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Obsessive-compulsive disorder — USMLE Step 2 CK MCQ

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ModeratePsychiatryObsessive-compulsive disorderUSMLE Step 2 CK

A 29-year-old woman has intrusive fears of contamination and spends 6 hours each day washing her hands and cleaning her home. She recognizes that the fears and rituals are excessive but cannot resist them, has stopped working, and meets criteria for severe obsessive-compulsive disorder. She has no mania, psychosis, or substance use and is willing to participate in therapy. Which initial treatment is most appropriate?

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Correct answer: B — Exposure-and-response-prevention CBT combined with an SSRI

Exposure and response prevention is the best-supported form of cognitive behavioral therapy for OCD, and an SSRI is first-line pharmacotherapy. Because her illness is severe and profoundly impairs function, combined ERP-based CBT and an SSRI is appropriate initial treatment. ERP gradually exposes her to feared cues while preventing the washing ritual, allowing anxiety and catastrophic beliefs to diminish without compulsions. Supportive counseling or insight-oriented therapy without ERP does not adequately target the maintaining cycle. Benzodiazepines do not treat core obsessions and compulsions and can cause dependence. Antipsychotics are not routine monotherapy; selected agents may augment an adequate SRI trial when response is incomplete. SSRI response in OCD can require higher tolerated doses and a longer trial than depression, with careful monitoring. Safety, comorbid depression, family accommodation, adherence, and functional recovery should be reassessed throughout treatment.

Reference: American Psychiatric Association. What Is Obsessive-Compulsive Disorder? https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder