Obsessive Compulsive & Trichotillomania Flashcards
Which of the following statements about compulsive behaviors in obsessive-compulsive disorder (OCD) is true?
A. Compulsions in OCD are best understood as a form of addictive behavior.
B. Compulsive behaviors in OCD are aimed at reducing the distress triggered by obsessions.
C. Examples of compulsive behaviors include paraphilias (sexual compulsions), gambling, and substance use.
D. Compulsions involve repetitive and persistent thoughts (e.g., of contamination), images (e.g., of violent or horrific scenes), or urges (e.g., to stab someone).
E. Compulsive behaviors in OCD are typically goal directed, fulfilling a realistic purpose.
Correct Answer: B. Compulsive behaviors in OCD are aimed at reducing the distress triggered by obsessions.
A 52-year-old man with raw, chapped hands is referred to a psychiatrist by his primary care doctor. The man reports that he washes his hands repeatedly, spending up to 4 hours a day, using abrasive cleansers and scalding hot water. Although he admits that his hands are uncomfortable, he is entirely convinced that unless he washes in this manner he will become gravely ill. A medical workup is unrevealing, and the man takes no medications. What is the most appropriate diagnosis?
A. Delusional disorder, somatic type.
B. Illness anxiety disorder.
C. Obsessive-compulsive disorder, with absent insight.
D. Obsessive-compulsive personality disorder.
E. Generalized anxiety disorder.
Correct Answer: C. Obsessive-compulsive disorder, with absent insight.
Men with obsessive-compulsive disorder (OCD) differ from women with the disorder in which of the following ways?
A. Men tend to get OCD later in life.
B. Men are more likely to have comorbid tics.
C. Men are more likely to be obsessed with cleaning.
D. Men are more likely to spontaneously recover.
E. Men have much higher rates of OCD.
Correct Answer: B. Men are more likely to have comorbid tics.
Explanation: Males have an earlier age at onset of OCD than females and are more likely to have comorbid tic disorders. Gender differences in the pattern of symptom dimensions have been reported, with, for example, females more likely to have symptoms in the cleaning dimension and males more likely to have symptoms in the forbidden thoughts and symmetry dimensions. The 12-month prevalence of OCD in the United States is 1.2%, with a similar prevalence internationally (1.1%–1.8%). Females are affected at a slightly higher rate than males in adulthood, although males are more commonly affected in childhood. For both genders, the course of OCD is usually chronic, often with waxing and waning symptoms. Without treatment, remission rates in adults are low (e.g., 20% for those reevaluated 40 years later).
A 63-year-old woman has been saving financial documents and records for many years, placing papers in piles throughout her apartment to the point where it has become unsafe. She acknowledges that the piles are a concern; however, she says that the papers include important documents and she is afraid to throw them away. She recalls several instances in which her taxes were audited and she needed certain documents to avoid a penalty. She is concerned because her landlord is threatening to evict her unless she removes the piles of papers. What is the most likely diagnosis?
A. Obsessive-compulsive disorder.
B. Hoarding disorder.
C. Delusional disorder.
D. Nonpathological collecting behavior.
E. Dementia (major neurocognitive disorder).
Correct Answer: A. Obsessive-compulsive disorder.
Explanation: Although hoarding shares some features with obsessive-compulsive disorder (OCD), research suggests that it is an independent disorder. DSM-5 recognizes hoarding disorder as a diagnosis; however, distinguishing individuals with hoarding disorder from those with OCD (who may hoard as a result of their disorder) can be difficult. This woman is worried about the harm that may ensue should she discard potentially important information. The focus on performing a ritual to prevent harm is more typical of OCD, whereas persons with hoarding disorder simply have difficulty discarding items that they have accumulated (i.e., the focus is on the hoarding itself). This woman appears to have insight into her behavior; thus, it is not delusional.
Although gambling can seem compulsive, gambling disorder is not considered a type of obsessive-compulsive disorder (OCD) for which of the following reasons?
A. A person with gambling disorder derives direct pleasure from the behavior.
B. Individuals with gambling disorder have poorer insight into their irrational behavior.
C. Gambling disorder is better conceived of as a personality trait.
D. The repetitive behavior associated with gambling is meant to avoid anxiety.
E. In gambling disorder, individuals have control over their repetitive behaviors.
Correct Answer: A. A person with gambling disorder derives direct pleasure from the behavior.
Explanation: Although a number of behaviors, such as gambling or sexual behavior, can seem compulsive, gambling disorder and sexual paraphilias differ from OCD in that the compulsive behaviors associated with OCD are meant to decrease anxiety, whereas in the other disorders they are a source of direct pleasure. Individuals with gambling disorder seek treatment mainly out of concern for the deleterious consequences of their behavior. In both gambling disorder and OCD, the level of insight into the behavior can vary, but like individuals with OCD, those with gambling disorder cannot control their gambling.
