famous ocd case study

• Presidential Message
• Nominations/Elections
• Past Presidents
• Member Spotlight
• Fellow List
• Fellowship Nominations
• Current Awardees
• Award Nominations
• SCP Mentoring Program
• SCP Book Club
• Pub Fee & Certificate Purchases
• LEAD Program
• Introduction
• Find a Treatment
• Submit Proposal
• Dissemination and Implementation
• Diversity Resources
• Graduate School Applicants
• Student Resources
• Early Career Resources
• Principles for Training in Evidence-Based Psychology
• Advances in Psychotherapy
• Announcements
• Submit Blog
• Student Blog
• The Clinical Psychologist
• CP:SP Journal
• APA Convention
• SCP Conference

CASE STUDY John (obsessive-compulsive disorder)

Case study details.

John is a 56-year-old man who presents to you for treatment. His symptoms started slowly; he tells you that he was always described as an anxious person and remembers being worried about a lot of things throughout his life. For instance, he reported he was very afraid he’d contract HIV by touching doorknobs, even though he tells you he knew this was “irrational.” He tells you that about 10 years ago, following a few life stressors, his anxiety and intrusive thoughts worsened significantly. He tells you he began washing his hands excessively. He reports he developed an intense fear that someone would break into the house and it would be his fault because he left something unlocked. He states that this fear led him to repeatedly check doors and windows before sleep in a specific order, which was a source of contention with his wife. He says that his fear of making a mistake also leads him to be slow to turn in work for his job, checking many times to make sure there are no mistakes, for which he gets reprimanded on occasion.

John reports that his symptoms are getting worse, which is why he has sought treatment. For example, currently he washes his hands until he finishes the whole soap bar, and his hands are cracked because they are so dry. He says he continues to check the doors and windows of his house numerous times throughout the day, not just at night, and has on occasion driven home from work to be sure everything truly was locked. If he notices even a speck of dust on the floor, he states he has the urge to clean the whole house and he often complies with that urge.

John expresses significant distress over these symptoms, as they are taking up more of his time and robbing him of his confidence, as he is increasingly distracted at work and in his family life.

• Compulsions
• Concentration Difficulties
• Intrusive Thoughts
• Ruminations

Diagnoses and Related Treatments

1. obsessive-compulsive disorder.

Thank you for supporting the Society of Clinical Psychology. To enhance our membership benefits, we are requesting that members fill out their profile in full. This will help the Division to gather appropriate data to provide you with the best benefits. You will be able to access all other areas of the website, once your profile is submitted. Thank you and please feel free to email the Central Office at  [email protected] if you have any questions

A True Story of Living With Obsessive-Compulsive Disorder

An authentic and personal perspective of the internal battles within the mind..

Posted April 3, 2017

• What Is Obsessive-Compulsive Disorder?
• Take our Generalized Anxiety Disorder Test
• Find a therapist to treat OCD

Contributed by Tiffany Dawn Hasse in collaboration with Kristen Fuller, M.D.

The underlying reasons why I have to repeatedly re-zip things, blink a certain way, count to an odd number, check behind my shower curtain to ensure no one is hiding to plot my abduction, make sure that computer cords are not rat tails, etc., will never be clear to me. Is it the result of a poor reaction to the anesthesiology that was administered during my wisdom teeth extraction? These aggravating thoughts and compulsions began immediately after the procedure. Or is it related to PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection) which is a proposed theory connoting a strange relationship between group A beta-hemolytic streptococcal infection with rapidly developing symptoms of obsessive-compulsive disorder in the basal ganglia? Is it simply a hereditary byproduct of my genetic makeup associated with my nervous personality ? Or is it a defense tactic I developed through having an overly concerned mother?

The consequences associated with my OCD

Growing up with mild, in fact dormant, obsessive-compulsive disorder, I would have never proposed such bizarre questions until 2002, when an exacerbated overnight onset of severe OCD mentally paralyzed me. I'd just had my wisdom teeth removed and was immediately bombarded with incessant and intrusive unwanted thoughts, ranging from a fear of being gay to questioning if I was truly seeing the sky as blue. I'm sure similar thoughts had passed through my mind before; however, they must have been filtered out of my conscious, as I never had such incapacitating ideas enter my train of thought before. During the summer of 2002, not one thought was left unfiltered from my conscious. Thoughts that didn't even matter and held no significance were debilitating; they prevented me from accomplishing the simplest, most mundane tasks. Tying my shoe only to untie it repetitively, continuously being tardy for work and school, spending long hours in a bathroom engaging in compulsive rituals such as tapping inanimate objects endlessly with no resolution, and finally medically withdrawing from college, eventually to drop out completely not once but twice, were just a few of the consequences I endured.

Seeking help

After seeing a medical specialist for OCD, I had tried a mixed cocktail of medications over a 10-year span, including escitalopram (Lexapro), fluoxetine (Prozac), risperidone (Risperdal), aripiprazole (Abilify), sertraline (Zoloft), clomipramine (Anafranil), lamotrigine (Lamictal), and finally, after a recent bipolar disorder II diagnosis, lurasidone (Latuda). The only medication that has remotely curbed my intrusive thoughts and repetitive compulsions is lurasidone, giving me approximately 60 to 70 percent relief from my symptoms.

Many psychologists and psychiatrists would argue that a combination of cognitive behavioral therapy (CBT) and pharmacological management might be the only successful treatment approach for an individual plagued with OCD. If an individual is brave enough to undergo exposure and response prevention therapy (ERP), a type of CBT that has been shown to relieve symptoms of OCD and anxiety through desensitization and habituation, then my hat is off to them; however, I may have an alternative perspective. It's not a perspective that has been researched or proven in clinical trials — just a coping mechanism I have learned through years of suffering and endless hours of therapy that has allowed me to see light at the end of the tunnel.

In my experience with cognitive behavioral therapy, it may be semi-helpful by deconstructing or cognitively restructuring the importance of obsessive thoughts in a hierarchical order; however, I still encounter many problems with this type of technique, especially because each and every OCD thought that gets stuck in my mind, big or small, tends to hold great importance. Thoughts associated with becoming pregnant , seeing my family suffer, or living with rats are deeply rooted within me, and simply deconstructing them to meaningless underlying triggers was not a successful approach for me.

In the majority of cases of severe OCD, I believe pharmacological management is a must. A neurological malfunction of transitioning from gear to gear, or fight-or-flight, is surely out of whack and often falsely fired, and therefore, medication works to help balance this misfiring of certain neurotransmitters.

Exposure and response prevention therapy (ERP) is an aggressive and abrasive approach that did not work for me, although it may be helpful for militant-minded souls that seek direct structure. When I was enrolled in the OCD treatment program at UCLA, I had an intense fear of gaining weight, to the point that I thought my body could morph into something unsightly. I remember being encouraged to literally pour chocolate on my thighs when the repetitive fear occurred that chocolate, if touching my skin, could seep through the epidermal layers, and thus make my thighs bigger. While I boldly mustered up the courage to go through with this ERP technique recommended by my specialist, the intrusive thoughts and compulsive behaviors associated with my OCD still and often abstain these techniques. Yes, the idea of initially provoking my anxiety in the hope of habituating and desensitizing its triggers sounds great in theory, and even in a technical scientific sense; but as a human with real emotions and feelings, I find this therapy aggressive and infringing upon my comfort level.

How I conquered my OCD

So, what does a person incapacitated with OCD do? If, as a person with severe OCD, I truly had an answer, I would probably leave my house more often, take a risk once in a while, and live freely without fearing the mundane nuances associated with public places. It's been my experience with OCD to take everything one second at a time and remain grateful for those good seconds. If I were to take OCD one day at a time, well, too many millions of internal battles would be lost in this 24-hour period. I have learned to live with my OCD through writing and performing as a spoken word artist. I have taken the time to explore my pain and transmute it into an art form which has allowed me to explore the topic of pain as an interesting and beneficial subject matter. I am the last person to attempt to tell any individuals with OCD what the best therapy approach is for them, but I will encourage each and every individual to explore their own pain, and believe that manageability can come in many forms, from classic techniques to intricate art forms, in order for healing to begin.

Tiffany Dawn Hasse is a performance poet, a TED talk speaker , and an individual successfully living with OCD who strives to share about her disorder through her art of written and spoken word.

Kristen Fuller M.D. is a clinical writer for Center For Discovery.

Facebook image: pathdoc/Shutterstock

Kristen Fuller, M.D., is a physician and a clinical mental health writer for Center For Discovery.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Online Therapy
• United States
• Brooklyn, NY
• Chicago, IL
• Houston, TX
• Los Angeles, CA
• New York, NY
• Portland, OR
• San Diego, CA
• San Francisco, CA
• Seattle, WA
• Washington, DC
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Self Tests NEW
• Therapy Center
• Diagnosis Dictionary
• Types of Therapy

It’s increasingly common for someone to be diagnosed with a condition such as ADHD or autism as an adult. A diagnosis often brings relief, but it can also come with as many questions as answers.

• Emotional Intelligence
• Gaslighting
• Affective Forecasting
• Neuroscience

An official website of the United States government

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock Locked padlock icon ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Publications
• Account settings
• Advanced Search
• Journal List

Woman diagnosed with obsessive-compulsive disorder became delusional after childbirth: A case report

Jing-fang gao.

• Author information
• Article notes
• Copyright and License information

Author contributions: Lin SS reviewed the literature and drafted the manuscript; Gao JF was responsible for the revision of the manuscript for important intellectual content; all authors have read and approve the final manuscript.

Corresponding author: Jing-Fang Gao, MD, Chief Doctor, Full Professor, Department of Psychiatry and Psychology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou 310000, Zhejiang Province, China. [email protected]

Received 2021 Oct 22; Revised 2022 Dec 22; Accepted 2022 Feb 23; Issue date 2022 Apr 6.

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

Obsessive-compulsive disorder (OCD) is a common mental disorder that varies greatly in manifestation and causes much distress to individuals. We describe a case in which a Chinese woman with OCD became delusional after childbirth, and discuss the possible phenomenological and psychological alterations.

CASE SUMMARY

A 27-year-old woman presented to the Psychiatry Department of our hospital with obsessions and compulsions. After taking medication, her symptoms were alleviated. Three years later, during her pregnancy, the obsessions returned and even progressed into paranoid delusions after childbirth. After multiple adjustments of treatment along with several fluctuations, she finally achieved remission and gained reasonable insight.

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.

Keywords: Delusion, Obsession, Paranoid thinking, Perfectionism, Obsessive-compulsive disorder, Case report

Core Tip: Obsessive-compulsive disorder (OCD) is a common mental disorder that varies greatly in manifestation and causes much distress to individuals. We describe a case that developed over a decade where a Chinese woman with OCD became delusional after childbirth, seriously affecting her marriage and parent–child relationship. We hope it can remind psychiatric practitioners to attach more importance to perinatal interventions for those who suffer from OCD.

INTRODUCTION

Obsessive-compulsive disorder (OCD) is characterized by obsessions or compulsions that are distressing and anxiety provoking. Researchers are now increasingly recognizing that OCD is a clinically heterogeneous disorder that varies greatly in the specific content of obsessions and compulsions and has discrete subtypes[ 1 ]. Although the significant variability in the presentations of individuals creates difficulties for differential diagnosis of OCD, it also provides opportunities for research.

Here, we present the case of a woman who suffered marked anxiety and experienced a continuum of beliefs during the perinatal course of pregnancy, with obsessive beliefs eventually progressing into delusions and leading to secondary obsessions, which aroused our discussion and reflection. We describe the patient’s symptom progression and treatment and discuss the possible underlying phenomenological and psychopathological alterations, hoping to remind psychiatrists to attach more importance to perinatal interventions for OCD.

CASE PRESENTATION

Chief complaints.

A 27-year-old woman presented to the Psychiatry Department of our hospital with obsessions and compulsions.

History of present illness

A 27-year-old woman named Laura came to our clinic in 2009, stating that she was quite anxious due to preparing for the national postgraduate entrance exam. She gradually manifested the symptoms of feeling compelled to turn pages over and over again, to rearrange objects in order on her desk, and to repetitively check whether doors and lamps were closed before going out. She did not resist these behaviors or feel miserable, but these behaviors were quite time-consuming and obviously interfered with her studies. She sought help from a psychiatrist in our department. After finishing laboratory and imaging tests, which ruled out physical disease, as well as psychiatric interviews and psychological assessments [she scored 21 on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Obsession-7, and Compulsion-14; she scored 72 on the Self-rating Anxiety Scale (SAS)], she was diagnosed with OCD. The psychiatrist prescribed sertraline for her and titrated it up to 75 mg/d. The symptoms of compulsion were greatly relieved, and after reassessment, she obtained a total score of 7 on the Y-BOCS and 53 on the SAS. She adhered to the medication for 3 years.

In 2012, Laura got married. She wanted to stop the medication to prepare for pregnancy. Under the guidance of the psychiatrist, sertraline was gradually discontinued. Soon Laura found she was pregnant. After calculating the date of conception, she found that the time to conception was only three weeks after withdrawal, and she had drunk some beer and applied some ointment to treat nail inflammation after conception. Hence, Laura was worried that the fetus might be unhealthy and wanted to have an abortion, but her family discouraged this. Her husband thought these conditions would not affect the fetus. Her husband was an only child and his father was terminally ill. To enable his father to see his grandchild before he died, he insisted that Laura keep the baby despite her concerns.

She kept going to many departments of different hospitals and asking for all kinds of tests and examinations, but doubted all positive answers the doctors gave. She was quite sensitive during that period and increasingly believed the fetus would be unhealthy and should not be born. The idea that she might give birth to an unhealthy baby made her uneasy. She suffered from anxiety, irritability, and insomnia. Despite her complaints as well as strong demands for an abortion, she never attempted to injure the fetus in any way. She came to our department again [she scored 19 on the Y-BOCS, 75 on the SAS, and 55 on the Self-rating Depression Scale (SDS)]. We offered supportive psychotherapy and relaxation therapy in every follow-up during pregnancy, but the effect was not good. Considering that the patient was deeply tormented by the symptoms, we recommended medication treatment to her. She declined in view of possible adverse effects on the fetus. Ultimately, because no one gave permission for an abortion, the standoff lasted until the moment of delivery.

In March 2014, Laura gave birth naturally to a baby girl; no abnormalities were found in the physical examination after birth. However, she denied the results and insisted there was definitely something wrong with the baby. She thought it was wrong for her to bring an imperfect child into the world. She had a strong, overwhelming impulse to kill the baby and imagined all kinds of methods, such as strangling her or throwing her down the stairs. Three days after giving birth, her husband took the baby away for the sake of safety and brought the baby to the grandmother.

Laura came to us again, accompanied by her father, telling us she had given birth to an imperfect child; this thought tormented her frequently. She even planned to take the train to find the baby and kill her. Her family hid her ID card and was required to watch her around the clock. We reevaluated her, she scored 31 on the Y-BOCS and 71 on the SAS. Sertraline was administered again for almost 2 wk without any improvements. Taking her anxiety and insomnia into account, sertraline was discontinued, and fluvoxamine was introduced and quickly increased to 200 mg/d. Because of her agitation and insomnia, sodium valproate was introduced and added up to 0.5 g/d. After her mood was stabilized, sodium valproate was discontinued. Meanwhile, Laura exhibited obvious somatic symptoms, such as headache, chest tightness, and shortness of breathing. After a general examination, no physical problems were detected. We switched medications by adding duloxetine and titrating it to 60 mg/d. Then, the somatic symptoms alleviated. She still insisted that her baby had problems and should not have been born, although the urge to kill her baby was not as strong or frequent as before. She felt incompetent at work after giving birth and changed to a different job. Her relationship with her husband had been strained since her pregnancy. In August 2015, a divorce judgment was finalized. The judge persuaded her that the child was innocent. At that moment, she felt what he said was reasonable, and there was no need to kill her baby. From then on, the impulse to kill her baby occurred much less, and she was not bothered by it . During follow-up visits, which normally took place every 3 to 4 wk, she stuck to the medication.

