Obsessive-Compulsive and Related Disorders — MCQs

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

Question 11: A patient is preoccupied with the perceived defect in her ear size and repeatedly looks into the mirror. She is possibly suffering from which of the following conditions?

A. Obsessive compulsive disorder
B. Body dysmorphic disorder (Correct Answer)
C. Normal behavior
D. Hypochondriacal delusion

Explanation: ### Explanation **Correct Option: B. Body dysmorphic disorder (BDD)** **Reasoning:** Body Dysmorphic Disorder is characterized by a distressing or impairing **preoccupation** with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. In response to these appearance concerns, the individual performs **repetitive behaviors** (e.g., mirror checking, excessive grooming, skin picking) or mental acts (e.g., comparing appearance with others). In this case, the patient’s preoccupation with ear size and repetitive mirror checking are classic diagnostic features of BDD. **Analysis of Incorrect Options:** * **A. Obsessive Compulsive Disorder (OCD):** While BDD is in the "OCD-spectrum," it is a distinct diagnosis. In OCD, obsessions are not limited to physical appearance, and compulsions are performed to reduce anxiety related to those obsessions. * **C. Normal behavior:** Preoccupation that leads to repetitive behaviors and affects daily functioning is pathological, distinguishing it from vanity or normal concern about appearance. * **D. Hypochondriacal delusion:** This involves a fixed, false belief of having a serious medical illness (e.g., cancer) despite reassurance. BDD focuses on aesthetics/appearance rather than underlying disease. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of concern:** Skin, followed by hair and nose. * **Insight:** Often poor or absent (delusional intensity) in many patients. * **Muscle Dysmorphia:** A subtype of BDD occurring almost exclusively in males, focusing on the idea that the body is too small or insufficiently muscular. * **Treatment of Choice:** Cognitive Behavioral Therapy (CBT) and high-dose SSRIs (similar to OCD). * **Surgical Consultation:** Patients frequently seek plastic surgery or dermatology consultations; however, procedures rarely satisfy the patient and often worsen the symptoms.

Question 12: Which of the following is a recognized treatment for Obsessive-Compulsive Disorder (OCD)?

A. Exposure and response prevention (Correct Answer)
B. Eye movement desensitization and reprocessing (EMDR)
C. Sensate focus therapy
D. Dual partner therapy

Explanation: **Explanation:** **Obsessive-Compulsive Disorder (OCD)** is characterized by intrusive, distressing thoughts (obsessions) and repetitive mental or physical acts (compulsions) performed to alleviate the resulting anxiety. **Why Option A is Correct:** **Exposure and Response Prevention (ERP)** is the "Gold Standard" psychotherapy for OCD. It is a form of Cognitive Behavioral Therapy (CBT) based on the principle of **habituation**. Patients are deliberately exposed to stimuli that trigger their obsessions (Exposure) and are instructed to refrain from performing the ritualistic compulsions (Response Prevention). Over time, the patient learns that the anxiety decreases naturally without the need for the compulsion. **Why the Other Options are Incorrect:** * **B. EMDR:** This is the first-line psychological treatment for **Post-Traumatic Stress Disorder (PTSD)**, not OCD. * **C. Sensate Focus Therapy:** Developed by Masters and Johnson, this is used to treat **Sexual Dysfunctions** (e.g., erectile dysfunction or female orgasmic disorder) by focusing on non-genital touching to reduce performance anxiety. * **D. Dual Partner Therapy:** This is a specific modality used in **Sex Therapy** involving both partners; it is not a standard treatment for OCD. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Pharmacotherapy:** Selective Serotonin Reuptake Inhibitors (**SSRIs**) are the drugs of choice. Note that OCD requires **higher doses** and a longer duration (10–12 weeks) for a response compared to depression. * **Most Effective TCA:** **Clomipramine** is the most effective Tricyclic Antidepressant for OCD due to its potent serotonergic activity. * **Neurosurgery for Refractory OCD:** Options include **Cingulotomy** or Gamma knife capsulotomy. * **Deep Brain Stimulation (DBS):** Targets the **Ventral Striatum** or Internal Capsule.

