CMN 552: MODULE 3 STUDY GUIDE OBSESSIVE-COMPULSIVE & TRAUMA- AND
STRESSOR-RELATED DISORDER
,TABLE OF CONTENTS
Section I: Foundations and DSM-5 Classification
• DSM-5-TR Changes and Diagnostic Framework
• Classification of Obsessive-Compulsive Disorders
• Classification of Trauma- and Stressor-Related Disorders
• Epidemiology and Prevalence
• Risk Factors and Protective Factors
• Neurobiology of OCD
• Neurobiology of Trauma Disorders
• Genetic Influences
• Neurotransmitters and Brain Circuitry
• Etiological Models and Current Research
Section II: Obsessive-Compulsive Disorder (OCD)
• Diagnostic Criteria and DSM-5-TR Features
• Obsessions and Compulsions
• Common OCD Symptom Dimensions
• Insight Specifiers and Severity Levels
• Differential Diagnosis
• Functional Impairment
• Pediatric and Adult Presentations
• Assessment Tools and Clinical Evaluation
• Evidence-Based Treatment Approaches
• Long-Term Management and Prognosis
Section III: Obsessive-Compulsive Related Disorders
• Body Dysmorphic Disorder
• Hoarding Disorder
• Trichotillomania (Hair-Pulling Disorder)
• Excoriation (Skin-Picking) Disorder
• Substance/Medication-Induced OCD-Related Disorders
, • OCD-Related Disorders Due to Medical Conditions
• Differential Diagnosis and Clinical Distinctions
• Assessment and Screening
• Functional and Psychosocial Impact
• Evidence-Based Management
Section IV: Trauma- and Stressor-Related Disorders
• Trauma Exposure and Stress Response
• Acute Stress Disorder
• Posttraumatic Stress Disorder (PTSD)
• Adjustment Disorders
• Reactive Attachment Disorder
• Disinhibited Social Engagement Disorder
• Dissociative Features and Specifiers
• Risk and Resilience Factors
• Functional Impairment and Recovery
• Trauma-Informed Care Principles
Section V: PTSD Assessment and Diagnostic Evaluation
• Trauma History Assessment
• DSM-5-TR PTSD Diagnostic Criteria
• Symptom Cluster Evaluation
• Screening and Assessment Tools
• Differential Diagnosis
• Dissociative Subtype Assessment
• Cultural and Developmental Considerations
• Military and Combat Trauma Assessment
• Sexual Assault and Interpersonal Violence Evaluation
• Comprehensive Diagnostic Formulation
Section VI: Clinical Assessment and Risk Evaluation
• Psychiatric Interview and Mental Status Examination
, • Suicide Risk Assessment
• Self-Harm Evaluation
• Violence and Homicide Risk Assessment
• Dissociation Assessment
• Substance Use Evaluation
• Functional Impairment Assessment
• Family and Social Support Assessment
• Protective Factors and Resilience Evaluation
• Comprehensive Risk Formulation
Section VII: Psychopharmacology
• Serotonergic Mechanisms and Treatment Principles
• SSRIs in OCD and PTSD
• SNRIs and Alternative Pharmacologic Options
• Clomipramine and Tricyclic Antidepressants
• Prazosin for Trauma-Related Nightmares
• Antipsychotic Augmentation Strategies
• Treatment-Resistant Pharmacotherapy
• Medication Monitoring and Safety
• Special Population Prescribing Considerations
• Evidence-Based Medication Management
Section VIII: Psychotherapy and Evidence-Based Interventions
• Exposure and Response Prevention (ERP)
• Cognitive Behavioral Therapy (CBT)
• Cognitive Processing Therapy (CPT)
• Prolonged Exposure Therapy (PE)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Acceptance and Commitment Therapy (ACT)
• Dialectical Behavior Therapy (DBT) Skills
• Trauma-Focused CBT for Children and Adolescents
, • Group and Family Interventions
• Relapse Prevention and Long-Term Recovery
Section IX: Special Populations
• Children and Adolescents
• Older Adults
• Pregnancy and Postpartum Considerations
• Veterans and Military Populations
• Military Sexual Trauma
• Refugees and Immigrant Populations