A 19-year-old woman is referred to a psychiatrist by her internist after she admits to him that she recurrently pulls hair from her eyebrows to the point that she has scarring and there is little or no eyebrow hair left. She states that her natural eyebrows are “bushy” and “repulsive” and that she “looks like a caveman.” A photograph of the woman before she began pulling her eyebrow hair shows a normal-looking teenager. What is the most appropriate diagnosis?
A. Trichotillomania (hair-pulling disorder).
B. Body dysmorphic disorder.
C. Delusional disorder, somatic type.
D. Normal age-appropriate appearance concerns.
E. Obsessive-compulsive disorder.
Correct Answer: B. Body dysmorphic disorder.
What is the most common site of hair pulling in trichotillomania?
A. Scalp.
B. Axillary area.
C. Facial area.
D. Pubic area.
E. Perirectal area.
Correct Answer: A. Scalp.
Although microscopic examination of hair can aid the diagnosis of trichotillomania (hair-pulling disorder), such examination is rarely performed, for which of the following reasons?
A. Patients generally admit to the hair-pulling.
B. The effects on hair are easily observed macroscopically.
C. Patients generally have a long medical history of the disorder.
D. Patients rarely consent to the examination.
E. Microscopic examination is prohibitively expensive.
Correct Answer: A. Patients generally admit to the hair-pulling.
A 25-year-old man is referred to a psychiatrist by his primary care doctor after mentioning to the doctor that he routinely spends a lot of time pulling out facial hair with tweezers, even after carefully shaving. On evaluation, he admits to frequent pulling of his facial hair, consuming significant amount of time; he explains that he becomes anxious when looking at himself because his moustache, hairline, and sideburns are asymmetrical. He pulls out hairs in an effort to make them more symmetrical, but is rarely satisfied with the results. He finds this very upsetting but cannot resist the urge to try and “fix” his facial hair. What is the most appropriate diagnosis?
A. Trichotillomania (hair-pulling disorder).
B. Body dysmorphic disorder (BDD).
C. Delusional disorder, somatic type.
D. Normal age-appropriate appearance concerns.
E. Obsessive-compulsive disorder (OCD).
Correct Answer: E. Obsessive-compulsive disorder (OCD).
Explanation: In the case of repetitive hair pulling, distinguishing among trichotillomania, BDD, and OCD can sometimes be difficult. The differential diagnosis rests on the reasons for the pulling. Trichotillomania generally stems from boredom or anxiety, whereas BDD-related hair pulling is generally associated with perceived ugliness of the hair. When the pulling is in the service of symmetry, OCD is the more appropriate diagnosis. Further examination of the individual would likely reveal additional examples of his preoccupation with symmetry. Although some amount of hair pulling may be normal, the degree and the distress caused make normal age-appropriate appearance concerns an unlikely explanation in this case. Psychotic disorders should be ruled out— in this vignette, the patient’s symptoms appear to be more a preoccupation than a delusion.
A 55-year-old retail worker believes that he has “chronic halitosis” and fears that his bad breath is “scaring away shoppers.” He is in danger of losing his job because he so frequently absents himself from the sales floor to brush his teeth and use mouthwash. He constantly chews mint gum, even though his employer has asked him not to. His coworkers regularly reassure him that his breath is fine, but he is convinced that they are just being polite. Although the possibility of losing his job causes him concern, he finds his worries about his breath to be intolerable. He has seen his doctor and dentist, both of whom tell him that he is healthy and does not have malodorous breath. What is the most appropriate diagnosis?
A. Social anxiety disorder (social phobia).
B. Obsessive-compulsive disorder.
C. Body dysmorphic disorder.
D. Other specified obsessive-compulsive and related disorder.
E. Illness anxiety disorder.
Correct Answer: D. Other specified obsessive-compulsive and related disorder.
Explanation: Olfactory reference syndrome is characterized by excessive odorrelated preoccupations and repetitive behaviors designed to address the odor sufficient to cause distress or impairment. Currently this disorder is provisional and classified under other specified obsessive-compulsive and related disorder. When the individual lacks any insight, a delusional disorder should be diagnosed as well. Although the other disorders listed could cause repetitive behaviors, the focus on an imaginary odor is diagnostic for olfactory reference syndrome.
Which of the following substances, when abused, is most likely to cause symptoms mimicking obsessive-compulsive disorder?
A. Heroin.
B. Cocaine.
C. Alprazolam.
D. Marijuana.
E. Lysergic acid diethylamide (LSD).
Correct Answer: B. Cocaine.
What is the 12 month prevalence of obsessive compulsive disorder:
A. US (1.2%), internationally (1.1%-1.8%)
B. US (12%), internationally (11%-18%)
C. 8%
D. 16%
Correct Answer: A.
In childhood, who is more commonly affected:
A. Females
B. Males
Correct Answer: B.
Which of the following statements are true about trichotillomania prevalence rates in children and adolescents:
A. Hair pulling only occurs from the scalp
B. Adolescent 12 month prevalence rates are 1%-2%
C. Hair pulling only occurs from the big toe
D. Among children, males and females are equally represented
Correct Answer: B, D
