An OCD client on her way to the clinic wonders "Did I remember to turn off the stove?" What sub-type of OCD must she be suffering from?

Appeared in: UP NHM CHO 7 Sept 2022(shift-1st)

Explanation

The client's intrusive thought, "Did I remember to turn off the stove?" is a form of obsessional doubt.
This doubt is centered on a fear of causing harm or danger (e.g., starting a fire), which is a core feature of the checking subtype of OCD.
This type of obsession typically triggers a compulsive behavior, which in this case would be repeatedly checking the stove.
The scenario directly aligns with the clinical description of pathologic doubt followed by checking compulsions.

Option A: Rumination involves prolonged, repetitive, and often unproductive internal debates about various topics, rather than a specific doubt about a completed action.
Option C: Organisation (or Symmetry) involves a need for objects to be perfectly ordered, aligned, or symmetrical. The client's thought is not related to orderliness.
Option D: Contamination involves a fear of germs, dirt, or becoming unclean. The client's concern is about safety and a forgotten action, not cleanliness.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of Obsessive-Compulsive Disorder (OCD) subtypes based on clinical presentation as background academic context rather than a clinical decision trigger.
Recognizing the specific subtype of OCD is crucial for tailoring therapeutic interventions, particularly Exposure and Response Prevention (ERP), to the client's specific fears and compulsions.
Nurses play a key role in assessing the nature of obsessions and compulsions, monitoring their severity, and supporting the client in managing anxiety during therapy.
What if the client's thought was 'My hands are dirty and I might spread a disease'? In that case, the correct subtype would be Contamination, as the obsession relates to germs and cleanliness, not a forgotten action.

How to Approach the Question

First, identify the core thought or behavior described in the question stem. Here, it is the thought: "Did I remember to turn off the stove?"
Analyze the nature of this thought. It is a doubt about a past action that has potential safety consequences.
Review the definitions of the OCD subtypes provided in the options.
Match the identified thought to the most fitting subtype. The doubt about the stove directly corresponds to the 'Pathologic Doubt/Checking' category.
Eliminate the other options by confirming that the client's symptom does not relate to rumination (endless debate), organisation (order/symmetry), or contamination (germs/dirt).

Concept Tested & Keywords

Concept Tested: Identification of Obsessive-Compulsive Disorder (OCD) subtypes based on clinical presentation.
Stem keywords: OCD client, wonders, turn off the stove
Lead-in keywords: What sub-type
Clinical cues: The client's thought 'Did I remember to turn off the stove?' is a classic obsessional doubt related to safety, a hallmark of the checking subtype of OCD.

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E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 1325-1327, 1326-1328

Practise the full UP NHM CHO 7 Sept 2022(shift-1st)

Attempt every question from this paper in a timed mock, then review the full solution for each one.