In 2016, Laura met her ex-husband by accident. He showed her a picture of the baby and expressed his desire to get back together. Moreover, Laura’s aunt persuaded her to get back with him and sarcastically indicated that nobody would marry a divorced woman like her. She came to feel she was an imperfect woman because she had given birth to her daughter. She could not bear to let the baby become a reminder that she was an imperfect woman. The belief that the baby was problematic and the impulse to kill her relapsed. At this time, we discontinued duloxetine and introduced aripiprazole and quickly titrated it up to 25 mg/d. Her impulse to kill the child was greatly mitigated. She even came to realize that killing a child was against the law and she would be put in prison. She feared she would lose control and let the child be taken far away to avoid a possible encounter. After adding aripiprazole for 1 mo, she felt greatly relieved (she scored 15 on the Y-BOCS and 45 on the SAS). Aripiprazole and fluvoxamine were maintained for treatment.

Personal and family history

Laura is an only child, outgoing and gentle, and mostly lived with her mother before she was 15, when her mother died of cancer. After that, Laura began to live with her father, a businessman who was strong and stubborn. Her clothing style gradually became more androgynous, her personality slowly became stubborn and intolerant of uncertainty, and she tended to be a perfectionist and expected everything to be exactly right.

FINAL DIAGNOSIS

Obsessive-Compulsive Disorder, with absent insight/delusional beliefs.

OUTCOME AND FOLLOW-UP

Her condition has been stable since then. She has no desire or impulse to kill her daughter any more. However, she still believes the child is not good enough and is imperfect, and that it was wrong to give birth to her. Moreover, she complained that her ex-husband did not respect her and just wanted to carry on his family line. She argued that a baby should bring hope and happiness to life, whereas this child made her miserable and led her to divorce. However, these thoughts no longer bothered her. After three years of persistently taking medication, she is now competent at her job and leads a stable life. Upon returning to visit in 2020, she scored 5 on the Y-BOCS and 39 on the SAS, and her relationship with her ex-husband improved. Now, she remarries her husband and lives with their daughter. She even plans to have a second child.

In our case, Laura experienced a recurrence of OCD during pregnancy, which was exacerbated after childbirth. A few studies suggest that the perinatal period increases the risk for the development and deterioration of OCD in some women[ 2 ]. However, there are conflicting results. The only prospective study on OCD in a community sample of pregnant women in the third trimester reported that of the 15 women (out of 434) identified with OCD, the vast majority experienced an improvement or no change in symptomatology during pregnancy and postpartum[ 3 ]. In one study, 83% of the sample reported either an improvement or no change in pre-existing symptomatology during pregnancy[ 4 ]. Hence, there is no clear picture regarding OCD onset and exacerbation in pregnancy and the postpartum period.

Anxiety and paranoid thinking

In our case, Laura suffered increasing anxiety given her improper behaviors in the early stages of pregnancy. Her obsessions and compulsions were present, and she repetitively went to many departments of different hospitals to inquire about her concerns, but doubted all positive answers she received and insisted there was something wrong with the fetus. It seemed that she had developed paranoid thinking about fetal abnormalities, similar to the hypochondriacal idea. Studies have found that paranoid thinking is associated with recent anxiety levels; anxiety is considered to predict or even cause paranoid thinking and lead to negative interpretations of ambiguous events[ 5 - 8 ]. Anxiety can result in negative anticipation, which in turn generates incredible ideas or beliefs and causes a change in one’s perceived state. The cognitive model of OCD suggests that misinterpreting intrusive thoughts as unacceptable outcomes leads to increased anxiety[ 9 ]. In this framework, it is not the content of intrusive thought, but its interpretation that results in increased anxiety and preoccupation. A range of cognitive-affective processing biases are active in people with paranoid thinking[ 10 ], and cognitive processes are mediators of the links between anxiety and paranoid thinking.

It was quite confusing whether Laura should initially be diagnosed with postpartum psychosis or OCD. It seemed that her symptoms conformed to both of the diagnoses. However, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, if an individual with OCD is completely convinced that his/her beliefs are true (which is considered a special subtype of OCD), then the diagnosis of OCD with absent insight/delusional beliefs should be given, rather than a diagnosis of delusional disorder or postpartum psychosis. The revision seems to expand the diagnostic range of OCD based on symptomatology. Nevertheless, the paranoid thinking beneath delusion in our case is worth studying.

Distinction of the continuum of beliefs in OCD

There is increasing evidence that in the general population, each psychotic experience of an individual is manifested by a continuum of features. In our case, during the perinatal period, Laura’s obsessions recurred and were exacerbated; at first, she repetitively went to many departments of different hospitals to inquire about her concerns but doubted all positive answers she received, and she was almost completely convinced that the fetus was abnormal. After delivery, she strongly believed she had given birth to an unhealthy child, regardless of the examination results, and even felt a strong impulse to kill her daughter, which reflected irrationality and absurdity. Her belief was delusional, and her insight was absent. Her strong impulse to kill her baby was secondary to delusional belief.

Beliefs play an ambiguous role in OCD. The characteristics of beliefs vary widely along the continuum, and delusions seem to be at the severe end of the spectrum. Delusions refer to beliefs held with conviction and subjective certainty in light of conflicting evidence[ 11 ]. Overvalued ideas are ‘‘unreasonable and sustained beliefs that are associated with strong affect ( e.g. , anxiety or anger) and are more likely to lead to repeated action that is considered justified”[ 12 - 13 ]. According to Kozak and Foa[ 12 ], overvalued ideas lie on a continuum of ‘‘strength of belief’’ between OCD-related, non-delusional beliefs and delusions. Obsessions are recurrent and persistent thoughts, urges, or images experienced as intrusive and unwanted. The distinction between a delusion and obsession depends in part on the degree of conviction with which the belief is held, despite clear contradictory evidence regarding its correctness. However, this is not always effective. One study[ 14 ] proposed an approach in which beliefs arising in the context of OCD are assessed along the following well-defined characteristics: conviction, fixity, fluctuation, resistance (to beliefs), insight pertaining to an awareness of the inaccuracy of one’s belief, and insight referring to the ability to attribute the belief to an illness, which may allow for a clearer distinction between non-delusional beliefs, overvalued ideas, and delusions. In addition, emerging empirical evidence suggests that obsessions and delusions might not be mutually exclusive. In the literature on body dysmorphic disorder and eating disorders, Phillips et al [ 15 ] concluded that non-delusional and delusional variants of both disorders likely constitute a single disorder containing a range of insights, with an entire spectrum characterized by obsessions. This insight can range from good (obsessions) to bad (overvalued ideas) to absent (delusions). Therefore, it is reasonable to speculate that Laura experienced an alteration of the continuum of belief, from obsessions to delusions, and that delusions and even secondary obsessions coexisted, which had a significant impact on her parent–child relationship and marital status.

Perfectionism and anxiety in OCD

Many individuals with OCD have dysfunctional belief domains. In the cognitive model, three types of intermediate beliefs have been hypothesized to contribute to obsessive-compulsive symptoms, one of which is perfectionism and the intolerance of uncertainty. Perfectionism, typically defined as setting extremely high standards along with critical evaluations of one’s own behavior[ 16 ], has long been regarded as a risk and maintenance factor for OCD and robustly associated with anxiety[ 17 ]. In our case, Laura experienced excessive and marked anxiety during pregnancy in fear of fetal abnormalities, which interacted with her perfectionism, leading to obsessions and compulsions. She even felt a strong urge to do away with her “imperfect” child after childbirth to reduce anxiety and maintain her own sense of perfection. After taking medication, her obsessions and paranoid delusions underwent several fluctuations, and she finally entered a state of remission. Data indicate that high levels of perfectionism impede treatment responses across different psychopathologies, and treatment of perfectionism results in a reduction in symptoms, including anxiety[ 18 - 19 ]. Therefore, perfectionism may be a promising area regarding cognitive interventions for OCD. It is hoped that such a focus will help to improve the efficacy of treatment for OCD and potentially reduce a potent risk of exacerbation, especially for perinatal women in avoidance of potentially adverse effects on fetuses if taking medicine. We suggest that psychiatrists routinely assess and address perfectionism in OCD, aiming to alleviate symptoms and avoid the exacerbation of OCD.

We reviewed the literature in terms of anxiety and paranoid thinking, as well as perfectionism, and tried to analyze the alterations and distinctions of a continuum of belief in OCD in the perinatal and postpartum periods. The patient developed OCD over a decade, and it seriously affected her marriage and parent–child relationship. We hope this case will remind psychiatric practitioners to attach more importance to perinatal interventions for those who suffer OCD given a range of adverse maternal and fetal developmental outcomes. Due to the great heterogeneity in the clinical presentation of OCD, we hope we will make a major breakthrough in etiology and treatment research on OCD.

ACKNOWLEDGEMENTS

The authors would like to thank Professor En-yan Yu for providing insight into this case and the colleagues of the department in the course of writing this article.

Informed consent statement: Informed verbal consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Peer-review started: October 22, 2021

First decision: December 17, 2021

Article in press: February 23, 2022

Specialty type: Psychology

Country/Territory of origin: China

Peer-review report’s scientific quality classification

Grade A (Excellent): A

Grade B (Very good): 0

Grade C (Good): C

Grade D (Fair): 0

Grade E (Poor): 0

P-Reviewer: Hosak L, Zhang Y S-Editor: Ma YJ L-Editor: A P-Editor: Ma YJ

Contributor Information

Si-Si Lin, Department of Psychiatry and Psychology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China.

Jing-Fang Gao, Department of Psychiatry and Psychology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, [email protected].

• 1. McGuinness M, Blissett J, Jones C. OCD in the perinatal period: is postpartum OCD (ppOCD) a distinct subtype? Behav Cogn Psychother. 2011;39:285–310. doi: 10.1017/S1352465810000718. [ DOI ] [ PubMed ] [ Google Scholar ]
• 2. Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR. Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord. 2003;17:461–478. doi: 10.1016/s0887-6185(02)00206-2. [ DOI ] [ PubMed ] [ Google Scholar ]
• 3. Uguz F, Gezginc K, Zeytinci IE, Karatayli S, Askin R, Guler O, Kir Sahin F, Emul HM, Ozbulut O, Gecici O. Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Compr Psychiatry. 2007;48:441–445. doi: 10.1016/j.comppsych.2007.05.001. [ DOI ] [ PubMed ] [ Google Scholar ]
• 4. Forray A, Focseneanu M, Pittman B, McDougle CJ, Epperson CN. Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. J Clin Psychiatry. 2010;71:1061–1068. doi: 10.4088/JCP.09m05381blu. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 5. Lincoln TM, Lange J, Burau J, Exner C, Moritz S. The effect of state anxiety on paranoid ideation and jumping to conclusions. An experimental investigation. Schizophr Bull. 2010;36:1140–1148. doi: 10.1093/schbul/sbp029. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 6. Thewissen V, Bentall RP, Oorschot M, A Campo J, van Lierop T, van Os J, Myin-Germeys I. Emotions, self-esteem, and paranoid episodes: an experience sampling study. Br J Clin Psychol. 2011;50:178–195. doi: 10.1348/014466510X508677. [ DOI ] [ PubMed ] [ Google Scholar ]
• 7. Freeman D, Pugh K, Antley A, Slater M, Bebbington P, Gittins M, Dunn G, Kuipers E, Fowler D, Garety P. Virtual reality study of paranoid thinking in the general population. Br J Psychiatry. 2008;192:258–263. doi: 10.1192/bjp.bp.107.044677. [ DOI ] [ PubMed ] [ Google Scholar ]
• 8. Freeman D, Stahl D, McManus S, Meltzer H, Brugha T, Wiles N, Bebbington P. Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Soc Psychiatry Psychiatr Epidemiol. 2012;47:1195–1203. doi: 10.1007/s00127-011-0433-1. [ DOI ] [ PubMed ] [ Google Scholar ]
• 9. Calkins AW, Berman NC, Wilhelm S. Recent advances in research on cognition and emotion in OCD: a review. Curr Psychiatry Rep. 2013;15:357. doi: 10.1007/s11920-013-0357-4. [ DOI ] [ PubMed ] [ Google Scholar ]
• 10. Freeman D, Dunn G, Fowler D, Bebbington P, Kuipers E, Emsley R, Jolley S, Garety P. Current paranoid thinking in patients with delusions: the presence of cognitive-affective biases. Schizophr Bull. 2013;39:1281–1287. doi: 10.1093/schbul/sbs145. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ]
• 11. American Psychiatric Association. (2013) The Fifth Edition of Diagnostic and Statistical Manual of Mental Disorders(DSM-V). Washington, DC: American Psychiatric Association. [ Google Scholar ]
• 12. Veale D. Over-valued ideas: a conceptual analysis. Behav Res Ther. 2002;40:383–400. doi: 10.1016/s0005-7967(01)00016-x. [ DOI ] [ PubMed ] [ Google Scholar ]
• 13. American Psychiatric Association. (2000) The Fourth Edition of Diagnostic and Statistical Manual for Mental Disorders, Text Revision (DSM-IV TR). Washington DC: American Psychiatric Press. [ Google Scholar ]
• 14. Brakoulias V, Starcevic V. The characterization of beliefs in obsessive-compulsive disorder. Psychiatr Q. 2011;82:151–161. doi: 10.1007/s11126-010-9157-8. [ DOI ] [ PubMed ] [ Google Scholar ]
• 15. Sanders J, Whitty P, Murray D, Devitt P. Delusions or obsessions: the same only different? Psychopathology. 2006;39:45–48. doi: 10.1159/000089663. [ DOI ] [ PubMed ] [ Google Scholar ]
• 16. Wu KD, Cortesi GT. Relations between perfectionism and obsessive-compulsive symptoms: examination of specificity among the dimensions. J Anxiety Disord. 2009;23:393–400. doi: 10.1016/j.janxdis.2008.11.006. [ DOI ] [ PubMed ] [ Google Scholar ]
• 17. Egan SJ, Wade TD, Shafran R. Perfectionism as a transdiagnostic process: a clinical review. Clin Psychol Rev. 2011;31:203–212. doi: 10.1016/j.cpr.2010.04.009. [ DOI ] [ PubMed ] [ Google Scholar ]
• 18. Pleva J, Wade TD. Guided self-help vs pure self-help for perfectionism: a randomised controlled trial. Behav Res Ther. 2007;45:849–861. doi: 10.1016/j.brat.2006.08.009. [ DOI ] [ PubMed ] [ Google Scholar ]
• 19. Glover DS, Brown GP, Fairburn CG, Shafran R. A preliminary evaluation of cognitive-behaviour therapy for clinical perfectionism: a case series. Br J Clin Psychol. 2007;46:85–94. doi: 10.1348/014466506x117388. [ DOI ] [ PubMed ] [ Google Scholar ]
• View on publisher site
• PDF (413.9 KB)
• Collections

Similar articles

Cited by other articles, links to ncbi databases.

• Download .nbib .nbib
• Format: AMA APA MLA NLM

Add to Collections

OCD is so much more than handwashing or tidying. As a historian with the disorder, here’s what I’ve learned

PhD Candidate in History, University of Sheffield

Disclosure statement

Eva Surawy Stepney receives funding from the Arts and Humanities Research Council (AHRC) via the White Rose College of the Arts and Humanities (WRoCAH).

