OCD and Related Disorders MCQs

Psychiatry · 33 free questions with answers & explanations.

1. A 29-year-old man spends four hours a day washing his hands, driven by intrusive thoughts that he will contaminate his family with a deadly pathogen. He recognises the thoughts as irrational but cannot resist the compulsions. His work performance is significantly impaired. What is the first-line treatment combination for OCD?
2. A 16-year-old girl presents with recurrent, distressing urges to pull out her eyebrow and scalp hair, resulting in visible patches of hair loss. She experiences tension before pulling and relief afterward. She feels ashamed but cannot stop. Which DSM-5-TR diagnosis best fits her presentation?
3. A 31-year-old man is preoccupied with a perceived slight bump on his nose. He spends three to four hours daily examining it in mirrors, seeks repeated reassurance, and has had two rhinoplasties that he felt worsened the appearance. He is now housebound. Which OCD-related diagnosis applies?
4. A 24-year-old woman with OCD has failed adequate trials of two different SSRIs at maximum doses. What is the recommended next pharmacological strategy according to evidence-based guidelines?
5. Which of the following best distinguishes obsessions in OCD from the intrusive thoughts experienced in normal individuals?
6. A 25-year-old man with OCD has failed two adequate SSRI trials (fluoxetine 60 mg for 12 weeks and sertraline 200 mg for 12 weeks). What is the most evidence-based next step?
7. In DSM-5, which of the following disorders is correctly classified under Obsessive-Compulsive and Related Disorders?
8. Body Dysmorphic Disorder (BDD) in DSM-5 differs from Illness Anxiety Disorder in which key way?
9. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) assesses OCD severity. A score of ≥16 indicates clinically significant OCD. A score of 0–7 is considered remission. What is the minimum score reduction considered a treatment 'response'?
10. A 24-year-old man has severe OCD refractory to two adequate SSRI trials. He is started on fluvoxamine augmented with risperidone. The rationale for adding an antipsychotic to an SSRI in OCD is:
11. In DSM-5, Body Dysmorphic Disorder (BDD) is classified under which grouping, and what feature distinguishes it from somatic symptom disorder?
12. A 30-year-old woman with OCD has good insight into the irrationality of her compulsions but cannot resist them. In DSM-5, which specifier would be applied to her OCD diagnosis?
13. A 29-year-old software engineer spends 3 hours daily checking whether he locked his car, despite having done so repeatedly. He recognizes these thoughts as excessive but cannot stop them. His Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score is 24. In DSM-5, OCD is categorized under which chapter?
14. A 35-year-old man with OCD fails to respond after 12 weeks of fluoxetine 60 mg/day combined with adequate CBT/ERP therapy. The MOST appropriate pharmacological augmentation strategy is:
15. Body Dysmorphic Disorder (BDD) is categorized under OCD and Related Disorders in DSM-5. Which of the following features DISTINGUISHES BDD from OCD in terms of insight specifiers?
16. A 22-year-old student reports recurrent intrusive thoughts about harming others, which distress him. He has never acted on these thoughts and recognizes them as ego-dystonic. He performs mental rituals (counting) to neutralize the anxiety. According to OCD classification, these intrusive thoughts are BEST described as:
17. A 32-year-old woman compulsively pulls her hair from the scalp, resulting in noticeable patchy alopecia. She feels tension before pulling and relief afterward. She is embarrassed and has avoided social situations for 6 months. Which DSM-5 diagnosis BEST fits?
18. A 30-year-old woman has moderate OCD (Y-BOCS = 22) unresponsive to adequate trials of two different SSRIs at maximum doses. What is the next evidence-based pharmacological step?
19. A 24-year-old male engineering student becomes preoccupied with a perceived misalignment of his nose despite normal appearance. He spends 4 hours daily examining his face in mirrors, seeks repeated reassurance, and has dropped out of college. He believes 80% that the defect is real but acknowledges 20% uncertainty. What specifier applies in DSM-5?
20. Exposure and Response Prevention (ERP) is first-line psychological treatment for OCD. What is the critical 'response prevention' component, and which learning theory mechanism explains its long-term efficacy?
21. A 28-year-old woman with OCD has failed two adequate SSRI trials at maximum tolerated doses. Which pharmacological augmentation strategy has the strongest evidence base for treatment-resistant OCD?
22. In DSM-5, Hoarding Disorder is classified as a separate entity from OCD. Which feature most strongly supports this distinction?
23. A patient with Body Dysmorphic Disorder (BDD) insists on consulting a dermatologist for a 'deformity' no one else can see. In DSM-5, which specifier distinguishes BDD with 'absent insight/delusional beliefs' from a primary psychotic disorder?
24. A 19-year-old man with OCD has predominantly contamination obsessions. He refuses to touch door handles and spends 4 hours daily washing his hands. The most evidence-based psychological treatment is:
25. A 22-year-old medical student is plagued by intrusive thoughts that he might harm his family members, despite being a gentle person who is horrified by these thoughts. He spends hours performing mental rituals to 'neutralise' them. He has insight that the thoughts are senseless. Which feature of this presentation SPECIFICALLY distinguishes OCD from violent psychosis?
26. A 22-year-old medical student has intrusive thoughts of contamination and performs elaborate washing rituals for 3–4 hours daily. He recognises the thoughts are irrational but cannot resist. For pharmacotherapy, which regimen is MOST appropriate if he fails to respond to adequate first-line monotherapy?
27. Body Dysmorphic Disorder (BDD) is classified under OCD and Related Disorders in DSM-5. Which of the following treatment approaches is SPECIFICALLY contraindicated in BDD?
28. A 19-year-old woman presents with recurrent, distressing urges to pull out her hair from the scalp and eyebrows, resulting in noticeable hair loss. She denies any skin disorder and experiences gratification after pulling. The MOST effective first-line treatment is:
29. Exposure and Response Prevention (ERP) is the evidence-based psychotherapy for OCD. The 'exposure' component involves:
30. Body dysmorphic disorder (BDD) is an OCD-related disorder. A patient is preoccupied with an imagined defect in his nose and spends 4 hours daily checking mirrors and seeking surgical consultations. The medication class with BEST evidence for BDD is:
31. Trichotillomania (Hair-pulling disorder) and Excoriation (skin-picking) disorder are classified in DSM-5 under:
32. A 25-year-old woman has severe hair-pulling episodes resulting in significant alopecia. She describes a mounting tension before pulling, satisfaction during the act, and guilt afterwards. She has tried to stop repeatedly but cannot. The DSM-5 diagnosis is:
33. In body dysmorphic disorder (BDD), the obsessive preoccupation is with perceived defects in physical appearance. Which insight specifier is associated with the poorest prognosis and highest treatment refusal in BDD?