Obsessive Compulsive Disorder (OCD) Practice Questions and Correct Answers
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Obsessive Compulsive Disorder
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Obsessive Compulsive Disorder
ICD-10 definition of OCD A common chronic condition often associated with marked anxiety and depression, characterised by 'obsessions' and 'compulsions'
2 ICD-10 points for OCD 1= Obsessional thoughts are ideas, images, or impulses that enter the patient's mind again and again in a stereotyped for...
Obsessive Compulsive Disorder (OCD)
Practice Questions and Correct Answers
ICD-10 definition of OCD ✅A common chronic condition often associated with marked
anxiety and depression, characterised by 'obsessions' and 'compulsions'
2 ICD-10 points for OCD ✅1= Obsessional thoughts are ideas, images, or impulses
that enter the patient's mind again and again in a stereotyped form. They are distressing
for the patient and they often try to resist them - unsuccessfully. They are recognised as
their own thoughts, even though they are involuntary
2= Compulsive acts or rituals are stereotyped behaviours that are repeated again and
again. They are not enjoyable or useful.
prevalence of OCD ✅1= Mean age = 20 years - 70% onset before 25 years
2= Male = female
3= Prevalence = 0.5-3% of the general population
what are the commonest obsessions ✅-contamination (50%)
-fears of harming self or others (24%)
-symmetry (10%)
what are the commonest compulsions ✅-checking(28%)
- cleaning (27%)
-repeating (11%)
how does OCD impair QoL ✅sufferers are less likely to marry, and have worsesocial
functioning both at work and in leisure activities than those with diabetes
gender differences in OCD ✅M VS F:
-onset: earlier Vs later
-marital status: often never married vs more likely to be married
-clinical themes: sexual, exactness, symmetry, odd rituals Vs more agressive
obsessions & cleaning compulsions
-associated conditions: IN rates of bipolar disorders Vs IN rate of panic disorders
, risk factors of OCD ✅- FHx or OCD
- PANDAS (paediatric autoimmune neuropsychiatric disorders associated with
streptococcal infection)
-Pregnancy
genetic causes of OCD ✅Positive family history often absent, but limited family studies
showtwin concordance MZ =65% DZ=25%.
other causes of OCD ✅-Premorbid personality: 30% anankastic, but avoidant &
dependent traits also common
- Organic factors
-
Psychodynamic theory (Freud) of OCD ✅OCD represents defensive regression toanal
stage (defensive triad of orderliness, obstinacy and parsimony ie stinginess).Interesting
but little supporting evidence! Key defences said to be:
-Magical thinking : especially aggression/ causing harm to others
-Reaction formation = feeling or behaving in a way which is opposite of unconscious
unacceptable impulses (eg excessive prudery if INsex drive)
-Undoing = attempting to cause past thoughts not to have occurred
-Isolation = separation of an idea from its associated affect
maintaining factors of OCD ✅1=Behavioural theory (Marks 1973) states that rituals
(checking, cleaning etc),avoidance and reassurance seeking produce short-term relief
from anxiety symptoms but long-term worsening of problems (negative reinforcement of
behaviour, operant conditioning
2=Cognitive theory (Salkovskis 1997) states that OCD kept going by exaggerated
appraisal of threat, assuming excessive responsibility for consequences, and attempts
to suppress recurrent worrying thoughts
differential diagnosis of OCD ✅- 'Normal' (but recurrent) thoughts, worries, or habits
(do not cause distress or functional impairment)
-anakastic personality disorder: lifelong excessive doubt, rigidity,stubbornness,
conscientiousness, preoccupation with rules, lists, or perfectionisminterfering with task
completion [ICD-10])- coexists in up to 30% of OCD cases
- Schizophrenia
-depression: (esp if obsessions > compulsions, coexists in 30% OCD cases,treat if in
doubt)
- Phobias
-organic conditions: head injury, CVA, dementia, post-flu encephalitis,Sydenham's
chorea, HIV ) BUT unlike true OCD thoughts/ actions not resisted
q's to ask for OCD ✅-Do you get awful thoughts coming into your mind even when you
try to keep them out?
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