University of Sheffield provides funding as a founding partner of The Conversation UK.

View all partners

Readers are advised that this article contains explicit discussion of suicide and suicidal and obsessional thoughts. If you are in need of support, contact details are included at the end of the article.

At the age of 12, “out of nowhere”, Matt says he started having repetitive thoughts concerning whether he wanted to end his life. Every time he saw a knife, he would ask himself: “Am I going to stab myself?” Or, when he was near a ledge: “Am I going to jump?”

Matt had heard a lot about teenage depression, and thought this must be what was going on. But it was confusing, he says: “I didn’t feel suicidal, I really enjoyed my life. I just had an intense fear of doing something to hurt myself.”

Shortly afterwards, pre-empted by hearing about a notorious banned film, Matt began questioning whether he, like the central character, might be a serial killer. These thoughts “kept coming and coming” and he would lie in bed running over scenarios, trying to work out whether he was “going crazy”:

I really needed help. I didn’t know who to talk to. But it wasn’t on my radar to think about this as OCD.

Obsessive-compulsive disorder (OCD) is a significant mental health diagnosis in the 21st century. The World Health Organization (WHO) lists it as one of the ten most disabling illnesses in terms of loss of earning and reduced quality of life, and OCD is frequently cited as the fourth most common mental disorder globally after depression, substance abuse and social phobia (anxiety about social interactions).

Yet everything Matt knew about OCD, he tells me, came from daytime talkshows where “people were washing their hands 1,000 times a day – it was all about external and really extreme behaviours”. And that didn’t feel like what he was going through.

Across the world, we’re seeing unprecedented levels of mental illness at all ages, from children to the very old – with huge costs to families, communities and economies. In this series , we investigate what’s causing this crisis, and report on the latest research to improve people’s mental health at all stages of life.

A similar experience is recounted in the 2011 book Taking Control of OCD by John (not his real name) who, after a colleague had taken their own life, became “inundated with thoughts” about what he might do to himself. Every time he crossed the road, John thought: “What would happen if I stopped moving and was run over by a bus?” He also had thoughts of murdering those he loved. John recalled:

Try as I might, I just couldn’t chase the thoughts out of my head … When I tried to explain what was going on to my girlfriend, I couldn’t find a way of articulating what was happening to me … At the time, I thought OCD was all about triple-checking you had locked the front door and that your drawers were tidy.

Despite the prevalence of OCD in contemporary society, the experiences of Matt and John reflect two important features of this disorder. First, that the stereotype of OCD is one of washing and checking behaviours – the compulsions aspect, defined clinically as “repetitive behaviours that a person feels driven to perform”. And that obsessions – defined as “ unwanted, unpleasant thoughts ” often of a harmful, sexual or blasphemous nature – are viewed as obscure, confusing and unrecognisable as OCD.

People who experience obsessional thoughts are therefore frequently unable to identify their symptoms as OCD – and neither , very often, are the experts they see in clinical settings. Due to mischaracterisations of the disorder, OCD sufferers with non-typical, less visible presentations usually go undiagnosed for ten or more years .

When John visited his GP, he was diagnosed with depression. He recalled that the GP concentrated more on the visible effects of his distress - a lack of appetite and disrupted sleeping patterns. The thoughts remained invisible. As he put it:

I don’t know how you’re supposed to tell someone you don’t know that you have thoughts about killing people you love.

Even for those with “textbook” OCD such as my friend Abby, “the compulsion is just the tip of the iceberg”. Abby was able to self-diagnose at the age of 12, when she experienced handwashing and locking door compulsions. She says people still think of her as “Abby [who] likes to wash her hands a lot”.

Now, she tells me, “I realise that I have no interest in washing my hands – I’m a pretty messy person, and I don’t mind other people being messy.” Rather than a love of cleaning, her acts were related to the altogether scarier obsessional thought: “What if I am going to hurt other people?”

Clinical guidelines, such as those provided in the UK by the National Institute for Health and Care Excellence , define OCD as being characterised by both compulsions and obsessions. So, why do the difficulties encountered by Matt, John and Abby – of recognising the internal thoughts that dominate their lives – appear to be so common ?

My experience of OCD

From the age of 16, I have also suffered with thoughts that I later came to associate with OCD, but which began as invisible and tormenting. An article I wrote in 2014, entitled The Unseen Obsession , described my experience of having left university midway through my studies due to a single thought that gathered “such power that I even ended up attacking my body in an attempt to eliminate its force”. I wrote:

I have suffered with obsessional thoughts for the last four years, and can safely say that [OCD] is far from being about clean hands.

My obsessions have taken many forms since my teenage years. They began with me wondering whether things really existed, whether my parents were really who they said they were, and whether I wanted to harm – and was a risk to – my family, friends, even my dog.

Many of us know what it is like to ruminate about a person, a conflict, or something else we feel anxious about. But for those with obsessional thoughts (diagnosed or otherwise), this is quite different to simply “overthinking”. As I attempted to explain in my article:

Conversations falter as the thought leaps through your mind. Other topics seem less important, and time to yourself provides space to assess, analyse, and look for evidence of the thought being ‘true’ … [Obsessing] is like fighting: you push and shove your thoughts away and they come back with twice as much force. You spend time trying to avoid them and they pop up everywhere, taunting and mocking your failed attempt at running away.

It took me six months of weekly therapy sessions before I felt able to voice my obsessional thought to my therapist – someone I had known for a number of years. My unwillingness to be open about it was not only tied up with feelings of shame about its taboo content, but also my inability to see such thinking as part of a recognised disorder.

The question of what constitutes OCD, why we understand – and misunderstand – it as we do, as well as my own experience of living with it, led me to study how OCD became recognised and categorised as a mental health disorder .

In particular, my research shows that there are important insights to be gained from the research decisions made by a group of influential clinical psychologists in south London in the early 1970s – shedding light on why so many people, myself included, still struggle to recognise and make sense of our obsessional thoughts.

The origin of the concepts

Categories of mental illness are not stable across time. As medical, scientific, and public knowledge about an illness changes, so does how it is experienced and diagnosed.

Prior to the 1970s, “obsessions” and “compulsions” did not exist in a unified category – rather, they appeared in an array of psychiatric classifications. At the start of the 20th century, for example, British doctor James Shaw defined verbal obsessions as “a mode of cerebral activity in which a thought – mostly obscene or blasphemous – forces itself into consciousness”.

Such cerebral activity could, according to Shaw, arise in hysteria, neurasthenia , or as a precursor to delusions. One of his patients – a woman who experienced “irresistible, obscene, blasphemous and unutterable thoughts” – was diagnosed with obsessional melancholia, a “form of insanity”.

The symptom arose from what Shaw defined as “nervous weakness”, an explanation that reflected the broader 19th-century view that obsessional thoughts were indicative of a fragile nervous system – either inherited, or weakened through overwork, alcohol or promiscuous behaviour (described as “ degeneration theory ”). Notably, Shaw did not mention any form of repetitive behaviour in relation to these verbal obsessions.

At a similar time to Shaw’s writings, Sigmund Freud, the Austrian founder of psychoanalysis, developed his psychoanalytic category of “ Zwangsneurose – translated in Britain as "obsessional neurosis” and in the US as “compulsion neurosis”. In Freud’s writings , the “Zwang” referred to persistent ideas that emerged from a repressed conflict between unresolved childhood impulses (those of love and hate) and the critical self (ego).

Freud’s most famous case study , published in 1909, featured the “Rat Man”, a former Austrian army officer who possessed a variety of elaborate symptoms. In the first instance, he had become obsessed that he would fall victim to a horrific rat-based punishment that had been recounted to him by a colleague. The patient also expressed that if he had certain desires such as a wish to see a woman naked, his already-deceased father “will be bound to die”.

The Rat Man was described by Freud as engaging in a “system of ceremonial defences” and “elaborate manoeuvres full of contradictions” that have been read by some as the behavioural aspects of what would become OCD. However, there are crucial differences between the “defences” of Freud’s client and the compulsions of OCD, including that the former largely involved thinking rather than acting, and were by no means consistent or stereotyped.

This article is part of Conversation Insights The Insights team generates long-form journalism derived from interdisciplinary research. The team is working with academics from different backgrounds who have been engaged in projects aimed at tackling societal and scientific challenges.

The psychoanalytic category of “obsessional neurosis” was adopted and modified in Britain during the first world war, and became a staple – but inconsistently defined – diagnosis in British psychiatric textbooks of the inter-war period. Up to the 1950s, the terms “obsession” and “compulsion” were being used interchangeably in psychiatric writing. The complexity surrounding their meaning is demonstrated in the writings of Aubrey Lewis , a leading figure in post-war British psychiatry, who referred to “obsessional illnesses” as being made up of “compulsive thoughts” and “compulsive inner speech”.

Like Freud, Lewis mentioned the “complex rituals” of the obsessional – such as the patient “who is perpetually putting himself in the greatest trouble to ensure that he never steps on a worm inadvertently”. But he cautioned against “the dangers of associating any kind of repetitious activity with obsessionality”, writing that “it certainly cannot be judged on behaviourist grounds”.

Defining OCD by visible behaviour

OCD began to emerge in the form we recognise it today from the early 1970s – and was established as a formal psychiatric disorder through its inclusion in the third and fourth editions of the American Psychiatric Association’s Diagnostic and Statistical Manual (commonly known as DSM-III and DSM-IV) in 1980 and 1994.

The centrality of visible and measurable behaviours in the categorisation of OCD – particularly washing and checking – can be traced back to a series of experiments conducted by clinical psychologists in the early 1970s at the Institute of Psychiatry and the Maudsley Hospital in south London.

Under the direction of South African psychologist Stanley Rachman, the complex array of symptoms contained in the categories of obsessional illness and obsessional neurosis were divided into two: “visible” compulsive rituals, and “invisible” obsessional ruminations. While Rachman and his colleagues conducted a large research programme on compulsive behaviours, obsessions were relegated to the backburner.

For example, in their investigation of ten psychiatric inpatients diagnosed with obsessional neurosis, “compulsions had to be present for entry into the trial and patients complaining of ruminations were excluded” – a statement reiterated throughout subsequent experiments.

Indeed, this study did not merely require patients to exhibit some form of visible compulsion. The ten patients included were exclusively those with “visible handwashing” behaviour, which was viewed as the “easiest” symptom to experiment on. Likewise, the second round of studies only included patients who engaged in visible “checking” behaviour, such as whether a door was unlocked.

In a 1971 paper , Rachman offered his rationale for taking this approach, explaining how “obsessional ruminators raise special problems for the clinical psychologist because of their subjective, private nature”. This, he argued, was in contrast with “the other main feature of obsessional neurosis, compulsive behaviour, which can be approached with greater ease. It is visible, has a predictable quality, and many reproducible analogies in animal research”.

Rachman viewed compulsions as “visible” and “predictable” in large part due to the way clinical psychology had developed as a new profession in Britain, at the Maudsley Hospital in particular, in the decades following the second world war. To differentiate their practice from the existing mental health professions of psychiatry (medically trained doctors specialising in mental health) and psychoanalysis (talking therapy derived from Freud), these early clinical psychologists presented themselves as “ applied scientists ” who brought scientific methods from the laboratory to a clinical setting. Their conception of science was rooted in empiricism – with an emphasis on visibility, measurability and experimentation.

As part of this commitment to empirical science, these clinical psychologists adopted a model of anxiety derived from 20th-century behaviourism. This focus on observable behaviour was viewed as having much greater scientific value than psychoanalysis, which dealt with the “ unverifiable ” and “unscientific” realm of thoughts and thinking.

So, when obsessional ruminations gained a renewed focus in the mid-1970s, it was through this lens of visible compulsive behaviours. Rachman and his colleagues started talking about “mental compulsions” (such as saying a good thought after a bad thought) as “equivalent to handwashing”- rather than focusing on the importance and content of these thoughts in their own right.

In the early 1980s, clinical psychology came under pressure from cognitive psychologists (those concerned with thinking and language) for its reductive focus on behaviour. But despite this move to include cognitive approaches , the centrality of visible behavioural compulsions has continued to characterise perceptions of OCD in cultural and clinical domains.

This is perhaps most evident in media portrayals of the disorder – a critique taken up by cultural scholars such as Dana Fennell , who look at representations of OCD in TV and film.

The archetypal portrayal of OCD has not been helped by the recent publicity given to David Beckham and his extensive tidying . When I ask Abby what she thought about the attention that Beckham’s OCD was receiving in the media, she replies: “It’s so boring. It’s the same presentation that always gets thought of as OCD.”

Limitations to the ‘gold standard’ treatment

This archetypal portrayal of OCD also relates to how it is treated. The “gold standard” treatment in the UK today is the behavioural technique of exposure and ritual prevention (ERP), either on its own or combined with cognitive therapy. ERP gained acceptance from the experiments of Rachman and colleagues in the early 1970s, when they were exclusively working with patients with observable behaviours.

One of their key studies involved patients from the Maudsley Hospital who repeatedly washed their hands. They were told to touch smears of dog excrement and put hamsters in their bags and in their hair, while being prevented from washing for increased lengths of time.

Such experiments were again governed by observability and measurability. The “success” of ERP treatment – and its perceived superiority over psychiatric and psychoanalytic methods – was demonstrated by a reduction in the patients’ visible handwashing behaviour.

Today, if you are diagnosed with OCD by a psychiatrist and given OCD-specialist treatment via the NHS, you will most likely be told to undergo the same kind of ERP procedure that hospital inpatients were experimentally given in the 1970s: touching a set of items that you fear (exposure) while being prevented from engaging in your usual compulsive behaviour.

An identical method is also used when it comes to obsessional thoughts. Patients are asked to identify their worrying obsession, then either expose themselves to provoking situations or repeat the thought in their mind without engaging in “mental compulsions” – such as counting, replacing a bad thought with a good thought, or trying to “solve” the content of the obsessional thought.

It’s certainly true that this form of behavioural therapy can be hugely helpful in the treatment of OCD symptoms. Abby, after undergoing ERP for 14 years, said she had “developed a lot of practices around not giving into my [washing and checking] compulsions”.

I also found the approach beneficial in reducing the threatening quality of my obsessional thoughts. Repeating “I want to hurt my family” or “I don’t really exist” to myself over and over again, without actually trying to solve these issues, reduced the time I spent ruminating.

However, while being a huge advocate of ERP, Abby also observed that “sometimes when I get rid of a compulsion, it doesn’t mean I just get rid of the obsession.” While the “outward compulsions” disappear, “it doesn’t mean my mind stops cycling and mental questioning”.

Some contemporary clinicians have referred to ERP, designed around visible symptom reduction, as a “ whack-a-mole technique ” – you get rid one symptom (obsession or compulsion) and another pops up.

ERP is frequently accompanied with cognitive therapy techniques, such as cognitive restructuring (identifying beliefs and providing evidence for and against them), or being told that obsessions are “just thoughts”, that they are meaningless, and that you do not want to enact them.

Despite the success of cognitive-behaviour therapy (CBT) and ERP in scientific trials, a major review of evidence in 2021 questioned whether the effects of the approach in treating OCD had been overstated – reflecting the high proportion of OCD cases that are designated as “ treatment resistant ”.

I also believe there are some crucial limitations to contemporary treatments for OCD. Exposure (ERP) techniques stem from a period in which thoughts were not being considered at all by clinical psychologists, while CBT designates the content of obsessional thoughts as unimportant. Matt, like me, has found that CBT “can only take you so far”, explaining:

Part of this was that [CBT therapists] are so committed to the idea that thoughts don’t have meaning … [They] treat your symptom and once those are gone, you should get on with your life. I didn’t find that there was a way of thinking about [my] ruminations in the context of my whole life.

