Obsessive-Compulsive and Related Disorders Practice Questions

Q: 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?

Body dysmorphic disorder. ### 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.

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

Exposure and response prevention. **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.

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

Decontamination. **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.

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

Obsessions are ego-syntonic.. ### 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).

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

Fluoxetine. **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.

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

Pathological doubt. **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 1

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?

Accepted Answer

Body dysmorphic disorder

Answer

Obsessive compulsive disorder

Answer

Normal behavior

Answer

Hypochondriacal delusion

Question 2

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

Accepted Answer

Exposure and response prevention

Answer

Eye movement desensitization and reprocessing (EMDR)

Answer

Sensate focus therapy

Answer

Dual partner therapy

Question 3

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

Accepted Answer

Decontamination

Answer

Magical thinking

Answer

Pathological doubt

Answer

Hoarding

Question 4

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

Accepted Answer

Undoing

Answer

Reaction formation

Answer

Regression

Answer

Displacement

Question 5

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

Accepted Answer

Obsessions are ego-syntonic.

Answer

Obsessions are ego-alien.

Answer

The patient tries to resist the obsessions.

Answer

Insight is present regarding the obsessions.

Question 6

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

Accepted Answer

Combination of behavior and drug therapy

Answer

Behavior therapy

Answer

Drug therapy

Answer

Psychosurgery

Question 7

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

Accepted Answer

Reaction formation, Undoing, and Isolation of affect are present

Answer

Reaction formation, Undoing, Dissociation, and Isolation of affect are all present

Answer

Reaction formation, Undoing, and Dissociation are present

Answer

Undoing and Isolation of affect are present

Question 8

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

Accepted Answer

Fluoxetine

Answer

Clomipramine

Answer

Clonazepam

Answer

Carbamazepine

Question 9

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

Accepted Answer

Pathological doubt

Answer

Symmetry

Answer

Sexual thoughts

Answer

Aggression

Question 10

Which of the following are features of obsessive-compulsive disorder?

Accepted Answer

Irresistibility

Answer

Repetitiveness

Answer

Unpleasantness

Answer

Poor personal care

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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