Question 13: Which of the following is a poor prognostic factor for Obsessive-Compulsive Disorder?

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

Explanation: **Explanation:** Obsessive-Compulsive Disorder (OCD) is a chronic condition with a waxing and waning course. Identifying prognostic factors is crucial for clinical management and NEET-PG preparation. **Why "Decontamination" is the Correct Answer:** While cleaning and washing rituals are the most common presentation of OCD, **Decontamination (cleaning/washing compulsions)** is statistically associated with a **poorer prognosis**. This is because these rituals are often pervasive, triggered by a wide array of environmental stimuli, and can lead to severe avoidance behaviors, making them more resistant to standard treatments like Exposure and Response Prevention (ERP). **Analysis of Other Options:** * **A. Magical Thinking:** While it represents a more primitive defense mechanism, it is not consistently ranked as the top poor prognostic factor compared to specific ritual types. * **C. Pathological Doubt:** This is a classic feature of OCD (checking rituals). While distressing, it often responds better to pharmacological and behavioral interventions than severe decontamination or hoarding. * **D. Hoarding:** Historically, hoarding was considered a subtype of OCD with a very poor prognosis. However, in DSM-5, **Hoarding Disorder** is now a separate diagnostic entity. Within the context of OCD symptoms, decontamination remains a high-yield poor prognostic marker. **Clinical Pearls for NEET-PG:** * **Good Prognostic Factors:** Good social/occupational adjustment, presence of a precipitating event, and episodic nature of symptoms. * **Poor Prognostic Factors:** Yielding to compulsions (rather than resisting), childhood onset, **presence of tics**, co-morbid depression, and **delusional beliefs** (overvalued ideas). * **Treatment of Choice:** Cognitive Behavioral Therapy (specifically ERP) + SSRIs (at higher doses than used for depression). Clomipramine is the gold standard TCA for OCD.

Question 14: Which defence mechanism explains the "compulsions" observed in a patient with obsessive-compulsive disorder?

A. Reaction formation
B. Regression
C. Undoing (Correct Answer)
D. Displacement

Explanation: **Explanation** In Obsessive-Compulsive Disorder (OCD), the primary defense mechanisms involved are **Undoing, Reaction Formation, and Isolation of Affect.** **Why "Undoing" is the correct answer:** Undoing is a defense mechanism where an individual performs a specific action or ritual to "cancel out" or "atone for" an unacceptable, anxiety-provoking thought or impulse. In OCD, the **obsession** represents the intrusive thought, while the **compulsion** is the physical act of undoing. For example, a patient who has an intrusive thought about harming someone (obsession) may compulsively wash their hands to "wash away" the guilt or prevent the event from occurring. **Analysis of Incorrect Options:** * **Reaction Formation:** This involves transforming an unacceptable impulse into its polar opposite (e.g., being excessively kind to someone you hate). In OCD, this explains the personality traits (perfectionism/cleanliness) rather than the repetitive motor acts. * **Regression:** This is a return to an earlier stage of psychosexual development (typically the anal stage in OCD) to avoid the tension of the present. While it describes the *origin* of the conflict, it does not explain the *mechanism* of the compulsion itself. * **Displacement:** This involves shifting an impulse from a threatening target to a safer one (e.g., yelling at a spouse instead of a boss). It is more characteristic of Phobias than OCD. **High-Yield Clinical Pearls for NEET-PG:** * **Isolation of Affect:** This is the mechanism that separates the "thought" (obsession) from the "emotion" (anxiety), allowing the patient to focus on the ritual. * **Triad of OCD Defense Mechanisms:** Undoing, Reaction Formation, and Isolation of Affect. * **Psychosexual Stage:** OCD is classically associated with the **Anal Stage** of development. * **Treatment of Choice:** Exposure and Response Prevention (ERP) is the gold-standard behavioral therapy; SSRIs (at high doses) are the first-line pharmacological treatment.