Experiences of alternative treatments

So much of my understanding about OCD has changed since I first wrote about it for Rethink Mental Illness almost a decade ago. Thinking about the historical development and categorisation of OCD has, it turns out, given me a greater sense of ease regarding this widely misunderstood condition. I feel less bound by our current conceptual frameworks, and more able to reflect on what I think is helpful in terms of how to successfully manage my obsessional thoughts.

For example, despite being warned away from psychoanalysis from a young age (my mum is a clinical psychologist, and psychologists are often fervently anti-psychoanalytic!), I have found psychoanalysis incredibly helpful in becoming comfortable with my thoughts.

This is because CBT typically focuses on present symptoms without looking into their meaning or how they relate to your personal history, and this comes into tension with my desire, as a historian, to think about the past. In contrast, psychoanalysis locates obsessional thoughts in history – pointing to childhood as a crucial point of psychic development. I have been able to understand my obsessions as the result of a deep childhood fear concerning the death of my loved ones, from which I developed a rigid desire for control.

As a young teenager trying to determine what was going on with him, Matt went to the public library and took out a Freud reader . He describes this as “the worst possible thing for a 14-year-old to read”, as it made him believe “that I did really have all these [murderous suicidal] impulses and all my fears are true”.

Despite this experience, while training to become a social worker, he “got into psychoanalysis as an alternate way to think about therapy and think about my own experience”. For him, psychoanalysis revealed the opposite to the image of “OCD as handwashing”.

Instead, he says, it focused on the aspects of “obsessionality that are internal”, showing him that the “mind is so powerful that it can produce a lot of imaginary fears”. It also allowed him to see “OCD symptoms as wrapped up with my whole life”.

Particularly profound in psychoanalytic thought is the acceptance of the complexity and unknowability at the heart of human experience. As Jaqueline Rose, professor of humanities at Birkbeck, University of London, wrote: :

Psychoanalysis begins with a mind in flight, a mind that cannot take the measure of its own pain. It begins, that is, with the recognition that the world – or what Freud sometimes refers to as ‘civilisation’ – makes demands on human subjects that are too much to bear.

This idea of “a mind in flight” has helped me think about my obsessions – whether my parents are really who they say they are; am I going to hurt those I love? – as part of a battle for certainty and control that is both unattainable and understandable, considering the world we live in.

The aim of psychoanalytic treatment is not to eradicate symptoms but to bring to light the difficult knots that humans have to deal with. Matt refers to psychoanalysis as acknowledging “a sort of messiness of the mind … I’ve found the psychoanalytic view of accepting your own messiness extremely helpful”. Rose similarly describes psychoanalysis as “the opposite of housework in how it deals with the mess we make”.

In the UK, psychoanalysis has been rejected within NHS service provision. And I believe this is, at least in part, a result of historical critiques levelled at it by clinical psychologists as they developed behaviour therapies to treat OCD in the late 20th century.

‘A lot of emotion and sadness’

While compulsive behaviour such as handwashing and checking is widely perceived as “representative” of OCD, the tormenting experience of having obsessional thoughts is still rarely acknowledged and discussed. The shame and confusion attached to such thoughts, coupled with the feeling of being misunderstood, make this an important issue to address, particularly when misdiagnosis of OCD is so high.

My PhD on the history of OCD has also showed me the ways in which psychological research shapes how we conceive of diagnostic categories – and consequently, ourselves. While psychology’s commitment to objectivity, empiricism and visibility has provided tools that are tremendously useful in the clinic, my research sheds lights on how the often-exclusive focus on visible symptoms has at times trumped the appreciation of the complex experience of having obsessional thoughts.

I first met Matt in 2019 at the first OCD in Society conference, held at Queen Mary University of London, where he was giving a presentation on the “multiple meanings of OCD”. We discussed our own experiences of the disorder, and what we thought that history, psychoanalysis and anthropology could contribute to understandings of OCD.

Matt was 34, and he told me this was the first time he “had ever voiced the internal stuff out loud, and heard other people talk about it”. Recalling how this made him feel, he continued:

I felt a lot of emotion and sadness. The isolation had been such a big part of my life that I had stopped noticing it. Then being out of the isolation was such a relief, it made me realise how bad it had been.

If you are experiencing suicidal thoughts and need support, you can call your GP, NHS 111 , or free helplines including Samaritans (116 123), Calm (0800 585858) or Papyrus (0800 068 4141).

In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here .

For you: more from our Insights series :

How to solve our mental health crisis

How music heals us, even when it’s sad – by a neuroscientist leading a new study of musical therapy

Unlocking new clues to how dementia and Alzheimer’s work in the brain – Uncharted Brain podcast series

To hear about new Insights articles, join the hundreds of thousands of people who value The Conversation’s evidence-based news. Subscribe to our newsletter .

• Mental health
• Sigmund Freud
• Mental illness
• Obsessive-compulsive disorder
• Mental illness stigma
• Mental health care
• Psychoanalysis
• Insights series
• Obsessive compulsive disorder
• Tackling the mental health crisis

Research Fellow Virology

Integrated Management of Invasive Pampas Grass for Enhanced Land Rehabilitation

Economics Editor

Deputy Vice-Chancellor (Indigenous Strategy and Services)

Join our Newsletter

Get helpful tips and the latest information

10 Famous People With OCD & What You Can Learn From Them

Author: Elizabeth Yoak, LMHC, NCC

Elizabeth Yoak LMHC

Elizabeth specializes in anxiety, trauma, ADHD, and OCD treatment, integrating DBT, CBT, mindfulness, and EMDR for comprehensive care.

Meera Patel DO

Dr. Patel has been a family physician for nearly a decade. She treats and evaluates patients of all ages. She has a particular interest in women’s mental health, burnout, anxiety, and depression.

Struggling with obsessive-compulsive disorder (OCD) can feel isolating, like you’re the only one experiencing the symptoms you’re going through. However, there are lots of other people out there with OCD, even celebrities. Some famous people who have been open about OCD are David Beckham, Justin Timberlake, Camila Cabello, and more.

Do I have OCD?

NOCD therapists can evaluate you for OCD and help you receive appropriate care. Get started with a free 15 minute call .

What Is OCD?

Obsessive-compulsive disorder is a mental health condition that affects roughly 2-3% of people in the United States. 1 People with OCD often experience intense anxiety, although OCD is no longer classified as an anxiety disorder. OCD typically follows a cyclical pattern of having intrusive thoughts, known as obsessions and completing repetitive behaviors, known as compulsions, in response to these obsessions.

OCD symptoms can develop at multiple points throughout life. The two most common periods where OCD symptoms occur are between 8-12 years old and late adolescence to early adulthood. 2 Family history of OCD and exposure to trauma or stressful events are risk factors for this disorder. 3

OCD is characterized by:

• Obsessions: Obsessions are recurring, unwanted, intrusive thoughts that cause high distress for the individual experiencing them.
• Compulsions: Compulsions are repetitive behaviors that someone with OCD feels compelled to perform, often in response to an obsession. These behaviors can take multiple forms, such as mental compulsions or observable behaviors.

How OCD Can Increase Success

Although OCD can lead to increased distress and anxiety, there are also traits of OCD that may be helpful and viewed as strengths. People with OCD may have good organization skills, attention to detail, and higher levels of empathy. These skills can be beneficial in various job settings, especially when people learn to manage the anxiety aspects of their OCD.

Here are common OCD strengths that can increase success:

• Good organizational skills: Some individuals with OCD, particularly symmetry OCD , may need to arrange items in a specific way. This can be used as a strength in the form of organizational skills.
• Attention to detail: Many people with OCD are detail-oriented, which can be useful in various settings and workplaces.
• Imagination and creativity: People with OCD often imagine various scenarios that cause them distress. However, harnessing this creativity and channeling it into something productive can use this as a strength.
• Empathy for others: Because of the struggles and anxiety that often accompany OCD, this can create more profound empathy for others who have had similar experiences.
• Determination: Compulsions are often described as a drive to perform certain behaviors. This same drive and determination to do other tasks can be seen as a strength.
• Persistence: Directing the drive that propels someone with OCD to perform compulsive behaviors into a meaningful goal can help them continue to work toward that goal, even when faced with adversities.

OCD Community - Free To Join!

Join others who are overcoming OCD. Participate anonymously. Find support, connect, and overcome challenges with us. The community is managed by NOCD. Join The Community

10 Famous People With OCD

A great example of using OCD as a strength can come from looking at famous people who have OCD and have been able to overcome their symptoms or use them as a strength. Living with OCD can have its challenges, but the famous individuals below have spoken out about OCD and their advice for living with it.

Here are ten celebrities with OCD:

1. David Beckham

Soccer superstar David Beckham has opened up about living with OCD and its impact on his life. He reports struggling with specific cleaning rituals and having to arrange and organize items in a specific way. He has stated, “I’ve got this obsessive-compulsive disorder where I have to have everything in a straight line or everything has to be in pairs.” 4

Beckham has shared about this in his most recent Netflix documentary, including how it affects him at home, stating, “The fact that when everyone’s in bed I then go around, clean the candles, turn the lights on to the right setting, make sure everywhere is tidy.” 5

2. Howie Mandel

Comedian and actor Howie Mandel has been an advocate for helping others further understand OCD and what it’s really like for those living with it. He has worked with NOCD , an online platform helping to educate others about OCD and help provide therapy for individuals with OCD. In his partnership with them, he shares about the debilitating nature of the disorder to show others what it is truly like. 6

Mandel shares about living with “repetitive and intrusive thoughts and fixations often brought on by my debilitating fear of germs.” 7 He shares his advice for others who believe they may have OCD, stating, “You are not alone. Seek support and help from professionals. So many people are misdiagnosed, so take the important steps to get help and find community and treatment so you can thrive and live!” 7

3. Leonardo DiCaprio

Actor Leonardo DiCaprio has shared about his struggles with OCD throughout his life. He shares that he initially struggled with OCD at age 11, which worsened when he moved to LA at age 18. 8 He has disclosed having repeating compulsions, such as walking on cracks in the sidewalk a specific way, walking in and out of doorways, and knocking on wood before entering a room a certain number of times. 8,9

DiCaprio shares that his symptoms worsened while portraying another famous individual with OCD, Howard Hughes, in the movie The Aviator . Although he wanted to portray this role to show the impacts of living with OCD, he reports his symptoms increased, stating, “I was trying to be the character. It became real bothersome, even after the filming.” 10 Fortunately, once he was able to return to treating his OCD , he was able to manage his symptoms. 9

4. Howard Hughes

Howard Hughes experienced severe symptoms of contamination OCD . After his death, a psychological autopsy was completed to investigate his mental health before his passing. 11 This revealed that Hughes feared germs throughout childhood that continued to increase in adulthood.

Some measures he took to prevent contamination included detailed rituals and manuals he provided to his staff on food preparation and serving, hand washing, and more. For example, he wrote a manual on opening cans by removing the label, scrubbing the can, and pouring the contents without touching the can into the bowl. 11 This is just one example of the rituals he had his staff perform to prevent contamination.

5. Cameron Diaz

Actress Cameron Diaz has shared her fear of germs and compulsions such as repetitive hand washing, avoiding touching door handles in public places and cleaning door knobs in her home so much that the paint has worn off. 12 Although she has shared about the debilitating nature of this in the past, she has recently shared about how she has “made her peace” with it now. 12

Treatment for OCD

NOCD: Online OCD Treatment Covered by Insurance – Regain your life from OCD. Do live video sessions with a licensed therapist specialized in treating OCD. Treatment from NOCD is covered by most major insurance plans. Learn how you can use your insurance benefits. Visit NOCD

Talkiatry: Is OCD Medication Right for You? Speak with a Doctor – Talkiatry can match you with a psychiatrist who takes your insurance and is accepting new patients. They’re in-network with major insurers and offer medication management with supportive therapy. Free Assessment

6. Justin Timberlake

Singer Justin Timberlake has disclosed living with both OCD and ADHD , both of which have made life challenging for him at times. He reports having OCD since childhood and has shared about the intrusive thoughts and compulsions that come with this disorder, such as hand-washing rituals and arranging items a specific way. 13 Despite these symptoms, Timberlake has succeeded in acting and singing.

7. Camila Cabello

Singer Camila Cabello has been open about her struggles with OCD and how much of an impact it has had on her. She reported having relentless “obsessive thoughts and compulsive behaviors” that caused her to experience physical symptoms, such as headaches and difficulty sleeping. 14 She shares about the “internal war” within herself as well as how she was able to overcome it.

Cabello shares that she has managed these symptoms with therapy, medication, and breathing techniques. 14 She shares the importance of getting help and breaking the mental health stigma of doing so, stating, “Social media can make us feel like we should be as perfect as everybody else seems to be. Far from being a sign of weakness, owning our struggles and taking the steps to heal is powerful.” 14

8. Daniel Radcliffe

Actor Daniel Radcliffe has shared about OCD symptoms he has experienced since as young as five. He reports compulsive behaviors, such as repeating things he says to himself under his breath. Regarding his advice for anyone else experiencing OCD, he states, “I would encourage everyone to undergo therapy. It doesn’t mean you’re insane or weak.” 15

9. Jessica Alba

Actress Jessica Alba has opened up about living with OCD and where she feels it derived from. She shares that, as a child, she struggled with ongoing medical issues that left her out of control. This, in turn, led to a need for control that came in the form of her OCD symptoms. Alba has opened up about having checking compulsions and repetitive hand-washing behaviors. 13,16

10. Billy Bob Thornton

Actor Billy Bob Thornton has shared in the past about his struggles with OCD and the origin of these symptoms in childhood. He shares that his OCD symptoms developed from childhood trauma from being abused by his father. 17 Thornton has reported symptoms of counting OCD , stating that his symptoms focus on mathematics and numbers. 12,17

He describes, “Certain numbers represent certain people. And I can’t use that number in certain circumstances. And then I have to use it in another circumstance.” 17 Thornton has shared about channeling these struggles into his work by using them to portray characters and even writing a song about his repetitive counting behaviors, titled “Always Countin.” 12

How to Be Successful With OCD

Like the famous people listed above, others can also succeed with OCD. An important first step in the process is seeking treatment for OCD so that it does not interfere with daily life tasks. Once OCD is properly treated, using the strengths that can come from it can lead to success both personally and professionally.

Treatment options for OCD include:

• Exposure and response prevention (ERP):  This therapeutic approach is considered the gold standard exposure therapy for OCD . It involves completing exposures that provoke the feared obsessive thought without engaging in compulsive behaviors during the exposure. This ultimately helps break the link between obsessions and compulsions and reduces distress.
• Medications: The most common medications for OCD are known as selective serotonin reuptake inhibitors (SSRIs), also called antidepressants. Some medications helpful for OCD are Luvox, Prozac, and Paxil.
• Cognitive behavioral therapy (CBT): CBT explores the connection between thoughts, feelings, and behaviors. CBT for OCD attempts explicitly to break the link between obsessive thoughts and compulsive behaviors that are used to reduce distressing feelings caused by these thoughts.
• Mindfulness-based CBT: Mindfulness-based CBT teaches individuals to notice intrusive thoughts and let them come and go without judgment or the need to act on them. By taking a more observational stance on these obsessive thoughts, the drive to work on compulsions in response to these thoughts can decrease.
• Acceptance and Commitment Therapy (ACT): The ACT approach encourages psychological flexibility and looking at ways to respond to the distress caused by obsessions other than compulsions. ACT emphasizes letting an obsessive thought pass and choosing a different response aside from a compulsion.
• EMDR: The EMDR for OCD therapeutic approach can be helpful if OCD symptoms are thought to be rooted in past traumas. EMDR works to desensitize and reprocess prior traumatic events that contribute to present-day distress, therefore reducing symptoms of OCD.

