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Pure O Maintenance — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersPure O MaintenanceMRCPsych Paper B

A 29-year-old with OCD experiences recurrent intrusive thoughts that they might have harmed someone. They perform no observable rituals, but repeatedly review their memory and silently pray until they feel sufficiently certain that no harm occurred. Their anxiety falls briefly but soon returns. In the cognitive-behavioural model, which process most directly maintains this presentation, sometimes described as “pure obsessional” OCD?

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Correct answer: D — Threat-laden appraisal of the intrusion followed by covert neutralising that produces short-term relief

The correct answer is D. So-called “pure obsessional” OCD is not necessarily free of compulsions: rituals may be covert, including mental reviewing, praying, counting or replacing thoughts. The intrusive thought is appraised as significant or threatening, prompting neutralisation. Its brief reduction of distress negatively reinforces the ritual and prevents corrective learning, thereby maintaining OCD. NICE specifically advises response prevention of mental rituals and neutralising strategies when obsessive thoughts occur without overt compulsions. Allowing an intrusion without neutralisation supports exposure and habituation rather than maintenance, so A is incorrect. Thought suppression can cause rebound and is not extinction, excluding C. Obsessional personality traits neither explain the episodic anxiety-relief cycle nor make ordinary intrusions pathological, excluding D. Visible compulsions are not required, excluding E.

Reference: National Institute for Health and Care Excellence. CG31, Obsessive-compulsive disorder and body dysmorphic disorder: treatment, recommendation 1.5.2.2 and full-guideline discussion of mental compulsions and neutralising. 2005; last reviewed 2024. https://www.nice.org.uk/guidance/cg31/chapter/Recommendations