Case Report: Obsessive compulsive disorder in posterior cerebellar infarction - illustrating clinical and functional connectivity modulation using MRI-informed transcranial magnetic stimulation

Urvakhsh Meherwan Mehta Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Darshan Shadakshari Roles: Data Curation, Investigation, Resources, Writing – Review & Editing Pulaparambil Vani Roles: Data Curation, Investigation, Methodology, Supervision, Writing – Review & Editing Shalini S Naik Roles: Methodology, Project Administration, Writing – Review & Editing V Kiran Raj Roles: Data Curation, Formal Analysis, Visualization, Writing – Review & Editing Reddy Rani Vangimalla Roles: Data Curation, Formal Analysis, Visualization, Writing – Review & Editing YC Janardhan Reddy Roles: Supervision, Writing – Review & Editing Jaya Sreevalsan-Nair Roles: Formal Analysis, Investigation, Visualization, Writing – Review & Editing Rose Dawn Bharath Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Visualization, Writing – Review & Editing

ocd case study conclusion

This article is included in the Wellcome Trust/DBT India Alliance gateway.

Obsessive Compulsive Disorder, Cerebellar cognitive affective syndrome, Neuromodulation, Functional brain connectivity, Cerebellar infarct, Theta burst stimulation

Revised Amendments from Version 1

The new version provides more clinical details about the patient, in response to the review comments raised. These include details and justifications for past treatment, iTBS treatment details, rationale for performing an MRI scan and follow-up information beyond the earlier reported period of three months.

See the authors' detailed response to the review by Shubhmohan Singh See the authors' detailed response to the review by Peter Enticott

Introduction

Cortico-striato-thalamocortical circuitry dysfunction is central to an integrated neuroscience formulation of obsessive-compulsive disorder (OCD) 1 , 2 . However, more recent large-scale brain connectivity analyses implicate the role of the cerebello-thalamocortical networks also 3 . Here, we report a case of OCD secondary to a cerebellar lesion. We test the mediating role of the cerebellum in the manifestation of OCD by manipulating the frontal-cerebellar network using MRI-informed transcranial magnetic stimulation (TMS).

Case report

A 21-year-old male, an undergraduate student from rural south India, presented to our emergency with suicidal thoughts. History revealed three years of academic decline, pathological slowness in routine activities (e.g., bathing, eating, dressing up, and using the toilet), repetitive ‘just-right’ behaviors (e.g., wiping his mouth after eating, clearing his throat, pulling down his shirt, mixing his food in the plate and walking back and forth until ‘feeling satisfied’). As a result, he spent up to three hours completing a meal or his toilet routines. Before presentation to us, he had received trials with two separate courses of electroconvulsive therapy (ECT) – six bitemporal ECTs at first, followed by nine bifrontal) spaced about two months apart. ECT was prescribed because of a further deterioration in his condition over the prior 18-months, with reduced oral intake, weight loss, grossly diminished speech output, and passing urine in bed (as he would remain in bed secondary to his obsessive ambitendency, as disclosed later). His oral intake and speech output improved with both ECT treatments, only to gradually worsen over the next few weeks. Given the potential catatonic phenomena (withdrawn behaviour and mutism) in the background of ongoing academic decline, slowness and stereotypies, he was also treated with oral olanzapine 20mg for eight weeks and risperidone 6mg for six weeks with minimal change in his slowness and repetitive behaviors. He did not receive any antidepressant medications. Psychotherapy was also not considered given the limited feasibility due to the severe withdrawal and near mutism. We could not elicit any contributory clinical history of prodromal or mood symptoms from adolescence when we evaluated his past psychiatric and medical history. Two months after the last ECT treatment, he presented to our emergency services with suicidal thoughts. He was admitted, and mental status examination revealed aggressive (urges to harm himself by jumping in front of a moving vehicle or touching electric outlets) and sexual obsessions with mental compulsions and passing urine in bed (as he could not go to the toilet in time due to obsessive ambitendency). The Yale-Brown Obsessive-Compulsive Scale (YBOCS) severity score was 29 4 . He had good insight into obsessions, but not the ‘just right’ repetitive behaviors; it was, therefore, challenging to engage him in psychotherapy. We treated him with escitalopram 40mg and brief psychoeducation before being discharged. After three months, his obsessions had resolved, but pathological slowness, ‘just right’ phenomena, and passing urine in bed had worsened (YBOCS score 31).

We then obtained a plain and contrast brain MRI, to rule out an organic aetiology given the atypical nature of symptoms (apparent urinary incontinence) and the poor treatment response. The MRI revealed a wedge-shaped lesion in the right posterior cerebellum, suggestive of a chronic infarct in the posterior inferior cerebellar artery territory ( Figure-1A ). MR-angiogram revealed no focal narrowing of intracranial and extracranial vessels. Electroencephalography, cerebrospinal fluid analysis, autoimmune and vasculitis investigations were unremarkable. Echocardiogram was normal and the sickling test for sickle cell anemia was also negative. We specifically inquired about history of loss of consciousness, seizures or motor incoordination, but these were absent. His neurological examination with a detailed focus on cerebellar signs was unremarkable. The International Cooperative Ataxia Rating Scale (ICARS) score was zero. The Cerebellar Cognitive Affective Syndrome (CCAS) scale revealed >3 failed tests – in domains of attention, category switching, response inhibition, verbal fluency, and visuospatial drawing, suggestive of definite CCAS 5 .

Cerebellar lesion detection ( A & B ), its functional connectivity map ( C ) and MRI-guided transcranial magnetic stimulation delivery ( D ). Average blood oxygen level-dependent (BOLD) signal time-series were extracted from voxels within a binarized lesion-mask that overlapped with the right crus II ( 1A & 1B ). This was used as the model predictor in a general linear model to determine the brain regions that temporally correlated with the lesion-mask using FSL-FEAT 11 . The resultant seed-to-voxel connectivity map (z-thresholded at 4) was used to identify the best connectivity of the seed with voxels in the pre-supplementary motor area (pre-SMA; MNI x=3; y=13; z=58; 1C ). Six-hundred pulses were delivered as triplet bursts at theta frequency and 90% of the resting motor threshold (50 Hz; 2s on; 8s off) using a MagPro X100 (MagVenture, Denmark) device under MR-guided neuronavigation using the Brainsight stereotaxic system (Rogue Research, Montreal, Canada) with a figure-of-eight coil held with the handle in line with the sagittal plane, pointing toward the occiput to stimulate the pre-SMA site ( 1D ).

MRI-informed neuromodulation

Owing to inadequate treatment response and the possibility of OCD secondary to the cerebellar lesion, we discussed with the patient about MRI-informed repetitive transcranial magnetic stimulation (rTMS) and obtained his consent. The presence of a lesion involving a node (cerebellum) within the cerebello-thalamo-cortical circuit – a key pathway for error monitoring 6 and inhibitory control 7 – cognitive processes typically impacted in OCD prompted us to utilize a personalized-medicine approach to treatment. We acquired a resting-state functional-MRI echoplanar sequence (8m 20s; 250-volumes) in duplicate – before, and one-month after rTMS treatment on a 3-Tesla scanner (Skyra, Siemens), using a 20-channel coil with the following parameters: TR/TE/FA= 2000ms/30ms/78; voxel=3mm isotropic; FOV=192*192.

Image processing was performed using the FMRIB Software Library (FSL version-5.0.10) 8 . Figure 1 describes how we obtained a seed-to-voxel connectivity map to identify the best connectivity of the cerebellar lesion-seed with voxels in the pre-supplementary motor area (pre-SMA; MNI x=3; y=13; z=58) – a commonly used site for neuromodulation in OCD 9 . This area demonstrates connections with the non-motor (ventral dentate nucleus) parts of the posterolateral cerebellum 10 and contributes to error processing and inhibitory control along with the cerebellum 7 .

We augmented escitalopram with rTMS, administered as intermittent theta-burst stimulation (iTBS) to the pre-SMA coordinates ( Figure-1D ). Six-hundred pulses were delivered as triplet bursts at theta frequency and 90% of the resting motor threshold (50 Hz; 2s on; 8s off) using a MagPro X100 (MagVenture, Farum, Denmark) device under MR-guided neuronavigation using the BrainSight stereotaxic system (Rogue Research, Montreal, Canada) with a figure-of-eight (MagVenture MCF-B-70) coil held with the handle in line with the sagittal plane, pointing toward the occiput to stimulate the pre-SMA site. We hypothesized that iTBS 12 to the pre-SMA could adaptively engage the cerebellum lesion, with which it shares neuronal oscillation frequencies, and hence improve the disabling symptoms. He received 27 iTBS sessions, once daily over the next month. Following ten sessions, he began to show a reduction in his repetitive behaviors, and by the 15 th session, he acknowledged that his behaviors were irrational. The YBOCS severity score had reduced to 24 (~22.5% improvement), which remained the same, even at the end of 27 sessions of iTBS treatment. There was no change in the CCAS and ICARS scores. The clinical benefits remained unchanged until three months of follow-up. Subsequently, we observed a gradual reversal to pre-TMS symptom severity. Maintenance TMS was suggested but was not feasible due to logistic reasons and therefore he was initiated on oral fluoxetine that was gradually increased to 80mg/day, with which we observed minimal change in symptoms over the next four months.

Post-neuromodulation functional connectivity visualization

The pre- and post-rTMS scans 13 were parcellated into 48-cortical, 15-subcortical, and 28-cerebellar regions as per the Harvard-Oxford 14 and the Cerebellum MNI-FLIRT atlases 15 . Average BOLD-signal time-series from each of these nodes, obtained after processing within FSL version-5.0.10, were then concatenated to obtain a Pearson’s correlation matrix between 91 nodes, separately for the pre- and post-TMS studies.