When to Seek Professional Support for OCD

As some of the celebrities above have mentioned, getting treatment for OCD is an important step. Seeking treatment can help you use OCD as a strength rather than it being what is holding you back. Searching an online therapist directory for an OCD specialist is a great place to start looking for a professional who is the right fit for you. Using an online therapy platform like NOCD can also be helpful for those who want to seek treatment from home.

OCD Therapy That Works!

NOCD Therapy is clinically proven to reduce OCD symptoms in over 90% of members. Covered by many insurance plans.

In My Experience

Additional resources.

To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.

OCD Therapy

NOCD: Effective, Affordable, & Convenient OCD Therapy Do live, face-to-face video sessions with a therapist who specializes in treating OCD and get 24/7 support between sessions. NOCD is covered by many insurance plans and is available nationwide. Visit NOCD

Treatment from an Online Psychiatrist

Talkiatry OCD is treatable. Talkiatry specializes in OCD and provides personalized care with medication and additional support. Get started with a short assessment.

OCD Community - Free to Join!

Join others who are overcoming OCD. Participate anonymously.  Find support, connect, and overcome challenges with us. The community is managed by NOCD. Join The Community

OCD Newsletter

A free newsletter from Choosing Therapy for those impacted by OCD. Get helpful tips and the latest information. Sign-Up

What to know when finding a therapist for OCD

With so much information out there regarding providers and treatment options for obsessive compulsive disorder, it can be hard to know exactly where to start—especially when you have to consider everything from the type of provider to the different treatment methods, as well as how you’ll fit it into your busy schedule.

Can OCD make it hard to make decisions?

From choosing what to wear in the morning to picking what to eat for dinner, decision-making is a part of everyone’s daily routine. But for millions of people with Obsessive-Compulsive Disorder (OCD), making any choice can feel like a daunting, sometimes impossible task.

10 Famous People With OCD & What You Can Learn From Them Infographics

Find a therapist in your state

Get the help you need from a therapist near you

Arizona California Colorado Connecticut District of Columbia Florida Georgia Illinois Indiana Kansas Kentucky Maryland Massachusetts New Jersey New York North Carolina Pennsylvania Virginia

Are you a Therapist? Get Listed Today

A free newsletter for those impacted by OCD. Get helpful tips and the latest information.

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy .

American Psychiatric Association. (2022, October 1). Psychiatry.org – What Is Obsessive-Compulsive Disorder? American Psychiatric Association. Retrieved from https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder

International OCD Foundation. (n.d.). Who Gets OCD? International OCD Foundation. Retrieved from https://iocdf.org/about-ocd/who-gets-ocd/

Obsessive-Compulsive Disorder . (2021, February 23). MedlinePlus. Retrieved  from https://medlineplus.gov/obsessivecompulsivedisorder.html

Banfield, M. (2023, April 28). David Beckham reveals impact of OCD in new documentary . The Guardian. Retrieved from https://www.theguardian.com/football/2023/apr/28/david-beckham-ocd-obsessive-compulsive-disorder-netflix-documentary

Wrench, S. (2023, May 9). David Beckham Opens up About the Reality of Life With OCD . Men’s Health. Retrieved from https://www.menshealth.com/uk/mental-strength/a43834867/david-beckham-netflix-ocd/

Davis, P. (2023, February 2). Howie Mandel is on a mission to redefine how the world understands OCD . NOCD. Retrieved from https://www.treatmyocd.com/blog/howie-mandel-is-on-a-mission-to-redefine-how-the-world-understands-ocd

The Editors of The Healthy. (2022, November 3). Howie Mandel Details His Obsessive-Compulsive Disorder: ‘People Need to Know They Are Not Alone’ . The Healthy. Retrieved from https://www.thehealthy.com/mental-health/news-howie-mandel-ocd/

Mantracare Author. (n.d.). Leonardo DiCaprio OCD | How He Overcome His OCD Symptoms . MantraCare. Retrieved from https://mantracare.org/ocd/ocd-examples/leonardo-dicaprio-ocd/

D’Arcy, A. (2020, October 29). Leonardo Dicaprio’s Battle With OCD – Impulse . Impulse Therapy. Retrieved from https://impulsetherapy.com/leonardo-dicaprios-battle-with-ocd/

Eastman, A., & Everitt, A. (2017, April 16). Post . Post – Mentality Magazine. Retrieved from http://www.mentalitymagazine.org/speak-out-sunday/2017/4/16/speak-out-sunday-leonardo-dicaprio

OCD UK. (n.d.). Howard Hughes . OCD-UK. Retrieved from https://www.ocduk.org/ocd/history-of-ocd/howard-hughes/  

Kennard, J., & Bailey, E. (2018, September 14). Famous People with Obsessive-Compulsive Disorder . HealthCentral. Retrieved from https://www.healthcentral.com/slideshow/famous-people-who-have-OCD

Mantracare Author. (n.d.). 8 Famous Celebrities With OCD . MantraCare. Retrieved from https://mantracare.org/ocd/ocd-examples/celebrities-with-ocd/

VanHoose, B. (2020, May 28). Camila Cabello Gets Candid About Battling OCD: ‘I Was Desperate for Relief’ . People Magazine. Retrieved from https://people.com/health/camila-cabello-gets-candid-about-battling-ocd/

Macleod, M. (2022, November 2). Daniel Radcliffe health: Harry Potter star’s battle with alcoholism, OCD, dyspraxia . HELLO! magazine. Retrieved from https://www.hellomagazine.com/healthandbeauty/health-and-fitness/20221102155874/daniel-radcliffe-health-dyspraxia-ocd-alcoholism/

18 Celebrities and Famous People with OCD . (n.d.). Summit Malibu. Retrieved from https://summitmalibu.com/blog/celebrities-and-famous-people-with-ocd/

Curry, A. (2004, April 2). Billy Bob Thornton opens up . NBC News. Retrieved from https://www.nbcnews.com/id/wbna4654882

Your Voice Matters

Can't find what you're looking for.

Request an article! Tell ChoosingTherapy.com’s editorial team what questions you have about mental health, emotional wellness, relationships, and parenting. The therapists who write for us love answering your questions!

Leave your feedback for our editors.

Share your feedback on this article with our editors. If there’s something we missed or something we could improve on, we’d love to hear it.

Our writers and editors love compliments, too. :)

FOR IMMEDIATE HELP CALL:

Medical Emergency: 911

Suicide Hotline: 988

© 2024 Choosing Therapy, Inc. All rights reserved.

• Search Search Search …
• Search Search …

Case Study of an Adolescent Boy with Obsessive Compulsive Disorder

Susan S. Woods, Ph. D.

Youth Services, Department of Psychiatry, University of Michigan

P.Q. is a boy from Ohio, thirteen years, nine months of age. He was admitted to

Children’s Psychiatric Hospital on an emergency basis on 28 March 1975. He had

been noted by both parents to have had increasing emotional difficulties since the

previous summer. Thes.e became worse during the week prior to .his admission. His

symptoms were primarily of an obsessive ritualistic nature involving repetitious

behavior, compulsive repetitive hand washing, and gradual elaboration of rituals

around bedtime. During the week before admission he was described as

“immobilized to the point that he cannot get out of bed”, spending the larger part of

his waking hours in rituals, and being generally unable to function. His primary

symptom on.admission was that he found members of his family and certain objects

“germy” and was therefore “unable to deal with them” His father believed the

problem began in mild form during the previous summer, following a visit to his

maternal grandmother. One incident during this visit involved a trip to a

convalescent hospital, with P. subsequently being concerned and upset by sick or

damaged people, He started then by being unable to wear certain clothing because

“it was contaminated.” As time went by, areas of the house became off-limits to

him. Similarly, he felt that one of his stepbrothers “was unclean” (germy), a situation

that soon extended to all the members of the family. They were all felt to be

contaminated, with the exception of his father. His stepmother however felt that P.

had been having difficulty for a substantially longer period of time. in fact, it seems

that his symptoms had been apparent to some degree for several years, having

started some months after his mother’s death. The stepmother described the

appearance of what proved to be a long series of “strange habits” about five years

earlier during the summer. For instance, he began hopping every so many steps.

That was followed by repetitive smelling of the table and the walls, eye-blinking,

head-jerking and pausing with hands in

148 Obsessional Neuroses

praying position before entering rooms. Simultaneously, his peer relationships

deteriorated and for a year or so now his brothers and stepbrothers had been teasing him

about this behavior. More recently they had developed a strong hatred of him. Further, his

symptoms had been increasing very noticeably for the five months previous to the referral

to this institution. Thus, shortly before this happened, the Q.’s received a call from P.’s

school one evening stating that P, had been trying to get through the door and out of his

classroom for a period of over two hours. This Fall P. was referred for evaluation

somewhere else, and therapy was recommended and begun on a weekly basis with a

psychologist affiliated with the Department of Pediatrics of Ohio State University.

Three weeks prior to his admission here P. reported that he had “lost the key” to his

mental processes. His parents were uncertain as to the meaning of this and could think of

no precipitating events either within the family or with P.’s personal life.

Dr. and Mrs. Q. (P.’s stepmother) were eager for adMission at Children’s Psychiatric

Hospital and it has subsequently become obvious that they are relieved by his absence and

reluctant to have him rejoin the family unit. The Q.’s are involved in marital therapy at the

present time in Ohio, the marriage having become very rocky as a result of the stresses of

P.’s psychopathology.

P. expresSed concern upon admission that there would be retarded or weird children at

C.P.H. He was relieved after seeing the place because he saw no “weirdos” and found the

hospital to look “very clean.”

From the beginning P. has had a generally positive attitude toward admission, seeing it

as “the only way to get rid of my problem.” He can be expected at times to resent the

family’s splitting him off or scapegoating him as the one with the problems,

Description Of The Child

P. is a small, thin adolescent who has been described as an, Oliver Twist type. Indeed

he often walks around with a haunted expression, hair falling into his eyes, shirttail

hanging out, holes in.

hiS pants, etc.

Clinical Examples 149

He hardly gives the impression of a. compulsive personality, judging from his unkempt

appearance. There have been occasions when he takes care as to how he looks. These

times usually accompany a trip home or an outing with his family where he has enjoyed

Upon admission most of his clothes were rather old and shabby. He explained that he

had plenty of “cool” clothes but that they became germy after his trip to his grandmother’s

home. Finally P. was having to use safety pins to hold his pants together, wore no socks

and had large holes in his sneakers (the only shoes he would wear). He was upset, crying

when the staff finally felt that his father should be approached to ask him to buy P. some

new clothes. Dr. Q. was angry and somewhat embarrassed, explaining that P. had many

new articles of clothing including new shoes but to his and the family’s endless frustration

P. wouldn’t wear them. Dr. Q. finally bought P. some trousers and socks and a new pair of

sneakers. P. was amazed and overjoyed that his father had bothered to buy him clothes

and had spent so much money on him.

Generally P.’s behavior in the various areas of the milieu were consistent. Upon arrival

everyone was concerned about his need for repetition; for example, on his first morning at

breakfast he felt a need to throw away and retrieve his milk carton numerous times,

stating he had to “think right.” Showers and bedtime preparation were another source of

concern, often consuming the better part of the evening. Any attempt to interrupt the

rituals or hurry P. were met by his whining and crying that people didn’t understand him

or his problem. A staff member commented that he had rarely seen such pain in another

human being.

Group activities in the school and with his ward group also became problematic.

Briarwood Mall (a large, new shopping center near the hospital) for example was germy

because it was so “modern and weird.” The arboretum later became off-limits because it

bordered a cemetery. Most recently anything related to magic i.e., the color black,

sparkles, glitters, psychodelic posters, record album covers, or book covers, movies about

ghosts or witches, have produced enormous fear and given P. difficulties when trying to

“think right.”

Classroom behavior has been good and appropriate for the most part with occasional

problems with some students. After Passover P.

150 Obsessional Neuroses

developed an intense interest in Judaism, making a Star of David in Occupational

Therapy and wearing it around his neck. For a time another class member drew swastikas

on the blackboard, During TB’s vacation this rivalry became so intense that P. spent most

of his class time in the hall voluntarily and began to carry a transitional object, a ceramic

bunny, which he had made in Occupational Therapy. In P.’s Occupational Therapy group

he is the oldest member the other children ranging from ages eight to ten. The group has

changed from five to three members since P. was admitted. It is reported that P.’s

intelligence, gross and fine motor skills and creativity all appear to be age appropriate or

higher. Initially P. did not accomplish much, He spent much time•perfecting his projects.

The planning and organizational aspects of. the project were difficult for P. For example,

he wanted to make a Star of David and it was suggested to him to bend the wire to the

desired angles. He rejected this suggestion and became involved in finding a mathematical

formula to approach the problem. P. spent the remainder of the hour, approximately thirty

minutes, attempting to devise a mathematical formula. He became anxious and frustrated

with being unable to solve the problem. The next day however he was able to enter the

shop and just bend the wire to the desired angle, This seems to be P.’s approach to

problems—many times he must try to find a means of ordering or perfecting a project

before he is able to work at a more appropriate pace.

Initially P. remained apart from the group. He appeared very anxious and withdrawn.

He spoke only when addressed and interacted minimally with other group memberi. As he

became more comfortable with the others he began to interact more. He appeared to be

more at ease and seemed to enjoy the group. It appears that this group of younger children

allows him to regress to behavior inappropriate for his age i.e., making animal noises etc.

P. approached his occupational therapist on several occasions, asking about her

family and her. practice of Judaism. These conversations were precipitated by her

announcement to the group that she was taking several days off for Passover. Of late there

have been no questions concerning Judaism.

P.’s concern about a family have been brought up on a number of occasions in the

group. Once he made a family of ceramic rabbits and in a childlike manner stated “a

family—isn’t that cute?”

Clinical Examples 151

Generally P. relates N,vell to ward staff and peers and is not considered a behavior

P,’s relationship to two of his ward staff have been significant. K. and J. became

vehicles for P.’s lingering phallic-oedipal conflicts, and were loved objects. P.

frequently told K. that he wanted J. to tuck him in at night, He became anxious when

he discovered his liking for J. was greater than that for K., and he found it difficult to

understand that both could be loved .in different ways at the same time.

After K. left, P.’s liking for J. as a maternal object developed into a “crush.” He

discussed her constantly in therapy, voicing his anger after learning she was married

but seeing how futile his desires were because “she is a lot older than me,” He wanted

to be “mature” to win her attention.

During J.’s vacation P. decided that she was germy since she flew through the

“Bermuda Triangle.” Their relationship was over as far as P. was concerned. P. also

knew thatbpon J.’s return she would become a primary staff and thus have relatively

little to do with him, He attempted to leave her before she left him.

Family Background and Personal History

Mother: P.’s mother, H.Q., is deceased. A slim, dark-haired woman, she married P.’s

father in 1952, and suffered a reactive depression upon leaving her mother. After the

birth of each child except P. she suffered post-partum depressions. At each of these

times Mrs. Q.’s mother would come to aid her daughter. Mrs. Q. felt her mother could

“magically” help her to improve. Mrs. Q.’s mother was described in one report as an

“aggressive unloving woman. Mrs. Q. seemed to thrive on her criticism.”

Mrs. Q. was admitted to N,P,1. on four separate occasions for severe anxiety and

depression, She was expecting P. during her fourth hospitalization. This is a part of

the report of her psychiatrist:

If I were to speculate on some of the psychodynamics, I feel that unconsciously

Mrs. Q, felt she won the oedipal struggle against her mother. The patient’s mother is

a very hostile and aggressive woman who constantly yells and degrades the patient.