• Healthcare Workers and First Responders
• LGBTQ+ Populations
• Marginalized and High-Risk Communities
• Culturally Responsive Care
Section X: Advanced Practice Nursing Management
• Therapeutic Communication
• Trauma-Informed Nursing Practice
• Psychoeducation and Patient Advocacy
• Safety Planning and Crisis Intervention
• Measurement-Based Care
• Medication Adherence and Monitoring
• Interprofessional Collaboration
• Ethical and Legal Considerations
• Recovery-Oriented Practice
• Leadership and Care Coordination
Section XI: Treatment-Resistant and Complex Presentations
• Treatment-Resistant OCD
• Treatment-Resistant PTSD
• Complex PTSD
• Psychiatric Comorbidities
, • Substance Use and Dual Diagnosis
• Emotional Dysregulation and Personality Factors
• Advanced Augmentation Strategies
• Functional Rehabilitation
• Long-Term Recovery Planning
• Integrated Complex Case Management
Section XII: Clinical Application and Board Review
• High-Yield PMHNP Concepts
• Diagnostic Pearls and Clinical Distinctions
• Differential Diagnosis Strategies
• Risk Assessment Pearls
• Psychopharmacology Review
• Psychotherapy Selection and Application
• Special Population Considerations
• Complex Case Analysis
• Clinical Decision-Making Frameworks
• Comprehensive Board Examination Preparation
Answer Key and Rationales
• Detailed Rationales for All Questions
• Clinical Decision-Making Explanations
• Differential Diagnosis Highlights
• Psychopharmacology Pearls
• Trauma-Informed Care Pearls
• PMHNP Board Examination Tips
• Evidence-Based Practice Guidelines
• Clinical Application Summaries
• High-Yield Review Concepts
• Final Comprehensive Board Review Notes
References and Evidence-Based Resources
, • DSM-5-TR Diagnostic References
• Current OCD Treatment Guidelines
• Current PTSD Treatment Guidelines
• Evidence-Based Psychotherapy Resources
• Psychopharmacology References
• PMHNP Board Review Resources
• Trauma-Informed Care Standards
• Contemporary Research and Clinical Updates
• Professional Practice Guidelines
• Advanced Practice Nursing Resources
CMN 552: Module 3 Study Guide – Obsessive-Compulsive & Trauma- and Stressor-Related Disorders
Section I: Foundations and DSM-5 Classification
Question 1
A PMHNP is reviewing DSM-5-TR diagnostic classifications with a graduate nursing student. Which statement
accurately reflects the current classification of Obsessive-Compulsive Disorder (OCD)?
A. OCD is classified under Anxiety Disorders
B. OCD is classified under Neurodevelopmental Disorders
C. OCD is classified under Obsessive-Compulsive and Related Disorders
D. OCD is classified under Somatic Symptom Disorders
Correct Answer: C
Rationale: DSM-5 and DSM-5-TR established Obsessive-Compulsive and Related Disorders as a distinct chapter
separate from Anxiety Disorders. This change reflects growing evidence that OCD possesses unique
neurobiological mechanisms, symptom patterns, familial tendencies, and treatment responses. While anxiety
remains a prominent feature, obsessive thoughts and compulsive behaviors represent a distinct
psychopathological process requiring specialized diagnostic and treatment approaches.
Why Not the Other Options?
• A: OCD was removed from Anxiety Disorders in DSM-5.
• B: OCD is not considered a neurodevelopmental condition.
• D: Somatic Symptom Disorders focus on physical symptom preoccupation rather than obsessions and
compulsions.
,Clinical Pearl: The separation of OCD from Anxiety Disorders is one of the most significant DSM classification
changes and is frequently tested on PMHNP certification examinations.
Question 2
A patient reports recurrent intrusive thoughts about contamination and spends hours washing his hands.
Which symptom represents an obsession?