We analyzed the two 91 × 91 matrices using the Rank-two ellipse (R2E) seriation technique for node clustering 16 ( Figure 2 ). This technique reorders the nodes by moving the ones with a higher correlation closer to the diagonal. Thus, blocks along the diagonal of the matrix visualization show possible functional coactivating clusters.

Rank-two ellipse seriation-based visualization of correlation matrix before ( A ) and after ( B ) rTMS treatment. The dotted-black boxes denote the cerebellar network and other connected networks, where the green boxes show the inter-network overlap. Thus, we see that the overlapped region in ( 2A ) has now transitioned to three different overlapped areas in ( 2B ), which shows the increase in the overlap between modular networks after treatment. Cerebellar nodes are denoted in black, cortical nodes in blue and subcortical nodes in green. The lesion node (right crus II) and the region of neuro-stimulation are given in red; R2E= Rank-two ellipse.

We observed (a) extended connectivity of the cerebellar network after iTBS treatment as evidenced through its diminished modularity – the larger cerebellar cluster/block had an increased overlap with both anterior and posterior brain networks as observed along the diagonal in ( Figure 2B ), and (b) formation of better-defined sub-clusters within the larger cerebellar cluster indicating improved within-network modularity of distinct functional cerebellar networks [e.g., vestibular (lobules IX and X) and cognitive-limbic (crus I/II and vermis)].

Conclusions

We illustrate a case of OCD possibly secondary to a posterior cerebellar infarct, supporting the role of the cerebellum in the pathophysiology of OCD 3 . That OCD was perhaps secondary to the posterior cerebellar lesion is supported by several lines of evidence. Firstly, there seemed to be a possible temporal correlation between the duration of OCD and the chronic nature of the cerebellar lesion. Despite the challenges in inferring a precise temporal relationship based on clinical history, the signal changes with free diffusion and atrophy indicated that the infarct was indeed chronic, supporting the symptom onset at about three years before presentation. Previous studies have indeed reported OCD in posterior cerebellar lesions 17 – 19 . Secondly, the clinical phenotype was somewhat atypical, characterized by severe ambitendency, precipitating urinary incontinence, and poor insight into compulsions along with comorbid CCAS. Thirdly, our patient was resistant to an anti-obsessional medication but improved partially with neuromodulation of the related circuit. The MRI-informed iTBS engaged the lesion-area by targeting its more superficial connections in the frontal lobe. The changes in clinical observations paralleled the changes in cerebellar functional connectivity – enhanced within-cerebellum modularity and expanded cerebellum to whole-brain connectivity.

This report adds to the growing evidence-base for the involvement of the posterior cerebellum in the pathogenesis of OCD. Drawing conclusions from a single case study and the absence of a placebo treatment will prevent any confirmatory causal inferences from being made. The opportunity to examine network-changes that parallel therapeutic response in an individual with lesion-triggered psychiatric manifestations not only helps mapping symptoms to brain networks at an individual level 13 but also takes us a step further to refine methods to deliver more effective personalized-medicine in the years to come.

Data availability

Underlying data.

Harvard Dataverse: PICA OCD Raw fMRI files NII format. https://doi.org/10.7910/DVN/X12BZD 20 .

This project contains the following underlying data:

- postTMS_fmri.nii (raw post TMS fMRI file)

- preTMS_fmri.nii (Raw pre TMS fMRI file)

Reporting guidelines

Harvard Dataverse: PICA OCD case report CARE guidelines for case reports: 13-item checklist. https://doi.org/10.7910/DVN/2XKSXL 21 .

Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).

Written informed consent for publication of their clinical details and clinical images was obtained from the patient.

Acknowledgments

We thank our patient and his parents for permitting us to collate this data for publication.

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Comments on this article Comments (0)

Open peer review.

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Cognitive neuroscience

  • Respond or Comment
  • COMMENT ON THIS REPORT

Is the background of the case’s history and progression described in sufficient detail?

Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Is the case presented with sufficient detail to be useful for other practitioners?

  • This is a very interesting case report, even without the intervention component (which itself is a fascinating approach to neuromodulation). I particularly appreciated the approach to regional (SMA)
  • This is a very interesting case report, even without the intervention component (which itself is a fascinating approach to neuromodulation). I particularly appreciated the approach to regional (SMA) targeting, which involved resting state fMRI to detect functional connectivity with the affected cerebellar region. The report itself is very clear and well-written.
  • ECT appears to have been provided in the context of a depressive episode, but were other (e.g., psychotherapy, pharmacotherapy) treatments initially trialled? It would be useful to present any clinical history from adolescence, although this may not be feasible.
  • Please describe the reason for conducting MRI; why was this not undertaken earlier?
  • Was iTBS the “standard” course (i.e., 600 pulses, trains comprising 3 pulses at 50 Hz, repeated for 2 seconds at 5 Hz, followed by an 8-second ITI)? How was intensity determined (e.g., 70%RMT, 80%AMT)? Specify the stimulator, coil type, and neuronavigation method.
  • Given that the duration of both the cerebellar lesion and OCD symptoms seems quite unclear, it is somewhat difficult to suggest a temporal relationship (as stated in the Conclusion).
  • Was the patient followed-up over a longer-term period? I would be interested to know if these improvements are lasting (i.e., longer than 3 months), although again this might not be possible. 

Reviewer Expertise: Neuromodulation, psychiatry

  • Author Response 11 Sep 2020 Urvakhsh Mehta , Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bangalore, 560029, India 11 Sep 2020 Author Response We thank this reviewer for the time taken to provide constructive feedback and the encouraging comments on this report.    Competing Interests: None We thank this reviewer for the time taken to provide constructive feedback and the encouraging comments on this report.    We thank this reviewer for the time taken to provide constructive feedback and the encouraging comments on this report.    Competing Interests: None Close Report a concern Reply -->

Reviewer Status

Alongside their report, reviewers assign a status to the article:

Reviewer Reports

  • Shubhmohan Singh , Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • Peter Enticott , Deakin University, Geelong, Australia

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  • Case report
  • Open access
  • Published: 11 July 2020

Obsessive compulsive disorder in very young children – a case series from a specialized outpatient clinic

  • Veronika Brezinka   ORCID: orcid.org/0000-0003-2192-3093 1 ,
  • Veronika Mailänder 1 &
  • Susanne Walitza 1  

BMC Psychiatry volume  20 , Article number:  366 ( 2020 ) Cite this article

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Paediatric obsessive-compulsive disorder (OCD) is a chronic condition often associated with severe disruptions of family functioning, impairment of peer relationships and academic performance. Mean age of onset of juvenile OCD is 10.3 years; however, reports on young children with OCD show that the disorder can manifest itself at an earlier age. Both an earlier age of onset and a longer duration of illness have been associated with increased persistence of OCD. There seems to be difficulty for health professionals to recognize and diagnose OCD in young children appropriately, which in turn may prolong the interval between help seeking and receiving an adequate diagnosis and treatment. The objective of this study is to enhance knowledge about the clinical presentation, diagnosis and possible treatment of OCD in very young children.

Case presentation

We describe a prospective 6 month follow-up of five cases of OCD in very young children (between 4 and 5 years old). At the moment of first presentation, all children were so severely impaired that attendance of compulsory Kindergarten was uncertain. Parents were deeply involved in accommodating their child’s rituals. Because of the children’s young age, medication was not indicated. Therefore, a minimal CBT intervention for parents was offered, mainly focusing on reducing family accommodation. Parents were asked to bring video tapes of critical situations that were watched together. They were coached to reduce family accommodation for OCD, while enhancing praise and reward for adequate behaviors of the child. CY-BOCS scores at the beginning and after 3 months show an impressive decline in OCD severity that remained stable after 6 months. At 3 months follow-up, all children were able to attend Kindergarten daily, and at 6 months follow-up, every child was admitted to the next level / class.

Conclusions

Disseminating knowledge about the clinical presentation, diagnosis and treatment of early OCD may shorten the long delay between first OCD symptoms and disease-specific treatment that is reported as main predictor for persistent OCD.

Peer Review reports

Paediatric obsessive compulsive disorder [ 1 ] is a chronic condition with lifetime prevalence estimates ranging from 0.25 [ 2 ] to 2–3% [ 3 ]. OCD is often associated with severe disruptions of family functioning [ 4 ] and impairment of peer relationships as well as academic performance [ 5 ]. Mean age of onset of early onset OCD is 10.3 years, with a range from 7.5 to 12.5 years [ 6 ] or at an average of 11 years [ 7 ]. However, OCD can manifest itself also at a very early age - in a sample of 58 children, mean age of onset was 4.95 years [ 8 ], and in a study from Turkey, OCD is described in children as young as two and a half years [ 9 ]. According to different epidemiological surveys the prevalence of subclinical OC syndromes was estimated between 7 and 25%, and already very common at the age of 11 years [ 10 ].

Understanding the phenomenology of OCD in young children is important because both an earlier age of onset and a longer duration of illness have been associated with increased persistence of OCD [ 11 , 12 , 13 ]. One of the main predictors for persistent OCD is duration of illness at assessment, which underlines that early recognition and treatment of the disorder are crucial to prevent chronicity [ 10 , 14 , 15 ]. OCD in very young children can be so severe that it has to be treated in an inpatient-clinic [ 16 ]. This might be prevented if the disorder were diagnosed and treated earlier.

