Case study OCD PDF

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Summary

Case Studies: Individuals will be assigned a case study from the case study textbook. This is an opportunity to apply the knowledge from the various disorders to the case study. There is a Case Study Format that needs to be used for this assignment. This assignment will be due on the Sunday at the e...

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Junhan An February 3, 2019 Case study 2 OCD 1. Case The client is 26 years old, African American, Female, Accountant. The chief complaint was her frequent anxiety and fear she had since her college years. The client stated she has “been a worrier for as long as she could remember” and decided to receive treatment due to the issue interfering with her everyday life. She was also recommended by her fiancé because he was concerned about her symptoms exacerbating. The client reported the feeling of anxiety started during her college years where she had to check the lock on her door 3 or 4 times before leaving the house. The client described her emotions to be “doubtful” and “worried”. She was more concerned about her actions or “negligence” doing harm to others than to herself. Over the years she had difficulty paying the bills online and would have to re-read the number 3 or 4 times and the doubtful feelings go stronger. The client reported a traumatic experience that made her worsened her symptoms. She was a victim of a sexual assault attempt. A stranger physically tried to force himself to her vehicle with an intention of sexually assaulting her. The client acted accordingly by screaming for help which helped the ushers to apprehend the stranger. The client stated her feelings of insecurity and the levels of anxiety increased drastically. Since the event, the client stated she developed a ritual that made is “impossible for her to lead a normal life”. The client stated she had to double check all the household appliances were plugged out, faucet closed, and the stove was off before leaving to work in the morning. She was compelled to check each item several times and would sometimes take 2 hours on bad mornings. The client reported another set of symptoms which would manifest as she was driving to work. She drove past a minor accident one day and drove over a bump that caused an increase in her anxiety level. The client stated she would wonder if she accidentally hit a person accidentally, frequently check her rear view mirror for precaution, and go back to check if she had run over somebody, every day. The client reported she is also triggered by matches and knives. She would experience the intrusive image of havoc and destruction when witnessing the trigger items. The client would imagine herself lighting things on fire or stabbing someone without actually carrying out the actions. The client avoids seeing these items. The client is currently engaged and plans to get married in 6 months. She is compliant and wishes to “live a normal life” with her future spouse.

2. Diagnosis: Obsessive-Compulsive Disorder

The client frequently experiences unwanted images, thoughts, and urges. There are physical acts that she would like to avoid or reduce. Multiple obsessive thoughts about everyday items that may cause destruction to her house if left unchecked. The client is triggered by matches and knives and constructs images of havoc. The client is obsessed with the safety of others when driving. Compulsive behaviors before leaving the house in the morning. The client would at times take 2 hours to check house appliances whether they are turned off properly.

3. Medical Conditions No information

4. Psychological and Environmental problems: “LIST” Problems with primary support group including family circumstances. The client grew up in a “comfortable middle-class” environment in an ethnically diverse suburb. She was pressured to perform well in school and to conduct herself in a manner that was beyond reproach. She was also exposed to the idea that the slightest misstep might increase her vulnerability to prejudice during her developmental stage.

5. Model Psychodynamic Model- Pressure from parents expecting her to grow up successfully caused her to feel insecure about herself. The client was more concerned about the destructions harming others than herself. Cognitive Behavioral Model- Development of maladaptive behaviors in order to find comfort over the anxiety. Anxious thought led to abnormal behaviors until it became a compulsion.

6. Cultural Aspect Growing up in a middle-class African American family increased her anxiety through expectations. There seems to increase in pressure by the African American families because they want to make sure their children don’t fail and descend to a lower class.

7. Medication Antidepressant, SSRI was recommended by the provider if the CBT was not successful.

8. Treatment Exposure and response prevention.

The client was repeatedly exposed to anxiety-provoking stimuli in relation to their obsessive fears and thoughts. Then they are prevented from performing the compulsions. This method helped the client recognize that intrusive thoughts are common and that their obsessive fears are harmless. It also helped the client realize that the compulsions serve no positive purpose. The provider separated her treatment into three different categories. They were household anxieties, driving anxieties, and anxieties over destructive thoughts and imagery. This method did not completely eliminate all her obsession at once but rather focused on making small progress. The client reported she was living a “normal life” by the 14th session. The client’s occasional urges to her compulsions were resisted.

9. Challenges The challenges of OCD are that the clients are fully aware of their symptoms. They can visually see the source of the issue but is unable to control their own compulsions. These compulsions affect their lives by making time management an impossible task. Particularly with this client, I did not see any specific challenges. She had a great support system and was very goal oriented. She wanted to get better in order to successfully start her new chapter in life.

10. Prognosis The client is diagnosed with severe obsessive-compulsive disorder. She is aware of her own obsessions and compulsions. Her symptoms were associated with household appliances, triggers, and driving. These symptoms are evidence of her obsession for the security of others and created uncontrollable compulsions. The client was compliant with the treatment and was honest about her limits to the treatment. She has a great support system who supported her before, during, and after the treatment. Even though the client was successful with the CBT, she will need to personally monitor all her symptoms.

11. Clinical Observations: The case study provided all the information that was needed to learn about the client. No additional questions are needed by the tech at this time. Observation: I want to give credit to the client and her significant other for a successful recovery. The client was extremely compliant to the treatment and made sure to follow all the directions given by the

provider. Her significant other was always there for support and was hopeful even during her worst time.

12. Deviance, Distress, Dysfunction and Danger Deviance- Not identified. Distress- The symptoms interfering with her relationship and everyday life. Dysfunction- Obsessed with own intrusive thoughts. Uncontrollable compulsions and certain items triggering destructive images. Danger- Unable to meet the deadline due to compulsions. Can lead to financial issues....