Obsessive-Compulsive Disorder, Case Study Example

In the case study presented, James, the African American teenager, clearly exhibits symptoms of obsessive-compulsive disorder.  While the cause of his illness cannot absolutely be determined, there is enough information to speculate about the source of his condition.  While there is no reported family history of OCD, his mother has a history of generalized anxiety disorder.  Since obsessive-compulsive disorder is largely considered to be an anxiety disorder, the family appears to be genetically loaded for any number of these conditions.  In addition, a specific chromosome/gene variation has been found to possibly double the chances of a person developing OCD, and a serotonin imbalance in the brain may also contribute to developing illness (Dryden-Edwards, 2012.) Finally, it is believed that certain life stressors can heighten the chances of developing OCD, and the case study makes it clear that James’ mother causes him a great deal of angst with her erratic behavior, including fears that she will hurt him.  Certainly, such a situation would cause any child or teenager to feel anxious about the possibility of being harmed by a parent.

In order to consider pharmacological treatment, a thorough clinical assessment must be conducted which permits both the teenager and the parents separately to recount their version of the situation.  These private accounts are important because often OCD symptoms are hidden from family members, or minimized so as not to worry the parent or to sound “crazy”.  Part of the assessment must include detailed history pertaining to the parents, including physical and mental health treatment.  Aspects of the clinical evaluation must include: the history of current illness, co-morbid symptoms, past psychiatric history, social as well as the developmental history, physical illnesses, substance use, medications as well as drug allergies, and a mental status exam (Stewart, 2010.)

The history of the present illness must include the duration and severity of obsessive-compulsive symptoms and the factors which precipitate, exacerbate, and improve them.  For example, if the family has reason moved to a new home, or the child is changed schools, these are relevant factors in the assessment, as are the functional consequences of OCD symptoms in all areas of the patient’s life (home, school, social environment.) Another important aspect of the assessment is evaluating the level of insight, resistance, and control over the OCD symptoms.  Other illnesses with similar symptoms must be ruled out, such as body dysmorphic disorder and trichotillomania (Stewart, 2010.) Finally, any assessment must include evaluating the level of risk of self harm as well as harm to others.

There are two main treatments to be considered for James.  Psychotherapy, specifically cognitive behavioral therapy, can be extremely effective in the treatment of OCD.  This treatment involves retraining thought patterns and routines in order to extinguish the obsessive compulsive behaviors.  For James, it could be beneficial to utilize exposure and response prevention, in which he would be gradually exposed to comments and behaviors demonstrated by his mother, and helping him to learn healthy ways to cope with the anxiety created by these actions and words (OCD: Treatment and Drugs, 2012.) Choosing to treat James with medication could also be an extremely way of helping him with his OCD, since medication has been an effective treatment for this disease.  The treatment would utilize anti depressant, more specifically, Selective Serotonin Reuptake Inhibitors, or SSRI’s, such as Prozac, Zoloft, Paxil, and others in that category.  These treatment methods are indicated for James because approximately 70% of people treated with either cognitive behavioral therapy or medication for OCD will benefit from treatment (Jenike, 2012.)

Bibliography:

Dryden-Edwards, R. (2012). Obsessive-Compulsive Disorder. Retrieved October 26, 2012, from Medicine.net: http://www.medicinenet.com/obsessive_compulsive_disorder_ocd/article.htm

Medication for OCD . (2012). Retrieved October 26, 2012, from International Obsessive-Compulsive Disorder Foundation: http://www.ocfoundation.org/MedSummary.aspx

OCD: Treatment and Drugs. (2012, August 10). Retrieved October 26, 2012, from Mayo Clinics: http://www.mayoclinic.com/health/obsessive-compulsive-disorder/DS00189/DSECTION=treatments-and-drugs

Stewart, S. E. (2010). Clinical Assessment of OCD in Children and Adolescents. Retrieved October 26, 2012, from International Obsessive-Compulsive Disorder Foundation: http://www.ocfoundation.org/ocdinkids/professionals/Clinical_Assessment.aspx