OCD Case Study: Real Patient Story of Obsessive Compulsive Disorder
Patient Background
Rajesh is a software engineer. He works from home, is married, and has a 7-year-old son. His wife is a corporate employee, and his son is in class II.
Obsessions
Rajesh was obsessed with keeping things clean and organized. While he had always been a person who preferred sanitization, COVID made him even more paranoid. His habit became an extreme fear of germs and contamination.
His thoughts were full of doubts and fears of:
- His family members did not take a proper bath after coming from outside.
- His son and wife ate without washing their hands with antiseptic soap for one minute.
- Friends would use their contaminated hands to take food from his plate in a social setting.
- Home would be contaminated if people came home.
- Grocery items are contaminated.
- Packaged items contained the germs of the delivery people.
Despite knowing that his thoughts were excessive, he couldn’t control them. His anxiety caused him to lose sleep and made him irritable.
Compulsions
Compulsions are repetitive behaviors of the patient caused as a response to the obsessions. In Rajesh’s case, he:
- Washed his hands every time he touched any surface.
- Sanitized every item that came home, including packaged food items, ready food deliveries from restaurants, groceries, clothes, and even the boxes of electronics.
- Bought large amounts of sanitizers, antiseptic soaps, handwashes, wet wipes, sanitizer liquids and sprays, and phenyl.
- Start cleaning the sofa, keys, phone, carpet, TV, and other items anytime anybody comes from outside.
- Mopped floor five times a day.
- Changed and washed clothes before going to bed.
- Did not allow anyone to go to bed without changing, even if they had stayed home all day.
- Forced guests to wash their hands, feet, and face, and sanitize their belongings and clothes with a sanitizer spray.
Not following his orders made him irritable. Guests stopped coming to his place, affecting his whole family’s social life.
Symptoms:
The warning signs of addiction arrived long before anyone could understand what was happening and could act upon it. Rahul started looking absent-minded when at home and even at work.
Physical Symptoms
He started wearing full shirts to cover the track marks on his arms. But what he couldn’t hide was the 12 kg he lost in 8 months. He started having breathing problems and often complained about constipation and other digestive issues. Also, his skin became dry and pale.
Psychological Symptoms
Psychologically, his mood swings became noticeable every time he couldn’t take heroin for more than 5 hours. His attitude became increasingly withdrawn. Rahul stopped caring about work performance, the manager’s calls, family responsibilities, and even personal hygiene.
Diagnosis Process
His wife, unable to take it anymore, warned Rajesh that if he didn’t go to a psychiatrist, she would divorce him and take their son away with her. He finally went to Calida Rehab, where Dr. Abhijit Bombe diagnosed him with contamination-focused Obsessive Compulsive Disorder.
The diagnosis process involved:
- Interviewing him and his family member (Rajesh’s wife)
- Questionnaire
- Checking his hands
- Assessment of symptom severity using standard OCD rating scales
Treatment Plan - OCD Case Study
The OCD treatment plan was tailored to the needs of Rajesh. Since the symptoms of Rajesh were severe, he was advised 4 months of inpatient treatment followed by outpatient treatment. His treatment basically consisted of medicines, therapy, and lifestyle change.
Cognitive Behavioral Therapy (CBT)
CBT was used to identify the triggers and thoughts behind these obsessions. It also helped him to challenge thoughts that caused him anxiety. Identifying triggers made way for developing strategies to address them.
Exposure and Response Prevention (ERP)
Exposure and Response Prevention is considered to be one of the most effective treatments for OCD. As the name suggests, it involves gradual exposure to feared situations while preventing compulsive responses.
In Rajesh’s case, living in rehab with strangers was a struggle. He was encouraged to:
- Touched commonly used objects
- Delay handwashing
- Reduce cleaning rituals
- Remain in public areas that triggered him without reacting
Medication
The doctor prescribed a selective serotonin reuptake inhibitor (SSRI), a medication commonly used to treat OCD symptoms. It helps to reduce anxiety levels in an OCD patient, making it easier for them to absorb and engage in therapy.
How long does OCD treatment take: Step-by-Step Improvement
Recovery in OCD is a slow process. It takes time, but since Rajesh was in rehab for four months, his family got to see a massive improvement after he was released.
First Month
Rajesh started taking his medicines and attended therapy sessions. During the day, he was involved in physical exercise and mindful practices. He was also tasked to track his triggers and record his compulsive behaviors in a journal.
