A 39 year old mother with obsessive-compulsive disorder has become immobilized by her elaborate hand washing and walking rituals. Nurse recognizes that the basis of Obsessive compulsive disorder is often?

1. A

   Problems with being too conscientious

2. B

   Problems with anger and remorse

3. C

   Feelings of guilt and inadequacy

4. D

   Feeling of unworthiness and hopelessness

Appeared in: SJH Nursing Officer - 2019

Explanation

• The core of OCD involves obsessions (intrusive, unwanted thoughts) that generate intense anxiety, doubt, and guilt.
• Compulsions (ritualistic behaviors like hand washing) are performed as a maladaptive coping mechanism to neutralize or reduce these distressing feelings.
• The patient in the scenario is trapped in a cycle where obsessive thoughts about contamination or harm lead to feelings of inadequacy and guilt, which she tries to alleviate through her washing and walking rituals.
• Psychodynamic theories suggest these rituals can act as an 'undoing' defense mechanism, attempting to cancel out the distressing obsessive thought.

Why Other Options Were Wrong

• Option A: Being 'too conscientious' is the hallmark of Obsessive-Compulsive Personality Disorder (OCPD), not OCD. In OCPD, the individual sees their perfectionism and rigidity as positive traits (ego-syntonic).
• Option B: While anger and remorse can be present in individuals with OCD, they are not the primary driving force. The fundamental basis is the anxiety and guilt that stem from the obsessions.
• Option D: Pervasive feelings of unworthiness and hopelessness are the core symptoms of Major Depressive Disorder (MDD). While OCD and depression are often comorbid, these feelings are not the specific basis for the OCD cycle itself.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Psychological basis of Obsessive-Compulsive Disorder (OCD) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses should understand that interrupting an OCD ritual can cause extreme anxiety for the patient. Initially, it's often better to allow time for the ritual while working on therapeutic goals.
• The primary nursing interventions for OCD involve supporting the patient through Cognitive-Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP), and administering prescribed medications like SSRIs.
• Patient education is crucial. The nurse can help the patient and family understand that OCD is a neurobiological disorder and that the behaviors are not a matter of choice or willpower.

How to Approach the Question

• First, identify the core diagnosis in the clinical scenario, which is clearly stated as Obsessive-Compulsive Disorder (OCD).
• Recall the fundamental psychopathology of OCD. The key is the relationship between obsessions (thoughts) and compulsions (actions).
• Analyze the function of the compulsions. Ask yourself: 'What purpose does the hand washing serve for the patient?' The answer is that it alleviates a negative feeling caused by an obsessive thought.
• Evaluate the options to see which one best describes this underlying negative feeling. 'Guilt and inadequacy' directly relate to the self-doubt and fear of causing harm that often characterize obsessions.
• Eliminate options that describe other conditions. Recognize 'conscientiousness' as OCPD and 'hopelessness/unworthiness' as depression to confirm your choice.

Concept Tested & Keywords

• Concept Tested: Psychological basis of Obsessive-Compulsive Disorder (OCD)
• Stem keywords: obsessive-compulsive disorder, immobilized, hand washing, walking rituals
• Lead-in keywords: basis of
• Clinical cues: The patient's immobilization by rituals indicates a severe form of OCD, where the compulsions dominate daily life.

Question ID

QFhdFDWSim88PT3kP9nuhf

Copy ID

Reference Book

E6 Psychology Morgan King 9e Part 2 p. 256-258

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1326-1328