ASSIGNMENT NO 2

Submitted to: Mam Ayesha

Summited by: Sadia Imam
Registration no: MSCSR07223031
Program: MS Clinical Psychology
Semester: MS-1
Subject: Psychopathology
Topic: Obsessive Compulsive Disorder (OCD Case Study)

Department of professional studies (Psychology)

The University of Lahore, Sargodha Campus, Sargodha
Summary of Case
A 35-year-old man named M.R. has been struggling with intrusive thoughts of harming
others for the past year. He spends hours each day checking to make sure the doors and windows
are locked and repeatedly washes his hands to the point of causing raw skin. He avoids social
situations and has trouble at work due to his rituals taking up much of his time.
It is clear that a person has obsessive-compulsive disorder, maladjusted anxiety, and
aggression. Presenting complaints and results of the tests support our diagnosis that the patient
tends to have an obsessive-compulsive disorder.
Identifying Information
Name: M. Rizwan
Age: 35 yrs. old
Sex: Male
Education: Educated
Marital status: Married
Religion: Muslim
Siblings: 4 (3 brothers and 1 sister)
Parents: Only mother Is alive
Birth order: 3rd
Parents’ Education: Both are uneducated.
Residence: Sargodha
Presenting Complaint
Table 1
Symptoms Duration Complaints
Intrusive thoughts 4 months ‫مجھے بار بار عجیب عجیب خیاالت آتے ہیں‬
Aggression 2 months ‫جب کچھ صاف نا ہو تو مجھے غصہ آتا ہے‬
Insomnia 1 month ‫مجھے نیند نہیں آتی‬
Thoughts of harming others 2 months ‫ارنے کے‬VVV‫و م‬VVV‫روں ک‬VVV‫ار دوس‬VVV‫ار ب‬VVV‫مجھے ب‬
‫خیاالت آتے ہیں‬
Compulsions 3.5 month ‫میں بار بار اپنے ہاتھ دھوتا ہوں‬
Feeling of anxiety 1 month ‫ے‬VV‫االت کی وجہ س‬VV‫نے خی‬VV‫ر وقت اپ‬VV‫مجھے ھ‬
‫گھبراہٹ ہوتی ہے ۔‬
Educational History
He graduated in 2010 in computer science.
Medical history
He had a minor brain injury in his childhood.
Drug History
He started smoking for the sake of relaxation and adventure at the age of 15.
Occupational history
He is a professor in college.
History of presenting complaints.
He is suffering from these symptoms for the past few months, actually, it’s been many
years that he is encountering all these symptoms and he had control over his thoughts and
behaviors but now it seems he has loosened his control.
General Home Environment
His home environment was good but too strict especially when it comes to hygiene.
Family History
Mr. M.R. belongs to a middle-class family. He had 3 brothers and 1 sister. He was the 3 rd
child in the family. His parents were not educated. He had normal relationships with his siblings
and a weak relationship with his father because of his father’s dominating personality. Their
relationship was very flat.
Evaluating techniques:
1. Informal Assessment
 Clinical Observation
 Mental Status Examination
2. Formal Assessment
 DSM-5 Self-Rated Level 1Cross Cutting Symptom Measure—Adult
 Level 2 – Anger -Adult
 Level 2 – OCD -Adult
 Rotter Incomplete Sentence Blank
Informal Assessment
Clinical observation:
My client’s appearance didn’t match his reported age he looked young, and he wand s tall
and skinny. He was wearing the salwar kameez that looked neat a crease-free. His hair was
combed, his tone was high pitched, tries to complete every sentence in a rush manner, was in
restlessness mode, his eyes were roaming the whole room, his hands and legs were continuously
in movement, his speech and thoughts were irregular and he was continually trying to arrange to
the things placed in the table and after that cleaning his hands again and again with tissues. His
open legs and arms show his open personality, willingness to engage and to be admired.
Mental Status Examination
Appearance
 Mr. M.R. was a 35-year-old male. He looked exceptionally clean and hygiene loving.
Speech
His speech was low, but the frustration element was present.
Motor Behavior
He was showing normal motor behavior. he didn’t show any bizarre movement.
General Attitude
He was very cooperative and provided the proper asked information.
Emotions
He was in an emotional state, his voice clearly depicts his emotions.
Orientation
He had a good orientation of time, place and person. he could easily recall names of his
parents, siblings and where he lived.
Memory
He seemed to have intact remote memory as he could recall most of his past events.
General knowledge was good.
Formal Assessment
DSM-5 Self-Rated Level 1Cross Cutting Symptom Measure—Adult
Table 3
Scoring of Level 1 Cross Cutting Symptom measure are given as
Domain name scores
Depression 2
Anger 4
Mania 0
Anxiety 2
Somatic symptoms 1
Suicidal ideation 0
Psychosis 0
Sleep disorder 2
Memory 0
Repetitive thoughts &behavior 8
Dissociation 0
Personality functioning 0
Substance abuse 0

