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Case Study I

Obsessive-Compulsive Disorder
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Table of contents

Identifying data………………………………………………………………..……………….3

Symptoms……………………………………………………………………………………….4

Family history……………………………………………………………………..…………...4

Personal history………………………………………………………………………………...5

Onset of illness………………………………………………………………………………….5

Premorbid personality……………………………………………………………….………...6

Behavior observation………………………………………………………………..………....6

Tentative diagnosis……………………………………………………………………..………6

Case formulation………………………………………………………………………….……6

Therapeutic recommendations………………………………………………………...……...7

Prognosis………………………………………………………………………………...….......8

References……………………………………………………………………………..………..9
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Identifying Data

Name N.N

Age 40 years

Gender Female

Religion by birth Islam

Education Intermediate

Occupation Housewife

Father alive / dead Alive

Mother alive / dead Alive

Marital Status Married

Spouse Age 45 years

Spouse Education Bachelors

Spouse occupation Teacher

No. of issues 0

Number of siblings 4

Gender of siblings 2 brothers, 2 sisters

Birth order Youngest

Father’s occupation Retired

Mother’s occupation Housewife

Current hospitalization Armed Forces Institute Of Mental Health

Referred by Self-referred

Date of assessment 8th, February 2020

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Current Treatment

Medication

• Tablet Paroxa

• Tablet Chomipril

• Tablet Epival

• Tablet Alepra

Presenting Complaints

Patient’s Report

‫مج ھے وہم ہوتا ہے کسی سے ہاتھ مالئی ہوں تو گ تدے ہو جاتے ہیں۔ مج ھے غصہ آ تا ہے جب کوئی کہ تا ہے یہ کام غلط ہے تم‬
‫لوگوں سے ہاتھ ک یوں نہیں مالئی‬

Clinical Symptoms according to DSM-V

• Fear of being contaminated by germs by shaking hands.

• Repetitive behavior of Hand washing

• Anxiety till the act is not performed

• Frequency: 7 times after shaking hands with anyone

• Duration: 2 years

Family History

The patient belonged to a middle-class family. she had 4 siblings (2 brothers, 2 sisters). she

was the last-born child of her parents. Her father was retired, and her mother was a housewife. She

had good relationships with her siblings. Her family was a happy family with no interpersonal
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issues. The client had been married since last 17 years. She had good relationship with her husband

but had no children. Also, there was no history of any psychological problem reported in any of

her family member.

Personal History

The patient was a 40 years old female. She was born through a normal delivery and attained

developmental milestones on time. She was an active and lively child who enjoyed playing with

her siblings and friends. She was good in her studies and also enjoyed participating in extra-

curricular activities in school. She got married 17 years back to a man who was a teacher by

profession. They were living a happy and satisfied life. Her husband loved her a lot. She did not

have any child. She used to be alone at home as her husband went to his job. Due to loneliness she

even started teaching in a private school for some years. She tried to engage herself in activities,

but she felt very lonely inside due to being childless. She felt distress, anxiety, depression had low

self-esteem. 2 years back she started to experience extreme anxiety which led her to excessive

cleaning behavior.

Onset of illness

The patient’s suffering began 2 years back as she started to have episodes of anxiety on the

thoughts of being contaminated by germs. She started avoiding shaking hands with people because

she thought that she would get germs this way. To get rid of these germs she started washing hand

excessively i-e 7 times after shaking hands with anyone. She reported that she knew her behavior

was irrational and did not make any sense, but she could not control and resist it.
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Premorbid personality

Before the onset of illness, the patient’s life was very normal. Always had a good

relationship with peers and other age fellows. She was socially active and always had a good

academic career. She had a friendly personality and a good term with all her family members. She

had no conflict with her family. There was no history of any psychological disturbances or any

major mental problem running in her family.

Behavior observation

The patient was dressed elegantly. She did not show any signs of bizarre behavior. She was

maintaining full eye contact. She was very co-operative and answered all the questions. She

apparently seemed to be comfortable but was twirling her house keys around her finger all the time.

Tentative diagnosis

300.3 (F42) Obsessive-Compulsive Disorder having fair insight

Case Formulation

The Patient was a 40 years old female born through a normal delivery. She lived in

Islamabad. She was leading a happy life but being childless after so many years of marriage made

her depressed and anxious. Her loneliness led to extreme anxiety which ultimately results in

development of OCD.

Following models explain the etiology of OCD.

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Cognitive Model

The model that best explain the following case is Cognitive Model. According to

the cognitive model of OCD, everyone experiences intrusive thoughts from time-to-time.

However, people with OCD often have an inflated sense of responsibility and misinterpret these

thoughts as being very important and significant which could lead to catastrophic consequences.

The repeated misinterpretation of intrusive thoughts leads to the development of the

obsessions and because the thoughts are so distressing, the individual engages in compulsive

behavior to try to resist, block, or neutralize the obsessive thoughts. This might be the case with

the present case as the present patient was childless and have strong feelings of loneliness which

generate anxiety in her, and this anxiety might be misinterpreted as fear of germs and lead to

development of compulsion in her.

Di-thesis Stress Model

Another model that explains this case is Di-thesis Stress Model, according to this model

when a person is not able to cope with stressor, it leads to pathology, in the present case the client

had some environmental stressors, Which led to the development of OCD.

Therapeutic Recommendations

Tricyclic Antidepressants

Tricyclic antidepressants regulate the neurotransmitters serotonin and/or noradrenalin in

the brain. They have been used effectively for the treatment of OCD. Improvement is usually

seen in 2 to 6 weeks after beginning treatment. This treatment might prove helpful for the current

patient.
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Exposure therapy

The psychotherapy of choice for the treatment of OCD is exposure and response

prevention (ERP), which is a form of CBT. In ERP therapy, people who have OCD are placed in

situations where they are gradually exposed to their obsessions and asked not to perform the

compulsions that usually ease their anxiety and distress. This technique might help the present

patient in getting rid from the OCD.

Cognitive Behavioral Therapy

CBT is a blend of cognitive therapy and behavioral therapy. Cognitive therapy focuses

on moods and thoughts. Behavioral therapy specifically targets actions and behaviors. A therapist

practicing the combined approach of CBT works in a structured setting. The client and the

therapist work to identify specific negative thought patterns and behavioral responses to

challenging or stressful situations.

Treatment involves developing more balanced and constructive ways to respond to

stressors. Ideally these new responses will help minimize or eliminate the troubling behavior or

disorder. This therapy will help the present patient to reconstruct her disturbed and unhealthy

behavior and thoughts and thus may help her in living a healthy life.

Prognosis

The prognosis seems to be favorable because her family members was very helpful. she has

full support from her family, and she also agree to Continue treatment till recovery.
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References

American Psychiatric. (2013). Diagnostic and statistical manual of mental disorders (DSM-5).

American psychiatric pub.

Vogel PA, Stiles TC, Gotestam KG. Adding cognitive therapy elements to exposure therapy for

obsessive compulsive disorder: a controlled study. Behav CognPsychother. 2004;32:275–

290.