Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders Indian Medical PG Practice Questions and MCQs

Question 91: 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 92: All are used in OCD except:

A. Behavioural therapy
B. Clomipramine
C. SSRIs
D. ECT (Correct Answer)

Explanation: ***ECT*** - **Electroconvulsive therapy (ECT)** is a treatment primarily used for severe depression that has not responded to other treatments, **schizophrenia**, and **bipolar disorder with psychotic features**, not for OCD. - While it can be considered for very severe, refractory OCD in rare cases under specific guidelines, it is not a routine or primary treatment. *Behavioural therapy* - **Exposure and response prevention (ERP)**, a type of behavioral therapy, is considered the **gold standard non-pharmacological treatment** for OCD. - ERP involves gradually exposing the individual to feared situations or thoughts and preventing them from performing ritualistic compulsions. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that is well-established as an effective pharmacotherapy for OCD. - It has potent serotonin reuptake inhibition properties, making it particularly useful in treating OCD symptoms. *SSRIs* - **Selective serotonin reuptake inhibitors (SSRIs)** are considered **first-line pharmacological treatments** for OCD. - They work by increasing the levels of serotonin in the brain, helping to reduce obsessive thoughts and compulsive behaviors.

Question 93: Excessive buying is termed as: DNB 08

A. Trichotillomania
B. Pyromania
C. Kleptomania
D. Oniomania (Correct Answer)

Explanation: ***Oniomania*** - **Oniomania** is characterized by an uncontrollable urge to **buy goods**, often leading to financial difficulties and personal distress. - It is also known as **compulsive buying disorder** or **buying addiction**. *Trichotillomania* - This impulse control disorder involves the **recurrent, irresistible urge to pull out one's hair**, leading to noticeable hair loss. - It is not associated with excessive buying but rather with **self-inflicted hair removal**. *Pyromania* - **Pyromania** is an impulse control disorder characterized by a fascination with fire and an uncontrollable urge to **deliberately set fires**. - It is distinct from buying impulses and is associated with **arsonistic behavior**. *Kleptomania* - **Kleptomania** is an impulse control disorder involving the recurrent failure to resist urges to **steal items** that are not needed for personal use or monetary value. - This condition is about stealing, not compulsive purchasing.

Question 94: Drug most useful in the treatment of obsessive compulsive disorder is

A. Doxepin
B. Fluoxetine (Correct Answer)
C. Dothiepin
D. Amoxapine

Explanation: ***Fluoxetine*** - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)**, which are considered first-line treatments for **obsessive-compulsive disorder (OCD)**. - SSRIs, including fluoxetine, are effective in **reducing the severity of obsessions and compulsions** by increasing serotonin levels in the brain. *Doxepin* - **Doxepin** is a **tricyclic antidepressant (TCA)** that primarily blocks the reuptake of norepinephrine and serotonin but also has significant anticholinergic and antihistaminic properties. - TCAs are generally **less preferred for OCD** due to their side effect profile and **SSRIs** typically showing greater efficacy. *Dothiepin* - **Dothiepin** is also a **tricyclic antidepressant (TCA)** with similar mechanisms and side effects to doxepin. - Like other TCAs, dothiepin is **not a first-line treatment for OCD**; SSRIs are more commonly used due to better tolerability and efficacy. *Amoxapine* - **Amoxapine** is a **tetracyclic antidepressant** with properties similar to TCAs, also acting as a **norepinephrine and dopamine reuptake inhibitor**. - While it has antidepressant effects, amoxapine is **not typically used for OCD** and carries a risk of inducing extrapyramidal side effects.

Question 95: Compulsive sexual behavior is most closely associated with which of the following disorders?

