# Situation: The nurse on a psychiatric unit reviews admission records. Each record lists the client's diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and nursing diagnoses written with NANDA International (NANDA-I) 2024–2026 labels. The nurse groups the clients' diagnoses by chapter of the current psychiatric manual. Which pair of diagnoses belongs to the SAME chapter?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630094  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: The nurse on a psychiatric unit reviews admission records. Each record lists the client's diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and nursing diagnoses written with NANDA International (NANDA-I) 2024–2026 labels.

The nurse groups the clients' diagnoses by chapter of the current psychiatric manual. Which pair of diagnoses belongs to the SAME chapter?

## 보기

1. Body dysmorphic disorder and illness anxiety disorder
2. Body dysmorphic disorder and hoarding disorder **✔ 정답**
3. Obsessive-compulsive disorder and panic disorder
4. Posttraumatic stress disorder and generalized anxiety disorder

**정답: 2**

## 해설

Body dysmorphic disorder and hoarding disorder are both in the obsessive-compulsive and related disorders chapter. Obsessive-compulsive disorder was separated from the anxiety disorders, posttraumatic stress disorder is in the trauma- and stressor-related disorders chapter, and illness anxiety disorder is in the somatic symptom and related disorders chapter.

## 심화 해설

DSM-5-TR chapter grouping

The question asks you to recognize which two diagnoses are classified under the same chapter in the current DSM-5-TR. The correct pairing is body dysmorphic disorder and hoarding disorder, both of which belong to the obsessive-compulsive and related disorders chapter.

The DSM-5 created a separate chapter for obsessive-compulsive and related disorders, pulling OCD out of the anxiety disorders chapter and grouping it with body dysmorphic disorder, hoarding disorder, excoriation disorder, and trichotillomania. This reorganization reflects shared features across these conditions: preoccupations and repetitive behaviors, similar clinical course, overlapping risk factors, and comparable treatment response [1][4].

The core unifying thread is the presence of repetitive thoughts and repetitive behaviors. In obsessive-compulsive disorder, these appear as obsessions and compulsions. In body dysmorphic disorder, the person is preoccupied with perceived appearance flaws and performs repetitive rituals such as mirror checking or grooming. In hoarding disorder, the repetitive behavior involves acquiring items and the persistent difficulty discarding possessions [4].

The rationale for grouping these disorders together was to improve clinical utility and scientific validity by recognizing that they share more with each other than with the anxiety disorders [2]. Although anxiety is often present, the defining pathology centers on the obsessive-compulsive spectrum rather than on fear or worry alone.

Now examine why the other options are incorrect.

| Option | Diagnoses | DSM-5-TR chapters | Why they do not match |
| --- | --- | --- | --- |
| 1 | Body dysmorphic disorder and illness anxiety disorder | Obsessive-compulsive and related disorders vs. somatic symptom and related disorders | Illness anxiety disorder involves preoccupation with having a serious illness, not with appearance or repetitive rituals |
| 3 | Obsessive-compulsive disorder and panic disorder | Obsessive-compulsive and related disorders vs. anxiety disorders | OCD was moved out of the anxiety disorders chapter in DSM-5 |
| 4 | Posttraumatic stress disorder and generalized anxiety disorder | Trauma- and stressor-related disorders vs. anxiety disorders | PTSD was also separated from the anxiety disorders into its own chapter |

Watch out! A common exam trap is assuming OCD still belongs with anxiety disorders. In DSM-5 and DSM-5-TR, OCD is no longer classified under anxiety disorders. Similarly, PTSD is not an anxiety disorder; it sits in the trauma- and stressor-related disorders chapter.

Key point! The obsessive-compulsive and related disorders chapter includes OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder. Illness anxiety disorder belongs to somatic symptom and related disorders, panic disorder and generalized anxiety disorder remain in anxiety disorders, and PTSD is in trauma- and stressor-related disorders.

The higher-order structure of these conditions continues to be studied, with evidence supporting that obsessive-compulsive spectrum disorders form a coherent group distinct from internalizing and externalizing dimensions . For the licensure examination, the essential task is to recall the chapter boundaries as defined in DSM-5-TR and recognize that body dysmorphic disorder and hoarding disorder share the same chapter, while the other pairs cross chapter lines.References (research sources)

- [1]Obsessive-compulsive and related disorders.Research articleMattina GF, Slyepchenko A, Steiner M (2020) · DOI: 10.1016/B978-0-444-64123-6.00025-4

- [2]The classification of Obsessive-Compulsive and Related Disorders in the ICD-11.Research articleStein DJ, Kogan CS, Atmaca M, Fineberg NA, Fontenelle LF, Grant JE (2016) · DOI: 10.1016/j.jad.2015.10.061

- [4]Mental Disorders: Obsessive-Compulsive Disorder and Body Dysmorphic Disorder.Research articleMorgan S (2020)

## 임상 시나리오

DSM-5-TR Chapter GroupingObsessive-Compulsive and Related Disorders
Body dysmorphic disorder and hoarding disorder both belong to the obsessive-compulsive and related disorders chapter in DSM-5-TR.

This chapter also includes OCD, excoriation disorder, and trichotillomania, reflecting shared features of repetitive thoughts and behaviors.

CautionIllness anxiety disorder is in somatic symptom and related disorders, not with body dysmorphic disorder. PTSD is in trauma- and stressor-related disorders, and panic disorder remains in anxiety disorders.

## 핵심 개념

- **DSM-5-TR** — Current psychiatric diagnostic manual that reorganizes disorders into chapters based on shared features
- **Obsessive-compulsive and related disorders** — Chapter including OCD, body dysmorphic disorder, hoarding disorder, excoriation, and trichotillomania
- **Body dysmorphic disorder** — Preoccupation with perceived appearance flaws with repetitive rituals like mirror checking
- **Hoarding disorder** — Persistent difficulty discarding possessions with acquiring behaviors
- **Somatic symptom and related disorders** — Chapter that includes illness anxiety disorder

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