Master the board step 3

Master the Boards: USMLE Step 3
Body Dysmorphic Disorder
The diagnosis is body dysmorphic disorder when the case describes a young
woman who is preoccupied with an imagined or slight defect in appearance,
causing distress and impaired ability to function in a social or occupational
setting. The distress is most commonly related to facial features, although
any body part may be the focus of anxiety. The patients are often isolated and
housebound.
Treatment
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High doses of SSRIs are first-line therapy.
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If the only concern is body shape and weight, anorexia nervosa is the more
accurate diagnosis.
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If the only concern is sex characteristics, gender identity disorder is the more
accurate diagnosis.
Disruptive, Impulse Control, and Conduct Disorders
These occur in people who are unable to resist impulses. The question will
describe anxiety prior to the impulse that is relieved after the patient acts on
the impulse.
Check urine toxicology for
cocaine in patients with
intermittent explosive
disorder.
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Intermittent explosive disorder: This is the diagnosis when the case
describes episodes of aggression out of proportion to the stressor. There
may be a history of head trauma. If there is a history of drug intake, intermittent
explosive disorder is not the diagnosis. It must be found in someone age
> 6 and occur, on average, twice weekly for 3 months or involve more
destructive episodes (assault) 3 times within a 12-month period. Treatment
of choice is SSRIs and mood stabilizers.
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Kleptomania: This is the diagnosis when the case describes an individual
who repeatedly steals items to relieve anxiety. The person does not steal
because she needs the object, and the individual often secretly replaces the
object after stealing it.
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Pyromania: This is the diagnosis when the case describes an individual
who repeatedly lights fires. Pyromania is not the diagnosis if the motive is
personal gain (i.e., insurance money) or to show anger, which differentiates
this from conduct disorder.
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Pathologic gambling: This is the diagnosis when the case describes obsession
with gambling despite the consequences. Treatment of choice is group
psychotherapy (e.g., gambling anonymous).
Individuals with impulse control disorders do not believe their actions are
excessive or out of proportion (i.e., they lack insight), unlike in OCD.
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