Lesson 1: Clinical Disorders - Part A

Description

At an interview, a 14 year-old girl was recalling how her life was just one year earlier. As a 13 year-old, she was obsessed with germs. She was afraid they were all over her clothes and other belongings. She shook the germs from her clothes for thirty minutes before wearing them. She would wash her hands before washing her face. She would then wash her hands again before getting dressed. At her worst point, she used rubbing alcohol for washing – this caused her hands to bleed. These rituals often left no time for breakfast before going to school. At the most severe point with the disorder, she had to get up at 6:00 a.m. just to get ready for an event at 11:00 a.m., but her disorder was so severe that, on occasion, even five hours were insufficient to prepare to leave the house.

The teen also had some obsessions and compulsions regarding numbers. For example, she would often re-read things three times. She would also mentally say “three” (or a multiple of three) to “clean” germs from “dirty” words. In one day she might say a multiple of three over 124 times! She was very much afraid that something bad would happen if she did not perform her rituals – although her friends told her that the behaviour was “stupid,” to which she agreed. She even began worrying that something bad would happen to her family if she did not perform her rituals.

After treatment, the girl was much better. On occasion, she still reads things three times if she has trouble understanding the content the first time, but she is able to get up, brush her teeth, shower, and get dressed in half an hour!

Diagnosis

The girl vividly displays symptoms of severe obsessive compulsive disorder. Her obsessions and compulsions are a major source of stress to her and interfere with her daily functioning. Her obsessions are based on ideas that interject themselves into her consciousness and are experienced as senseless. Her need to neutralize such thoughts has led to repetitive and persistent compulsions. For example, washing hands for hours at a time to prevent infection by germs (to the point that her hands were bleeding) was clearly excessive. She reacted as though the dangers were real despite knowing they were not.

While she does display evidence of OCD, she does not display obsessive compulsive personality disorder – a disorder that involves such traits as perfectionism, indecisiveness, and a restricted ability to express warm and tender emotions. She did, however, admit to an episode of major depression – a common occurrence with OCD sufferers. Her DSM diagnosis for Axis I is obsessive compulsive disorder - Severe