, and individuals with Down's syndrome, if female, would still have a Barr body. *Klinefelter syndrome* - Individuals with **Klinefelter syndrome** have a **47, XXY karyotype**, possessing at least two X chromosomes and one Y chromosome. - This condition is characterized by the presence of a **Barr body** due to the inactivation of one of the multiple X chromosomes. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 175-177.

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