A. Excessive handwashing
B. Avoidance of public places
C. Recurrent intrusive contamination fears
D. Repeated cleaning rituals
Correct Answer: C
Rationale: Obsessions are recurrent, persistent, intrusive thoughts, urges, or images that cause marked anxiety
or distress. Contamination fears represent the obsessive component of OCD. Patients recognize these thoughts
as unwanted and often attempt to suppress or neutralize them through compulsive behaviors.
Why Not the Other Options?
• A: Handwashing is a compulsion.
• B: Avoidance may occur but is not itself an obsession.
• D: Cleaning rituals represent compulsions.
Clinical Pearl: Obsessions generate anxiety; compulsions temporarily reduce anxiety but reinforce the OCD
cycle.
Question 3
Which disorder is classified within the Obsessive-Compulsive and Related Disorders chapter?
A. Panic Disorder
B. Body Dysmorphic Disorder
C. PTSD
D. Illness Anxiety Disorder
Correct Answer: B
Rationale: Body Dysmorphic Disorder (BDD) belongs within the OCD-related disorders spectrum due to
repetitive behaviors, intrusive thoughts, and shared neurobiological features with OCD. Patients experience
excessive concern about perceived appearance flaws.
Why Not the Other Options?
• A: Panic Disorder is an anxiety disorder.
• C: PTSD belongs to Trauma- and Stressor-Related Disorders.
• D: Illness Anxiety Disorder belongs to Somatic Symptom Disorders.
,Clinical Pearl: BDD patients often seek cosmetic procedures rather than psychiatric treatment.
Question 4
Which diagnosis requires exposure to a traumatic event as a diagnostic criterion?
A. Generalized Anxiety Disorder
B. OCD
C. PTSD
D. Major Depressive Disorder
Correct Answer: C
Rationale: PTSD requires exposure to actual or threatened death, serious injury, or sexual violence. Trauma
exposure is the defining feature separating PTSD from most other psychiatric disorders.
Why Not the Other Options?
• A, B, D: These conditions may occur without trauma exposure.
Clinical Pearl: Always evaluate Criterion A trauma exposure before considering a PTSD diagnosis.
Question 5
A nurse practitioner is teaching about PTSD diagnostic criteria. Which event qualifies under DSM-5-TR Criterion
A?
A. Divorce from a spouse
B. Failing a licensing examination
C. Witnessing a fatal motor vehicle accident
D. Losing employment unexpectedly
Correct Answer: C
Rationale: Witnessing actual death qualifies as Criterion A trauma exposure. Criterion A specifically involves
actual or threatened death, serious injury, or sexual violence.
Why Not the Other Options?
• A, B, D: Although stressful, these events do not meet trauma criteria.
Clinical Pearl: Not every stressful life event is considered a trauma under DSM-5-TR.
Question 6
Which symptom cluster is unique to OCD?
A. Flashbacks
B. Hypervigilance
C. Compulsions
D. Dissociation
Correct Answer: C
, Rationale: Compulsions are repetitive behaviors or mental acts performed to reduce distress caused by
obsessions. They are a hallmark feature of OCD.
Why Not the Other Options?
• A, B: Commonly associated with PTSD.
• D: Often associated with trauma-related disorders.
Clinical Pearl: Mental rituals such as silent counting are also compulsions.
Question 7
Research suggests the lifetime prevalence of OCD in the general population is approximately:
A. 15–20%
B. 10–12%
C. 1–3%
D. Less than 0.1%
Correct Answer: C
Rationale: OCD affects approximately 1–3% of the population worldwide, making it more common than many
clinicians initially realize.
Why Not the Other Options?
• A, B: Greatly overestimate prevalence.
• D: Significantly underestimates occurrence.
Clinical Pearl: OCD frequently remains undiagnosed for years before treatment is sought.
Question 8
Which group demonstrates the highest risk for developing PTSD?
A. Individuals exposed to severe trauma
B. Individuals with hypertension
C. Healthy adolescents without trauma
D. Patients with seasonal allergies
Correct Answer: A
Rationale: Trauma exposure is the strongest predictor of PTSD development. Severity, duration, and proximity
of trauma increase risk.
Why Not the Other Options?
• B, C, D: Not major PTSD risk factors.
