Obsessive-Compulsive and Related Disorders Practice Questions

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: Sexual stimulation obtained through some inanimate object is known as?

Fetishism. ***Fetishism*** - This paraphilia involves recurrent, intense sexually arousing fantasies, urges, or behaviors involving the use of **nonliving objects** (fetishes) or a highly specific focus on non-genital body parts. - The object itself becomes the focus of sexual arousal, often to the exclusion of interpersonal sexual activity. *Transvestism* - This involves sexual arousal from **cross-dressing** (wearing clothes of the opposite sex), where the arousal comes from the act of dressing or impersonating the opposite gender. - Unlike fetishism, the primary focus is on the behavior of cross-dressing itself, not on the clothing as an inanimate object of sexual desire. *Voyeurism* - This paraphilia involves recurrent, intense sexually arousing fantasies, urges, or behaviors involving **observing unsuspecting people** who are naked, disrobing, or engaging in sexual activity. - The sexual gratification comes from the act of secret observation, not from an inanimate object. *Zoophilia* - This refers to sexual activity or arousal involving **animals**, which are living beings, not inanimate objects. - It is classified as a paraphilia involving non-human animals.

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: Which of the following is not considered a habit disorder?

Temper tantrum. ***Temper tantrum*** - A **temper tantrum** is an emotional outburst, typically in young children, characterized by **stubbornness**, crying, screaming, and physical aggression, and is not classified as a habit disorder. - While it can be a learned behavior, it primarily reflects an inability to regulate emotions and is not a focused, repetitive habit like those seen in habit disorders. *Nail biting* - **Nail biting** (onychophagia) is a repetitive body-focused behavior often triggered by **anxiety** or stress. - It falls under **body-focused repetitive behaviors** (BFRBs), which are considered habit disorders. *Thumb sucking* - **Thumb sucking** is a common habit in infants and young children, often serving as a **self-soothing mechanism**. - If it continues past a certain age or causes dental problems, it is classified as a habit disorder. *Hair pulling (trichotillomania)* - **Trichotillomania** is characterized by the **recurrent urge to pull out one's hair**, leading to noticeable hair loss. - It is classified as an **obsessive-compulsive and related disorder** in DSM-5, which is distinct from simple habit disorders. - While it has repetitive features, it involves complex urges and tension relief patterns beyond typical habit disorders like nail-biting or thumb-sucking.

Q: Irresistible sexual desire is known as:

Hypersexuality. ***Hypersexuality*** - This term describes an **unusually high or frequent sexual drive** or activity in either males or females that causes significant distress or impairment. - While "satyriasis" was historically used for males, **hypersexuality** is the current, more inclusive and clinically recognized term for excessive sexual desire. *Nymphomania* - This term specifically refers to **excessive sexual desire in a female**. - It is an older, often pathologizing term and is generally replaced by terms like **hypersexuality** or **compulsive sexual behavior**. *Tribadism* - This refers to a specific sexual practice between **women involving friction** of the vulva or clitoris. - It describes a *sexual act*, not an overwhelming sexual desire. *Sadism* - This is a paraphilia characterized by deriving **sexual pleasure from inflicting pain or humiliation on others**. - It describes a *preference for a certain type of sexual activity* rather than an irresistible or excessive general sexual desire.

Q: An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?

Trichotillomania (Hair-Pulling Disorder). ***Trichotillomania (Hair-Pulling Disorder)*** - This condition is characterized by the **recurrent pulling out of one's hair**, resulting in noticeable hair loss or **bald patches**. - The description of a **circumscribed bald patch** without evidence of organic disease in an 18-year-old girl is highly suggestive of trichotillomania, especially given that organic causes of hair loss have been ruled out. *Depression* - While depression can be a **comorbid condition** with trichotillomania, it does not directly cause a circumscribed bald patch. - Depression is a **mood disorder** primarily characterized by persistent sadness, loss of interest, and other emotional and physical symptoms. *OCD* - **Obsessive-compulsive disorder** (OCD) involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - Although trichotillomania can share some characteristics with OCD (e.g., repetitive behavior), it is classified as a distinct **body-focused repetitive behavior disorder** in the DSM-5, not OCD itself. *Phobia* - A phobia is an **anxiety disorder** defined by an intense and irrational fear of a specific object or situation. - Phobias do not directly cause **physical symptoms** like bald patches; their primary manifestation is avoidance and panic in the presence of the feared stimulus.

Question 1

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 2

A 24-year-old male with obsessive-compulsive disorder, refractory to high-dose SSRIs, reports persistent intrusive thoughts and rituals. What are the next-line treatment options to evaluate?

Accepted Answer

Add atypical antipsychotic, continue SSRI

Answer

Add clomipramine, monitor ECG

Answer

Switch to SNRI, add CBT

Answer

Consider deep brain stimulation

Question 3

Obsessions are best defined as:

Accepted Answer

Recurrent, intrusive thoughts

Answer

Repetitive behaviors

Answer

Sudden mood changes

Answer

Auditory hallucinations

Question 4

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 5

Sexual stimulation obtained through some inanimate object is known as?

Accepted Answer

Fetishism

Answer

Transvestism

Answer

Voyeurism

Answer

Zoophilia

Question 6

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 7

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 8

Which of the following is not considered a habit disorder?

Accepted Answer

Temper tantrum

Answer

Nail biting

Answer

Thumb sucking

Answer

Hair pulling (trichotillomania)

Question 9

Irresistible sexual desire is known as:

Accepted Answer

Hypersexuality

Answer

Nymphomania

Answer

Tribadism

Answer

Sadism

Question 10

An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?

Accepted Answer

Trichotillomania (Hair-Pulling Disorder)

Answer

Depression

Answer

OCD

Answer

Phobia

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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