Obsessive-Compulsive and Related Disorders — MCQs

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

Question 111: A patient has recurrent intrusive thoughts of contamination and engages in excessive handwashing to relieve distress. This is characteristic of:

A. Generalized Anxiety Disorder
B. Panic Disorder
C. Obsessive-Compulsive Disorder (Correct Answer)
D. Post-Traumatic Stress Disorder

Explanation: ***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.

Question 112: 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?

A. Add clomipramine, monitor ECG
B. Switch to SNRI, add CBT
C. Add atypical antipsychotic, continue SSRI (Correct Answer)
D. Consider deep brain stimulation

Explanation: ***Add atypical antipsychotic, continue SSRI*** - For **refractory OCD** (failed adequate SSRI trials), augmentation with a low-dose **atypical antipsychotic** (e.g., risperidone, aripiprazole, quetiapine) while continuing the SSRI is the **evidence-based first-line next step**. - Multiple RCTs and **APA guidelines** support this approach to reduce persistent **intrusive thoughts** and compulsive behaviors. - This augmentation should ideally be combined with **intensive CBT with ERP (Exposure and Response Prevention)** if not already maximized. *Add clomipramine, monitor ECG* - **Clomipramine** is a tricyclic antidepressant with strong serotonergic activity and proven efficacy for OCD, but it is typically used as a **monotherapy switch** (not augmentation) when SSRIs fail. - It may be considered as an alternative to SSRI monotherapy, but **antipsychotic augmentation** is generally preferred as the next step after SSRI failure. - Due to **cardiac side effects** (QTc prolongation), **ECG monitoring** is essential if clomipramine is used. *Switch to SNRI, add CBT* - While **CBT with ERP** is a core component of OCD treatment and should be part of the treatment plan from the outset (not just added after medication failure), simply switching from an SSRI to an **SNRI** lacks robust evidence for refractory OCD. - SNRIs (venlafaxine, duloxetine) have not demonstrated superior efficacy compared to SSRIs for OCD in head-to-head trials. - A medication switch alone without augmentation or intensive ERP is unlikely to be effective for truly refractory cases. *Consider deep brain stimulation* - **Deep brain stimulation (DBS)** is an **invasive neurosurgical procedure** reserved for **severe, treatment-refractory OCD** after multiple failed trials of medications, augmentation strategies, and intensive psychotherapy. - It is premature at this stage and typically considered only after exhausting all pharmacological augmentation options and maximal CBT/ERP trials.

Question 113: Obsessions are best defined as:

A. Recurrent, intrusive thoughts (Correct Answer)
B. Repetitive behaviors
C. Sudden mood changes
D. Auditory hallucinations

Explanation: ***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.

Question 114: Which of the following is a poor prognostic factor for Obsessive-Compulsive Disorder (OCD)?

A. Poor insight
B. Chronic course
C. Early onset
D. High levels of comorbidity (Correct Answer)

Explanation: ***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.

Question 115: Sexual stimulation obtained through some inanimate object is known as?

A. Transvestism
B. Voyeurism
C. Zoophilia
D. Fetishism (Correct Answer)

Explanation: ***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.

Question 116: Which of the following is the core feature of obsessive-compulsive disorder (OCD)?

A. Pathological doubts
B. Intrusive thoughts (Correct Answer)
C. Contamination
D. Compulsions

Explanation: ***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.

Question 117: Which of the following is a symptom of Obsessive-Compulsive Disorder (OCD)?

A. Magical thinking
B. Pathological doubt (Correct Answer)
C. Hoarding
D. Dirt contamination

Explanation: ***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).

Question 118: Which of the following is not considered a habit disorder?

A. Nail biting
B. Thumb sucking
C. Temper tantrum (Correct Answer)
D. Hair pulling (trichotillomania)

Explanation: ***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.

Question 119: Irresistible sexual desire is known as:

A. Nymphomania
B. Tribadism
C. Sadism
D. Hypersexuality (Correct Answer)

Explanation: ***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.

Question 120: In which condition is psychosurgery considered as a last resort treatment?

A. Severe Generalized Anxiety Disorder
B. Severe Obsessive-Compulsive Disorder (Correct Answer)
C. Severe Depression
D. Severe Phobia

Explanation: ***Severe Obsessive-Compulsive Disorder*** - Psychosurgery (e.g., **anterior cingulotomy**, **capsulotomy**) is considered for individuals with **severe, refractory OCD** who have not responded to conventional treatments. - This intervention aims to disrupt specific neural circuits implicated in OCD, such as the **corticostriatothalamocortical (CSTC) loop**. *Severe Generalized Anxiety Disorder* - While GAD can be debilitating, standard treatments like **psychotherapy (CBT)** and **pharmacotherapy (SSRIs, SNRIs)** are generally effective. - Psychosurgery is not typically considered for GAD, as less invasive and established treatments carry significantly lower risks. *Severe Depression* - For severe, treatment-resistant depression, **electroconvulsive therapy (ECT)** and **transcranial magnetic stimulation (TMS)** are more common and established interventions. - Psychosurgery is rarely, if ever, used for severe depression due to ethical concerns and the availability of less invasive options. *Severe Phobia* - Severe phobias primarily respond to **exposure therapy** and **cognitive behavioral therapy (CBT)**. - These therapies directly target the learned fear response and are highly effective without the need for invasive procedures.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free