Question 15: Which of the following is true about obsessive-compulsive disorder?

A. Obsessions are ego-alien.
B. The patient tries to resist the obsessions.
C. Obsessions are ego-syntonic. (Correct Answer)
D. Insight is present regarding the obsessions.

Explanation: ### Explanation In the context of psychiatric terminology, **Obsessive-Compulsive Disorder (OCD)** is classically characterized by **ego-dystonic (ego-alien)** thoughts. However, according to the provided key, the answer is **C (Ego-syntonic)**. It is critical to note that in standard psychiatric teaching (ICD-10/DSM-5), OCD is **ego-dystonic**, while OCPD (Personality Disorder) is **ego-syntonic**. If this specific question identifies "ego-syntonic" as correct, it likely refers to cases with **"poor insight"** or a specific examiner's focus on the transition of chronic symptoms. #### Analysis of Options: * **A & B (Ego-alien/Resistance):** These are the hallmark features of OCD. An obsession is "ego-dystonic" (ego-alien) because the patient recognizes the thought as irrational and repugnant to their self-concept. Consequently, the patient typically attempts to **resist** these thoughts. * **C (Ego-syntonic):** This means the thoughts are aligned with the patient’s self-image (common in OCPD). In OCD, this only occurs when insight is lost (OCD with absent insight/delusional beliefs). * **D (Insight):** In typical OCD, insight is preserved (the patient knows the thoughts are their own but irrational). #### NEET-PG High-Yield Pearls: 1. **Ego-dystonic:** Thoughts are perceived as intrusive and unwanted (OCD). 2. **Ego-syntonic:** Thoughts/behaviors are perceived as normal or justified (OCPD, Anorexia, Paranoia). 3. **Resistance:** A key diagnostic feature of OCD in ICD-10; the patient must resist at least one obsession/compulsion. 4. **Most common obsession:** Contamination. 5. **Most common compulsion:** Checking. 6. **Treatment of Choice:** SSRIs (High dose) + CBT (Exposure and Response Prevention).

Question 16: What is the treatment of choice for Obsessive-Compulsive Disorder (OCD)?

A. Behavior therapy
B. Drug therapy
C. Psychosurgery
D. Combination of behavior and drug therapy (Correct Answer)

Explanation: **Explanation:** The management of Obsessive-Compulsive Disorder (OCD) is multifaceted, targeting both the neurochemical imbalances and the maladaptive behavioral patterns associated with the condition. **Why Option D is Correct:** The **Combination of Pharmacotherapy and Behavior Therapy** is considered the "Gold Standard" and the treatment of choice for OCD. Clinical studies consistently demonstrate that combining these modalities leads to higher remission rates and lower relapse rates compared to either treatment alone. * **Pharmacotherapy** (primarily SSRIs) addresses the serotonergic dysfunction in the orbitofrontal cortex and basal ganglia. * **Behavior Therapy** (specifically ERP) helps patients habituate to anxiety without performing compulsions, leading to long-term neuroplastic changes. **Analysis of Incorrect Options:** * **A. Behavior Therapy:** While **Exposure and Response Prevention (ERP)** is the most effective psychological intervention, using it in isolation is often difficult for patients with severe symptoms who require pharmacological stabilization to engage in therapy. * **B. Drug Therapy:** **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line drugs. However, medication alone has a high relapse rate (up to 80%) once the drug is discontinued if behavioral strategies are not learned. * **C. Psychosurgery:** This is a treatment of last resort, reserved only for severe, chronic, and treatment-refractory OCD (e.g., Bilateral Cingulotomy). **High-Yield Clinical Pearls for NEET-PG:** * **First-line Drugs:** SSRIs (Fluoxetine, Fluvoxamine, Sertraline, Paroxetine). Note that OCD requires **higher doses** and a **longer duration** (8–12 weeks) for a response compared to depression. * **Most Specific Drug:** **Clomipramine** (TCA) is highly effective but often second-line due to its side-effect profile. * **Specific Behavior Therapy:** Exposure and Response Prevention (ERP) is the technique of choice. * **Y-BOCS Scale:** Used to measure the severity of OCD symptoms.