Mrs. Q. felt that she

152 Obsessional Neuroses

must have done something wrong and therefore felt guilty. We can see that since

childhood and especially since the patient has been married any symbolic libidinal or

aggressive energy (such as buying a house, having children, etc.) makes the patient

very anxious and depressed as a reaction to her guilt and she seeks the reassurance and

acceptance of her mother via the mother’s hostile and degrading comments. The patient

described a very hostile, symbiotic, sadomasochistic relationship that she had with her

mother. She felt she always had to go to her mother who in turn would berate and

belittle her, in order that Mrs, Q. should feel that she was still loved and accepted by

her mother.

The patient went on to describe that she would even provoke situations as a a child

which would ’cause her mother to yell at her and this would reassure the patient that

her mother still “cared for her,” Mrs. Q.’s mother exhibited both overtly hostile and

passive aggressive attitudes toward the child and the only way that Mrs. Q. could

retaliate was in her own passive-aggressive way by dawdling or doing things just the

opposite from the way that her mother wished.

During her hospitalization Mrs. Q. expressed suicidal thoughts and fears of harming

her children.

During her last pregnancy (P.) Mrs. Q. was told by her mother that she should never

have any more children because she couldn’t care for the ones she already had.

. Mrs. Q. went to her father as a child for emotional support and felt he loved her more

than he did his wife.

Mrs. Q. had a sister whom she viewed as “the bad daughter” and felt she had to be “the

good daughter.” Mrs. Q.’s sister has also been hospitalized for depression.

Mrs. Q. was always involved in aggressive battles throughout her life. In college she

and her husband-to-be were in the. same class. She was the valedictorian and he the

salutatorian. She went on to obtain a master’s in chemistry. On her third admission to the

psychiatric ward she talked about her husband’s attitude, stating he felt her

hospitalization was not necessary and that she was taking the easy way out.

Mrs. Q. was tremendously conflicted about motherhood. She felt

Clinical Examples 153

One can assume that during this period there was little emotional energy for nurturing

the young children in. the home.

she was still a child and wanted to be a child, Mother’s Day was apparently an enormous

symbol for her. She was admitted once just before Mother’s Day complaining that she

“couldn’t handle her life.” On another admission she became “preoccupied”, staring into

space and complaining of being frightened after a conversation among the patients

regarding Mother’s Day.

On Mother’s Day 1970 Mrs. Q. took an overdose of barbiturates and died two days

Father: R.Q. is a forty-five-year-old physician somewhere in the State of Ohio. He and

his wife were both originally from Boston where they met and married while attending

the university.

The couple moved several times early in the marriage, to Arizona, New Mexico, and

finally to Detroit, where Dr. Q. completed his residency in medicine..

Dr. Q. was seen twice on Mrs. Q.’s first admission in 1960. He was quite anxious and

seemed uncomfortable. He also seemed depressed and agitated, stating that he was unable

to concentrate on his work. He intellectualized -a great’ deal, saying that he thought his

reaction was a typical one to a depressed wife. He added that he was quite ldnely and did

not like being away from his wife. He felt that if he could be with her he could be

supportive of her as he had been in the past. Dr. Q. felt that the only person he could

accept reassurance from was a doctor who was treating his wife. Dr. T. (wife’s therapist)

called Dr. Q. daily to support him and tell him of his wife’s progress. Dr. Q.. felt that this

was not very effective in easing his anxiety but that it was all he had to hold onto. Dr. Q.

also stated that when his wife was depressed he felt depressed too and when she felt better

he felt better. The report of the treating psychiatrist goes as follows:

The highly interdependent nature of the relationship described above was confirmed

by Dr. Q.’s statements to me that he thinks his own willingness to be constantly

available to his wife tended to feed her dependency on him and that the two of them

seemed locked ,together in the ups and downs of this depressions

154 Obsessional Neuroses

Dr. Q. placed a great deal of emphasis on the kind or quality of therapy his wife

might be receiving. He was concerned that she be treated by a staff psychiatrist rather

than a resident, He resented seeing a social worker about-his adjustment to his wife’s

illness. Remnants of this are still visible in Dr. Q.’s wondering why neither he nor P.

saw psychiatrists at C.P.H. He asked about his son’s therapist’s credentials. P. too

shares these feelings, frequently asking what a social worker is, what M. S. W. stands

for, and on one occasion commenting that he believed his therapist could probably

help him as well as a senior psychiatrist. Dr. Q. is a rigid, obsessive-compulsive

character himself. This became evident in his endless ramblings from subject to

subject during the time of history taking. It was impossible for him to get through

recounting a simple event without trying also to include every minute detail of his

association to the event. He feels that his memory is poor and confused and he never

ends satisfied that he has really told the story “right.” He described himself as having a

“stubborn streak.”

Stepmother: This is the report of the parent’s therapist: During the summer

following P.’s mother’s death, – Dr. Q. arranged for a housekeeper, now Mrs. S. Q , to

come into the home. She had just divorced her first husband and was supporting three

sons from her first marriage. Her sons were away at camp during the first few weeks

after she came to the job, and she recalls that P. was the first of the Q. boys to make

friends with her, She had a great deal of time to devote to P. during these weeks and it

was only when her own children returned that she and Dr. Q. began going together. P.

then began to distance himself from her, When the marriage became imminent the

following fall, P.’s siblings reacted quite angrily and P.’s more quiet reaction seemed to

go unnoticed. Following the marriage P. became more and more withdrawn. He

especially had difficulty accepting her youngest son, who is described as being quite

different from P., i.e., rough and aggressive.

The family moved in 1971 to Toledo, where Dr. Q, practices. P.’s siblings were very

unhappy about the move and again their more obvious behavior pushed P.’s into the

background. One had problems in school and another became very depressed. O. cried

frequently, withdrew, developed colitis. At his school’s suggestion a began

Clinical Examples 155

psychiatric treatment of problems described as “similar to P.’s.” This treatment has

been ongoing to the present time. Mrs. Q. described the relationship between herself

and 0. at that time as very poor. 0. is described as being much like his mother, the first

Mrs. Q., bright and close to his dad. P. was closest to 0. of all his sibs and would often

try to emulate him (this relationship has now dete’riorated to the point that the boys

rarely speak). As relationships became more strained throughout this period it was

more and more difficult for Dr. and Mrs. Q. to communicate with each other about the

children. In 1971 the Q.’s daughter, B., was born. According to both parents her birth

was greeted quite positively by the older children. Currently B. is the only sibling

within the family with whom P. is willing to interact on his home passes and she is the

only child who inquires when he is coming home.

Developmental history: P.’s mother was hospitalized at N,13

.1, for the third and

fourth time during her pregnancy with P., for symptoms . of anxiety and depression.

She was admitted and discharged in May of 1961 and readmitted in June of 1961. Just

before Mother’s Day in 1961 she phoned her psychiatrist and described suicidal

thoughts. This pregnancy was obviously a strain for Mrs. Q. and increased her fears of

inadequacy about motherhood.

P. Was born two weeks early as was the pattern of all Mrs. Q.’s children. Labor

lasted one hour and ten minutes. P. was a six-pound, eleven-ounce infant delivered

under caudal, anesthesia. Mrs. Q. recovered quickly with no complications for either

mother or son. P. was breast-fed.

from birth and follow-up interviews with Mrs. Q. at

N. P.1. found she experienced this as pleasant and took pride in the care of her infant.

P. was described as a peaceful sleeper and he slept completely throughout the night

very early .on.

P. developed atopic dermatitis which Dr. Q. described as a red rash occurring in the

creases of his body. He said that P. did not seem to be uncomfortable with this. For

several weeks P. was put on a special diet in an attempt to determine the source of his

allergy. Dr. Q. again recalls no difficulty or food refusal during this time and the

special diet was finally stopped as the pediatrician seemed to feel it was not helping

diagnostically.

Dr. Q. says that he recalls very few specifics regarding the P.’s age at

156 Obsessional Neuroses

the various early developmental milestones, However he feels that P. accomplished most

things just a bit earlier than his two older brothers. For example, he believes his son held

his head up quite early, was responsive to external stimuli and began picking up. and

playing with crib toys at a very early age. Although he cannot recall when P. was weaned

it seems that it was fairly early and he does recall that by the age of one P. was feeding

himself, While recounting this history Dr, Q. often interjected that he recalled his wife

being troubled and anxious and on’many occasions emotionally tied up within herself. He

says that even though Mrs. Q. took good physical care of the children he feels now that

they probably were emotionally, neglected.

P. toilet trained himself at age two and half “almost overnight,” Dr. Q. does not recall

the development of P.’s speech but does remember that once he began talking he talked

almost incessantly. P, rarely played with children his own age, preferring to spend his

time with adults or playing with his older brothers,. When P. went to

kindergarten at age five, Dr. Q. recalls him telling long stories about what had happened

at the end of the day. He also recalls himself and P.’s mother being amused at what a long

story P. could make out of a very small event. The father remembers no difficulty in

separation from Mrs. Q. when P. began kindergarten.

The following information was learned from the second Mrs. Q.: Mrs. Q. said that by

the time she met P, at age seven almost all of his interests and interpersonal relationships

centered on adults. He struck her as being a very dependent but cooperative child. She

even described Him as “a model child.” She recalls that he always liked to have his things

in order although he was not really fastidious. It was always quite difficult for him to get

off to school•in the mornings as it was quite a chore to get through all of his routines. By

the age of twelve P,’s compulsive mannerisms and rituals had become a point of great

contention between him and his siblings. Mrs. Q. remembers that approximately ten

months prior to P.’s hospitalization his brothers began to noticeably withdraw from him

and make fun of him. Before long all of the siblings seemed to be angry with P. It was

also during this year, fall of 1973, that P,’s grandfather died. Although the parents would

not characterize P.’s relationship with his grandfather as a close • one, he did visit with the

grandparents annually and seemed to greatly

Clinical Examples 157

enjoy walking downtown with his retired grandfather and being a part of the

interaction with all of his grandfather’s “old cronies.” When the grandfather died the

maternal grandmother sent • the grandfather’s personal watch to O. rather than to P.

Dr. Q. •stated somewhat resentfully that this was typiCal of his former mother-in-law,

that is, to be more interested in a tradition of giving a gift to the oldest grandchild

rather than giving it to the one who had been closest to her husband.

The summer prior to this hospitalization all three of the older Q. boys were invited

to visit the grandmother. True to form, •only P. accepted the invitation and remained

with the grandmother for about three weeks. .Upon his return from this trip Mrs. Q.

states that she began really pushing for help for P.

Possibly Significant Environmental Circumstances

Timing of the Referral: The timing of the referral seems to have coincided with the

severe manifestation of the obseSsive compulsive neurosis, however the problem in

earlier more manageable stages seems to have been present for some time longer.

Since P. often has difficulties determining when events happened and how long he has

experienced difficulty, both the extent and duration of his symptoms are still

unknown, He believes, however, in agreement with his father, that the major

disturbance began last Summer after a visit to his maternal grandmother in

Connecticut.

This visit was an event for P. each year.. He was the only grandchild who enjoyed

these trips to Connecticut and last summer he went alone. This was P.’s first trip to his

grandmother’s after his grandfather had died of a heart ‘attack a year before. P. had felt

very close to his grandfather, more than to his grandmother whom he described as

“mean and al vays telling me what to do.” It is significant that P. was concerned to

maintain the ties with his mother’s parents. P. is also the only child who wants to

practice Judaism, something which is frowned upon by the rest of the family but

which was highly regarded by P.’s mother, It seems P. is trying very hard to keep his

mother alive in a sense by holding onto the significant objects in her life.

Causation of the Disturbance: Four areas can be delineated as causally significant:

1.158 ObsessionalNeuroses

2. The mother’s suicide. H.Q.’s suicide is a pivotal issue in P.’s psycho- pathology. He failed to mourn her loss, fearing that to express his feelings would be

against his father’s wishes. He is now engaged in the draining process of keeping

her alive (which he believes his father, a physician, failed to do) by holding onto

her traditions. as previously mentioned, Significantly P.’s stepmother is neither

Jewish nor religious and he resents the fact that the family has given up all Jewish

traditions. A particular blow came on P.’s thirteenth birthday when his father

offered him money and said that would take the place of being bar rnitzvahed. P.

felt this cheapened what is to him an important event – symbolizing his “becoming a

man.”.

In therapy P. had tremendous difficulty remembering his mother or any experiences

they shared. He vividly remembered, however, the day she died and described it several

times. The most significant aspects seem to have been when his mother was taken to the

ambulance. She opened her eyes for a second and looked at P. He also remembered how

angry his father became when P. told a neighbor that his mother was

1. The father’s remarriage. P. was initiallS

, warm and accepting of the present

Mrs. Q. before she married his father. After the marriage their relationship

deteriorated, She describes P. as acting like “a twoyearTold.”

The division between old family and new has continued to worsen. P. cannot accept

his stepbrothers especially now that they “have changed.” What this change entails

is their move into adolescence with a concommitant increase in foul language, rough

behavior and less care in personal hygiene.

1. The father-son relationship, ,In one session, P. described his relationship

with his father as being like the song, “Little Boy Blue and the Man in the Moon,”

where a little boy all through his life asks for time with his father but the father is

always too busy. Later the father retires and wants to be with his son but the son by

that time has his own life and says he’s too busy to see his father.

P. has tremendous difficulty expressing his feelings to his dad. He perceives him as

all-knowing and all-powerful but very inaccessible. P. is visibly elated by the grief times

he spends with his father but it seems he does not convey this when he is actually with

his father. Dr. Q. describes P.’s behavior when they are together as passive, bored and

Clinical Examples 159

angry toward sibs. When P. and his father are together they talk about science. P becomes

anxious when he runs out of things to say to his dad. (This happens in therapy too.) He

needs a mental script Well planned out before he feels comfortable.

Dr. Q. is a rigid, authoritarian person who seems to have provided an atmosphere

where P.’s feelings could not be exhibited. Childish emotions of glee or anger were

scorned. To show them meant to risk rejection and withdrawal of IOW. P. learned from an

early age to control himself, to measure up, to be adult in order to obtain parental

acceptance.

4. Adolescence. P. wants to be a man but fears outdoing his dad. He has tried to avoid

any competition with him so far, Now he is beginning to see that his father may have

problems but at the same time he has decided that all doctors are perfect and able to

overcome all difficulties.

Physically P. is small and underdeveloped. This concerns him because he wants to

be strong so he can “beat people” in games and frequently taLks of beating people up

when they upset him.

He likes to be with younger children so he can be superior but resents their childish

Adolescence has also raised the unresolved oedipal issues which are central to P.’s

difficulties.

Possibly Favorable Influences: P. is a bright, interesting, and interested child. He

relates well to peers and staff and relates warmly to particular staff, mainly women. He is

an attractive . child and is frequently described as cute.

His interests are varied and socially he is quite sophisticated.

His parents though severely troubled themselves have engaged in marital counseling. It

family is trying hard to get back on its feet. What place P. will have upon

reuniting with the family is hard to guess. P. has tremendous motivation in thearapy. He

is insightful and frequently makes his own interpretations which are often accurate.

160 Obsessional Neuroses

Assessments of Development

Drive Development

development

P. is developmentally a preadolescent. He has brodd interests in art, science, music,

especially popular music, i.e., John Denver and the Beatles. He has good relationships

with peers and adults but has difficulty when peers exhibit aggression which could be a

physical threat, or when staff is authoritarian. He expresses dislike for the rules that are

imposed and would like to liVe in the wilderness all alone, free from society’s restrictions.