In order to disseminate knowledge about early childhood OCD, detailed descriptions of its phenomenology are necessary to enable clinicians to recognize and assess the disorder in time. Yet, studies on this young population are scarce and differ in the definition of what is described as ‘very young’. For example, 292 treatment seeking youth with OCD were divided into a younger group (3–9 years old) and an older group (10–18 years old) [ 17 ]. While overall OCD severity did not differ between groups, younger children exhibited poorer insight, increased incidence of hoarding compulsions, and higher rates of separation anxiety and social fears than older youth. It is not clear how many very young children (between 3 and 5 years old) were included in this study. Skriner et al. [ 18 ] investigated characteristics of 127 young children (from 5 to 8) enrolled in a pilot sample of the POTS Jr. Study. These young children revealed moderate to severe OCD symptoms, high levels of impairment and significant comorbidity, providing further evidence that symptom severity in young children with OCD is similar to that observed in older samples. To our knowledge, the only European studies describing OCD in very young children on a detailed, phenotypic level are a single-case study of a 4 year old girl [ 16 ] and a report from Turkey on 25 children under 6 years with OCD [ 9 ]. Subjects were fifteen boys and ten girls between 2 and 5 years old. Mean age of onset of OCD symptoms was 3 years, with some OCD symptoms appearing as early as 18 months of age. All subjects had at least one comorbid disorder; the most frequent comorbidity was an anxiety disorder, and boys exhibited more comorbid diagnoses than girls. In 68% of the subjects, at least one parent received a lifetime OCD diagnosis. The study reports no further information on follow-up or treatment of these young patients.

In comparison to other mental disorders, duration of untreated illness in obsessive compulsive disorder is one of the longest [ 19 ]. One reason may be that obsessive-compulsive symptoms in young children are mistaken as a normal developmental phase [ 20 ]. Parents as well as professionals not experienced with OCD may tend to ‘watch and wait’ instead of asking for referral to a specialist, thus contributing to the long delay between symptom onset and assessment / treatment [ 10 ]. This might ameliorate if health professionals become more familiar with the clinical presentation, diagnosis and treatment of the disorder in the very young. The purpose of this study is to provide a detailed description of the clinical presentation, diagnosis and treatment of OCD in five very young children.

We describe a prospective 6 month follow-up of five cases of OCD in very young children (between 4 and 5 years old) who were referred to the OCD Outpatient Treatment Unit of a Psychiatric University Hospital. Three patients were directly referred by their parents, one by the paediatrician and one by another specialist. Parents and child were offered a first session within 1 week of referral. An experienced clinician (V.B.) globally assessed comorbidity, intelligence and functioning, and a CY-BOCS was administered with the parents.

Instruments

To assess OCD severity in youth, the Children Yale-Brown Obsessive Compulsive Scale CY-BOCS [ 21 ] is regarded as the gold standard, with excellent inter-rater and test-retest reliability as well as construct validity [ 21 , 22 ]. The CY-BOCS has been validated in very young children by obtaining information from the parent. As in the clinical interview Y-BOCS for adults, severity of obsessions and compulsions are assessed separately. If both obsessions and compulsions are reported, a score of 16 is regarded as the cut-off for clinically meaningful OCD. If only compulsions are reported, Lewin et al. [ 23 ] suggest a cut-off score of 8. In their CY-BOCS classification, a score between 5 and 13 corresponds to mild symptoms / little functional impairment or a Clinical Global Impression Severity (CGI-S) of 2. A score between 14 and 24 corresponds to moderate symptoms / functioning with effort or a CGI-S of 3. Generally, it is recommended to obtain information from both child and parents. However, in case of the very young patients presented here, CY-BOCS scores were exclusively obtained from the parents. The parents of all five children reported not being familiar with any obsessions their child might have. In accordance with previous recommendations [ 23 ], a cut-off point of 8 for clinically meaningful OCD was used.

Patient vignettes

Patient 1 is a 4 year old girl, a single child living with both parents. She had never been separated an entire day from her mother. At the nursery, she suffered from separation anxiety for months. Parents reported that the girl had insisted on rituals already at the age of two. In the evening, she ‚had‘ to take her toys into bed and had got up several times crying because she ‚had to‘ pick up more toys. In the morning, only she ‚had the right‘ to open the apartment door. When dressing in the morning, she ‚had‘ to be ready before the parents. Only she was allowed to flush the toilet, even if it concerned toilet use of the parents. Moreover, only she ‘had the right’ to switch on the light, and this had to be with ten fingers at the same time. If she did not succeed, she got extremely upset and pressed the light button again and again until she was satisfied. The girl was not able to throw away garbage and kept packaging waste in a separate box. In the evening, she had to tidy her room for a long time until everything was ‚right‘. Whenever her routine was changed, she protested by crying, shouting and yelling at her parents. Moreover, she insisted on repeating routines if there had been a ‚mistake‘. In order to avoid conflict, both parents adapted their behavior to their daughter’s desires. In the first assessment with the parents, her score on the CY-BOCS was 15, implying clinically meaningful OCD. Psychiatric family history revealed that the mother had suffered from severe separation anxiety as a child and the father from severe night mares. Both parents described themselves as healthy adults.

Patient 2 is a four and a half year old boy, the younger of two brothers. He was reported to have been very oppositional since the age of two. Since the age of three, he insisted on a specific ritual when flushing the toilet – he had to pronounce several distinct sentences and then to run away quickly. Some months later he developed a complicated fare-well ritual and insisted on every family member using exactly the sentences he wanted to hear. If one of these words changed, he started to shout and threw himself on the floor. After a short time, he insisted on unknown people like the cashier at the supermarket to use the same words when saying good-bye.Moreover, he insisted that objects and meals had to be put back to the same place as before in case they had been moved. When walking outside, he had to count his steps and had to start this over and over again. In the morning, he determined where his mother had to stand and how her face had to look when saying good-bye. In order to avoid conflict, parents and brother had deeply accommodated their behavior to his whims. On the CY-BOCS, patient 2 reached a score of 15, which is equivalent to clinically meaningful OCD. Neither his father nor his mother reported any psychiatric disorder in past or present.

Patient 3 is a 4 year old boy referred because of possible OCD. Since the age of three, he had insisted on things going his way. When this was not the case, he threw a temper tantrum and demanded that time should be turned back. If, for example, he had cut a piece of bread from the loaf and was not satisfied with its form, he insisted that the piece should be ‘glued’ to the loaf again. Since he entered Kindergarten at the age of four, his behavior became more severe. If he was not satisfied with a certain routine like, for example, dressing in the morning, he demanded that the entire family had to undress and go to bed again, that objects had to lie at the same place as before or that the clock had to be turned back. In order to avoid conflict, the parents had repeatedly consented to his wishes. His behavior was judged as problematic at Kindergarten, because he demanded certain situations to be repeated or ‚played back‘. When the teacher refused to do that, the boy once run away furiously. On the CY-BOCS, patient 3 reached a score of 15. The mother described herself as being rather anxious (but not in treatment), the father himself as not suffering from any psychiatric symptoms. However, his mother had suffered from such severe OCD when he was a child that she had undergone inpatient treatment several times. This was also the reason why the parents had asked for referral to a specialist for the symptoms of their son.

Patient 4 is a 5 year old girl, the eldest of three siblings. Since the age of two, she was only able to wear certain clothes. For months, she refused to wear any shoes besides Espadrilles; she was unable to wear jeans and could only wear one certain pair of leggings. Wearing warm or thicker garments was extremely difficult, leading to numerous conflicts with her mother in winter. Socks had to have the same height, stockings had to be thin, and slips slack. When dressing in the morning, she regularly got angry and despaired and engaged in severe conflicts with her mother; dressing took a long time, whereas she had to be in Kindergarten on time. Her compulsions with clothes seemed to influence her social behavior as well; she had been watching other children at the playground for 40 min and did not participate because her winter coat did not ‚feel right‘. She started to join peers only when she was allowed to pull the coat off. She also had to dry herself excessively after peeing and was reported to be perfectionist in drawing, cleaning or tidying. Her CY-BOCS score was 15, equivalent to clinically meaningful OCD. Both parents described themselves as not suffering from any psychiatric problem in past or present. However, the grandmother on the mother’s side was reported to have had similar compulsions when she was a child.

Patient 5 was a four and a half year old girl referred because of early OCD. She had one elder brother and lived with both parents. At the age of 1 year, patient 5 was diagnosed with a benign brain tumor (astrocytoma). The tumor had been removed for 90% by surgery; the remaining tumor was treated with chemotherapy. The first chemotherapy at the age of 3 years was reasonably well tolerated. Shortly thereafter, the girl developed just-right-compulsions concerning her shoes. When the second chemotherapy (with a different drug) was started at the age of four, compulsions increased so dramatically that she was referred to our outpatient clinic by the treating oncologist. She insisted on her shoes being closed very tightly, her socks and underwear being put on according to a certain ritual, and her belt being closed so tightly that her father had to punch an additional hole. She refused to wear slack or new clothes and was not able to leave the toilet after peeing because ‘something might still come’; she used large amounts of toilet paper and complained that she wasn’t dry yet. She also insisted on straightening the blanket of her bed many times. She was described by her mother as extremely stressed, impatient and irritable; she woke up every night and insisted to go to the toilet, from where she would come back only after intense cleaning rituals. In the morning, she frequently threw a severe temper tantrum, including hitting and scratching the mother, staying naked in the bathroom and refusing to get dressed because clothes were not fitting ‚just right‘or were not tight enough. Shortly after the start of the second chemotherapy, the girl had entered Kindergarten which was in a different language than the family language. Moreover, her mother had just taken up a new job and had to make a trip of several days during the first month. Although the mother gave up her job after the dramatic increase in OCD severity, the girl’s symptoms did not change. As an association between chemotherapy and the increase in OCD symptoms could not be excluded, the treating oncologist decided to stop chemotherapy 2 weeks after patient 5 was presented with OCD at our department. At the moment of presentation, she arrived at Kindergarten too late daily, after long scenes of crying and shouting, or refused to go altogether. She reached a score of 20 on the CY-BOCS, the highest score of the five children presented here. Her father described himself as free of any psychiatric symptoms in past or present. Her mother had been extremely socially anxious as a child.

