A person fears that something bad will happen if he throws anything away. He voluntarily keeps things that he doesn't really need to use. The nurse says that the patient is in which category of OCD?

Appeared in: NHM MP Staff Nurse-2022

Explanation

Hoarders because the patient exhibits the defining characteristics of hoarding disorder.
This includes a persistent difficulty discarding possessions, driven by a fear that something bad will happen if items are thrown away.
The patient voluntarily keeps items they do not need, leading to clutter, which is a classic compulsion in hoarding.
According to diagnostic criteria, the core issue in hoarding is the distress associated with parting with possessions and the perceived need to save them (SRC_25063, SRC_25065).

Why Other Options Were Wrong

Option B: Arrangers are primarily concerned with symmetry and order, not the act of discarding items. Their compulsion is to arrange things perfectly.
Option C: Doubters are plagued by fears of having made a mistake or forgotten something important, leading to compulsive checking behaviors (e.g., checking locks, stoves).
Option D: Counters have an obsession with numbers and feel compelled to count objects or perform actions a certain number of times to reduce anxiety.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of Obsessive-Compulsive Disorder (OCD) subtypes based on clinical presentation to guide bedside assessment, documentation, and the next nursing action.
Nurses are often the first to identify signs of hoarding, which can pose significant health and safety risks (e.g., fire hazards, poor sanitation, falls).
A non-judgmental and empathetic approach is crucial, as patients with hoarding disorder often lack insight and may not perceive their behavior as a problem.
What if the patient was keeping items because they feared the items were contaminated and could not be touched or thrown away? This would point more towards an obsession with contamination, a different OCD subtype, where the hoarding is secondary to the contamination fear rather than a primary fear of losing the item itself.

How to Approach the Question

First, analyze the patient's behavior presented in the stem. The key elements are the fear associated with throwing things away and the action of keeping unnecessary items.
Identify the core obsession (the fear/thought) and the compulsion (the action). The obsession is the fear of a bad outcome from discarding items. The compulsion is the act of keeping everything.
Next, review the provided options, which are different categories of OCD.
Match the identified obsession-compulsion pair to the best-fitting category. The description directly matches the definition of 'Hoarders'.
Eliminate the other options by confirming their definitions do not match the scenario (Arrangers focus on order, Doubters on checking, and Counters on numbers).

Concept Tested & Keywords

Concept Tested: Identification of Obsessive-Compulsive Disorder (OCD) subtypes based on clinical presentation.
Stem keywords: fears something bad will happen, throws anything away, keeps things, doesn't really need
Lead-in keywords: which category of OCD
Clinical cues: The patient's fear is directly linked to the act of discarding items, which is a key diagnostic clue for hoarding.

Question ID

QxocYFBdfB0WojROxLj93C

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 1332-1334, 1347-1349

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 15582-15584

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