Oral Phase: The oral remnants are seen in P.’s occasional sucking motions and sounds

at the end of therapy sessions, in. his dislike of young children, and in the oral-sadistic

rituals around food (putting food into his mouth and then taking it out, difficulty entering

the dining room). He also has difficulty swallowing (he must think right) and he cannot

eat, for example, at the Detroit Zoo because it is surrounded by cemeteries. (Notice the

anal-sadistic connotations of this.)

Anal phase: P. strives to control his anal-sadistic impulses and fantasies with rituals and

obsessive thoughts. One such fantasy he described as “the pool of imagination, a horrible,

dirty, black gooey place that wants to pull me into it. Sometimes my eyes fall in.”

Whenever he thinks of this he must repeat what he has been doing to avoid anxiety.

Unconsciously he is, as his stepmother described, “a two year .old” expressing

ambivalence, sado-maSochism, tendencies toward stubbornness and rebelliousness.

Rdaction formation is P.’s main defense. The move toward adolescence has undoubtedly

contributed heavily to this pattern,

Phallic-oedipal: P. describes himself as “curious George” and expresses an interest in

sex. He developed a “crush” on one of his female child-care-workers but he found this

relationship odd when in therapy he saw her as both girlfriend and mother and said “but

you can’t have sex with your mother,”

Generally P. idealizes adults, particularly men but fears his own adulthood because it

might lead him to be better than his dad,

Clinical Examples 161

P. is just beginning the adolescent phase and has not reached phase dominance. He is

expressing an interest in sex though he is having difficulty with feelings of

embarrassment. He has recently begun to discuss some of his sexual feelings in therapy.

Often they have a decided oedipal component. Recently too he has shown some interest in

a twelve-year-old girl in his class and behaved quite appropriately with her, as opposed to

infantile behavior with another girl.

b. Libido distribution

i. Cathexis of self,

Primary narcissism: P. does not have difficulty in primary narcissism. Secondary

narcissism: P. considers himself to be intelligent with a good sense of humor, however

physically his estimation of himself goes way down.. He fears he is

inadequate, not

strong, uncoordinated and thus unable to successfully compete in athletics or engage in

physical fighting with peers. To some degree his older brother’s move into adolescence

was threatening to P. and may be responsible for the symptom formation to some extent.

He believes he never got enough love or attention from his father. He desperately tries

to prove himself to his dad but is always disappointed to learn how his dad “didn’t notice”

how happy he was to be with him. His chief complaint now is that his dad is strong and

capable, so why shouldn’t he let P. come home on weekends?

P. has developed a split between his natural mother as a good mother and his

stepmother as the bad mother. He can no longer have needs satisfied by his real mother

and he fears rejection by 1-

tisstepmother.

P. is highly invested in his memories and fantasies of his mother. He recalls that when

he was about four he and his mother had mumps. The whole family was concerned about

them. P. became deaf in one ear because of his illness. He is identifying with his mother

now and says he is a replica of her because he is hospitalized “for being crazy,” He

fequently talks of suicide when difficult material is raised in therapy. One day he even

said that he tried to commit suicide by cutting his wrist with a comb but it only made

white scratches. He said that he wasn’t interested in really killing himself, he just

wondered what other people would think if he did.

His goal now is to be like his father. He wants to be a doctor (a

162 Obsessional Neuroses

neurologist) so he can learn how the brain works. He depends on his father to supply

him with the guidelines so he will not fail. His father told him “a healthy body is a

healthy mind,” after his admission to C. P. H. P. immediately began an exercising

.program. He runs contests with himself. He wants to set records, which mean

winning to him, for instance brushing his teeth every night for a year. His favorite

hero is Einstein.

His relationships with other people are warm and accepting. However, once a strong

relationship develops and any hint of rejection is present he rejects before he can be

rejected. When he learned K,D. was leaving, K. became “germy.” When P,’s primary

staff was taken away from him and assigned to another child, she became germy. He

now realizes what this behaVior means and says that if he likes someone a lot they

can’t be germy for very long,

P. is dependent on external objects to regulate his self-esteem. However he is

capable of independent action and thought, the only motivation seeming to be self- satisfaction. He has difficulty accepting praise, usually laughing or saying “sure, sure,”

but it is obvious that he likes it an agrees with it,

ii. Cathexis of objects

P. has the capacity to form and maintain relationships with peers and adults. It often

seems that the peers who become objects of competition are rejected, for example,

brothers, and a friend from Ann Arbor whom he had not seen in several years. P. was

excited about seeing this friend again but this fifteen-year-old had matured and grown

quite .a lot in the meantime. P. felt weak and small by comparison and has not

contacted his friend since. Very recently, he has expressed interest in seeing him

again. –

P, attempts to control adults with his problems. “1. can’t do that because of my

problem” This has led to concern on staffs part as to how much to push or give in to

“the problem.” At first P. would take over an hour for an evening shower, and bedtime

rituals were an agony for all involved in his care.

P.’s closest and most enjoyable relationships have been with female peers or staff.

He was very proud when a young girl from fourth level showed some interest in him

(gave him a yo-yo and sat next to him at a movie) but was somewhat embarrassed

since she was “too young” for him, His relationship with J, (female staff) has been

primarily positive

Clinical Examples 163

but very much tied to oedipal conflicts. Recently he has shown some interest in a twelve- year-old girl in his class and feels she is “the right age for him” “not half as old or twice as

old” as with his other two female interests. P.’s relationship with K.D. was good but he

felt K. was not strong enough at first. Later he felt that K. was one of the few people who

could “really understand me.” Strong authoritarian men are seen as “fair” by P. though he

resents their orders.

2. Aggression

The expression of aggressive impulses has been one of P.’s major areas of conflicts.

Until quite recently he has denied angry feelings, particularly those addressed toward his

father. However a great deal of aggressive energy is bound up in his rituals and obsessive

thinking, which ward off his expressed fantasy of hitting people over the head with coke

bottles (particularly vacationing staff) or sending authoritarian staff through a bologna

slicer! For example, if he thinks of putting someone through a bologna slicer he must put

them back through to make them all right again (thinking right).

Aggression is also seen in his tremendous need to control the environment. Angry

crying spells and stubborn refusals often accompany change of plans for any

unanticipated event,

P.’s aggression not only inflicts pain on the environment but is most often more painful

to him. He feels trernend ously *anxious and guilty over his aggressive thought, and the

rituals also serve as punishment for his self-peiceived “badness.”

Ego and Superego Development

a. Ego apparatus: his ego apparatuses are intact.

b. Ego functions:

Affected by and interfered with by his psychopathology, he is nevertheless clearly a

highly intelligent child with reading skills, mathematical reasoning, and mathematical

fundamental skills above his chronological age.

a. Ego reactions to danger situations:

P.’s fears are lodged in the external world in the form of fear of loss of objects. The id

impulses are also feared characteristically because they may force him to become out of

control and do things (show anger

164 Obsessional Neuroses

or aggression) which would be severely punishable by his superego. d. Defensive system:

Denial: P.’s obsessional substitutions utilize magic and rituals and are a defense which

fosters power and strength in a world where he feels helpless and weak.

Rationalization: Since P. fears the “weakness” he thinks is implied in tender feelings,

he recently denied his anger and sorrow at the vacation of an important P . C. W by

claiming she had a “right” to the vacation and he should not.feel bad because it was her

“right” to go away.

Intellectualization: Enormous energy is spent in .holding back feelings by

intellectualization. P. has such an explosive need to love and hate (punish) his father for

rejecting him and/ or his mother but the only way he can deal with his father is through

scientific discussion, He feels anxious if he is with his father without some specific

intellectual topic to discuss, Unfortunately his father relates to P. in the same way.

Reaction-formation: Classic obsessive concerns for cleanliness, order, being good, are

perceived as knowing the rules and following them, according to P.’s pattern.

Paradoxically, he expresses a great longing to live in the wilderness free from human rules

and regulations and living exactly the way he please.

P. also belches frequently and then immediately bows his head and whispers “excuse

me please” sometimes three or four tlines in a row.

Doing and undoing: P. uses this defense in many areas but perhaps the most suggestive

is his need to read a line and then “unread” it, For example, read backwards, This may

indicate his need to know or his fear of knowing or the ramifications of the quest for

knowledge, related to the suppression of information regarding his mother and her death.

Extensive use of displacement, isolation of affect and content are noticeable,

e. Secondary interference of defense activity with ego achievements:

P.’s defensive system keeps him vulnerable to the fears he experiences in every new

situation. It prevents him from learning by experience. He is so involved in creating

reasons not to be somewhere or not to express feelings that he is virtually paralyzed by a

system where there is no relief and where every day poses a threht of defeat, f, Affective

states and responses:

P. is capable of expressing a wide range of affective responses. He is

Clinical Examples 165 •

a sensitive child and the potential loss of loved objects evokes anger, hate and guilt. It is

only recently and only to certain staff members that P, is able to tell how he feels. Sad

affects are usually masked by imitation crying or sarcasm,

P.’s self-esteem is low and this is particularly evident when gifts or praise are given to

him, He says he never felt anyone gave him anything because they loved him but only

because they wanted to “satisfy him,” The only area where he acknowledges success and

accepts praise is with his intelligence. Though P. is capable of affective responses and

often displays them appropriately, his behavior becomes inappropriate when he is moved

by a person important to him

P. is still somewhat egocentric and narcissistic. For example, he feels everyone

thinks the way he does, and should, therefore, understand his problem, He is

terrified of the anger of others especially – if it might result in physical confrontation,

Authoritarian people are disliked and criticized even when he believes their rules are fair

and right. He whimpers and cries and impotently feigns rage when forced to do something

he doesn’t want to do.. Often his responses can be described as overreaction. Usually the

anger or hurt is not long-lasting though he tends to hold a grudge against those who have

caused him to display negative affects.

Superego Development

a. Superego:

P.’s superego is overly developed, punitive, nonpleasure-giving, unrelenting, and

constricting, The superego introjects which contribute to this pattern stem from the anal

and phallic-oedipal stage based primarily on his overly restrictive father and his perhaps

uninvolved, distant or permissively ambivalent mother. He felt he had to be good to win

parental approval. “Bad behavior” meant risking parental rejection, The id has a need to

discharge its persistent drive and the ego is left as the battleground for the two opposing

sides. Normal childish feelings of gratitude, happiness, excited joy, sorrow, or pain and

anger came to be viewed as weaknesses to be avoided, denied or isolated, so that he could

be the good, calm, placid child he felt his parents desired.

a. Superego ideals:

166 Obsessional Neuroses

The most obvious and most frequently mentioned superego ideal stems from his

identification with the aggressor (father) and his wish to outdo or overcome his father.

He wants to be a brain surgeon who will find the definitive cure for cancer and be the

first to perform successfully brain and spinal-cord transplants. Not only will he be the

first but he will be nationally famous and admired.

a. Other types of ideal formation:

Certainly his desire to become a physician is an appropriate ego ideal as his

intelligence and latent personality strengths suggest. It is clear also that even as an ego

ideal there is the apparenridentification with the aggressor” and his own self-desribed

“little-boy-blue” phenomenon.

a. Development of the total personality:

In general P. has not reached age-appropriate development and may be found in the

preadolescent stage. His over-all development suggests an initial ease in the

developmental milestones without disruption.

There is no noted separation-anxiety in Anna Freud sense of the word, and since he

was the youngest child in the original family there was no conflict there. His illness,

mumps, along with his mother at age four, served to increase his identification with

her and left a permanent reminder of their shared experience.

P. did not want to attend nursery school (possibly a fear of • separation). He recalls

(or has been told) that he stubbornly refused to go and would not dress himself or

allow himself to be dressed for the occasion. This is reminiscent of his present

aggressive behavior around bedtime rituals. Ile states with pride “and 1 never did go to

nursery school.”

School itself was not a problem and both parents recall delight in observing P.’s

reaction to it. We can only speculate that the kind of disturbance observed -now, with

its anal-sadistic qualities, indicates difficulties stemming from the anal phase, though

toilet training-wasn’t a problem. The mother’s frequent depressions may have

contributed to these difficulties along with his father’s authoritarianism. Mrs. Q.’s

depressions continued to the phallic-oedipal stage and we may assume P. felt he could

have given her more suppoil and protection than his father did. The mother’s suicide at

the beginning of his latency caused an upset in this relatively peaceful period and sent

P. back to using the

Clinical Examples 167

defenses of an earlier developmental level and caused a hiatus in further growth.

Latency was accomplished, as seen in his adequate move from play to work, but the

damage was there, P. recalls that his repetitions began at about eight or nine years of

age, soon after mother’s death and his father’s remarriage. The suppression of

information about his mother and the birth of another child served to reinforce P.’s

feeling of being.

left out and unncessary.

The threatening arrival of adolescence was probably the last straw in P.’s ability to

ward off the instinctual impulses and oedipal conflicts tha t we r e then r e ignit ed.

P, is now beginning to feel that he needs his father less than before and this can be

seen as a sign of the impending move into adolescence. P. finds this very upsetting

however, because of his paradoxical view of loving and hating his “all-powerful”

Assessment of Fixation Points and Regressions

There is a fixation to the anal-sadistic and phallic-oedipal stages, with defenses

against regression to oral wishes and fantasies, This can be seen in his obsessive

compulsi-ve behavior and need to re-enact the oedipal situation. There are also some

elements of regression to oral sadism as exemplified in his food rituals.

Assessment of Conflicts

P.’s conflicts have an internal and internalized nature. The internal conflicts are:

(1) general ambivalence—his decision making is tortured, as when he wanted to give

his stepmother a Mother’s Day present but felt to do so might make her unhappy, even

though he also thought it might make her happy; (2) masculinity vs. femininity; and

(3) sadism vs. Masochism.

The internalized conflicts reflect the internalization of previously external conflicts.

There are regressive traces of the oral, anal and phallic-oedipal phases: (1) oral: eating

difficulties previously mentioned; (2) anal: reflected in his fears of aggression, death,

and his reference to death wishes, concerns with germs and magic; (3) phallic-oedipal:

as seen in his crushes and wish to re-enact the oedipal triangle.

168 Obsessional Neuroses

The latter is expressed in jealousy of his therapist and a female ward staff whenever

separations are imminent or when they are observed by P. to be interacting with male

staff. P. is also expressing some concern that his problems will make his therapist

depressed, necessitating her treatment as an inpatient at N. P. I. There is an obvious

sadistic wish here since he is angry about her impending vacation but there is also

guilt .perhaps reminiscent of the guilt he felt for not “making his mother happy” and

thus preventing her depreisions and subsequent suicide, for which he no doubt feels

responsible.

Assessment of Some General Characteristics

Frustration tolerance: 1

1s frustration tolerance is poor because of the pervasive

nature of his obsessions and compulsions. He feels he must do his repetitions even

though they take up a lot of time, If he is pushed beyond his own limit he will cry and

become very stubborn and accuse people of not understanding him or his problem.

Attitude toward anxiety: P. is engaged in a constant struggle to avoid anxiety. The

defenses he uses create the illusion of power and control and temporarily reduce_

At present, P.’s anxieties are so severe that he invests more and more time in

warding them off. His obsessive rituals consume most of his time and overshadow all

other events in his life. Despite their initial intensity they became worse during a

period when P. began to ask questions about his mother and to criticize his father’s

handling of her death. After this the obsession took on a more magical representation

(voodoo), attempting to hide the death wish he felt toward his father.

Sublimation potential: In view of the -present behavior crisis it is difficult to judge

the true sublimation potential, One can assume that it is quite high judging by his

latency-age creativity. For example, P. is making a report on the state of Israel,-This

reflects his search for an identity and his questioning about his mother. However this

has been interfered with and is now a problem for P. He may substitute.the study of

Saudi Arabia because he ‘feels that –

too many magical events happened in the creation

of the state of Israel, that the number 13 appears very often in its history. The one

example he uses is that Israel

Clinical. Examples 169 .

was formed on 13 May 1948; Robert was born on the 13th of the month and his mother

died on the 13th of the month.

