A patient is exhibiting repetitive behaviors, such as hand washing multiple times a day, which they feel compelled to perform. The nurse understands that this is characteristic of:

1. A

   Generalized Anxiety Disorder

2. B

   Post-Traumatic Stress Disorder

3. C

   Obsessive-Compulsive Disorder

4. D

   Panic Disorder

Appeared in: NORCET 7 Prelims -2024

Explanation

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• Obsessive-Compulsive Disorder (OCD) because the patient's repetitive, compelled hand washing is a hallmark symptom of a compulsion.
• According to the DSM-5, compulsions are defined as repetitive behaviors (e.g., hand washing) that an individual feels driven to perform in response to an obsession or according to rigid rules.
• These compulsive acts are aimed at preventing or reducing anxiety or distress, which directly matches the behavior described in the question.
• The other disorders listed do not have ritualistic, repetitive compulsions as their primary defining characteristic.

Why Other Options Were Wrong

• Option A: Generalized Anxiety Disorder (GAD) is characterized by excessive and persistent worry about a variety of topics, not by specific, repetitive, and ritualistic behaviors like compulsive hand washing.
• Option B: Post-Traumatic Stress Disorder (PTSD) develops after a person experiences or witnesses a traumatic event. Its core symptoms are flashbacks, nightmares, and avoidance of trauma-related stimuli, not the type of ritualistic compulsion described.
• Option D: Panic Disorder involves recurrent, unexpected panic attacks, which are abrupt surges of intense fear or discomfort. It does not involve the ongoing, ritualistic behaviors seen in OCD.

Related Visual

• Visual 1: Flowchart - The OCD Cycle. A diagram showing the cycle: 1. Obsession (e.g., 'My hands are contaminated') → 2. Anxiety (Distress and fear) → 3. Compulsion (Repetitive hand washing) → 4. Temporary Relief (Anxiety is reduced, reinforcing the behavior).

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differentiating Obsessive-Compulsive Disorder from other anxiety-related disorders based on clinical presentation to guide bedside assessment, documentation, and the next nursing action.
• Nurses must recognize that compulsions are not a choice but a response to overwhelming anxiety. The initial nursing approach should be non-judgmental and focus on building trust.
• A key nursing intervention is to initially allow the ritual while setting agreed-upon limits, as abruptly stopping the compulsion can cause a panic level of anxiety for the patient.
• What if the patient's compulsive hand washing leads to severe dermatitis or skin breakdown? The nursing priority would then include managing skin integrity (e.g., applying prescribed emollients, using gentle soaps) in addition to the psychiatric plan of care.

How to Approach the Question

• First, analyze the key behaviors described in the question stem: 'repetitive behaviors,' 'hand washing multiple times,' and 'feels compelled to perform.'
• Recognize that this description perfectly matches the definition of a 'compulsion' in psychiatric nursing.
• Next, review the answer options, which are all different psychiatric disorders.
• Evaluate each option based on its core defining features. Ask yourself, 'Which of these disorders is primarily defined by the presence of compulsions?'
• Recall that Obsessive-Compulsive Disorder (OCD) is characterized by obsessions and/or compulsions. This makes it the most likely correct answer.
• Rule out the other options by confirming they are defined by different primary symptoms: GAD (generalized worry), PTSD (trauma-related symptoms), and Panic Disorder (panic attacks).

Concept Tested & Keywords

• Concept Tested: Differentiating Obsessive-Compulsive Disorder from other anxiety-related disorders based on clinical presentation.
• Stem keywords: repetitive behaviors, hand washing, compelled to perform
• Lead-in keywords: characteristic of
• Clinical cues: The combination of a repetitive action (hand washing) and the internal feeling of being 'compelled' to do it is the classic presentation of a compulsion.

Question ID

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