Clinical Pearl: Most trauma-exposed individuals do not develop PTSD, highlighting the importance of resilience
factors.
STRESSOR-RELATED DISORDER
,TABLE OF CONTENTS
Section I: Foundations and DSM-5 Classification
• DSM-5-TR Changes and Diagnostic Framework
• Classification of Obsessive-Compulsive Disorders
• Classification of Trauma- and Stressor-Related Disorders
• Epidemiology and Prevalence
• Risk Factors and Protective Factors
• Neurobiology of OCD
• Neurobiology of Trauma Disorders
• Genetic Influences
• Neurotransmitters and Brain Circuitry
• Etiological Models and Current Research
Section II: Obsessive-Compulsive Disorder (OCD)
• Diagnostic Criteria and DSM-5-TR Features
• Obsessions and Compulsions
• Common OCD Symptom Dimensions
• Insight Specifiers and Severity Levels
• Differential Diagnosis
• Functional Impairment
• Pediatric and Adult Presentations
• Assessment Tools and Clinical Evaluation
• Evidence-Based Treatment Approaches
• Long-Term Management and Prognosis
Section III: Obsessive-Compulsive Related Disorders
• Body Dysmorphic Disorder
• Hoarding Disorder
• Trichotillomania (Hair-Pulling Disorder)
• Excoriation (Skin-Picking) Disorder
• Substance/Medication-Induced OCD-Related Disorders
, • OCD-Related Disorders Due to Medical Conditions
• Differential Diagnosis and Clinical Distinctions
• Assessment and Screening
• Functional and Psychosocial Impact
• Evidence-Based Management
Section IV: Trauma- and Stressor-Related Disorders
• Trauma Exposure and Stress Response
• Acute Stress Disorder
• Posttraumatic Stress Disorder (PTSD)
• Adjustment Disorders
• Reactive Attachment Disorder
• Disinhibited Social Engagement Disorder
• Dissociative Features and Specifiers
• Risk and Resilience Factors
• Functional Impairment and Recovery
• Trauma-Informed Care Principles
Section V: PTSD Assessment and Diagnostic Evaluation
• Trauma History Assessment
• DSM-5-TR PTSD Diagnostic Criteria
• Symptom Cluster Evaluation
• Screening and Assessment Tools
• Differential Diagnosis
• Dissociative Subtype Assessment
• Cultural and Developmental Considerations
• Military and Combat Trauma Assessment
• Sexual Assault and Interpersonal Violence Evaluation
• Comprehensive Diagnostic Formulation
Section VI: Clinical Assessment and Risk Evaluation
• Psychiatric Interview and Mental Status Examination
, • Suicide Risk Assessment
• Self-Harm Evaluation
• Violence and Homicide Risk Assessment
• Dissociation Assessment
• Substance Use Evaluation
• Functional Impairment Assessment
• Family and Social Support Assessment
• Protective Factors and Resilience Evaluation
• Comprehensive Risk Formulation
Section VII: Psychopharmacology
• Serotonergic Mechanisms and Treatment Principles
• SSRIs in OCD and PTSD
• SNRIs and Alternative Pharmacologic Options
• Clomipramine and Tricyclic Antidepressants
• Prazosin for Trauma-Related Nightmares
• Antipsychotic Augmentation Strategies
• Treatment-Resistant Pharmacotherapy
• Medication Monitoring and Safety
• Special Population Prescribing Considerations
• Evidence-Based Medication Management
Section VIII: Psychotherapy and Evidence-Based Interventions
• Exposure and Response Prevention (ERP)
• Cognitive Behavioral Therapy (CBT)
• Cognitive Processing Therapy (CPT)
• Prolonged Exposure Therapy (PE)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Acceptance and Commitment Therapy (ACT)
• Dialectical Behavior Therapy (DBT) Skills
• Trauma-Focused CBT for Children and Adolescents
, • Group and Family Interventions
• Relapse Prevention and Long-Term Recovery
Section IX: Special Populations
• Children and Adolescents
• Older Adults
• Pregnancy and Postpartum Considerations
• Veterans and Military Populations
• Military Sexual Trauma
• Refugees and Immigrant Populations
• Healthcare Workers and First Responders
• LGBTQ+ Populations
• Marginalized and High-Risk Communities
• Culturally Responsive Care
Section X: Advanced Practice Nursing Management
• Therapeutic Communication
