Rosh Psychiatry Board Practice Exam

Which question would best aid in diagnosing obsessive-compulsive disorder in a patient who experiences compulsive finger-tapping?

1. Do you feel the bad thought is put there by someone else?

2. Does the compulsive behavior cause you anxiety?

3. Does the compulsive behavior cause you social or occupational problems?

4. Does the thought of harming others bring you enjoyment?

The correct answer is: Does the compulsive behavior cause you social or occupational problems?

The option indicating that the compulsive behavior causes social or occupational problems is particularly relevant for diagnosing obsessive-compulsive disorder (OCD). OCD is characterized not only by the presence of obsessions (intrusive thoughts) and compulsions (repetitive behaviors), but also by the distress and impairment these symptoms cause in a person's daily functioning. When evaluating a patient for OCD, it is crucial to understand the impact of their compulsive behaviors on their life. If the finger-tapping compulsion is leading to difficulties in social interactions or disrupting occupational duties, it reinforces the severity of the disorder. This functional impairment is a core criterion in the diagnostic criteria for OCD, and it helps differentiate it from other conditions that may present with compulsive behaviors. The other options, while relevant to aspects of OCD, do not directly target the diagnostic criteria as effectively. Assessing whether the compulsive behavior causes anxiety may provide insight into the patient's emotional experience, but it does not capture the functional impairments that are central to the diagnosis. Similarly, understanding the origin of the thoughts or whether harmful thoughts bring enjoyment could relate to different disorders and would not directly aid in establishing OCD as the diagnosis.