The nurse is assessing a client with a strong urge to arrange and rearrange the items on the table several times a day. What other finding does the nurse associate with obsessive-compulsive disorder (OCD)?
The client is unable to tolerate deviations from routine
The client has a feeling of superiority and over confidence.
The client is energetic and has wide social contacts.
The client enjoys the company of family and friends.
The Correct Answer is A
Choice A reason: Inability to tolerate deviations from routine is a clinically significant finding associated with OCD. The compulsive behaviors in OCD, such as arranging and rearranging objects, are driven by an intense need for symmetry, order, and exactness, often referred to as the "just right" phenomenon in obsessive-compulsive symptomatology. Any disruption to established rituals or routines triggers acute anxiety and distress, as the compulsive behaviors serve as a mechanism to neutralize obsessional anxiety and restore a sense of control. This inflexibility in response to routine disruption is well-documented in the OCD literature and is directly linked to the rigid, rule-governed nature of compulsive behavior patterns, making it a clinically expected associated finding.
Choice B reason: A feeling of superiority and overconfidence is not associated with OCD. On the contrary, individuals with OCD frequently exhibit low self-esteem, self-doubt, and a sense of excessive responsibility for preventing harm, which are cognitive features closely studied in OCD research. The grandiosity and overconfidence described in this choice are more characteristic of narcissistic personality disorder or the manic phase of bipolar disorder, where elevated self-esteem and inflated grandiosity are defining features. Attributing these traits to OCD reflects a fundamental misunderstanding of the cognitive and affective profile of the disorder.
Choice C reason: Being energetic with wide social contacts is not consistent with the clinical presentation of OCD. The disorder is associated with significant functional impairment, including social withdrawal, avoidance, and reduced participation in interpersonal and occupational activities due to the time-consuming nature of compulsive rituals and the shame associated with obsessional thoughts. Social energy and broad social engagement are more characteristic of hypomanic or manic states in bipolar disorder or of histrionic personality disorder. The clinical presentation of OCD tends toward interpersonal withdrawal and social isolation as the disorder progresses, not broad social connectivity.
Choice D reason: Enjoying the company of family and friends suggests healthy social functioning and is not a finding typically associated with OCD. Clients with OCD often experience significant disruption of social and family relationships due to the imposition of their rituals on others, the time demands of compulsive behaviors, and the shame and secrecy surrounding their obsessional thoughts. Social engagement is frequently compromised by the disorder, and many individuals with OCD report that their symptoms interfere with their ability to participate meaningfully in family and social activities. The described enjoyment of social interaction does not represent an associated finding of OCD.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: Trusting behaviors are not characteristic of schizotypal personality disorder. According to the DSM-5, schizotypal personality disorder is defined by a pervasive pattern of social and interpersonal deficits, including marked discomfort with and reduced capacity for close relationships, as well as cognitive and perceptual distortions and eccentric behaviors. Individuals with this disorder typically exhibit pervasive suspiciousness and paranoid ideation in social situations, making trust difficult to establish or maintain. Describing trusting behavior as a characteristic of this disorder is clinically inaccurate.
Choice B reason: Dependency needs are a hallmark feature of dependent personality disorder (DPD), not schizotypal personality disorder. Clients with DPD exhibit excessive reliance on others for emotional support, difficulty making independent decisions, and fear of abandonment. In contrast, individuals with schizotypal personality disorder tend toward social isolation, interpersonal aloofness, and discomfort in close relationships, which is nearly the opposite of the dependent interpersonal style. Conflating these 2 disorders reflects a misclassification of personality disorder subtypes.
Choice C reason: Paranoid thoughts are a well-established and diagnostically significant characteristic of schizotypal personality disorder as defined by the DSM-5. During social situations, affected clients may experience suspiciousness and paranoid ideation, including transient, stress-related paranoid thoughts or ideas of reference — the belief that events in the environment have special personal significance. These cognitive distortions emerge in social contexts and contribute to the social withdrawal and discomfort that characterize the disorder. This is distinct from frank psychosis, as the paranoid thoughts in schizotypal personality disorder are generally not of delusional intensity.