None of the siblings of the children described above was reported to show any psychiatric symptoms in past or present (Table  1 ).

The five cases described above show a broad range of OCD symptomatology in young children. Besides Just-Right compulsions concerning clothes, compulsive behavior on the toilet was reported such as having to pee frequently, having to dry oneself over and over again as well as rituals concerning flushing. Other symptoms were pronouncing certain words or phrases compulsively, insisting on a ‘perfect’ action and claiming that time or situations must be played back like a video or DVD if the action or situation were not ‘perfect enough’. The patients described here have in common that parents were already much involved in the process of family accommodation. For example, the parents of patient 3 had consented several times to undress and go to bed again in order to ‘play back’ certain situations; they had also consented turning back the clock in the house. The parents of patient 2 had accommodated his complicated fare-well ritual, thus having to rush to work in the morning themselves. However, all parents were smart enough not just to indulge their child’s behavior, but to seek professional advice.

Treatment recommendations

Practice Parameters and guidelines for the assessment and treatment of OCD in older children and adolescents recommend cognitive behavior therapy (CBT) as first line treatment for mild to moderate cases, and medication in addition to CBT for moderate to severe OCD [ 24 , 25 ]. However, there is a lack of treatment studies including young children with OCD [ 26 ]. A case series with seven children between the age of 3 and 8 years diagnosed with OCD describes an intervention adapted to this young age group. Treatment emphasized reducing family accommodation and anxiety-enhancing parenting behaviors while enhancing problem solving skills of the parents [ 27 ]. A much larger randomized clinical trial for 127 young children (5 to 8 years of age) with OCD showed family-based CBT superior to a relaxation protocol for this age group [ 14 ]. Despite these advances in treatment for early childhood OCD, availability of CBT for paediatric OCD in the community is scarce due to workforce limitations and regional limitations in paediatric OCD expertise [ 28 ]. This is certainly not only true for the US, but for most European countries as well.

When discussing treatment of OCD in young children, the topic of family accommodation is of utmost importance. Family accommodation, also referred to as a ‘hallmark of early childhood OCD’ [ 15 ] means that parents of children with OCD tend to accommodate and even participate in rituals of the affected child. In order to avoid temper tantrums and aggressive behavior of the child, parents often adapt daily routines by engaging in child rituals or facilitating OCD by allowing extra time, purchasing special products or adapting family rules and organisation to OCD [ 29 , 30 , 31 ]. Although driven by empathy for and compassion with the child, family accommodation is reported to be detrimental because it further reinforces OCD symptoms and avoidance behavior, thus enhancing stress and anxiety [ 4 , 32 ].

Parent-oriented CBT intervention

At the moment of first presentation, the five children were so severely impaired by their OCD that attendance of (compulsory) Kindergarten was uncertain. All parents reported being utterly worried and stressed by their child’s symptoms and the associated conflicts in the family. However, no single family wanted an in-patient treatment of their child, and because of the children’s young age, medication was not indicated. Some families lived far away from our clinic and / or had to take care of young siblings.

Therefore, a CBT-intervention was offered to the parents, mainly focusing on reducing family accommodation. This approach is in line with current treatment recommendations to aggressively target family accommodation in children with OCD [ 15 ]. Parents and child were seen together in a first session. The following sessions were done with the parents only, who were encouraged to bring video tapes of critical situations. The scenes were watched together and parents were coached to reduce family accommodation for OCD, while enhancing praise and reward for adequate behaviors of the child. Parents were also encouraged to use ignoring and time-out for problematic behaviors. As some families lived far away and had to take care of young siblings as well, telephone sessions were offered as an alternative whenever parents felt the need for it. Moreover, parents were prompted to facilitate developmental tasks of their child such as attending Kindergarten regularly, or building friendships with peers. The minimal number of treatment sessions was four and the maximal number ten, with a median of six sessions.

Three of the five children (patients 3, 4 and 5) were raised in a different language at home than the one spoken at Kindergarten. This can be interpreted as an additional stressor for the child, possibly enhancing OCD symptoms. Instead of expecting their child to learn the foreign language mainly by ‚trial and error‘, parents were encouraged to speak this language at home themselves, to praise their child for progress in language skills and to facilitate playdates with children native in the foreign language.

Three and six months after intake, assessment of OCD-severity by means of the CY-BOCS was repeated. Table  2 shows an impressive decline in OCD-severity after 3 months that remained stable after 6 months. At 3 months follow-up, all children were able to attend Kindergarten daily, and at 6 months follow-up, every child was admitted to the next level of Kindergarten or, in the case of patient 4, to school.

We report on five children of 4 and 5 years with very early onset OCD who were presented at a University Department of Child and Adolescent Psychiatry. These children are ‚early starters‘with regard to OCD. As underlined in a recent consensus statement [ 10 ], delayed initiation of treatment is seen as an important aspect of the overall burden of OCD (see also [ 19 ]). In our small sample, a CBT-based parent-oriented intervention targeting mainly family accommodation led to a significant decline in CY-BOCS scores after 3 months that was maintained at 6 months. At 3 months, all children were able to attend Kindergarten daily, and at 6 months, every child was admitted to the next grade. This can be seen as an encouraging result, as it allowed the children to continue their developmental milestones without disruptions, like staying at home for a long period or following an inpatient treatment that would have demanded high expenses and probably led to separation problems at this young age. Moreover, the reduction on CY-BOCS scores was reached without medication. The number of sessions of the CBT-based intervention with the parents varied between four and ten sessions, depending on the need of the family. Families stayed in touch with the therapist during the 6 month period and knew they could get an appointment quickly when needed.

A possible objection to these results might be the question of differential diagnosis. Couldn’t the problematic behaviors described merely be classified as benign childhood rituals that would change automatically with time? As described in the patient vignettes, the five children were so severely impaired by their OCD that attendance of Kindergarten – a developmental milestone – was uncertain. Moreover, parents were extremely worried and stressed by their child’s symptoms and associated family conflicts. In our view, it would have been a professional mistake to judge these symptoms as benign rituals not worthy of diagnosis or disorder-specific treatment. One possible, but rare and debated cause of OCD are streptococcal infections, often referred to as PANS [ 33 ]. However, in none of the cases parents reported an abrupt and sudden onset of OCD symptoms after an infection. Instead, symptoms seem to have developed gradually over a period of several months or even years. In the case of patient 5 with the astrocytoma, first just-right compulsions appeared at the age of three (after the first chemotherapy), and were followed by more severe compulsions at the age of four, when – within a period of 6 weeks – a new chemotherapy was started, the mother took up a new job and the patient entered Kindergarten. Diagnosing the severe compulsions of patient 5 as, for example, adjustment disorder due to her medical condition would not have delivered a disorder-specific treatment encouraging parents to reduce their accommodation. This might have led to even more family accommodation and to more severe OCD symptoms in the young girl. Last but not least, a possible objection might be that the behaviors described were stereotypies. However, stereotypies are defined as repetitive or ritualistic movements, postures or utterances and are often associated with an autism spectrum disorder or intellectual disability. The careful intake with the children revealed no indication for any of these disorders.

Data reported here have several limitations. The children did not undergo intelligence testing; their reactions and behavior during the first session, as well as their acceptance and graduation at Kindergarten were assumed as sufficient to judge them as average intelligent. Comorbidities were assessed according to clinical impression and parents’ reports. The CBT treatment was based on our clinical expertise as a specialized OCD outpatient clinic. It included parent-oriented CBT elements, but did not have a fixed protocol and was adjusted individually to the needs of every family. Last but not least, no control group of young patients without an intervention was included.

Conclusions and clinical implications

We described a prospective 6 month follow-up of five cases of OCD in very young children. At the moment of first presentation, all children were so severely impaired that attendance of Kindergarten was uncertain. Parents were deeply involved in accommodating their child’s rituals. Because of the children’s young age, medication was not indicated. Therefore, a minimal CBT intervention for parents was offered, mainly focusing on reducing family accommodation. CY-BOCS scores at the beginning and after 3 months show an impressive decline in OCD severity that remained stable after 6 months. At 3 months follow-up, all children were able to attend Kindergarten daily, and at 6 months follow-up, every child had been admitted to the next grade. OCD is known to be a chronic condition. Therefore, in spite of treatment success, relapse might occur. However, as our treatment approach mainly targeted family accommodation, parents will hopefully react with less accommodation, should a new episode of OCD occur. Moreover, parents stay in touch with the outpatient clinic and can call when needed.

The clinical implications of our findings are that clinicians should not hesitate to think of OCD in a young child when obsessive-compulsive symptoms are reported. The assessment of the disorder should include the CY-BOCS, which has been validated in very young children by obtaining information from the parent. If CY-BOCS scores are clinically meaningful (for young children, a score above 8), a parent-based treatment targeting family accommodation should be offered.

