Module Two

Question 1

1. According to the DSM-5, under which category is Obsessive-Compulsive Disorder (OCD) classified?

Answer 1

OCD is classified under the “Obsessive-Compulsive and Related Disorders” category in the DSM-5.

Question 2

2. What two main symptom types define OCD in the DSM-5?

Answer 2

Obsessions (intrusive, unwanted thoughts or urges) and compulsions (repetitive behaviors or mental acts) define OCD.

Question 3

3. How does the DSM-5 describe obsessions in Criterion A?

Answer 3

They are recurrent, persistent thoughts, urges, or images experienced as intrusive and unwanted, causing marked anxiety or distress, and the person attempts to ignore or neutralize them.

Question 4

4. What characterizes compulsions, per Criterion A of the DSM-5?

Answer 4

They are repetitive behaviors or mental acts that a person feels driven to perform in response to obsessions or rigid rules, aimed at reducing distress or preventing a dreaded event, though not realistically connected or clearly excessive.

Question 5

5. What is the significance of Criterion B (time-consuming or distress) for an OCD diagnosis?

Answer 5

Criterion B requires that obsessions or compulsions take more than 1 hour a day or cause clinically significant distress or impairment in functioning.

Question 6

6. Which criteria ensure OCD symptoms are not explained by substances or other conditions?

Answer 6

Criterion C states symptoms are not attributable to substance use or another medical condition; Criterion D ensures they aren’t better explained by another mental disorder.

Question 7

7. Name the three DSM-5 insight specifiers for OCD.

Answer 7

They are: (1) Good or fair insight, (2) Poor insight, and (3) Absent insight/delusional beliefs.

Question 8

8. What does the tic-related specifier mean in OCD?

Answer 8

It indicates the individual has a current or past history of a tic disorder, such as Tourette syndrome.

Question 9

9. Provide an example of a common obsession-compulsion pair.

Answer 9

A contamination obsession leading to excessive cleaning or handwashing compulsion is a classic example.

Question 10

10. How do normal intrusive thoughts differ from clinical obsessions?

Answer 10

Normal intrusive thoughts are common and usually dismissed, but clinical obsessions are persistent, unwanted, cause marked distress, and typically trigger compulsive actions to relieve anxiety.

Question 11

11. What is the typical lifetime prevalence of OCD worldwide?

Answer 11

Research suggests a lifetime prevalence of about 2–3% globally for OCD.

Question 12

12. At what average age do OCD symptoms commonly appear?

Answer 12

OCD symptoms often start around 19–20 years old, with approximately 25% of cases beginning by age 14.

Question 13

13. How do gender differences manifest in OCD prevalence and onset?

Answer 13

Females have slightly higher rates overall, but males often experience an earlier onset (especially in childhood) and are more likely to have comorbid tics.

Question 14

14. Which brain circuits are implicated in OCD according to neurobiological research?

Answer 14

Cortico-striato-thalamo-cortical (CSTC) circuits, involving regions like the orbitofrontal cortex and basal ganglia, are key neurobiological correlates of OCD.

Question 15

15. What is one role of serotonin in the pathophysiology of OCD?

Answer 15

Serotonin dysregulation is believed to contribute to obsessive-compulsive symptoms, which is why SSRIs can be effective in managing OCD.

Question 16

16. What are common cognitive distortions found in individuals with OCD?

Answer 16

They include inflated responsibility, overestimation of threat, thought-action fusion, and intolerance of uncertainty.

Question 17

17. How can memory biases contribute to compulsive checking behaviors?

Answer 17

Low confidence in one’s memory (or doubt about completed actions) drives repeated checking to relieve anxiety about possible mistakes.

Question 18

18. Name two environmental factors that may increase the risk of developing OCD.

Answer 18

Exposure to stressful life events (e.g., trauma, abuse) and certain infections (like streptococcal) can be risk factors for OCD.

Question 19

19. What are typical symptom dimensions in OCD?

Answer 19

Common dimensions include contamination/cleaning, responsibility/checking, symmetry/ordering, and intrusive taboo or aggressive thoughts with mental rituals.

Question 20

20. How can OCD impact an individual’s daily life?

Answer 20

It can lead to significant social, occupational, and personal impairment, with compulsions and obsessions consuming hours each day and causing high distress.

Question 21

21. Which other disorders belong to the same DSM-5 category as OCD?

Answer 21

Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania (Hair-Pulling), and Excoriation (Skin-Picking) Disorder are part of the Obsessive-Compulsive and Related Disorders chapter.