Second Month
ERP exercises were started with relatively low-anxiety situations. The focus was to build resistance without causing anxiety. He was made to practice delaying his compulsive reaction for a minute. Rajesh also continued with his routine that included mindfulness practices like meditation and breathing exercises for anxiety management and regular exercise.
Third and Fourth Month
Rajesh successfully handled more challenging exposures without help. He could control his anxiety with breathing techniques. During the third and fourth months, his therapy sessions also included a dedicated time to map out his personal goals. This worked as a positive distraction, and with mindfulness activities and regular exercises, his response to therapy had also improved.
The medicine dosage was adjusted to test if Rajesh would show improvement without the medicines as well, and he did. Even though the medicines were not stopped completely, the dosage had been reduced.
Before discharge, his obsessions had absolutely stopped, and he was able to control his compulsive actions successfully, even if he got triggered.
Fifth Month and Beyond
Rajesh continued with his treatment as a visiting patient. His monthly visits involved checking his journal, where he continued tracking his triggers and compulsive actions. The doctor also checked on his progress in personal goals.
A short therapy session would involve revising his coping strategies.
After a year, the medicine was completely stopped. However, he is advised to visit after every four months for follow-up and relapse prevention with a family member.
The OCD case study highlights that consistent participation in treatment often leads to complete recovery.
Challenges During Recovery
The first month was extremely challenging for Rajesh. He had to live in a publicly shared space and a version of a hospital, which, according to him, was a center of contamination. Living in the rehab was like his worst fear coming true. Thus, managing his anxiety did not just require medicines but also his willpower. His fear of losing his family over OCD made him stick to the treatment and trust the doctor.
His second challenge was relapse when he went home. Going back to the old environment temporarily increased his anxiety, but he quickly checked himself and used coping strategies to overcome it.
Our Success: Before vs After Condition - OCD Case Study
Here is a comparison table to show why OCD treatment is important.
|
Before Treatment |
After Treatment |
|
Hours spent on compulsions daily |
Routine focused on self-development and a healthy lifestyle |
|
Severe contamination fears |
Effective strategies to control and challenge intrusive thoughts |
|
Social avoidance |
Improved social participation |
|
Poor work performance |
Increased productivity |
|
High anxiety levels |
Better emotional control with breathing techniques and exercise |
The improvement did not mean that every symptom disappeared completely. Instead, Rajesh became equipped with effective strategies to manage OCD successfully. Also, his focus shifted to personal goals. In his case, it was building an app to deal with mobile addiction.
Myth vs Reality
Myth: OCD Means Being Clean and Organized
Reality: OCD can be of different types. For example:
- Contamination fears (Rajesh’s case study is the example)
- Harm-related thoughts (Fear of harm from sharp objects or any form of accidents)
- Checking behaviors (locks of windows, doors, gas knobs, etc.)
- Religious obsessions (Following religious practices too much and a fear of sin)
- Symmetry concerns(organisation)
This OCD case study illustrates that OCD is a complex mental health disorder that extends far beyond a preference for hygiene and cleanliness.
Impact on Mental Health
Rajesh’s condition was not simple. The obsessive-compulsive disorder stemmed from chronic anxiety. Also, his inability to control his actions affected his family dynamics, social life, and even finances. The realization caused him guilt, decreased self-confidence, increased isolation, fatigue, and skin problems due to overwashing.
As treatment progressed, Rajesh learned to manage anxiety and worked on his self-confidence by working on personal goals alongside learning to manage his compulsive reactions.
Expert Comment
Dr. Abhijit Bombe, M.D. (Psychiatry): OCD initially may seem natural and even beneficial in the beginning, and hence, the treatment is often delayed. While the OCD treatment is difficult and comes with its own set of challenges, professional help can help patients get back to a healthy life. If Rajesh can, everyone can.
This OCD case study shows the importance of seeking professional help rather than attempting to manage severe symptoms alone.
Practical Advice
If you cannot control repetitive actions even after being told and knowing it’s wrong, you should immediately seek help. Check if you show signs of any type of OCD mentioned above, then follow these steps:
- Book an appointment at Calida Rehab or with a psychiatrist
- Follow treatment recommendations consistently
- Do not miss therapy sessions
- Take prescribed medication as directed
- Involve family in the treatment and keep them in loop
- Do not neglect symptoms
- Practice the exercises
- Follow the routine set by the doctor diligently
With timely treatment, individuals with OCD lead normal and fulfilling lives.