By disseminating knowledge about the clinical presentation, assessment and treatment of early childhood OCD, it should be possible to shorten the long delay between first symptoms of OCD and disease-specific treatment that is reported as main predictor for persistent OCD. Early recognition and treatment of OCD are crucial to prevent chronicity [ 14 , 15 ]. As children and adolescents with OCD have a heightened risk for clinically significant psychiatric and psychosocial problems as adults, intervening early offers an important opportunity to prevent the development of long-standing problem behaviors [ 10 , 19 ].

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Abbreviations

Obsessive compulsive behavior

Child Yale-Brown Obsessive Compulsive Scale

Cognitive Behavior Therapy

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V.B. conducted the diagnostic and therapeutic sessions and wrote the manuscript. V.M. was responsible for medical supervision and revised the manuscript. S.W. supervised the OCD treatment and research overall, applied for ethics approval and revised the manuscript. All authors have read and approved the manuscript.

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V.B. and V.M. declare that they have no competing interests. S.W. has received royalties from Thieme, Hogrefe, Kohlhammer, Springer, Beltz in the last 5 years. Her work was supported in the last 5 years by the Swiss National Science Foundation (SNF), diff. EU FP7s, HSM Hochspezialisierte Medizin of the Kanton Zurich, Switzerland, Bfarm Germany, ZInEP, Hartmann Müller Stiftung, Olga Mayenfisch, Gertrud Thalmann, Vontobel-, Unisciencia and Erika Schwarz Fonds. Outside professional activities and interests are declared under the link of the University of Zurich www.uzh.ch/prof/ssl-dir/interessenbindungen/client/web/

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Brezinka, V., Mailänder, V. & Walitza, S. Obsessive compulsive disorder in very young children – a case series from a specialized outpatient clinic. BMC Psychiatry 20 , 366 (2020). https://doi.org/10.1186/s12888-020-02780-0

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ocd case study conclusion

ocd case study conclusion

My OCD Story: Chapter 6 & Conclusion

Posted April 13, 2021

PLEASE NOTE: The following blog post contains discussion of topics that may be upsetting, including suicide. Please take care of yourself as you read this article. If you are in crisis, know that help is only a call or click away at 1-800-273-8255 or  suicidepreventionlifeline.org .

Chapter 6: Life after treatment 

Several years after extensive treatment, here I am about to graduate college. I was able to take acting classes and improve myself as an actor. I was in many plays and musicals during my time in college. I made connections with my peers and with my professors. I was able to study abroad for a summer in Barcelona. I tried new foods and explored Europe. I now live on my own in an apartment with my friends. I cook meals for myself every day. I have the most wonderful friends who are supportive and kind. I work at a toy store down the street from my apartment. I love to do art and my bedroom is covered with my imperfect paintings and drawings. I love to write stories and plays and I share them with my teachers and with my friends. I can finally say that I am living a happy life. These are all things I never thought I would ever be able to do because of how OCD had taken over my life. 

Of course, I still have challenges in regards to my OCD. Occasionally my OCD will slip into my school work. I often have to challenge myself to do things imperfectly instead of striving for perfection that will never be. I still have a hard time eating from time to time. Trying new food is hard, though I can usually get myself to do it. Washing dishes in my apartment can sometimes be a challenge. I sometimes will feel insecure in my friendships and will compulsively ask for reassurance that everything is still okay. 

Despite these challenges, I can gladly say that OCD does not impede on my ability to function. I now consider myself to have mild OCD, where at one point it was considered to be extremely severe. I never thought I would be in a place in my life where OCD wasn’t always on the forefront of my mind, but these days it doesn’t come up much at all. 

Before treatment, I was always secretive about my struggles with mental health. I felt ashamed and never wanted anyone to know what I was dealing with. When it was time for me to go back to school, I knew that people would have questions about where I had been for the past few months. My therapists at the program told me that I should have an answer prepared for these questions. They told me it was completely up to me how much I wanted to tell people or if I even wanted to tell people at all. I spent a long time thinking about what I wanted to tell people. I practiced answering the questions in the mirror before bed. I ultimately decided that the telling the truth would be the easiest route. I didn’t want to hide what I was going through anymore. After going through treatment, I didn’t have nearly as much shame surrounding my OCD. I knew that it didn’t define me. I also knew that the lack of education available about OCD was the reason why there were so many misconceptions about it. I decided that I was going to be an advocate for myself and for the other people in the OCD community by being open and honest about my experiences. 

The first person I ended up telling was a girl in my tutoring group. She asked me one day why I was there. I hesitated at first. My instinct was to brush her off. I took a deep breath and I told her that I was getting tutoring because I had missed school for a few months to do intensive treatment for my OCD. She asked me questions about what it was like and I answered honestly. I told her that it was long and difficult but that it ultimately was the thing that saved my life. She told me that she was asking so many questions because she had just been diagnosed with OCD and she was looking for treatment options. We talked for a long time about what treatment options are available and commiserated about the things that OCD had taken away from us. 

To this day, I try to be open and honest about my experiences with OCD. I aim to educate the people around me about what OCD is and how misunderstood it can be. For the past few years, I have led a team for the IOCDF 1 Million Steps for OCD Walk. Together with my team, I have been able to raise money for this organization that means so much to me and my family. Every year at the Walk, I get to see some of my old therapists who are also walking. They always tell me how proud they are of me. I can’t help but agree with them. I couldn’t be prouder of how far I have come. 

Conclusion: Looking Back 

I have a memory of being in a heap on the floor in front of my parents’ bedroom door. I was probably about five or six. I remember banging my tiny fists on their closed door and screaming for them to hear me. I banged on the door until my hands were bruised and I screamed until I lost my voice. I eventually gave up and wept right there on the floor. I felt alone and scared. Did they not hear me? Or did they just not want to listen? After a while I brought myself back to my bed and stared at the ceiling until I fell asleep. 

I look back at that tiny heap on the floor and I see that all she wanted was to be heard. She was scared and didn’t know how to express that to the people she loved the most. She yelled and screamed at them and pushed them away. I look back and see I was doing the best I could with what I was given. Struggling with something didn’t make me a bad kid. 

I still am working on not viewing myself as someone who was a bad or angry kid. I also look back at my parents and know that they were also doing the best they could. We were all fighting OCD even though it might have seemed like we were fighting each other at the time. This is why educating people about OCD is so important. The more people know about it, the easier it will be for families to spot when their child is struggling. 

Since my diagnosis in 2015, my dad has made education his mission. The hospital where I did my program was participating in a walk for OCD. My dad asked to join their team even though no one else in my family was able to go with him to the walk. At the walk he met some other 50 people who had had similar experiences as our family. They encouraged him to get involved with the International OCD Foundation. 

After hearing about the foundation he decided he wanted to be involved. In the summer of 2017, I went to San Francisco with my dad for the Annual OCD Conference. While at the Conference I went to seminars and met other people who also had OCD. I learned so much about OCD and how to be an advocate for people with OCD. 

I know that I am incredibly lucky to be able to tell my story. I am thankful that I was fortunate enough to have access to the treatment that got me to where I am today. Not everyone who has OCD is so fortunate. Many people cannot afford treatment. Others live far away from any sort of program for OCD. 

A lot of these people who are struggling go their whole lives without receiving any treatment, simply because of a lack of accessibility of treatment. Many will not even receive a diagnosis due to lack of understanding of this disorder. Without any sort of treatment, I don’t know what my life would have looked like. It is likely that I would not have lived long enough to be where I am now. OCD disrupted my life for over 17 years and I will not allow it to disrupt my life moving forward. That being said, I know that it is a privilege to be able to say that. 

OCD can be complicated and hard to understand. It can be difficult to recognize in both children and adults. However, there is always hope for a better life free from OCD. There is no cure, of course. I will be living with OCD for the rest of my life. It will ebb and flow and sometimes it will make my life more difficult. Having these experiences with OCD has made me strong and resilient. I am very different than I was when OCD had its hold on me. But I will always have a soft spot for that little girl crying in a heap outside her parents’ bedroom door.

Sources 

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Obsessive-Compulsive Disorder (1 edn)

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6 Conclusion

  • Published: May 2007
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This volume has covered the phenomenology, psychobiology, pharmacotherapy, and psychotherapy of obsessive-compulsive disorder (OCD). We have also briefly considered some of the OCD-related conditions. We have attempted to synthesize the growing research literature, with the aim of providing practical guidance to clinicians.

Significant advances have been made in describing the complex phenomenology of OCD, and this has important practical implications. First, given the high prevalence of OCD and related conditions there is growing consensus that there is value in screening patients with simple questions, such as those listed by Zohar and Fineberg. A high index of suspicion for OCD is justified in a number of contexts, including dermatology clinics, patients with tics, and pregnancy. Additional work is needed to reverse the underdiagnosis and undertreament of OCD.

Second, there is again a good deal of consensus that only a few symptom dimensions capture much of the variance in OCD symptoms. Of course, it is important for clinicians to remain on the lookout for rarer forms of OCD. However, instruments such as the dimensional Yale–Brown Obsessive Compulsive Scale (DY-BOCS), which focus on four key symptom dimensions, appear to be useful in the clinical setting. Instruments are also available for the assessment of OCD symptoms in children and adolescents.

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Case Report

Case study of obsessive-compulsive disorder (ocd).

Muhammad Zafar Iqbal*

Department of Hypnotherapist and Psychotherapist, Islamabad, Pakistan

Corresponding Author

Muhammad Zafar Iqbal, Department of Hypnotherapist and Psychotherapist, Islamabad, Pakistan.