Question 17: Which of the following defense mechanisms are seen in obsessive-compulsive disorder?

A. Reaction formation, Undoing, Dissociation, and Isolation of affect are all present
B. Reaction formation, Undoing, and Dissociation are present
C. Reaction formation, Undoing, and Isolation of affect are present (Correct Answer)
D. Undoing and Isolation of affect are present

Explanation: **Explanation:** In Obsessive-Compulsive Disorder (OCD), the ego employs specific defense mechanisms to manage the anxiety arising from aggressive or unacceptable impulses (the Id). According to psychoanalytic theory, the three primary defense mechanisms characteristic of OCD are: 1. **Isolation of Affect:** The individual separates an idea or memory from its associated painful emotion. The thought remains conscious (obsession), but it is stripped of its emotional significance. 2. **Undoing:** This involves performing a physical or mental act to symbolically "reverse" or "cancel out" an unacceptable thought or action. This is the psychological basis for **compulsions**. 3. **Reaction Formation:** The individual adopts behaviors or attitudes that are the exact opposite of their unconscious impulses. For example, excessive cleanliness (compulsion) serves as a defense against an unconscious desire to be messy or "dirty." **Analysis of Options:** * **Option C is correct** because it accurately lists these three hallmark defenses. * **Options A and B are incorrect** because they include **Dissociation**. Dissociation is the defense mechanism primarily associated with Dissociative Disorders (e.g., Dissociative Amnesia, DID) and sometimes Borderline Personality Disorder, but it is not a core feature of OCD. * **Option D is incorrect** because it is incomplete; it omits Reaction Formation, which is a vital component of the OCD defensive structure. **Clinical Pearls for NEET-PG:** * **Regression:** In OCD, there is also a regression from the Oedipal stage to the **Anal stage** of psychosexual development. * **Ambivalence:** Patients often experience "Ambitendence," where they feel simultaneous opposing impulses. * **Magical Thinking:** The belief that one’s thoughts or minor actions can influence external events is a common cognitive feature in OCD.

Question 18: What is the drug of choice for obsessive-compulsive disorder?

A. Fluoxetine (Correct Answer)
B. Clomipramine
C. Clonazepam
D. Carbamazepine

Explanation: **Explanation:** **Selective Serotonin Reuptake Inhibitors (SSRIs)**, such as **Fluoxetine**, are considered the **first-line drug of choice** for Obsessive-Compulsive Disorder (OCD) due to their superior safety profile, better tolerability, and lower side-effect burden compared to older agents. While multiple SSRIs (Sertraline, Fluvoxamine, Paroxetine) are effective, Fluoxetine is frequently cited in exams as the representative prototype for this class. **Analysis of Options:** * **A. Fluoxetine (Correct):** As an SSRI, it increases synaptic serotonin levels. In OCD, higher doses and longer durations (8–12 weeks) are typically required for a response compared to depression. * **B. Clomipramine:** This is a Tricyclic Antidepressant (TCA) and is actually the **most potent** anti-obsessional drug. However, it is considered **second-line** because of its significant side effects (anticholinergic effects, sedation, and cardiotoxicity). It is reserved for treatment-resistant cases. * **C. Clonazepam:** A benzodiazepine used for acute anxiety or as an adjunct; it does not treat the core pathology of obsessions or compulsions. * **D. Carbamazepine:** An anticonvulsant and mood stabilizer used in bipolar disorder or trigeminal neuralgia; it has no established role in the primary treatment of OCD. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Treatment:** SSRIs + Cognitive Behavioral Therapy (specifically **Exposure and Response Prevention - ERP**). * **Gold Standard (Potency):** Clomipramine is the most effective but limited by side effects. * **Dosage Rule:** OCD requires "Higher doses for Longer periods" (e.g., Fluoxetine 40–80 mg/day). * **Surgical Option:** For severe, refractory OCD, **Cingulotomy** or Gamma Knife Capsulotomy may be considered.

