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Religious Obsessions in OCD — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersReligious Obsessions in OCDMRCPsych Paper B

A 30-year-old devout Muslim woman has diagnosed obsessive-compulsive disorder. She experiences recurrent, intrusive blasphemous thoughts that are unwanted, distressing and inconsistent with her beliefs. She repeatedly performs mental prayers to neutralise them. Her symptoms cause moderate functional impairment. Which initial management is most consistent with NICE guidance?

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Correct answer: C — Offer a choice of an SSRI or more intensive CBT including ERP, delivered sensitively to her beliefs

The correct answer is C. Religious or blasphemous obsessions can be manifestations of OCD when they are intrusive, unwanted and distressing, with compulsive neutralisation such as mental prayer. For moderate functional impairment, NICE recommends offering a choice between an SSRI and more intensive CBT including exposure and response prevention. ERP should include exposure to the obsessive thoughts and prevention of mental rituals while respecting, rather than challenging, the patient's faith. Combined SSRI and CBT is not automatically required at this severity. A religious leader does not replace evidence-based treatment, although advice may be sought with consent if the boundary between OCD and normal religious practice is unclear. C overlooks the ego-dystonic symptoms and impairment; D wrongly excludes ERP; and E risks reinforcing the neutralising compulsion.

Reference: National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31), recommendations 1.1.3.1, 1.5.1.3 and 1.5.2.2. 2005. https://www.nice.org.uk/guidance/cg31/chapter/Recommendations