USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
An 18-year-old woman who is a college student, presents to the outpatient psychiatric clinic with multiple scabs on her arms. She has a history of attention deficit hyperactivity disorder (ADHD). She states that for the two months, she has been having thoughts of driving herself and her brother off a cliff. She states that her brother, who is 10 years older than her, is alive and well. However, she can’t get these images of her brother out of her head, and reports that it is causing her mental distress that she relieves by scratching and picking at her arms. Which of the following is the most likely diagnosis?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
Double-checking things is a pretty common human behavior, like—did I shut the garage-door? Better double-check. How about locking the front door? Double-check. Gas-stove and oven off? Double-check. We all do it.
But what if you feel compelled to triple-check it, or even quadruple check it, or quintuple check it even, then it might be considered an obsession.
Now, what if you have to do a certain ritual with the gas-stove and oven before leaving the home each time, like: make sure the gas-stove is off, wipe down the gas stove to clean it, double-check that the burners are off, make sure the oven is off, wipe down the oven to clean it, and then open the oven door to make sure no heat is coming out, and then leave the house.
Then that might be a compulsion.
Obsessions are recurrent and intrusive thoughts that are typically unwanted and tough to get out of your brain.
These unwanted thoughts like, “My house is unsafe!” cause anxiety, and usually they lead to compulsions, which are actions that might be performed to try and reduce the anxiety associated with obsessions.
As you might imagine, these thoughts and rituals can have a serious impact on someone’s daily life.
OCD affects around 3% of the population, and usually starts in childhood or in the teen years.
Celebrities like David Beckham and Howie Mandel are known to be affected by OCD.
A more severe example is that of Howard Hughes, business tycoon, entrepreneur, and inspiration for the movie Citizen Kane, who was affected by relatively incapacitating OCD later in his life.
A very common compulsion is cleaning, which often stems from an obsession with germs or contamination.
Another common compulsion is checking: people who have this compulsion usually have an associated obsession that something’s unsafe, so they’ll check to make sure that something’s definitely safe, like making sure the door’s locked by unlocking and re-locking, perhaps several times.
More generally, repeating is a compulsion on its own; this is where an action or phrase is repeated several times, and usually because the repeater believes that if it’s not, something bad will happen.
Sometimes patients might feel compelled to order and arrange things, because when they’re out of order, it causes anxiety and discomfort.
Finally, mental rituals are also obsessions; these are often done to try and neutralize intrusive or “bad” thoughts.
People engaging in mental rituals might try and call up specific words or phrases they think are “good” thoughts to try and replace the “bad” thoughts.