## Diagnostic and Management Principles of OCD ### Why Option 0 (Insight) is INCORRECT **Key Point:** Insight is NOT a requirement for OCD diagnosis. In fact, the DSM-5 specifies a specifier for "poor insight" or "absent insight/delusional beliefs," acknowledging that many patients with OCD lack full awareness that their beliefs are irrational. **High-Yield:** This is a common trap in NEET PG exams. Students often conflate OCD with ego-dystonic disorders (where insight is preserved). While *some* patients have good insight, others have poor or no insight — and both presentations satisfy diagnostic criteria. ### Correct Diagnostic Criteria for OCD 1. **Obsessions:** Recurrent, intrusive thoughts, urges, or images causing anxiety or distress 2. **Compulsions:** Repetitive behaviours or mental acts performed to reduce distress 3. **Time:** Obsessions/compulsions consume ≥1 hour per day (or cause marked distress) 4. **Functional Impact:** Significant distress or impairment in social, occupational, or other domains 5. **Exclusions:** Not attributable to substance use or another medical condition **Insight is NOT mandatory** — it is a specifier (good, fair, poor, or absent). ### Evidence-Based Management | Modality | Details | Evidence | |----------|---------|----------| | **ERP (Exposure & Response Prevention)** | First-line psychological treatment; patient confronts feared stimulus and refrains from compulsion | Gold standard; CBT + ERP most effective | | **SSRIs** | First-line pharmacotherapy; doses higher than for depression (e.g., fluoxetine 40–80 mg/day, sertraline 50–200 mg/day); longer trial (8–12 weeks) | Efficacy ~40–60% response rate | | **Augmentation** | Antipsychotics (risperidone, aripiprazole) if inadequate SSRI response | Evidence-based for partial responders | | **Combined Treatment** | SSRI + ERP superior to either alone | Recommended for moderate–severe OCD | **Clinical Pearl:** Patients often report that their obsessions feel "real" or "true" despite intellectual awareness that they are excessive. This is why poor insight does not exclude OCD diagnosis. ## Summary Table: True vs False Statements | Statement | True/False | Rationale | |-----------|-----------|----------| | Insight required for diagnosis | **FALSE** | Insight is a specifier, not a criterion | | Distress/impairment required | **TRUE** | DSM-5 criterion | | ERP is first-line psychotherapy | **TRUE** | Gold standard, highest efficacy | | SSRIs at higher doses than depression | **TRUE** | Typical: 40–80 mg fluoxetine, 50–200 mg sertraline | [cite:DSM-5 Diagnostic and Statistical Manual of Mental Disorders, OCD section]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.