Obsessive-Compulsive and Related Disorders Practice Questions

Q: A patient with obsessive-compulsive disorder (OCD) is most likely to develop

Depression. ***Depression*** - **Comorbidity** between OCD and depression is very high, with a significant percentage of individuals with OCD experiencing a major depressive episode at some point. - **Chronic stress**, functional impairment, and feelings of hopelessness associated with managing OCD symptoms often lead to the development of depression. *Schizophrenia* - Schizophrenia is a **psychotic disorder** characterized by significant disturbances in thought, perception, emotion, and behavior, which is distinct from the anxiety-based and ritualistic nature of OCD. - While there can be some overlapping obsessive features in schizophrenia, it is not a direct or highly probable development from OCD. *Hallucination* - **Hallucinations** are perceptual experiences that occur in the absence of an external stimulus, most commonly associated with psychotic disorders like schizophrenia, substance use, or severe mood disorders with psychotic features. - They are not a typical feature or direct development from OCD, which is primarily characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). *Delusion* - **Delusions** are fixed, false beliefs that are not amenable to change in light of conflicting evidence, a hallmark symptom of psychotic disorders. - While some individuals with OCD may experience **poor insight** into the irrationality of their obsessions and compulsions, these are distinct from true delusions.

Q: A person going to temple experiences unwanted, intrusive thoughts urging them to abuse God, which cause significant distress. The likely diagnosis is

Obsessive-Compulsive Disorder. ***Obsessive-Compulsive Disorder*** - The patient experiences **unwanted, intrusive thoughts** (obsessions) that cause significant anxiety and distress, such as the urge to abuse God. - The **irresistible urge** despite personal values suggests a compulsion to alleviate distress associated with the obsessive thought, even if the action is not performed. *Mania* - Characterized by an **elevated or irritable mood**, increased energy, and goal-directed activity, which does not fit the described symptom of internal, distressing urges. - Symptoms often include **racing thoughts**, grandiosity, and decreased need for sleep. *Schizophrenia* - Involves disruptions in thought processes, perceptions, emotional responsiveness, and social interactions, often including **hallucinations** or **delusions**. - The described symptom is an urge, not a break from reality or a hallucination. *Delusion* - A **fixed, false belief** that is not amenable to change in light of conflicting evidence. - The scenario describes an urge or an intrusive thought, which the person recognizes as distressing and unwanted, not a held belief.

Q: Which of the following is NOT true about Obsessive-Compulsive Disorder (OCD)?

Insight is always present. ***Insight is always present*** - While many individuals with OCD have good insight into the irrationality of their obsessions and compulsions, insight exists on a spectrum in OCD. - Some individuals may have **poor insight** or even **absent insight/delusional beliefs**, especially in severe cases, making this statement incorrect. *Ego-alien* - **Ego-alien** specifically refers to thoughts or impulses that are perceived as foreign, intrusive, and not originating from one's own self. - This term is often used interchangeably with **ego-dystonic**, describing the nature of obsessions in OCD. *Patient tries to resist against* - Individuals with OCD typically experience their obsessions and compulsions as distressing and make active efforts to **resist them** or neutralize them. - This resistance is a core feature, although it often fails, leading to the performance of compulsive acts. *Ego dystonic* - **Ego-dystonic** means that the thoughts, impulses, or behaviors are inconsistent with one's fundamental beliefs, values, and sense of self. - Obsessions in OCD are typically **ego-dystonic**, perceived as unpleasant, unwanted, and not in line with the person's character, which causes significant distress.

Q: A 40-year-old teacher reports excessive handwashing, counting rituals, and difficulty in completing daily tasks. She believes these actions prevent harm to her students. What is the diagnosis?

Obsessive-compulsive disorder. ***Obsessive-compulsive disorder*** - The patient's presentation of **recurrent, intrusive thoughts** (worries about students' harm) and **repetitive behaviors** (excessive handwashing, counting rituals) performed to reduce anxiety or prevent a dreaded event is characteristic of OCD. - The individual recognizes that these obsessions or compulsions are **excessive or unreasonable**, causing significant distress and impairment in daily functioning. *Generalized anxiety disorder* - This disorder is characterized by **persistent and excessive worry** about various aspects of life, not typically focused on specific, intrusive obsessions leading to compulsive rituals. - While anxiety is present, it does not manifest as specific **compulsive behaviors** performed in response to obsessions. *Paranoid schizophrenia* - Schizophrenia involves **psychotic symptoms** such as delusions (fixed false beliefs, often persecutory), hallucinations, disorganized speech, and negative symptoms. - The patient's symptoms are not indicative of a thought disorder, delusions, or hallucinations but rather anxiety-driven, repetitive behaviors. *Phobic disorder* - **Phobic disorders** involve intense, irrational fear of specific objects or situations (e.g., social phobia, specific phobia). - The patient's symptoms are not primarily triggered by a specific phobic stimulus but rather by intrusive thoughts leading to ritualistic behaviors.

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: A 28-year-old male with obsessive-compulsive disorder experiences minimal relief after an adequate trial of high-dose SSRIs. What is the next best treatment option?

Add clomipramine. ***Add clomipramine*** - **Clomipramine**, a tricyclic antidepressant (TCA), is a potent serotonin reuptake inhibitor and is considered an effective alternative for treatment-resistant OCD when SSRIs fail. - It can be used as monotherapy (after tapering the SSRI) or carefully as augmentation, though combination requires monitoring for serotonin syndrome. - Its efficacy in OCD is well-established in clinical trials, making it a valid option for SSRI non-responders. *Start electroconvulsive therapy* - **Electroconvulsive therapy (ECT)** is generally reserved for severe, treatment-resistant depression with psychotic features or catatonia. - While it has been explored in very refractory OCD cases after multiple medication failures, it is not a standard next-line treatment given the available pharmacological options. *Switch to antipsychotics* - **Antipsychotic monotherapy** is not indicated for OCD treatment. - However, **augmentation** with low-dose atypical antipsychotics (aripiprazole, risperidone) added to SSRIs is an evidence-based strategy for partial responders, but the option states "switch" rather than "add." - Direct switching to antipsychotics as monotherapy would be inappropriate. *Add benzodiazepines* - **Benzodiazepines** may provide short-term relief of severe anxiety symptoms or insomnia associated with OCD. - They do not address the core obsessive-compulsive symptoms and are not considered an effective augmentation strategy for the primary treatment of OCD. - They carry risks of dependence and tolerance with long-term use.

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 patient with OCD washes their hands excessively. What is the best cognitive-behavioral therapy (CBT) technique for this condition?

Exposure and Response Prevention (ERP). ***ERP*** - **Exposure and Response Prevention (ERP)** is the gold standard CBT technique for OCD. It involves **gradually exposing** the individual to situations or objects that trigger their obsessions while preventing them from engaging in their compulsive rituals. - For excessive hand washing, this would mean touching a perceived "contaminated" object (exposure) and then **refraining from washing their hands** (response prevention) for increasing periods. *Flooding* - **Flooding** is a form of exposure therapy where the individual is **immediately exposed to their most feared stimulus** at maximum intensity without the option of avoidance. - While it involves exposure, it **lacks the gradual approach** and response prevention specifically tailored for OCD in the same structured way as ERP, making it less preferred as a first-line CBT technique for OCD. *Systematic desensitization* - **Systematic desensitization** primarily focuses on pairing relaxation techniques with a **hierarchy of feared stimuli**, commonly used for phobias. - While it involves gradual exposure, it emphasizes **relaxation as the primary coping mechanism**, which is less effective for directly addressing the compulsive behaviors in OCD. *Cognitive restructuring* - **Cognitive restructuring** is a CBT technique that focuses on **identifying and challenging maladaptive thoughts** and beliefs. - While it can be a component of OCD treatment to address distorted thoughts related to obsessions, it does not directly target the **behavioral compulsions** as effectively as ERP.

Q: Which of the following is the first-line pharmacological treatment for obsessive-compulsive disorder?

Selective Serotonin Reuptake Inhibitors. ***Selective Serotonin Reuptake Inhibitors*** - **SSRIs** are widely recognized as the **first-line pharmacological treatment** for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the **serotonin levels** in the brain, thereby improving mood and reducing anxiety. *Beta blockers* - **Beta blockers** are primarily used to treat **physical symptoms of anxiety**, such as palpitations and tremors, but do not directly address the core symptoms of OCD. - They are not considered a first-line treatment for psychiatric conditions beyond performance anxiety or specific phobias. *Antipsychotics* - **Antipsychotics** may be used as an **adjunctive treatment** in refractory cases of OCD, particularly when there is a co-occurring psychotic disorder or severe tics. - They are not a first-line therapy because their primary mechanism of action targets dopamine, which is not the main pathway implicated in OCD. *Tricyclic antidepressants* - While some **TCAs**, particularly **clomipramine**, have shown efficacy in treating OCD, they are generally considered **second-line treatments** due to their less favorable side effect profile compared to SSRIs. - Their use is limited by potential side effects such as **anticholinergic effects**, cardiovascular risks, and a higher risk of overdose.

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.

Question 1

A patient with obsessive-compulsive disorder (OCD) is most likely to develop

Accepted Answer

Depression

Answer

Schizophrenia

Answer

Hallucination

Answer

Delusion

Question 2

A person going to temple experiences unwanted, intrusive thoughts urging them to abuse God, which cause significant distress. The likely diagnosis is

Accepted Answer

Obsessive-Compulsive Disorder

Answer

Mania

Answer

Schizophrenia

Answer

Delusion

Question 3

Which of the following is NOT true about Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

Insight is always present

Answer

Ego-alien

Answer

Patient tries to resist against

Answer

Ego dystonic

Question 4

A 40-year-old teacher reports excessive handwashing, counting rituals, and difficulty in completing daily tasks. She believes these actions prevent harm to her students. What is the diagnosis?

Accepted Answer

Obsessive-compulsive disorder

Answer

Generalized anxiety disorder

Answer

Paranoid schizophrenia

Answer

Phobic disorder

Question 5

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 6

A 28-year-old male with obsessive-compulsive disorder experiences minimal relief after an adequate trial of high-dose SSRIs. What is the next best treatment option?

Accepted Answer

Add clomipramine

Answer

Start electroconvulsive therapy

Answer

Switch to antipsychotics

Answer

Add benzodiazepines

Question 7

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 8

A patient with OCD washes their hands excessively. What is the best cognitive-behavioral therapy (CBT) technique for this condition?

Accepted Answer

Exposure and Response Prevention (ERP)

Answer

Flooding

Answer

Systematic desensitization

Answer

Cognitive restructuring

Question 9

Which of the following is the first-line pharmacological treatment for obsessive-compulsive disorder?

Accepted Answer

Selective Serotonin Reuptake Inhibitors

Answer

Beta blockers

Answer

Antipsychotics

Answer

Tricyclic antidepressants

Question 10

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

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?