Question 22

22. How does the DSM-5 differentiate OCD from generalized anxiety disorder (GAD)?

Answer 22

OCD involves obsessions and compulsions that are specific and ritualistic, whereas GAD involves more generalized, excessive worry about multiple life areas without compulsive rituals.

Question 23

23. What is a key difference between OCD and Obsessive-Compulsive Personality Disorder (OCPD)?

Answer 23

OCD involves unwanted obsessions and compulsions causing distress, whereas OCPD features a pervasive pattern of perfectionism and orderliness without true obsessions/compulsions.

Question 24

24. Why might someone with OCD have “absent insight” according to the DSM-5 specifiers?

Answer 24

They might be fully convinced that their obsessive-compulsive beliefs are true, leaving no doubt about the rationality of their actions/thoughts.

Question 25

25. How do selective serotonin reuptake inhibitors (SSRIs) help treat OCD?

Answer 25

They increase serotonin availability in the brain, which can reduce both obsessive thinking and compulsive behaviors. Higher doses are often used for OCD compared to depression.

Question 26

26. What is considered the ‘gold standard’ psychological treatment for OCD?

Answer 26

Cognitive-Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP), is regarded as the most effective treatment.

Question 27

27. Briefly explain Exposure and Response Prevention (ERP).

Answer 27

ERP involves exposing oneself to feared obsessions or triggers while resisting the urge to perform the compulsive behavior, helping reduce anxiety over time.

Question 28

28. Why might combining pharmacotherapy and ERP be beneficial for some individuals with OCD?

Answer 28

Because a combination can address severe symptoms quickly (through medication) while ERP targets behavioral change; together, they often yield better outcomes than either approach alone.

Question 29

29. What does Behavioral Activation (BA) address in comorbid OCD and depression?

Answer 29

BA increases engagement in rewarding, meaningful activities to counteract avoidance and depressive withdrawal, which can indirectly reduce OCD-driven inactivity as well.

Question 30

30. How can poor insight hinder OCD treatment outcomes?

Answer 30

Patients with poor or absent insight may resist therapy techniques, not fully recognizing that their obsessions/compulsions are excessive or unfounded.

Question 31

31. In what way can neuromodulation (e.g., TMS, DBS) be used for treatment-resistant OCD?

Answer 31

Transcranial Magnetic Stimulation (TMS) and Deep Brain Stimulation (DBS) can modulate dysfunctional brain circuits when standard treatments fail.

Question 32

32. What role do dysfunctional beliefs (e.g., inflated responsibility) play in maintaining OCD?

Answer 32

They lead individuals to interpret intrusive thoughts as critical threats requiring urgent action (compulsions) to avert perceived harm, reinforcing the OCD cycle.

Question 33

33. How does “reduced access to internal states” influence OCD symptoms, according to Hezel & McNally?

Answer 33

People may struggle to trust internal cues (e.g., memory or senses), leading to persistent doubt and reliance on external “rituals” or checks to gain certainty.

Question 34

34. Why can normal intrusive thoughts become clinically significant obsessions in some individuals?

Answer 34

They may appraise these thoughts as dangerous or morally unacceptable, develop anxiety around them, and use compulsive rituals to neutralize perceived threats.

Question 35

35. Why is it important to differentiate normal collecting behaviors from Hoarding Disorder, a related condition?

Answer 35

Hoarding Disorder involves persistent difficulty discarding possessions with significant distress, whereas normal collecting is organized, less distressing, and not functionally impairing.

Question 36

36. Name one important consideration when diagnosing OCD in children.

Answer 36

Children may not articulate the rationale behind their compulsions, and the rituals or fears may look different but still cause significant distress or impairment.

Question 37

37. What are common comorbid conditions with OCD?

Answer 37

Anxiety disorders (e.g., social anxiety), major depressive disorder, and tic disorders are frequently comorbid with OCD.

Question 38

38. Outline a simple, basic treatment plan for OCD.

Answer 38

1) Thorough assessment and diagnosis. 2) Psychoeducation about OCD. 3) Begin CBT with ERP. 4) Add SSRIs if indicated. 5) Monitor progress and adjust. 6) Include family or support as needed.

Question 39

39. How does OCD often affect a person’s quality of life (QOL)?

Answer 39

It can severely reduce QOL by consuming time, provoking high anxiety, straining relationships, impairing job/school performance, and causing social withdrawal.

Question 40

40. Which research insight helps explain why some individuals develop OCD while others do not?

Answer 40

A complex interplay of genetic predisposition, neurobiological factors, cognitive biases, environmental stressors, and individual psychological vulnerabilities contributes to OCD onset and maintenance.