A. Hair pulling (Correct Answer)
B. Gambling
C. Stealing
D. Sexual desire

Explanation: ***Hair pulling*** - **Compulsive sexual behavior disorder (CSBD)** and **trichotillomania (hair pulling)** are both classified as **impulse control disorders** involving recurrent, irresistible urges to engage in specific behaviors despite negative consequences. - Both disorders share similar neurobiological features, including **poor impulse control**, **reward dysregulation**, and repetitive behavioral patterns. - In ICD-11, CSBD is classified under "Impulse Control Disorders" (6C72), while trichotillomania shares features with obsessive-compulsive and related disorders, making them more closely related than other options. - Both involve ego-dystonic urges (distressing to the individual) and similar treatment approaches including cognitive-behavioral therapy and SSRIs. *Gambling* - **Gambling disorder** is classified as a **substance-related and addictive disorder** (behavioral addiction) in DSM-5, representing a different category from compulsive sexual behavior. - While some researchers debate whether CSBD should be classified as a behavioral addiction, current official diagnostic systems (DSM-5-TR, ICD-11) classify it as an impulse control disorder, not an addiction. - The neurobiological overlap exists but represents a different disorder category with distinct diagnostic criteria. *Stealing* - **Kleptomania (stealing)** is an **impulse control disorder** characterized by recurrent failure to resist impulses to steal objects not needed for personal use. - While it shares the impulse control feature with CSBD, it lacks the interpersonal, relationship-focused, and sexual drive components that characterize compulsive sexual behavior. - The primary motivation (tension reduction through stealing) differs from the sexual gratification seeking in CSBD. *Sexual desire* - **Sexual desire** is a normal human drive and is not a disorder in itself. It is a healthy component of human sexuality. - **Compulsive sexual behavior disorder** represents an *excessive* and *uncontrolled* manifestation that causes significant distress or impairment, differentiating it from healthy sexual desire. - Normal sexual desire does not involve the compulsive, uncontrollable urges characteristic of CSBD.

Question 96: Basanti, a 27-year-old female, thinks that her nose is ugly. Her idea is fixed and is not shared by anyone else. Whenever she goes out of the home, she hides her face. She visits a surgeon for plastic surgery. The appropriate next step would be:

A. Reassure the patient
B. Investigate and then operate
C. Immediate operation
D. Refer to psychiatrist (Correct Answer)

Explanation: ***Refer to psychiatrist*** - Basanti's fixed belief that her nose is ugly, despite it not being shared by others, and her subsequent **social avoidance** (hiding her face) are characteristic signs of **Body Dysmorphic Disorder (BDD)**. - Patients with BDD often present to plastic surgeons seeking multiple procedures, and surgery is typically ineffective and can worsen their distress; therefore, a psychiatric referral for diagnosis and treatment (e.g., **CBT and SSRIs**) is the appropriate first step. *Reassure the patient* - Reassurance alone is insufficient for a patient with BDD, as their distress is rooted in a **distorted self-perception** rather than a lack of understanding about their appearance. - While reassurance might provide temporary comfort, it does not address the underlying **psychological condition** and the severe impact it has on their life. *Investigate and then operate* - Performing investigations or surgery without addressing the underlying psychological disorder would be inappropriate and potentially harmful. - Surgery is unlikely to alleviate the patient's distress in BDD and may lead to dissatisfaction, further surgeries, and increased psychological morbidity, as the perceived defect is often **imagined or greatly exaggerated**. *Immediate operation* - An immediate operation would be highly unethical and detrimental given the clear indicators of a **psychiatric disorder**. - Surgery in such cases risks worsening the patient's **body image dissatisfaction** and mental health, as their perception of the defect is not based on reality.

Question 97: A woman comes to psychiatrist with history of spending a lot of time in washing her hands. She is distressed about it but says that she is not able to stop washing. This has started to affect her social life as well. What is the best mode of treatment for her?

A. Exposure and response prevention (Correct Answer)
B. Systematic desensitization
C. Cognitive behavioral therapy
D. Pharmacological agents

Explanation: ***Exposure and response prevention*** - **Exposure and response prevention (ERP)** is the **most specific and evidence-based** psychotherapy for **obsessive-compulsive disorder (OCD)**. - It is a specialized form of **Cognitive Behavioral Therapy (CBT)** that directly targets OCD by gradually exposing the individual to situations or objects that trigger their obsessions (e.g., dirt) and then preventing them from performing their compulsive rituals (e.g., handwashing). - **ERP is considered the gold standard psychotherapy** for OCD with the strongest evidence base, making it the **best** (most specific) answer. *Systematic desensitization* - This technique is primarily used for **specific phobias** and involves pairing relaxation techniques with gradual exposure to feared stimuli. - While it involves exposure, it does **not address the response prevention component** critical for treating compulsive rituals in OCD. - Less effective than ERP for OCD specifically. *Cognitive behavioral therapy* - **CBT is also a correct treatment** for OCD, as ERP is delivered within a CBT framework. - However, when answering "best mode of treatment," **ERP is the more specific answer** as it identifies the particular CBT technique with the strongest evidence for OCD. - Standard CBT without the specific ERP component (focusing only on cognitive restructuring) would be less effective than ERP for compulsive behaviors. *Pharmacological agents* - **SSRIs** (particularly high-dose) are first-line pharmacological treatment for OCD and often used in combination with ERP. - However, **psychotherapy with ERP** is generally considered the first-line treatment and can achieve significant long-term remission even as monotherapy. - The question asks for "mode of treatment" in a clinical context where behavioral intervention is being considered, making ERP the best answer.

