# Situation: A 34-year-old woman is admitted to the psychiatric unit with obsessive-compulsive disorder (OCD). She washes her hands for 3 to 4 hours a day because she fears contamination, and the skin of her hands is cracked and red. Her physical examination and electrocardiogram (ECG) on admission were normal. In obsessive-compulsive disorder, what is the main purpose of a compulsion such as her handwashing?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630180  
> 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: A 34-year-old woman is admitted to the psychiatric unit with obsessive-compulsive disorder (OCD). She washes her hands for 3 to 4 hours a day because she fears contamination, and the skin of her hands is cracked and red. Her physical examination and electrocardiogram (ECG) on admission were normal.

In obsessive-compulsive disorder, what is the main purpose of a compulsion such as her handwashing?

## 보기

1. To gain pleasure or a sense of thrill from the act
2. To meet her own high standards of order and control
3. To obey a voice that tells her she must keep washing
4. To reduce the anxiety from intrusive thoughts **✔ 정답**

**정답: 4**

## 해설

Compulsions are repetitive behaviors or mental acts performed to reduce the anxiety or distress caused by obsessions or to prevent a feared event. The short-term relief negatively reinforces the ritual and maintains the disorder.

## 심화 해설

Core mechanism of compulsions in OCD

In obsessive-compulsive disorder, an obsession is an intrusive, unwanted thought, image, or urge that repeatedly enters the mind and triggers marked anxiety or distress. A compulsion is a repetitive behavior or mental act that the person feels driven to perform in response to that obsession. The central function of the compulsion is not pleasure, perfectionism, or obedience to an external command, but an attempt to neutralize or reduce the anxiety generated by the obsessive thought, or to prevent a feared outcome from occurring.

In this patient, the obsession is a fear of contamination. The compulsion of handwashing for 3 to 4 hours a day is performed to lower the distress caused by that contamination fear. The cracked, red skin on her hands is a physical consequence of the excessive ritual, yet the behavior persists because it provides short-term relief from anxiety.

Key point! The relief is temporary and partial. Because the anxiety returns, the person repeats the compulsion again and again. This creates a negative reinforcement cycle: the behavior removes an unpleasant state, so the behavior is strengthened and maintained over time.

| Option | Explanation | Why incorrect |
| --- | --- | --- |
| 1. To gain pleasure or thrill | Compulsions are not performed for enjoyment or excitement. | Pleasure-seeking is more characteristic of impulse-control or addictive behaviors, not OCD rituals. |
| 2. To meet high standards of order | This describes obsessive-compulsive personality traits, not the anxiety-reducing function of OCD compulsions. | OCD rituals are driven by distress, not by a desire for perfection or control for its own sake. |
| 3. To obey a voice | Command auditory hallucinations are seen in psychotic disorders. | OCD obsessions are experienced as one’s own intrusive thoughts, not as an external voice giving orders. |
| 4. To reduce anxiety from intrusive thoughts | Negative reinforcement: the compulsion temporarily lowers the distress caused by the obsession. | This is the correct answer. |

The cognitive-behavioral model of OCD directly supports this. Compulsions are negatively reinforced because they provide temporary relief from distress and unwanted thoughts [1]. When a person with OCD performs a ritual, the immediate drop in anxiety strengthens the belief that the ritual is necessary, which makes the compulsion more likely to recur in the future [1]. This is why simply telling the patient that handwashing is excessive does not stop the behavior; the internal relief mechanism is powerful and automatic.

The same principle underlies effective treatment. Cognitive-behavioral therapy for OCD, particularly exposure and response prevention, works by having the person face the obsession without performing the compulsion, so that anxiety eventually habituates and the negative reinforcement loop is broken [2]. The ritual only maintains the disorder because it prevents the person from learning that the feared outcome would not occur or that the anxiety would subside on its own.

Qualitative reports from individuals with OCD consistently describe rituals as acts performed to reduce inner tension, discomfort, or a sense that something bad will happen if the ritual is not completed [3]. The behavior is experienced as driven and distressing, not as rewarding or satisfying. Even when the person recognizes the ritual as excessive or irrational, the urge to perform it remains because the short-term anxiety reduction is reinforcing.

Watch out! Do not confuse the function of a compulsion with the content of an obsession. The obsession is the thought, such as “my hands are contaminated.” The compulsion is the action, such as handwashing, and its purpose is to manage the anxiety that the thought produces. In test questions, the correct answer is the option that describes anxiety reduction or prevention of a feared event, not the option that describes enjoyment, orderliness, or external commands.

The same reinforcement pattern applies across different types of compulsions. Compulsive checking, for example, is triggered by anxiety, uncertainty, and inflated responsibility, and the checking behavior temporarily lowers that distress while simultaneously reducing the person’s confidence in their own memory over time [4]. The underlying mechanism is identical: the ritual is maintained because it offers short-term relief from an aversive internal state.References (research sources)

- [1]Why compulsions persist: An ecological momentary assessment study of the reinforcement of compulsions.Research articleSwisher VS, Newman MG. (2026) · DOI: 10.1016/j.jad.2025.120530

- [2]Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder.Research articleSpencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. (2023) · DOI: 10.1016/j.psc.2022.10.004

- [3]Compulsive rituals in Obsessive-Compulsive Disorder - A qualitative exploration of thoughts, feelings and behavioral patterns.Research articleWairauch Y, Siev J, Hasdai U, Dar R (2024) · DOI: 10.1016/j.jbtep.2024.101960

- [4]The Etiology, Assessment and Treatment of Compulsive Checking: A Review.Research articleGuo S, Yadegar M, Khaw H, Chang S. (2025) · DOI: 10.2147/prbm.s431339

## 임상 시나리오

OCD Compulsion FunctionWhy rituals persist despite harm
A compulsion is a repetitive behavior or mental act performed to reduce anxiety caused by an obsession or to prevent a feared event. In this patient, handwashing lowers distress from contamination fear.

The relief is temporary, so the ritual is repeated. This creates a negative reinforcement cycle: removing anxiety strengthens the compulsion and maintains the disorder.

CautionCompulsions are not for pleasure, perfectionism, or obeying voices. Skin damage such as cracked, red hands may occur, but the behavior continues because of short-term anxiety relief.

## 핵심 개념

- **Obsession** — Intrusive, unwanted thought, image, or urge that triggers marked anxiety or distress.
- **Compulsion** — Repetitive behavior or mental act performed to reduce anxiety from an obsession or prevent a feared event.
- **Negative reinforcement** — A behavior is strengthened because it removes or reduces an unpleasant state such as anxiety.
- **OCD** — Obsessive-compulsive disorder, characterized by obsessions and/or compulsions that are time-consuming and impairing.

## 같은 주제 문제

- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629966)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629967)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629968)
- [Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward…](https://mymerci.kr/pages/nclex_q.php?qn_id=629969)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629970)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629971)
- [Situation: The nurse in a community mental health program leads a psychoeducation session …](https://mymerci.kr/pages/nclex_q.php?qn_id=629972)
- [Situation: A 29-year-old factory worker is admitted to the psychiatric unit of a general h…](https://mymerci.kr/pages/nclex_q.php?qn_id=629973)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._