5.2- Obsessive-Compulsive Disorder

Case 5 - Case Formulation Using The Integrative Model: (pp. 66-67)

Which of the following best represents a predisposing factor for Pat’s OCD according to the integrative model?

A. Pat’s family accommodating her compulsive behaviors
B. A family history of panic disorder
C. A recent stressful life event
D. Relief after compulsive handwashing

Answer: B. A family history of panic disorder

Explanation: A family history of panic disorder reflects a biological vulnerability (genetic/diathesis), which is a predisposing factor. Family accommodation (A) and relief after handwashing (D) are perpetuating factors, while stressful events (C) are precipitating.

Which of the following is an example of a precipitating factor in Pat’s OCD?

A. Thought-action fusion beliefs
B. Stressful life events that increase intrusive thoughts
C. Short-term relief from compulsive washing
D. Supportive family relationships

Answer: B. Stressful life events that increase intrusive thoughts

Explanation: Stressful life events may act as triggers (precipitating factors), increasing the frequency of intrusive thoughts. Thought-action fusion (A) is a cognitive vulnerability (predisposing), while relief (C) is perpetuating, and (D) is protective.

Which of the following best illustrates a perpetuating factor in Pat’s case?

A. Her religious upbringing influencing views on unacceptable thoughts
B. Her husband complying with her demands about “contaminated” objects
C. A family history of anxiety disorders
D. The absence of trauma in early childhood

Answer: B. Her husband complying with her demands about “contaminated” objects

Explanation: Family members accommodating compulsions maintain the disorder by reinforcing avoidance. Religious upbringing (A) is predisposing, family history (C) is also predisposing, and absence of trauma (D) is irrelevant here.

Which of the following cognitive processes is central to the maintenance of OCD symptoms?

A. Avoidance conditioning
B. Thought-action fusion
C. Latent inhibition
D. Sensory over-responsivity

Answer: B. Thought-action fusion

Explanation: Thought-action fusion (Shafran et al., 1996) describes the belief that thinking about an action is morally equivalent to performing it, or that thoughts increase the likelihood of events happening. This is a key perpetuating factor.

Which of the following would be considered a protective factor in Pat’s case formulation?

A. Strong family support without accommodation of symptoms
B. Genetic loading for anxiety disorders
C. Intrusive thoughts triggered by stress
D. Compulsive washing rituals

Answer: A. Strong family support without accommodation of symptoms

Explanation: Supportive family dynamics that do not reinforce symptoms could serve as a protective factor, reducing severity and improving prognosis. Genetic loading (B) and stress (C) are vulnerabilities/precipitants, and compulsions (D) are perpetuating.

Which of the following could serve as a protective factor in Pat’s formulation?

A. Family support that avoids reinforcing compulsions
B. High levels of thought-action fusion
C. Frequent intrusive thoughts
D. Long-standing history of panic disorder

Answer: A. Family support that avoids reinforcing compulsions

Explanation: Supportive but non-accommodating family dynamics may reduce symptom severity and aid recovery.

According to research, what is the paradoxical effect of thought suppression in OCD?

A. It eliminates intrusive thoughts over time
B. It has no effect on thought frequency
C. It increases the frequency and intensity of intrusive thoughts
D. It replaces intrusive thoughts with compulsions

Answer: C. It increases the frequency and intensity of intrusive thoughts

Explanation: Attempting to suppress intrusive thoughts makes them stronger (Najmi et al., 2009).

Which statement best reflects why not all stressed individuals develop OCD?

A. Stress is never linked to OCD onset
B. Stress only causes intrusive thoughts, not compulsions
C. Stress interacts with vulnerabilities, but diathesis is needed
D. Only people with trauma history develop OCD

Answer: C. Stress interacts with vulnerabilities, but diathesis is needed

Explanation: According to the diathesis-stress model, stress alone is not enough — biological and cognitive vulnerabilities are required.

The belief that thinking about contamination is as dangerous as being contaminated reflects which concept?

A. Magical thinking
B. Overgeneralization
C. Thought-action fusion
D. Classical conditioning

Answer: C. Thought-action fusion

Explanation: Thought-action fusion describes the tendency to equate thoughts with actions or outcomes (Shafran et al., 1996).

Which example from Pat’s case illustrates neutralizing behaviors as defined in DSM-5 criteria for OCD?

A. Having intrusive contamination thoughts
B. Excessive handwashing to reduce distress
C. Family history of panic disorder
D. Experiencing short-term relief after washing

Answer: B. Excessive handwashing to reduce distress

Explanation: Compulsions (like handwashing) are neutralizing behaviors aimed at reducing anxiety caused by obsessions.

Pat’s husband removing her purse and her family allowing separate dishes are examples of:

A. Precipitating stressors
B. Perpetuating environmental factors
C. Protective coping strategies
D. Predisposing vulnerabilities

Answer: B. Perpetuating environmental factors

Explanation: These behaviors maintain OCD symptoms by preventing Pat from learning that her fears are exaggerated.

Which exaggerated assumption is often present in OCD patients like Pat?

A. Belief that stress never contributes to mental illness
B. Belief that not preventing harm is as bad as causing it
C. Belief that intrusive thoughts are always harmless
D. Belief that compulsions permanently eliminate anxiety

Answer: B. Belief that not preventing harm is as bad as causing it

Explanation: Inflated responsibility is common in OCD: failing to prevent harm is perceived as equivalent to causing harm.