Question 98: Repetitive hand washing is a symptom of

A. Anorexia nervosa
B. Obsessive compulsive disorder (Correct Answer)
C. Post traumatic stress disorder
D. Depression

Explanation: ***Obsessive compulsive disorder*** - **Repetitive hand washing** is a classic example of a **compulsion** in OCD, driven by an obsession (e.g., fear of contamination). - Patients with OCD feel compelled to perform these actions to reduce anxiety or prevent a dreaded outcome, despite recognizing their irrationality. *Anorexia nervosa* - Characterized by an intense **fear of gaining weight** and a distorted body image, leading to severe calorie restriction and low body weight. - Its symptoms revolve around eating habits, body image, and weight control, not repetitive hand washing. *Post traumatic stress disorder* - Develops after exposure to a **traumatic event** and is characterized by intrusive thoughts, flashbacks, avoidance behaviors, and hyperarousal. - While anxiety is a feature, repetitive hand washing is not a core symptom or compulsion associated with PTSD. *Depression* - Primary symptoms include **persistent sadness**, loss of interest or pleasure, changes in appetite or sleep, and feelings of worthlessness. - Though an individual with depression may have poor hygiene or, less commonly, obsessive thoughts, repetitive hand washing is not characteristic of major depressive disorder itself.

Question 99: Defence mechanism in OCD?

A. Sublimation
B. Regression
C. Reaction formation (Correct Answer)
D. Progression

Explanation: ***Reaction formation*** - In **Obsessive-Compulsive Disorder (OCD)**, individuals often use **reaction formation** by expressing the opposite of their true, unacceptable impulses or feelings. - This mechanism helps to keep unwanted **obsessive thoughts** or impulses out of conscious awareness by actively demonstrating behaviors or attitudes contrary to them. - **Note**: OCD also prominently involves other defense mechanisms like **undoing** (rituals to neutralize obsessions) and **isolation of affect** (separating emotion from thought). *Sublimation* - **Sublimation** involves channeling unacceptable impulses or emotions into socially acceptable or even productive behaviors. - While considered a mature defense mechanism, it is not the primary defense mechanism associated with the rigid and often ritualistic behaviors seen in OCD. *Regression* - **Regression** is a return to an earlier, more childlike, or less mature state of functioning in response to stress or anxiety. - While some individuals with OCD might show regressive behaviors, it is not the central or defining defense mechanism of the disorder. *Progression* - **Progression** is not a recognized psychological defense mechanism in psychodynamic theory. - It describes a movement forward or development, which is distinct from the unconscious strategies used to protect the ego from anxiety.

Question 100: OCD treatment is based on -

A. Serotonergic receptor (Correct Answer)
B. Glutamate receptor
C. Dopaminergic receptor
D. NA receptor

Explanation: ***Serotonergic receptor*** - The efficacy of **selective serotonin reuptake inhibitors (SSRIs)** in treating OCD strongly implicates **serotonin pathways** in its pathophysiology. - Many patients with OCD show improvement in symptoms with medications that enhance **serotonin neurotransmission**. *Glutamate receptor* - While **glutamate** plays a role in neural excitability and learning, it is not the primary target for established OCD treatments. - Research on **glutamate modulators** for OCD is ongoing, but they are not first-line therapies. *Dopaminergic receptor* - **Dopamine pathways** are primarily involved in reward, motivation, and motor control, and are targeted in conditions like schizophrenia and Parkinson's disease. - Treatments directly targeting dopamine receptors are not primary for OCD, although **dopamine antagonists** may be used as augmentation in some refractory cases. *NA receptor* - **Norepinephrine (NA)** is involved in alertness, stress, and mood regulation, and is targeted in depression and anxiety disorders. - While some **tricyclic antidepressants** with NA effects can be used, medications primarily targeting NA receptors are not the mainstay for OCD.

Practice by Chapter

Obsessive-Compulsive Disorder

Practice Questions

Body Dysmorphic Disorder

Practice Questions

Hoarding Disorder

Practice Questions

Trichotillomania

Practice Questions

Excoriation (Skin-Picking) Disorder

Practice Questions

Tic Disorders

Practice Questions

Tourette's Syndrome

Practice Questions

Pharmacotherapy for OCD and Related Disorders

Practice Questions

Cognitive-Behavioral Therapy for OCD

Practice Questions

Neurosurgical Approaches

Practice Questions

OCD in Children and Adolescents

Practice Questions

OCD Spectrum Disorders

Practice Questions

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