OCD
23 year old final year Engineering student with severe illness from childhood
A 23-year-old young man, studying engineering final year came to my clinic with complaints of repeated thoughts & acts from childhood, increased now for the past 2 yrs.
His complaints started during his childhood, when after touching somewhere, he would have repeated intrusive thoughts that his hands are dirty and contaminated and full of germs. He found it hard to control or resist these thoughts and found it extremely distressing. So, he was compelled to go and wash his hands very thoroughly with soap & water for about 10 minutes. But even after washing his hands very clean, he would again have these same repeated thoughts that still his hands are contaminated and dirty and if he doesn’t wash his hands properly, then he or his family members would get some illness. So, he would again go and wash. This cycle would continue for another 6-8 times. These thoughts and washing cycle would occur about 4-5 times a day, consuming most of his time.
He would have repeated thoughts that his body if full of germs and is contaminated. Hence, he would go and bath. Before beginning to bath he would find that the floor of bathroom is unclean and hence have to clean it first very thoroughly. Then he would clean his bucket and mug. He would even clean his soap to make sure that its clean! Then he would bath very meticulously for about 1 hour, being very careful to wash each and every part of his body. He would waste a lot of water and his parents would scold him for that. After bathing, when he closes the tap, he would feel that his hands have again become contaminated and he would have to again wash the tap and his hands. Sometimes after coming out of the bathroom after a marathon bathing, he would feel that his feet are still contaminated and not washed properly and so he would have to again go back and wash it properly all over again. He used to bath only once a day. But now he was compelled to bath 3 times a day.
When he would pray, blasphemous images of God- like God being naked or he having sex with God would come to his mind repeatedly again and again. These thoughts/images were very much distressing to him. He would feel that he is a bad person and & would feel very guilty about this. He would try to resist these thoughts/images very hard. When he would have such blasphemous thoughts/images, he would try to forcefully think about or picturize something else, try to distract himself away, but unsuccessfully. He would also get doubts if he has recited/told all the prayers correctly or not. So, he would again and again repeat the same prayers many times over to make sure he has said all the prayers correctly. Also, while praying he has repeated thoughts/fear that he may blurt out obscenities/bad words.
When he is interacting very close with his relatives, like having dinner together, he would experience repeated images/thoughts of he having sex with his close relatives. This is very distressing to him. He would feel very guilty about this. He would feel he is a very bad person and that’s why he is thinking about all such unthinkable stuff. These thoughts he would try to resist very hard but unsuccessfully. So, he began to avoid being in close proximity with his relatives like having dinner together, because he was afraid, he may sexually advance towards them. In college also he began distancing himself away from his female colleagues.
When he is using public transport like travelling in bus, he would have repeated doubts that he is emitting bad odour from his body and that is causing the fellow travellers much distress. He also feels other co-passengers are talking and making fun about him. So, he would carry pocket body spray and would use it in between. He would also have repeated doubts that his face is unformed especially his nose and others are noticing and talking about it. Also, while in bus, someone would step on his feet or inadvertently touch his body which would in turn make him have repeated doubts that his body part has been contaminated and is full of germs and have to wash it. All these made his travelling by public transport very distressing and near impossible.
He also had repeated checking behaviour. When he packs the books in college bag, he would have repeated doubts whether he has actually placed the books
or not. So, he is compelled to check many times over and over again. After closing the door, he has repeated doubts if he has actually closed it or not. So, he is compelled to look and lock it again repeatedly many times over. He would arrange the books on his table very symmetrically and very orderly and neatly. If anyone disturbs it, he would become very uneasy and have to go back and arrange it again in his own way. He wears only well ironed shirts and pants. If any stain happens to be on his clothes, it will be very distressing and he would then discard it. Also, if any scratches or stain happens on his mobile, he is compelled to discard it and buy a brand-new mobile phone.
While getting up from sleep, he has to get up in a particular way. Also, while walking he has to step on a crack or a particular tile. Otherwise he feels something bad may happen to him or his close relatives. While driving he is compelled to count the number of vehicles which has overtaken him and he has to make sure he overtakes more vehicles than that number. Otherwise he feels something bad may happen to him. While sitting he has repeated doubts if he sat properly or not. So, he would again get up and sit properly and firmly many times over. He would also have repeated fear that he may harm others in some way.
She was taken to many Psychiatrists and psychologists from the age of 19, but he reported only minimal improvement. Hence, he was desperately searching for a cure and was googling, and ended up in my clinic.
On examination- Patient was moderately built and nourished, fully conscious & cooperative, rapport established. Psychomotor activity was normal, Talk was normal in amount, tone & tempo, reaction time was normal, prosody was maintained, relevant & coherent. Examination of his Thought showed that he had severe obsessions and compulsions. Mood was anxious. Affect was appropriate. No perceptual abnormalities were present. Cognitive functions showed normal intelligence, memory and abstractability with intact judgement and good insight.
Diagnosis of Obsessive-Compulsive Disorder (OCD) was made.
Patient was psychoeducated regarding his illness, a definitive management plan was made taking the patient into confidence. He was started on Pharmacotherapy (Medicines) and Psychotherapy (CBT, Exposure & response prevention). After 6 weeks – up titration of medicines to therapeutic level & 6 Psychotherapy sessions, 100% improvement was attained and maintained. No side effects to medicines were reported. He passed his Engineering with flying colours and is now well placed in an MNC.
Self-Assessment
