A 35-year-old woman with obsessive-compulsive disorder experiences recurrent, unwanted images of stabbing her child. She interprets having the image

Question

A 35-year-old woman with obsessive-compulsive disorder experiences recurrent, unwanted images of stabbing her child. She interprets having the image as evidence that she may be dangerous and feels responsible for ensuring that she never loses control. Whenever it occurs, she silently repeats a protective phrase, mentally reviews her previous behaviour for evidence of violent intent, and avoids handling knives. These responses briefly reduce her anxiety, but the images continue to recur. She has no observable checking or washing rituals. According to the cognitive-behavioural model of OCD, which mechanism best explains the persistence of her symptoms?

Accepted Answer

Catastrophic appraisal of the image, followed by negatively reinforced covert neutralising and avoidance that prevent disconfirmation

Answer

A primary serotonergic deficit sustains the image independently of her interpretation of it and her responses to it

Answer

The image's recurrence strengthens its memory trace, while her subsequent cognitive and behavioural responses have no maintaining role

Answer

Suppression extinguishes the obsessional fear, but an independent state of free-floating anxiety causes the image to recur

Answer

Obsessional personality traits make the image persistent independently of anxiety reduction, avoidance, or mental neutralisation

Pure Obsessional OCD Maintenance — MRCPsych Paper B MCQ