Progressive vs. regressive tendencies: P. has a tremendous desire to move forward

and be rid of his problem. He has the potential for progressive movement. He also

acknowledges a disbelief that he will ever be without it or that certain areas of conflict

will cease to concern him. There is also an element of fear of what would happen if he

were no longer obsessive.

He wants to become an adolescent, mature, date, marry, go to medical school but all of

these things pose the threat of failure or worse, success (outdoing father). Sometimes P.

regresses, especially in O.T. groups when he is with younger children. Fear of a

classmate and separation from a teacher several weeks ago prompted P.’s need for a

transitional object, a small clay rabbit which he had made in 0.T. was carried to school

and brought to therapy.

There are a cornbination of permanent regressions which cause extraordinary

developmental Strain, and crippling symptom formation according to the location of the

fixation point and the amount of ego superego involvement. The symptomatic picture is

that of an obsessive compulsive neurosis.

You may also like

Q&A- What are the characteristics of Dependent Personality Disorder?

Q: What are the characteristics of Dependent Personality Disorder? A: People with Dependent Personality Disorder act anxious, nervous, clingy and fearful. They believe […]

Leave a comment Cancel reply

You must be logged in to post a comment.

• NeuroLaunch

Unraveling OCD: A Comprehensive Analysis of Case Studies and Examples

• OCD in Popular Culture
• NeuroLaunch editorial team
• July 29, 2024
• Leave a Comment

Table of Contents

From Howard Hughes’s compulsive hand-washing to the silent struggles of millions worldwide, the labyrinth of Obsessive-Compulsive Disorder unfolds through a tapestry of compelling case studies that illuminate the complexities of the human mind. Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that individuals feel compelled to perform to alleviate anxiety or prevent perceived catastrophic outcomes. While the disorder affects approximately 2-3% of the global population, its impact on individuals’ lives can be profound and far-reaching.

Case studies have long been a cornerstone of OCD research, offering invaluable insights into the nuanced manifestations of the disorder and the effectiveness of various treatment approaches. These detailed examinations of individual experiences provide researchers and clinicians with a deeper understanding of OCD’s complexities, helping to refine diagnostic criteria and develop more targeted interventions.

In this comprehensive exploration of OCD case studies, we will delve into the intricate world of obsessions and compulsions, examining notable examples, analyzing patterns, and discussing the implications for research and clinical practice. By unraveling these compelling narratives, we aim to shed light on the diverse presentations of OCD and the ongoing efforts to improve the lives of those affected by this challenging disorder.

The Anatomy of an OCD Case Study

To fully appreciate the value of OCD case studies, it’s essential to understand their key components and the methodologies employed in their creation. A well-constructed OCD case study typically includes several crucial elements:

1. Patient background: This section provides relevant demographic information, medical history, and any significant life events that may have contributed to the development or exacerbation of OCD symptoms.

2. Symptom presentation: A detailed description of the patient’s specific obsessions and compulsions, including their frequency, intensity, and impact on daily functioning.

3. Diagnostic process: An outline of the steps taken to diagnose OCD, including any assessments or screening tools used.

4. Treatment approach: A comprehensive account of the interventions employed, such as Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), or medication management.

5. Treatment outcomes: An evaluation of the patient’s progress, including any changes in symptom severity, quality of life, and overall functioning.

6. Follow-up and long-term prognosis: Information on the patient’s status after treatment completion and any recommendations for ongoing care.

Researchers employ various methodologies when conducting OCD case studies, ranging from single-subject designs to more extensive case series. These approaches allow for in-depth analysis of individual experiences while also identifying patterns across multiple cases. Some common methodologies include:

– Single-case experimental designs: These studies involve repeated measurements of an individual’s symptoms before, during, and after treatment interventions.

– Qualitative case studies: Researchers use interviews and observational techniques to gather rich, descriptive data about a patient’s experiences with OCD.

– Longitudinal case studies: These investigations follow individuals with OCD over extended periods, often years, to track the course of the disorder and the long-term effects of treatment.

It’s crucial to note that ethical considerations play a significant role in OCD case study research. Researchers must obtain informed consent from participants, maintain confidentiality, and ensure that the potential benefits of the study outweigh any risks to the individual. Additionally, researchers must be sensitive to the potential impact of participating in a case study on the individual’s OCD symptoms and overall well-being.

Notable OCD Case Study Examples

One of the most famous OCD case studies is that of Howard Hughes, the American business magnate, aviator, and film producer. Hughes’s struggle with OCD has been well-documented and offers a compelling example of how the disorder can manifest in extreme ways, even in individuals of exceptional talent and success.

Hughes’s OCD symptoms reportedly included:

– Extreme fear of contamination, leading to compulsive hand-washing and elaborate cleaning rituals – Obsessive concerns about germs and disease – Strict control over his environment, including detailed instructions for staff on how to handle objects – Hoarding tendencies, particularly related to tissues and other personal items

The case of Howard Hughes illustrates the potential severity of OCD and how it can significantly impact an individual’s life, regardless of their social status or achievements. It also highlights the importance of early intervention and appropriate treatment in managing OCD symptoms.

While Hughes’s case is well-known, contemporary OCD case studies continue to provide valuable insights into the diverse manifestations of the disorder. For instance, a case study exploring one of the most severe cases of OCD might reveal the extreme lengths to which individuals may go to alleviate their anxiety and the profound impact on their daily functioning.

Other notable OCD case study examples include:

1. The case of “Mary,” a 32-year-old woman with contamination-related OCD who spent up to 8 hours a day showering and cleaning her home. Her case study highlighted the effectiveness of Exposure and Response Prevention (ERP) therapy in reducing her symptoms and improving her quality of life.

2. “John,” a 45-year-old man with religious scrupulosity OCD, who experienced intrusive blasphemous thoughts and engaged in excessive prayer and confession rituals. His case demonstrated the importance of tailoring CBT techniques to address specific OCD themes.

3. “Sarah,” a 16-year-old girl with symmetry and ordering compulsions, whose case study showcased the potential benefits of family-based interventions in treating adolescent OCD.

These diverse case studies underscore the heterogeneity of OCD presentations and the need for individualized treatment approaches. They also reveal fascinating aspects of OCD that may not be immediately apparent, such as the wide range of obsessions and compulsions that can manifest in different individuals.

Analyzing OCD Cases: Patterns and Insights

When examining multiple OCD case studies, certain patterns and themes begin to emerge, offering valuable insights into the nature of the disorder and its treatment. Some common themes observed across various OCD cases include:

1. Age of onset: Many case studies report that OCD symptoms often begin in childhood or adolescence, although the disorder can develop at any age.

2. Comorbidity: A significant number of individuals with OCD also experience other mental health conditions, such as depression, anxiety disorders, or eating disorders. This raises important questions about whether OCD should be classified as an anxiety disorder or as a distinct entity.

3. Impact on relationships: OCD frequently affects interpersonal relationships, with many case studies highlighting the strain placed on family members and partners.

4. Fluctuating symptom severity: Case studies often reveal that OCD symptoms can wax and wane over time, influenced by various factors such as stress, life events, and treatment adherence.

5. Treatment response variability: While many individuals respond well to evidence-based treatments like CBT and ERP, case studies also illustrate that some patients may require more intensive or prolonged interventions.

Despite these common themes, each OCD case presents unique aspects that contribute to our understanding of the disorder. For example:

– Specific trigger events: Some case studies describe particular life events or traumas that seemed to precipitate or exacerbate OCD symptoms, providing insights into potential environmental factors in OCD development.

– Cultural influences: Cases from diverse cultural backgrounds highlight how OCD manifestations can be shaped by cultural beliefs and practices, emphasizing the need for culturally sensitive assessment and treatment approaches.

– Atypical presentations: Certain case studies document unusual or less common OCD symptoms, expanding our understanding of the disorder’s potential manifestations.

By analyzing multiple OCD case studies, researchers and clinicians can draw valuable lessons that inform both theory and practice. These insights include:

1. The importance of early identification and intervention in improving long-term outcomes for individuals with OCD.

2. The need for personalized treatment plans that address the specific obsessions and compulsions of each individual.

3. The potential benefits of involving family members or support systems in the treatment process.

4. The value of long-term follow-up and maintenance strategies to prevent relapse and manage residual symptoms.

5. The significance of addressing comorbid conditions alongside OCD symptoms for comprehensive care.

These lessons derived from case studies contribute to the ongoing refinement of OCD treatment approaches and help clinicians better understand the complexities of the disorder.

Treatment Approaches Highlighted in OCD Case Studies

OCD case studies have been instrumental in showcasing the effectiveness of various treatment approaches and highlighting areas for improvement. Cognitive Behavioral Therapy (CBT), particularly Exposure and Response Prevention (ERP), emerges as a cornerstone of OCD treatment in many case studies.

For instance, a case study of a 28-year-old man with severe contamination OCD demonstrated how ERP techniques, such as gradually touching “contaminated” objects without washing, led to significant symptom reduction over 16 weeks of treatment. This case highlighted the importance of a structured, gradual approach to exposure exercises and the role of the therapist in providing support and encouragement throughout the process.

Another case study focused on a 42-year-old woman with checking compulsions related to fear of harming others. This study illustrated the effectiveness of combining traditional ERP with cognitive restructuring techniques to address the patient’s overinflated sense of responsibility. The case emphasized the importance of tailoring CBT interventions to address specific OCD themes and underlying beliefs.

Medication management, particularly the use of selective serotonin reuptake inhibitors (SSRIs), is another treatment approach frequently discussed in OCD case studies. For example, a case series examining the use of fluoxetine in treating pediatric OCD demonstrated the potential benefits of medication in reducing symptom severity and improving overall functioning. However, these cases also highlighted the variability in individual responses to medication and the need for careful monitoring and dose adjustments.

Some case studies have also explored innovative treatment methods for OCD. For instance:

1. A case study of a 35-year-old woman with treatment-resistant OCD documented the successful use of transcranial magnetic stimulation (TMS) as an adjunct to traditional CBT, resulting in significant symptom improvement.

2. Another case report described the application of virtual reality exposure therapy for a patient with OCD related to fear of contamination in public spaces, demonstrating the potential of technology-enhanced interventions.

3. A case series examining the use of mindfulness-based interventions for OCD showed promising results in reducing symptoms and improving overall well-being, particularly for individuals who had not fully responded to traditional CBT approaches.

These case studies not only showcase the effectiveness of established treatments but also point to potential new directions in OCD management, emphasizing the importance of continued research and innovation in the field.

The Impact of OCD Case Studies on Research and Practice

OCD case studies have had a profound impact on both research and clinical practice, influencing diagnostic criteria, treatment protocols, and our overall understanding of the disorder. One significant contribution of case studies has been their role in informing and refining the diagnostic criteria for OCD.

For example, case studies have helped to elucidate the diverse manifestations of OCD, leading to a broader recognition of less common symptom presentations in diagnostic manuals. This expanded understanding has improved clinicians’ ability to accurately identify and diagnose OCD, even in cases where symptoms may not align with more stereotypical presentations.

Case studies have also played a crucial role in shaping OCD treatment protocols. By providing detailed accounts of treatment successes and challenges, these studies have:

1. Helped to establish the efficacy of CBT and ERP as first-line treatments for OCD. 2. Informed the development of treatment guidelines and best practices. 3. Highlighted the importance of tailoring interventions to individual needs and symptom presentations. 4. Demonstrated the potential benefits of combining multiple treatment modalities, such as psychotherapy and medication.

Furthermore, OCD case studies have influenced future research directions by:

1. Identifying gaps in current knowledge and treatment approaches. 2. Generating hypotheses for larger-scale studies. 3. Providing preliminary evidence for novel interventions or treatment combinations. 4. Highlighting the need for research on specific OCD subtypes or populations.

As we look to the future, case study research in OCD continues to evolve. Emerging trends include:

1. Increased focus on long-term follow-up studies to better understand the course of OCD over the lifespan. 2. Exploration of the role of new technologies, such as smartphone apps and wearable devices, in OCD assessment and treatment. 3. Investigation of the neurobiological correlates of OCD through case studies incorporating neuroimaging and other biological measures. 4. Examination of the impact of cultural factors on OCD presentation and treatment outcomes through diverse, cross-cultural case studies.

These ongoing efforts in case study research promise to further enhance our understanding of OCD and improve outcomes for individuals living with the disorder.

In conclusion, the examination of OCD case studies provides a wealth of insights into the complex nature of this challenging disorder. From the famous case of Howard Hughes to the countless unnamed individuals whose experiences have been documented in research, these studies offer a window into the diverse manifestations of OCD and the ongoing efforts to improve diagnosis and treatment.

Key takeaways from our exploration of OCD case studies include:

1. The importance of individualized assessment and treatment approaches, given the heterogeneity of OCD presentations. 2. The effectiveness of evidence-based treatments like CBT and ERP, as well as the potential of innovative interventions. 3. The value of long-term follow-up and comprehensive care that addresses comorbid conditions. 4. The ongoing need for research to refine our understanding of OCD and develop more effective treatments.

As we continue to unravel the complexities of OCD through case studies and other research methodologies, it is crucial to maintain a sense of empathy and awareness for individuals living with this disorder. By sharing these stories and insights, we not only advance scientific understanding but also help to reduce stigma and promote compassion for those affected by OCD.

The journey to fully understand and effectively treat OCD is ongoing, and case studies will undoubtedly continue to play a vital role in this process. As we look to the future, the lessons learned from these individual narratives will guide researchers, clinicians, and individuals with OCD towards more effective management strategies and, ultimately, improved quality of life for all those affected by this challenging disorder.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2. Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374(9688), 491-499.

3. Veale, D., & Roberts, A. (2014). Obsessive-compulsive disorder. BMJ, 348, g2183.

4. Öst, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156-169.

5. Brakoulias, V., Starcevic, V., Belloch, A., Brown, C., Ferrao, Y. A., Fontenelle, L. F., … & Kyrios, M. (2017). Comorbidity, age of onset and suicidality in obsessive–compulsive disorder (OCD): An international collaboration. Comprehensive Psychiatry, 76, 79-86.

6. Sookman, D., & Steketee, G. (2010). Specialized cognitive behavior therapy for treatment resistant obsessive compulsive disorder. In D. Sookman & R. L. Leahy (Eds.), Treatment resistant anxiety disorders: Resolving impasses to symptom remission (pp. 31-74). Routledge/Taylor & Francis Group.

7. Fineberg, N. A., Brown, A., Reghunandanan, S., & Pampaloni, I. (2012). Evidence-based pharmacotherapy of obsessive-compulsive disorder. International Journal of Neuropsychopharmacology, 15(8), 1173-1191.

8. Pallanti, S., & Grassi, G. (2014). Pharmacologic treatment of obsessive-compulsive disorder comorbidities. Expert Opinion on Pharmacotherapy, 15(17), 2543-2552.

9. Hirschtritt, M. E., Bloch, M. H., & Mathews, C. A. (2017). Obsessive-compulsive disorder: advances in diagnosis and treatment. JAMA, 317(13), 1358-1367.

10. Skapinakis, P., Caldwell, D. M., Hollingworth, W., Bryden, P., Fineberg, N. A., Salkovskis, P., … & Lewis, G. (2016). Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, 3(8), 730-739.

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Privacy Policy
• Terms of Service
• Cookie Policy

About NeuroLaunch

• Copyright Notice
• Accessibility Statement
• Advertise With Us
• Mental Health