Choice D reason: Perfectionism is a core feature of obsessive-compulsive personality disorder (OCPD), which is characterized by a pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal control. OCPD is categorized under Cluster C personality disorders, whereas schizotypal personality disorder falls within Cluster A. The clinical features of schizotypal personality disorder center on odd beliefs, magical thinking, unusual perceptual experiences, social anxiety, and paranoia, not perfectionism or need for control. Attributing perfectionism to schizotypal personality disorder conflates 2 diagnostically distinct conditions.
Correct Answer is ["A","B","D","E","F"]
Explanation
Choice A reason: Current substance use is a well-established and clinically significant risk factor for the development and perpetuation of major depressive disorder. Substances including alcohol, opioids, stimulants, and cannabis have direct neurobiological effects on monoamine neurotransmitter systems, including serotonergic, dopaminergic, and noradrenergic pathways, which are central to mood regulation. Chronic substance use leads to dysregulation of these systems, neuroinflammation, and disruption of the hypothalamic-pituitary-adrenal (HPA) axis, all of which predispose to or worsen depressive symptomatology. Comorbid substance use disorder and major depressive disorder represent a highly prevalent and bidirectionally reinforcing dual diagnosis.
Choice B reason: A lack of coping ability is a recognized psychosocial risk factor for depressive disorders. Coping skills mediate the relationship between stressors and their psychological impact. Individuals who lack effective adaptive coping strategies — such as problem-solving, cognitive reframing, emotional regulation, and help-seeking — are more vulnerable to the persistent psychological distress that can precipitate and maintain clinical depression. Poor coping is associated with rumination, learned helplessness, and passive avoidance, all of which are cognitive and behavioral mechanisms strongly implicated in the etiology of depressive disorders. Building coping capacity is therefore a key component of both prevention and treatment.
Choice C reason: A responsive support system is a protective factor against the development of depression, not a risk factor. Social support buffers the negative psychological effects of stressful life events, provides emotional validation and practical assistance, reduces feelings of isolation, and promotes adaptive coping. Research consistently demonstrates that individuals with strong, responsive social support networks have significantly lower rates of major depressive disorder compared to those who are socially isolated. A responsive support system therefore does not belong among the risk factors associated with depression and is correctly excluded from the correct answer set.
Choice D reason: Prior episodes of depression represent one of the most robust and clinically significant risk factors for future depressive episodes. The concept of episode sensitization or "kindling" in affective disorders suggests that each successive episode of depression lowers the threshold for subsequent episodes, requiring progressively less severe external stressors to trigger recurrence. The number of previous episodes is directly correlated with recurrence risk, with individuals who have experienced 3 or more episodes of major depression having a recurrence rate exceeding 90%. This makes prior depressive episodes a critical factor in longitudinal risk assessment and treatment planning.
Choice E reason: A family history of depressive disorder is a well-established genetic and epidemiological risk factor for major depressive disorder. Twin studies estimate the heritability of major depression at approximately 37%, with first-degree relatives of individuals with MDD having a 2 to 3 times higher lifetime risk than the general population. The specific genetic variants implicated include polymorphisms in the serotonin transporter gene (SLC6A4), brain-derived neurotrophic factor (BDNF) gene, and genes related to the HPA axis and circadian regulation. Family history also contributes to risk through shared environmental exposures and modeled behavioral patterns, making it both a genetic and environmental risk factor.
Choice F reason: The presence of life and environmental stressors is a foundational risk factor in the biopsychosocial model of depression etiology. Adverse life events — including trauma, loss, financial hardship, interpersonal conflict, and occupational stress — activate the HPA axis, elevating cortisol levels and promoting neurobiological changes associated with depression, including hippocampal atrophy, reduced neurogenesis, and altered serotonergic and dopaminergic signaling. The diathesis-stress model proposes that environmental stressors interact with biological vulnerability to precipitate depressive episodes. Chronic and cumulative stressors are particularly harmful, as they sustain HPA axis activation beyond the individual's adaptive capacity.
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