Qualitative interpretation:
Mr. A.A showed high score on anger and repetitive thoughts and behavior. Which shows
that he might had obsessive compulsive disorder or anger issue.
Level 2-Anger-Adult
Table 4
Scoring of Level 2 – Anger -Adult
Statement no Statement rating
1 irritated 3
2 angry 3
3 explode 4
4 grouchy 2
5 annoyed 3
Raw Score 15
T Score 58.8

Quantitative interpretation
Raw sum ×number of items on the short form
Number of items that are answered.
15×5
5
Raw Score =15
T Score =58.8 (Mild)
Qualitative interpretation.
The T score of the client is 58.8 which lies in mild range. So, we can say that this point
indicates that the client is at the border of the mild stage, he might face severe consequences the
in future because of his anger.
Level 2 – Repetitive Thoughts and Behavior – Adult
Table 5
Scoring of level 2- Repetitive Thoughts and Behavior -Adult are given as
Statement no Statement rating
1 time 4
2 distress 4
3 control 3
4 avoid 3
5 interfere 3
Raw Score 17

Quantitative observation
Raw Score =17
Qualitative interpretation.
The client scored 17 on the OCD scale, which indicates the severity of OCD in my client.
And my client needs treatment for this to control his OCD behavior.
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
Table 6
The scoring of Y-BOCS is given as
Statement no Statement Rating
1 The time occupied by obsessive thoughts 3
2 Interference due to obsessive thoughts 4
3 Distress associated with obsessive thoughts 3
4 resistance against obsessive thoughts 3
5 Degree of control over obsessive thought 2
6 Time spent performing a compulsive behavior 3
7 Interference due to compulsive behavior 4
8 Distress associated with compulsive behavior 4
9 Resistance against compulsive behavior 3
10 Degree of control over compulsive behavior 3
Raw Score 32

Quantitative observation
Raw Score =32
Qualitative interpretation.
The client scored 32 on the OCD scale, which indicates the severity of OCD in my client.
And my client needs treatment for this to control his OCD behavior.
Rotter Incomplete Sentence Blank test
Table 7
Scoring of RISB is given as
code Obtained score frequency
C3 36 6
C2 35 7
C1 8 2
N 9 3
P1 16 8
P2 2 2
P3 o 5

Quantitative Interpretation
Obtained score Cut off score result
106 135 Well adjusted

Qualitative Interpretation of RISB

Score of RISB of Mr. M.R. showed that he is well adjusted. He doesn’t have any
adjustment problem. Like he stated, “I used to be happy every time” and in another statement
hey say “one day I’ll be a good man” these statements show hope and positivity which is very
good sign.
Diagnosis
 Obsessive Compulsive disorder (F42.2)
Diagnostic criteria
A. Presence of obsessions, compulsions, or both: Obsessions are defined by (1) and (2): 1.
Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the
disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or
distress.
2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize
them with some other thought or action (i.e., by performing a compulsion). Compulsions are
defined by (1) and (2):
1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying,
counting, repeating words silently) that the individual feels driven to perform in response to an
obsession or according to rules that must be applied rigidly.
2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or
preventing some dreaded event or situation; however, these behaviors or mental acts are not
connected in a realistic way with what they are designed to neutralize or prevent, or are clearly
excessive. Note: Young children may not be able to articulate the aims of these behaviors or
mental acts.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or
cause clinically significant distress or impairment in social, occupational, or other important
areas of functioning.
C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical condition.
D. The disturbance is not better explained by the symptoms of another mental disorder (e.g.,
excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body
dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder;
hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin
picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior,
as in eating disorders; preoccupation with substances or gambling, as in substance-related and
addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual
urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and
conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or
delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or
repetitive patterns of behavior, as in autism spectrum disorder).
Treatment
 Exposure and Response Prevention (ERP)
 Cognitive Behavior Therapy
 Cognitive therapy
 Augmentation Therapy