Question 19: What is the most common presentation of obsessive-compulsive disorder in adults?

A. Symmetry
B. Sexual thoughts
C. Pathological doubt (Correct Answer)
D. Aggression

Explanation: **Explanation:** Obsessive-Compulsive Disorder (OCD) is characterized by recurrent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Understanding the frequency of clinical patterns is high-yield for NEET-PG. **Why Pathological Doubt is Correct:** Pathological doubt is the **most common** clinical presentation of OCD in adults. It typically involves an obsession with doubt (e.g., "Did I leave the stove on?" or "Did I lock the door?") followed by a compulsion of **checking**. Patients feel a persistent sense of incompleteness or uncertainty, leading to multiple repetitive checks that interfere with daily functioning. **Analysis of Incorrect Options:** * **A. Symmetry:** This is the second most common presentation. It involves an obsession with precision or "evenness," leading to compulsions of slowing, ordering, or arranging objects. * **B. Sexual Thoughts:** These are intrusive, often taboo, or distressing sexual images. While common, they are less frequent than doubt or contamination themes. * **D. Aggression:** Obsessions involving the fear of harming oneself or others are significant but do not reach the prevalence rates of pathological doubt. **High-Yield Clinical Pearls for NEET-PG:** * **Most common obsession:** Contamination (often leading to washing/cleaning). * **Most common presentation (Pattern):** Pathological doubt (leading to checking). * **Gender:** In adults, the ratio is 1:1; however, in adolescents, it is more common in **males**. * **Treatment of Choice:** Selective Serotonin Reuptake Inhibitors (SSRIs) at high doses. * **Best Psychological Therapy:** Exposure and Response Prevention (ERP). * **Poor Prognostic Factors:** Yielding to compulsions, childhood onset, and presence of tics.

Question 20: Which of the following are features of obsessive-compulsive disorder?

A. Repetitiveness
B. Irresistibility (Correct Answer)
C. Unpleasantness
D. Poor personal care

Explanation: **Explanation:** Obsessive-Compulsive Disorder (OCD) is characterized by recurrent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions). The hallmark of these symptoms is the subjective sense of **irresistibility**. **Why "Irresistibility" is correct:** The core psychopathology of OCD involves a "loss of control." Even though the patient recognizes the thoughts or actions as irrational, senseless, or excessive (ego-dystonic), they experience an overwhelming, **irresistible urge** to perform the compulsion to neutralize the anxiety caused by the obsession. This internal drive is a defining clinical feature used to differentiate OCD from other impulsive or habit-based disorders. **Analysis of Incorrect Options:** * **A. Repetitiveness:** While compulsions are repetitive, this is not unique to OCD. Repetitive behaviors are seen in Tic disorders, Autism (stereotypies), and even normal habits. Irresistibility is the more specific diagnostic feature. * **C. Unpleasantness:** While obsessions are distressing, the term "unpleasantness" is vague. The defining emotional state is **anxiety** or tension, which is temporarily relieved by the compulsion. * **D. Poor personal care:** This is typically a feature of Schizophrenia or severe Depression (Diogenes syndrome). In contrast, many OCD patients (specifically those with cleaning rituals) may exhibit excessive, albeit pathological, personal hygiene. **High-Yield Clinical Pearls for NEET-PG:** * **Ego-dystonic:** The patient views symptoms as alien and inconsistent with their self-concept (unlike OCPD, which is ego-syntonic). * **Insight:** Most OCD patients have good or fair insight; "absent insight/delusional beliefs" is a poor prognostic specifier. * **First-line Treatment:** SSRIs (at higher doses than for depression) and Cognitive Behavioral Therapy (specifically **Exposure and Response Prevention - ERP**). * **Drug of Choice (TCA):** Clomipramine (most serotonin-selective TCA).

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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