Received Date: April 05, 2019;   Published Date: May 08, 2019

Background: This document pertains of idiographic research; the case study of Obsessive-compulsive disorder (OCD). The objective of this case study was to reaffirm the efficacy of Fear-Stimuli Identification Therapy (FSIT). FSIT was used to eliminate the symptoms of OCD in a client, a successful treatment for disorders in different cases [1-8].

Method: Initially seven sessions of semi-structured interviews were conducted with client to dig out the reasons/causes of the disorder. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) was consulted for diagnosis [9]. Fear Stimuli Identification Therapy (FSIT) was used as therapeutic tool.

Results: After diagnosis, five sessions per week, a total of eighty-three sessions were conducted of FSIT. Positive behavioral change observed in client which proved the efficacy of FSIT.

Conclusion: Clinical observations during treatment indicated a gradual positive change in client’s personality. The client and her husband reported positive behavioral changes in different domains of life. The difference between pre-assessment and post- assessment confirmed precision of hypotheses and efficacy of FSIT.

Keywords: Obsessive compulsive disorder; Symptoms; Assessment; Case study; Idiographic

  • Introduction

The subject of the disorder was Mrs. S.H. (Initials of real name), age 38 years, a Housewife. The client was referred to therapist clinic by a fellow psychologist from a metropolitan southern city. She had been under treatment of various psychiatrists and psychologists in her city, but the client did not improve. She contacted therapist online. Client reported about her compulsively repeating some acts in her daily life as obsession. She supposed that her mind was persistently occupied by some specific thoughts and her act of repeating some actions is a result of these thoughts. Therapist contacted her husband for more details about the behavior of client. Aggressive behavior, Sleeplessness, weeping without any apparent reason, Breath shortness, Uncontrollable thoughts, Repetition of some of her daily life acts Symptoms are reported by Client and her husband.

• Participants

Mrs. S.H, Client, Client’s Husband and Therapist.

• Instrument

No instrument/ Material used in this case study.

As already mentioned, in the first seven sessions, semistructured interviews were conducted with Mrs. S.H. and her husband. In the subsequent eighty-three sessions Mrs. S.H. was asked to write about specific topics suggested by therapist. Crossquestioning was carried out over the ideas mentioned in the writings by client. After diagnosis of OCD, treatment was started in the light of FSIT method. Five sessions per week were conducted and total of eighty-three sessions were conducted. It may be noted that all these sessions were carried out online [4].

Following facts were explored through initial interviews which were ‘Semi-structured’. These interviews revealed that at the age of 11 years, one day she (client) returned back from school in the company of her close friend N.S. After reaching home she and her parents received the shocking news of death of N.S. They were told that N.S. had eaten something poisonous and had died instantly. S.H., the client was shocked deeply. The incident of her friend’s death became a stimulant for fear instinct.

At the day of her funeral, she feared to see the face of her deceased friend and couldn’t enter the room where the dead body was laid. After the death of her friend another death happened that provoke more fear about the death. Her grandmother died six months later after her friend’s death. She, for the first time watched her grandmother’s dead body wrapped in white clothes which leaves bad marks on her memory that she stopped wearing white cloth especially white scarf or shawl for rest of her life.

Another incident happened after one year of marriage. Her father-in-law died in ambulance due to sudden attack. The ambulance became a stimulus for her fear. After developing death phobia, each death intensified the sense of fear in her unconscious mind. In the course of time she became a religious orator orator of a specific type as she used to narrate rhetorically upon the miseries and sorrows which had emerged from the unfortunate events of wars of Islamic history. By performing so, she felt some sort of relief as this became a source of catharsis for her. She was strongly obsessed by the idea of death that her mind often used to get stuck at the thought of her friend’s death. While doing random stuff she often found herself motionless due to the flashback of her friend’s death and to get rid from this obsession she used to force her mind to think of other things. Similarly, she taps her mobile phone with her fingers frequently while obsessing about her brother’s death. During one of Skype sessions she informed the therapist that after marriage she finds it more difficult to cope with the obsessive ideas.

Therapist and treatment

It is single case experimental study which is handled by only one therapist and after taking history, it was diagnosed that client was suffering from OCD and the treatment was carried out accordingly: As per procedure of SFW (specific free writing; one of procedures of FSIT), in very first session of treatment, client was asked to pen down her ideas freely on the topic “death”. She was asked to put a cross mark for each time whenever she feels stuck or blank-minded during writing process. The piece of writing was received by E-mail. She told that during the process of writing she felt burden at the occipital region of head and pain and burden on her shoulders. In the view of writing, client was cross-questioned over the ideas mentioned in the writing. After fifteen minutes, client went through a deep spell of drowsiness. The session was ended at this point. This drowsiness continued in the next five sessions during questioning over her writing. The extreme hate for and fear of her own death which had previously gripped her unconscious level of mind was identified and brought out clearly as it had been suppressed by patient’s unconscious for a very long time in past. Next topics given to write about were: “White shawl” (considered as coffin), “Bathing place” for a dead person at holy shrine, the “couch” upon which dead body is laid down after bath, “Ambulance”, “Funeral Bus” and “Thoughts about dead persons”. During writing practice, same mental and physical response was reported each time as it was observed first time that was a result of unconscious resistance to express fears. The thoughts of “white shawl”, “coffin” and ambulance etc caused the fear of her own death and ultimately became reason for OCD. In last sessions of treatment, the mentioned above things were rooted out and recovered from OCD.

The symptoms of disorder gradually removed during therapy. Feedback obtained from husband & client was obtained regularly which indicated the positive changes in client behavior of. Result also proved the efficacy of FSIT method empirically.

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Brief description of a client’s social and family environment was obtained in order to comprehend the main causes of Mrs. S.H.’s disorder and this procedure is adopted in most of the cases treated by therapist. In this particular case following information came into knowledge of therapist. Mrs. S.H. was 38 years old, housewife and a lecturer in college. However, due to lack of concentration, disturbed sleep and unreasonable repetition of different acts of routine, her daily routine was badly affected, and it made her much depressed and disappointed. Mrs. S.H. was not much social person since her childhood. She had always tried to avoid social gatherings and people. After starting the problem of OCD, her social life became more difficult. It made her more depressed, but interestingly and contrarily, she had managed to carry out routine life activities as above the level of an ordinary social individual. She had been performing as an orator at religious gatherings. But she always avoided elaborating over the topics of death and afterlife in her speeches. No family history of OCD or any other psychiatric disorder was found and she. had no special medical/psychiatric problems in her childhood [10].

Fear Stimuli Identification Therapy (FSIT): Fear-Stimuli Identification Therapy (FSIT) is based upon the perception that some of the incidents (mostly the sudden incidents) in the early age of a child become stimuli for fear instinct which cast negative effects over the personality of a child and become reason for one or the other type of disorder. FSIT investigates and digs out such events from a person’s unconscious, which play as stimuli for fear instinct. In a later stage of life, if a person happens to face a situation or pass through an event having resemblance to that which he/ she had already faced in her/his childhood or early age of life, the present event becomes a strong stimulant for fear instinct as the previous incident is recalled.

Feedback & Clinical observations during treatment also indicated a gradual positive change in her personality. The difference between pre-assessment and post- assessment confirmed precision of hypotheses and efficacy of FSIT. Feedback was obtained on weekly basis for a period of three was confirmed that there was no reoccurrence of the disorder’s symptoms anymore.

  • Acknowledgement
  • Conflict of Interest

No conflict of interest.

  • Ejaz M, Iqbal MZ (2016) Case Study of Major Depressive Disorder. J Clin Case Rep 6: 698.
  • Iqbal MZ, Awan SN (2016) Case Study of Genophobia and Anxiety. J Depress Anxiety S2: 013.
  • qbal MZ, Bibi S (2017) Case Study of Panic Attacks. J Psychol Psychother 7: 306.
  • Iqbal MZ, Bibi S (2016) Treatment of Psychosis through Fear-Stimuli Identification Therapy (FSIT): A Case Report. Brain Disorders & Therapy 5(3): 221-224.
  • Iqbal MZ, Ejaz M (2016) Case Study of Schizophrenia (Paranoid). J Clin Case Rep 6: 779.
  • Iqbal MZ, Ejaz M (2016) Case Study of Functional Neurological Disorder (Aphonic). J Psychol Psychother 6(1): 243.
  • Iqbal MZ, un Awan SN (2016) Case Study of Major Depression. J Med Diagn Meth 5: 214.
  • Iqbal Z (2015) Case of Anxiety. J Psychol Clin Psychiatry 2(4): 79.
  • American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (DSM-IV-TR). Washington DC, USA.
  • Muhammad Zafar Iqbal (2017) Case study of Obsessive-Compulsive Disorder (OCD). Journal of Behavioral Health 6(2): 99-102.
  • Download PDF
  • ISSN: 2644-2957
  • DOI: 10.33552/OJCAM.2019.01.000509
  • Volume 1 - Issue 2, 2019
  • Open Access

Muhammad Zafar Iqbal. Case Study of Obsessive-Compulsive Disorder (OCD). On J Complement & Alt Med. 1(2): 2019. OJCAM. MS.ID.000509.

Obsessive Compulsive Disorder, Symptoms, Assessment, Case Study, Idiographic, Therapist, Spirituality, Preventive, Health care, Physical fitness, Spiritual exercises, Soul, Human values, Stress, Complementary Medicine, Holistic education, Phenomenological study, Holistically, Facilitate, Spiritual care, Trigger depression, Spiritual work

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Obsessive-compulsive disorder: case study and discussion of treatment.

