Question

Create a case study about someone who has a diagnosis of obsessive compulsive disorder. In your case study, you should define OCD, describe the symptoms and causes of the disorder and include common treatments.

Answer 1

Obsessive-Compulsive Disorder

This disorder is described as an anxiety disorder in which individuals experience recurrent, as well as, disturbing thoughts (obsession) that cannot be prevented unless a specific behavior is done (compulsion). This forms a cycle and it can only be broken once the individual gets reassured and the thought stops occurring.

Case Study

Case History

Mr. M was a 30-year-old, unmarried man, who worked at the airport as a member of ground crew (Passenger Service Agent). His duty was a full-time job, it started at 11.30 am and ended at 8.30 pm. He described the job as being overworked, stressful and a bit low paid. Mr. M, is currently in a relationship, and it is going well. He said that he lives with his parents as his parents’ home is closer to airport as from his previous apartment that he was renting out during training. He has been living with them for past 4 years now, from the time he started doing this job. His story was that, recently he started having intrusive thoughts about his family being in harm. He felt like they would be in some kind of accident and someone might die. This made him feel anxious, and fidgety. He told that these thoughts occurred many times a day, being recurrent almost every hour.

This caused him to start praying to God, to negotiate, and sincerely ask him to keep his family safe. He told about how he would get worried and start praying and this would interfere with his work. As most of the time this thought occurs when he is dealing with a passenger. So in between when he starts praying his clients look at him like he is mad or overzealous in his prayers. Sometimes, some clients also get angry as they are in hurry. He feels that if this goes on he will go mad, and he feels that this has also started to cause him a lot of worry, and anxiety. Due to this he has a lack of concentration and he has started to feel that he has been getting low moods during day. Low Mood is characterized by the feeling of uneasiness and unhappiness whenever he is free, and just thinking about his current condition and life. This mood occurs when he is not working and he has free time for thoughts. When asked if he gets these thoughts at home, he said that he does not get them, it only happens when he is at work.

Past Medical History

Mr. M has never been to any mental health professional before. This is his first time coming to one. Until now he had a healthy mind and body. He has no history of any substance abuse, or dependence on any medication. He only gets sick with flu, fever, or bad stomach once in a year or two, and it is only during that time he takes prescribed or over the counter medication. He has had no surgeries, or medication for any other diseases. He did say that he has a bit of worrisome personality, especially when it comes down to his loved one's. He gets worried even if anyone in his family comes down with a flu. When asked about his academic record, he said that he never stood out in anything. He was pretty average in every subject, "a B grade student you could say."

Social History

Mr. M said he has had very good relations with everyone. He had a lot of friends from school and he is still maintains contact with them. He has friends at the place he works. He is very close to his family. He has an older sister, she is married and living happily with her husband and her 1-year old son. He has a girlfriend, whom he intends to marry in a year, and he has remained a virgin. He is close to his mother as compared to his father. His father is a caring and providing man, he is a businessman. His mother is a homemaker, and he is also caring, and is overprotective about her children.

Family History

His father is well, except for physical pain (Knee and back pain) that he got due to old age and travelling around for his business. His father is mostly home, but he has to travel with regards to business, once in 2-3 months. His father is currently on medication for those. His mother has been on medication for few years now for anxiety disorder. He says his mother is anxiety ridden, one of the reason she is overprotective. She is always worried that something will happen, and she is unable to take her mind of it. His mother is being treated for anxiety disorder for last 4-5 years.

Mental Status Examination (MSE)

Mr. M was well-built and looked pretty much the same age he said he was. He was casually dressed, but was well dressed. His body language showed a little bit of nervousness (his speech was littered with lots of ahhs, and umms) and he had an anxious look on his face. When asked about his nervousness, he said that he is nervous as well as anxious about what disease he is suffering from and that visiting a medical professional makes him nervous. Most of his thought were focused on his family and their well-being. Mr. M looked a bit mellow and he was friendly and open.

Assessment

Diagnostic and Statistical Manual gives the following diagnostic criteria for Obsessive-Compulsive Disorder:

A. There should be a presence of either obsessions, or compulsions, or both

With Obsessions defined as:

1. Experiencing of intrusive and unwanted thoughts, urges, or impulses, that are recurrent and persistent in nature and causes anxiety or distress,

2. Attempts of ignoring, or suppressing, or neutralizing them with another thought or by action (compulsion).

Compulsions defined as:

1. Repetitive behaviors or mental acts driven to perform in response to obsession or rules applied rigidly.

2. The acts or behaviors are aimed at prevention or reduction of distress or anxiety caused by the situation and are either clearly excessive or are not connected in realistic way

B. These obsessions or compulsions are either impairing any area of functioning or/and is time-consuming.
C. Symptoms are not manifested due to some other medical condition or substance abuse.

D. Symptoms are not explainable by other mental disorder.

Mr. M's symptoms

• Intrusive thought of harm to his family
• Compulsion of praying and negotiating with God
• These symptoms interfering with work
• Anxiety produced due to the thought
• Low mood during day

Causes

This might be genetic, as is mother has a history of anxiety disorder or the chances are that it is learned by observing his mother. Mr. M is close to his mother, so he might have observed her anxiety and worry, and this might have caused a transference to him. Mr. M himself has also reported that he has a worrisome personality. Being a sole male in the house, he might feel as if he is expected to stand strong and support everyone, just like his father. He hs also said that his father is his model and he wants to be like him. So, all these factors and the stress of pressure of work and his assumed expectations might have caused him to start worrying about his family while being away from them.

Treatment

Mr. M's treatment might include both medications as well as therapy. Medications may include small dose of SSRI like Prozac (fluoxetine) and an anti-anxiety medication like alprazolam (xanax) or lorazepam (ativan). Mr. M will also be given sessions for CBT. CBT is a type of psychotherapy which aims to help the patient change their thinking and behavioral patterns. In this treatment patient goes through talk therapies to find out about his thought and behavior and with the therapist they find a way to change these abnormal behaviors. Mr. M will find out about his anxiety causing situations, make a priority list about them and then try to work through it. He will try to logically re-evaluate its consequences and the beliefs leading to it. Together with Mr. M, therapist will try to bring evidence and find an alternative way to the unwanted thought or actions.