• Trauma-Informed Nursing Practice
• Psychoeducation and Patient Advocacy
• Safety Planning and Crisis Intervention
• Measurement-Based Care
• Medication Adherence and Monitoring
• Interprofessional Collaboration
• Ethical and Legal Considerations
• Recovery-Oriented Practice
• Leadership and Care Coordination
Section XI: Treatment-Resistant and Complex Presentations
• Treatment-Resistant OCD
• Treatment-Resistant PTSD
• Complex PTSD
• Psychiatric Comorbidities
, • Substance Use and Dual Diagnosis
• Emotional Dysregulation and Personality Factors
• Advanced Augmentation Strategies
• Functional Rehabilitation
• Long-Term Recovery Planning
• Integrated Complex Case Management
Section XII: Clinical Application and Board Review
• High-Yield PMHNP Concepts
• Diagnostic Pearls and Clinical Distinctions
• Differential Diagnosis Strategies
• Risk Assessment Pearls
• Psychopharmacology Review
• Psychotherapy Selection and Application
• Special Population Considerations
• Complex Case Analysis
• Clinical Decision-Making Frameworks
• Comprehensive Board Examination Preparation
Answer Key and Rationales
• Detailed Rationales for All Questions
• Clinical Decision-Making Explanations
• Differential Diagnosis Highlights
• Psychopharmacology Pearls
• Trauma-Informed Care Pearls
• PMHNP Board Examination Tips
• Evidence-Based Practice Guidelines
• Clinical Application Summaries
• High-Yield Review Concepts
• Final Comprehensive Board Review Notes
References and Evidence-Based Resources
, • DSM-5-TR Diagnostic References
• Current OCD Treatment Guidelines
• Current PTSD Treatment Guidelines
• Evidence-Based Psychotherapy Resources
• Psychopharmacology References
• PMHNP Board Review Resources
• Trauma-Informed Care Standards
• Contemporary Research and Clinical Updates
• Professional Practice Guidelines
• Advanced Practice Nursing Resources
CMN 552: Module 3 Study Guide – Obsessive-Compulsive & Trauma- and Stressor-Related Disorders
Section I: Foundations and DSM-5 Classification
Question 1
A PMHNP is reviewing DSM-5-TR diagnostic classifications with a graduate nursing student. Which statement
accurately reflects the current classification of Obsessive-Compulsive Disorder (OCD)?
A. OCD is classified under Anxiety Disorders
B. OCD is classified under Neurodevelopmental Disorders
C. OCD is classified under Obsessive-Compulsive and Related Disorders
D. OCD is classified under Somatic Symptom Disorders
Correct Answer: C
Rationale: DSM-5 and DSM-5-TR established Obsessive-Compulsive and Related Disorders as a distinct chapter
separate from Anxiety Disorders. This change reflects growing evidence that OCD possesses unique
neurobiological mechanisms, symptom patterns, familial tendencies, and treatment responses. While anxiety
remains a prominent feature, obsessive thoughts and compulsive behaviors represent a distinct
psychopathological process requiring specialized diagnostic and treatment approaches.
Why Not the Other Options?
• A: OCD was removed from Anxiety Disorders in DSM-5.
• B: OCD is not considered a neurodevelopmental condition.
• D: Somatic Symptom Disorders focus on physical symptom preoccupation rather than obsessions and
compulsions.
,Clinical Pearl: The separation of OCD from Anxiety Disorders is one of the most significant DSM classification
changes and is frequently tested on PMHNP certification examinations.
Question 2
A patient reports recurrent intrusive thoughts about contamination and spends hours washing his hands.
Which symptom represents an obsession?
A. Excessive handwashing
B. Avoidance of public places
C. Recurrent intrusive contamination fears
D. Repeated cleaning rituals
Correct Answer: C
Rationale: Obsessions are recurrent, persistent, intrusive thoughts, urges, or images that cause marked anxiety
or distress. Contamination fears represent the obsessive component of OCD. Patients recognize these thoughts
as unwanted and often attempt to suppress or neutralize them through compulsive behaviors.