A patient's own account of her obsessive-compulsive disorder is presented. She describes her distressing experiences, the impact of the disturbance on her and her family's life and her subsequent improvement using the technique of exposure and response prevention. The treatments available are discussed and the benefits of self-directed behavioural psychotherapy are reviewed. A comment from a general practitioner is appended.

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (789K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References .

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  • Kettl PA, Marks IM. Neurological factors in obsessive compulsive disorder. Two case reports and a review of the literature. Br J Psychiatry. 1986 Sep; 149 :315–319. [ PubMed ] [ Google Scholar ]
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  • Marks I. Behavioural psychotherapy in general psychiatry. Helping patients to help themselves. Br J Psychiatry. 1987 May; 150 :593–597. [ PubMed ] [ Google Scholar ]
  • Meyer V. Modification of expectations in cases with obsessional rituals. Behav Res Ther. 1966 Nov; 4 (4):273–280. [ PubMed ] [ Google Scholar ]
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  • Marks IM, Lelliott P, Basoglu M, Noshirvani H, Monteiro W, Cohen D, Kasvikis Y. Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals. Br J Psychiatry. 1988 Apr; 152 :522–534. [ PubMed ] [ Google Scholar ]

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Case Study On Ocd For 12 CBSE (Obsessive–Compulsive Disorder)

Table of Contents

Acknowledgment

In acknowledging the myriad contributions that have sculpted this project into a comprehensive exploration of Obsessive-Compulsive Disorder (OCD), I extend my heartfelt appreciation to those who have played pivotal roles in its development.

Firstly, I express gratitude to the individuals who generously shared their insights and experiences, enriching this study with personal narratives that breathe life into the clinical framework of OCD. Your openness and willingness to contribute have added depth and authenticity to this exploration.

A sincere thank you extends to mental health professionals whose expertise and guidance have been instrumental in shaping the clinical aspects of this project. Their dedication to advancing our understanding of OCD and commitment to supporting those affected by it are invaluable.

The wealth of knowledge drawn from reputable academic sources forms the bedrock of this study. I extend appreciation to the authors and researchers whose work has illuminated the intricate landscape of OCD, providing the framework for our exploration.

To those who have participated in interviews and consultations, your willingness to share expertise has been instrumental. Your perspectives have broadened the scope of this project, fostering a holistic understanding of the multifaceted nature of OCD.

In crafting this project, I am grateful for the support systems that have played integral roles. Family and friends, who form the cornerstone of personal networks, deserve acknowledgment for their understanding, encouragement, and unwavering support throughout the research process.

Finally, I extend appreciation to the broader community dedicated to mental health advocacy. Your efforts contribute to a collective movement fostering awareness, empathy, and destigmatization of mental health issues.

This project stands as a testament to the collaborative spirit that fuels progress in our understanding of mental health. Each contribution, whether personal, professional, or academic, has left an indelible mark on this exploration of OCD, reflecting a shared commitment to fostering a compassionate and informed approach to mental health challenges.

Introduction

Embarking on a profound exploration of Obsessive-Compulsive Disorder (OCD), this project aims to unravel the intricacies of a condition that extends beyond the surface of its clinical definition. In the distinctive style we’ve come to know as the “Matthew style,” we delve into the realms of mental health, recognizing the importance of studying issues that impact individuals on a deeply personal level.

The purpose of this case study is twofold: firstly, to illuminate the myriad manifestations of OCD and, secondly, to provide a nuanced understanding of its profound impact on an individual’s daily life. In the grand tapestry of human experiences, mental health issues are threads that weave through the stories of countless individuals. By shedding light on OCD, we contribute to a broader conversation aimed at fostering empathy, awareness, and ultimately, a more compassionate approach to those navigating the complex terrain of mental health challenges.

Our journey begins with an exploration of general information about OCD, including prevalence, statistics, and common age of onset. We’ll delve into the causes and risk factors, recognizing the interplay of biological, genetic, and environmental elements that contribute to the development of this intricate condition.

Moving beyond the theoretical landscape, we’ll introduce Sarah, a pseudonymous individual whose journey becomes a focal point for our investigation. Through her case history, we’ll unravel the early signs, symptoms, and the familial context that shapes her narrative. The clinical manifestations of obsessions and compulsions, the very heart of OCD, will be explored in the context of Sarah’s daily life.

The diagnostic and assessment phase will pull back the curtain on the professional evaluation processes, involving mental health professionals and utilizing tools such as interviews, psychological tests, and observations. As we transition into treatment approaches, we’ll navigate the realms of medication and psychotherapy, unraveling the strategies employed to alleviate the burdens of OCD.

Beyond the clinical lens, we’ll delve into the impact of OCD on Sarah’s daily life, examining educational challenges and the dynamics of her personal relationships. Coping strategies, both within personal networks and through broader community resources, will be illuminated, offering insights into the resilience and strength exhibited by individuals contending with OCD.

ocd case study conclusion

Background Information

A. General information about OCD

  • Prevalence and statistics : Matthew Style: Let’s explore the prevalence and statistical aspects of OCD, gaining insights into how widespread this condition is in our society.
  • Common age of onset : Matthew Style: Understanding the age at which OCD typically surfaces is pivotal in recognizing and addressing it early on.

B. Causes and risk factors

  • Biological factors : Matthew Style: Biological underpinnings play a role in the development of OCD, and we’ll delve into these factors to unravel the roots of the disorder.
  • Genetic predisposition : Matthew Style: We’ll examine the genetic aspects that might contribute to the predisposition of individuals towards OCD.
  • Environmental triggers : Matthew Style: Environmental factors can act as catalysts, triggering the onset or exacerbation of OCD symptoms. Let’s explore these triggers.

Case Study Overview

A. Selection of the individual

  • Pseudonym and basic demographics : Matthew Style: Meet Sarah, a pseudonym for our focal individual, offering a glimpse into her world. We’ll also touch upon key demographics, providing context to her story.
  • Rationale for choosing this case : Matthew Style: The selection of Sarah’s case is intentional, aiming to highlight a representative narrative that encapsulates the multifaceted nature of OCD.

B. Case history

  • Early signs and symptoms : Matthew Style: We’ll unravel the early signs and symptoms exhibited by Sarah, offering a chronological exploration of her journey with OCD.
  • Family history of mental health issues : Matthew Style: Understanding the familial context is crucial, as we explore how mental health issues may have influenced Sarah’s experiences.

Clinical Manifestations

A. Obsessions

  • Definition and examples : Matthew Style: Obsessions, the intrusive thoughts at the heart of OCD, will be defined, and we’ll delve into real-life examples to illustrate their impact.
  • Impact on daily functioning : Matthew Style: We’ll explore how these obsessions ripple through Sarah’s daily life, influencing her choices and actions.

B. Compulsions

  • Definition and examples : Matthew Style: Compulsions, the repetitive behaviors individuals engage in to quell anxiety, will be defined with concrete examples for clarity.
  • Attempts to alleviate anxiety : Matthew Style: We’ll dissect how Sarah’s compulsions serve as coping mechanisms, providing temporary relief from the anxiety spurred by her obsessions.

Diagnosis and Assessment

A. Professional evaluation

  • Involvement of mental health professionals : Matthew Style: Delving into the professional realm, we’ll explore the pivotal role mental health professionals play in diagnosing and assessing OCD.
  • Diagnostic criteria for OCD : Matthew Style: Unpacking the diagnostic criteria, we’ll elucidate the benchmarks used to identify and categorize OCD.

B. Tools and methods used in the assessment

  • Interviews with the individual and family : Matthew Style: Personal narratives, gleaned from interviews with Sarah and her family, will enrich our understanding of her journey.
  • Psychological tests and observations : Matthew Style: Complementing personal accounts, we’ll explore the objective tools and observations employed in the clinical assessment of OCD.

Treatment Approaches

A. Medication

  • Overview of common medications for OCD : Matthew Style: Navigating the pharmacological landscape, we’ll provide an overview of common medications prescribed to alleviate OCD symptoms.

Matthew Style: Acknowledging the nuances, we’ll discuss potential side effects and considerations associated with medication-based approaches to managing OCD.

B. Psychotherapy

  • Cognitive-Behavioral Therapy (CBT) : Matthew Style: Cognitive-Behavioral Therapy emerges as a cornerstone in treating OCD, offering insights into how it aids individuals like Sarah in reshaping thought patterns and behaviors.
  • Exposure and Response Prevention (ERP) : Matthew Style: We’ll explore the therapeutic strategy of Exposure and Response Prevention, shedding light on its efficacy in helping individuals confront and overcome the challenges posed by OCD.

Impact on Daily Life

A. Educational challenges

  • School performance : Matthew Style: OCD’s impact extends to academic realms, affecting individuals like Sarah in their school performance, creating hurdles that demand careful consideration.
  • Social interactions : Matthew Style: Navigating the intricate landscape of social interactions becomes a unique challenge for those contending with OCD, as we explore how it shapes Sarah’s relationships within the school setting.

B. Personal relationships

  • Impact on family dynamics : Matthew Style: Unraveling the ripple effects, we’ll delve into how Sarah’s struggle with OCD reverberates through her family dynamics, shedding light on the adjustments and support systems in place.
  • Friends and social life : Matthew Style: Friendships and social engagements are not exempt from the impact of OCD. We’ll explore how Sarah’s condition influences her social life and connections.

ocd case study conclusion

Coping Strategies

A. support systems.

  • Role of family and friends : Matthew Style: In Sarah’s journey, the support of family and friends emerges as a crucial pillar, underscoring the significant role these relationships play in coping with the challenges posed by OCD.
  • Support groups and community resources : Matthew Style: Beyond personal networks, we’ll explore the broader community resources and support groups that contribute to the coping mechanisms available to individuals grappling with OCD.

