Rosh Psychiatry Board Practice Exam

What is the most likely diagnosis for a patient fearing getting lost while driving, leading to multiple accidents?

1. Generalized anxiety disorder

2. Obsessive-compulsive disorder

3. Paranoid personality disorder

4. Specific phobia

The correct answer is: Obsessive-compulsive disorder

The diagnosis that best fits the situation described involves a fear of getting lost while driving, which leads to the significant distress of multiple accidents. This fear can reflect a pattern of intrusive, distressing thoughts and fears, characteristic of obsessive-compulsive disorder (OCD). In OCD, individuals often experience obsessions—recurrent, unwanted thoughts that lead to anxiety. The fear of getting lost and the subsequent accidents likely represent a compulsive response to alleviate the distress caused by those obsessive thoughts. While other diagnoses may involve anxiety, OCD is particularly marked by the interplay between obsessions (fear of losing control or becoming lost) and compulsive behaviors (which could manifest as safety measures taken while driving, such as overly cautious driving or frequent checking of routes). This scenario highlights the intricate relationship between anxiety-provoking thoughts and specific behaviors, which aligns closely with the hallmark features of OCD. In contrast, generalized anxiety disorder typically involves a broader scope of worries and does not generally focus on the specific fear of losing one’s way in a driving context. Paranoid personality disorder centers around pervasive distrust and suspicion of others, which is not relevant here. Specific phobia involves an intense fear of a specific object or situation but does not encompass the compulsive behaviors associated with OCD. Thus