Why Not the Other Options?
• A: Handwashing is a compulsion.
• B: Avoidance may occur but is not itself an obsession.
• D: Cleaning rituals represent compulsions.
Clinical Pearl: Obsessions generate anxiety; compulsions temporarily reduce anxiety but reinforce the OCD
cycle.
Question 3
Which disorder is classified within the Obsessive-Compulsive and Related Disorders chapter?
A. Panic Disorder
B. Body Dysmorphic Disorder
C. PTSD
D. Illness Anxiety Disorder
Correct Answer: B
Rationale: Body Dysmorphic Disorder (BDD) belongs within the OCD-related disorders spectrum due to
repetitive behaviors, intrusive thoughts, and shared neurobiological features with OCD. Patients experience
excessive concern about perceived appearance flaws.
Why Not the Other Options?
• A: Panic Disorder is an anxiety disorder.
• C: PTSD belongs to Trauma- and Stressor-Related Disorders.
• D: Illness Anxiety Disorder belongs to Somatic Symptom Disorders.
,Clinical Pearl: BDD patients often seek cosmetic procedures rather than psychiatric treatment.
Question 4
Which diagnosis requires exposure to a traumatic event as a diagnostic criterion?
A. Generalized Anxiety Disorder
B. OCD
C. PTSD
D. Major Depressive Disorder
Correct Answer: C
Rationale: PTSD requires exposure to actual or threatened death, serious injury, or sexual violence. Trauma
exposure is the defining feature separating PTSD from most other psychiatric disorders.
Why Not the Other Options?
• A, B, D: These conditions may occur without trauma exposure.
Clinical Pearl: Always evaluate Criterion A trauma exposure before considering a PTSD diagnosis.
Question 5
A nurse practitioner is teaching about PTSD diagnostic criteria. Which event qualifies under DSM-5-TR Criterion
A?
A. Divorce from a spouse
B. Failing a licensing examination
C. Witnessing a fatal motor vehicle accident
D. Losing employment unexpectedly
Correct Answer: C
Rationale: Witnessing actual death qualifies as Criterion A trauma exposure. Criterion A specifically involves
actual or threatened death, serious injury, or sexual violence.
Why Not the Other Options?
• A, B, D: Although stressful, these events do not meet trauma criteria.
Clinical Pearl: Not every stressful life event is considered a trauma under DSM-5-TR.
Question 6
Which symptom cluster is unique to OCD?
A. Flashbacks
B. Hypervigilance
C. Compulsions
D. Dissociation
Correct Answer: C
, Rationale: Compulsions are repetitive behaviors or mental acts performed to reduce distress caused by
obsessions. They are a hallmark feature of OCD.
Why Not the Other Options?
• A, B: Commonly associated with PTSD.
• D: Often associated with trauma-related disorders.
Clinical Pearl: Mental rituals such as silent counting are also compulsions.
Question 7
Research suggests the lifetime prevalence of OCD in the general population is approximately:
A. 15–20%
B. 10–12%
C. 1–3%
D. Less than 0.1%
Correct Answer: C
Rationale: OCD affects approximately 1–3% of the population worldwide, making it more common than many
clinicians initially realize.
Why Not the Other Options?
• A, B: Greatly overestimate prevalence.
• D: Significantly underestimates occurrence.
Clinical Pearl: OCD frequently remains undiagnosed for years before treatment is sought.
Question 8
Which group demonstrates the highest risk for developing PTSD?
A. Individuals exposed to severe trauma
B. Individuals with hypertension
C. Healthy adolescents without trauma
D. Patients with seasonal allergies
Correct Answer: A
Rationale: Trauma exposure is the strongest predictor of PTSD development. Severity, duration, and proximity
of trauma increase risk.
Why Not the Other Options?
• B, C, D: Not major PTSD risk factors.
Clinical Pearl: Most trauma-exposed individuals do not develop PTSD, highlighting the importance of resilience
factors.