B. Personal coping mechanisms

  • Tec hniques to manage anxiety : Matthew Style: Delving into the toolbox of coping mechanisms, we’ll explore specific techniques that Sarah employs to manage the anxiety stemming from her OCD.
  • Long-term strategies for maintaining mental health : Matthew Style: Looking towards the future, we’ll discuss long-term strategies that individuals like Sarah adopt to sustain and promote their mental well-being.

In concluding this comprehensive exploration of Obsessive-Compulsive Disorder (OCD), we find ourselves standing at the intersection of knowledge and empathy. Through the lens of the “Matthew style,” we’ve navigated the complexities of OCD, unraveling its manifestations and impact on the daily life of individuals like our pseudonymous focal point, Sarah.

Summarizing the key findings, it becomes evident that OCD is not a monolithic entity; rather, it manifests uniquely in each individual, leaving an indelible mark on their journey. From the early signs and symptoms to the coping strategies employed, every facet of this disorder contributes to a narrative that extends beyond clinical definitions.

Reflecting on the importance of understanding and addressing OCD, we recognize that knowledge is the cornerstone of empathy. By peeling back the layers of this mental health challenge, we open doors to compassion and dispel misconceptions that may perpetuate stigma. Sarah’s story, though pseudonymous, echoes the experiences of countless others, emphasizing the universality of the human struggle with mental health.

This case study underscores the vital role of mental health professionals, the significance of personal support networks, and the wealth of community resources available. It stands as a testament to the resilience of individuals contending with OCD, showcasing the power of coping mechanisms and the efficacy of treatment approaches like medication and psychotherapy.

A call to action reverberates through these pages—an urgent plea for increased mental health awareness and the destigmatization of conditions like OCD. In embracing this call, we collectively contribute to a society that prioritizes empathy, understanding, and support for those grappling with mental health challenges.

As we acknowledge the extensive references drawn from academic sources and the invaluable insights gained through interviews with mental health professionals, gratitude permeates this conclusion. The collaborative efforts of individuals who contributed to this project have elevated it beyond a mere study, transforming it into a narrative of shared understanding and a beacon guiding us toward a more compassionate discourse on mental health.

Bibliography

  • National Institute of Mental Health – OCD
  • PubMed – Age at onset of OCD
  • Psychiatric Times – Neurobiology of OCD
  • American Journal of Medical Genetics – Genetic factors in OCD
  • Frontiers in Human Neuroscience – Environmental factors in OCD

III. Case Study Overview

  • No specific external reference for this section.
  • Psychology Today – Early signs of OCD
  • Journal of Abnormal Psychology – Family factors in OCD

IV. Clinical Manifestations

  • Anxiety and Depression Association of America – OCD Symptoms
  • PubMed – Impact of OCD on daily life
  • Verywell Mind – Compulsions in OCD
  • Psych Central – Coping with OCD

V. Diagnosis and Assessment

  • American Psychiatric Association – OCD Diagnosis
  • Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
  • Psychological Assessment – Tools for OCD assessment

VI. Treatment Approaches

  • Mayo Clinic – Medications for OCD
  • PsychCentral – Side effects of OCD medications
  • National Alliance on Mental Illness – CBT for OCD
  • International OCD Foundation – ERP

VII. Impact on Daily Life

  • Child Mind Institute – OCD and School
  • Psych Central – OCD and Social Interaction

Certificate of Completion

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COMMENTS

  1. Woman diagnosed with obsessive-compulsive disorder became delusional

    CONCLUSION This case suggests that the patient with OCD appeared to move along a continuum of beliefs, and highlights the importance of effective intervention during pregnancy, which would exert a significant impact on postpartum exacerbation outcomes.

  2. Case Report on Obsessive Compulsive Disorder

    Obsessive-compulsive disorder (OCD) is a mental disorder where people feel the. need to check things repeatedly, perform certain routines repeatedly (called "rituals"), or have. certain thoughts repeatedly (called "obsessions"). Obsessive compulsive disorder (OCD) is a. debilitating neuropsychiatric disorder with a lifetime prevalence of 2 to ...

  3. Jefferson Journal of Psychiatry

    A Case Study of Obsessive-Compulsive Disorder: Some Diagnostic Consideratio ns. Obsessive-Compulsive Disorder (OCD) was considered a rare disorderprior to 1984 when the initial resultsfrom theEpidemiologicCatchment Areasururydemonstrated a substantial prevalence of the disorder (1). Thus there ma)'be mmrypatients today whoentered treatment ...

  4. Case Report: Obsessive compulsive disorder...

    Conclusion: We illustrate a case of OCD possibly secondary to a posterior cerebellar infarct, supporting the role of the cerebellum in the pathophysiology of OCD. Functional connectivity informed non-invasive neuromodulation demonstrated partial treatment response.

  5. Clinical advances in obsessive-compulsive disorder: a positi ...

    advances judged to be of utmost relevance to the treatment of OCD, based on new and emerging evidence from clinical and translational science. Areas covered include refinement in the methods of clinical assessment, the importance of early intervention based on new staging models and the need to provide sustained well-being involving effective relapse prevention. The relative benefits of ...

  6. A Case Study of an Adolescent With Health Anxiety and OCD, Treated

    A single-case experimental design was employed to assess the effectiveness of the intervention. FINDINGS AND CONCLUSION. Routine outcome measures demonstrated the effectiveness of the OCD intervention, and the need for further research in health anxiety in young people, including the development of disorder and age-specific measures.

  7. Obsessive compulsive disorder in very young children

    Conclusions Disseminating knowledge about the clinical presentation, diagnosis and treatment of early OCD may shorten the long delay between first OCD symptoms and disease-specific treatment that is reported as main predictor for persistent OCD. Peer Review reports Background

  8. My OCD Story: Chapter 6 & Conclusion

    by JC Chapter 6: Life after treatment Several years after extensive treatment, here I am about to graduate college. I was able to take acting classes and improve myself as an actor. I was in many plays and musicals during my time in college. I made connections with my peers and with my professors.

  9. Course and outcome of obsessive-compulsive disorder

    Abstract. Obsessive-compulsive disorder (OCD) is generally believed to follow a chronic waxing and waning course. The onset of illness has a bimodal peak - in early adolescence and in early adulthood. Consultation and initiation of treatment are often delayed for several years. Studies over the past 2-3 decades have found that the long ...

  10. PDF Case Study of Obsessive-Compulsive Disorder (OCD)

    Conclusion: which proved After diagnosis, positive Clinical the efficacy of FSIT. per week, a total of eighty-three sessions were conducted of FSIT. Positive behavioral change observed in...

  11. A Case of Obsessive-Compulsive Disorder Triggered by the Pandemic

    Background: The pandemic caused by the sars-cov2 coronavirus can be considered the biggest international public health crisis. Outbreaks of emerging diseases can trigger fear reactions. Strict adherence to the strategies can cause harmful consequences, particularly for people with pathology on the spectrum of obsessive-compulsive disorder. Case presentation: We describe the clinical case of a ...

  12. CASE STUDY John (obsessive-compulsive disorder)

    Obsessions Ruminations Worry Diagnoses and Related Treatments 1. Obsessive-Compulsive Disorder The following treatments have empirical support for individuals with Obsessive-Compulsive Disorder:

  13. Conclusion

    In Chapter 3, on the pathogenesis of OCD, we emphasized the value of a cortico-striatal-thalamic-cortical (CSTC) model for conceptual-izing the psychobiology of OCD.A focus on CSTC circuitry allows an integration of several different sets of data on OCD, ranging from cognitive and affective studies, through to brain imaging research, and on to more molecular work on this disorder.

  14. Case Study of a Middle-Aged Woman's OCD Treatment Using ...

    Conclusion: CBT and ERP technique is an effective treatment in reducing obsessive and compulsive symptoms of the patient. Introduction Have you ever felt like a sudden urge to hurt somebody? What if such urges continuously appear in your head? What would you do to stop these urges?

  15. Case Study of Obsessive-Compulsive Disorder (OCD)

    Obsessive Compulsive Disorder, Symptoms, Assessment, Case Study, Idiographic, Therapist, Spirituality, Preventive, Health care, Physical fitness, Spiritual exercises, Soul, Human values, Stress, Complementary Medicine, Holistic education, Phenomenological study, Holistically, Facilitate, Spiritual care, Trigger depression, Spiritual work

  16. Case Study of Obsessive-Compulsive Disorder (OCD)

    The present study presents the case of psychosis. The subject of the disorder was Mr. S (Initial instead of real name), 26 years old young man. Mr. S was having sign and symptoms of aggressive ...

  17. Obsessive-compulsive disorder: case study and discussion of treatment

    Abstract. A patient's own account of her obsessive-compulsive disorder is presented. She describes her distressing experiences, the impact of the disturbance on her and her family's life and her subsequent improvement using the technique of exposure and response prevention. The treatments available are discussed and the benefits of self ...

  18. Case Study On Ocd For 12 CBSE (Obsessive-Compulsive Disorder)

    This is to certify that I, [Student's Name], a [Class/Grade Level] student, have successfully completed the project on "Case study on ocd for 12 CBSE (Obsessive-compulsive disorder).". The project explores the fundamental principles and key aspects of the chosen topic, providing a comprehensive understanding of its significance and ...