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Case Study

Obsessive Complusive Disorder

By Dr Stan Steindl

Excessive washing. This compulsive washing he explained was conducted to cleanse himself from the contamination of the past. He was obsessed about the past and had developed elaborate, compulsive washing rituals to manage his feelings of anxiety about the contamination.

He described how each morning he spent one hour in the shower going through a ritual of washing his hands and himself. He would even wash his eyeballs by lifting his eyelids and rubbing his eyes with soap. He would arrive at work at about 8.00am in the morning and then spend until about 11.00am carrying out a circuit of further washing rituals, including wiping down his whole clothed body with wet paper towels. He was then finally able to start work but was so exhausted from the rituals that he could barely perform his job. His manager was complaining about his work performance and he was on his last written warning before possibly being sacked. He would get home at about 5.00pm and was again compelled to wash for another one to two hours before being able to collapse into bed.

We diagnosed Matt with Obsessive Compulsive Disorder (OCD) and the above description indicates the oft-debilitating impact the disorder can have. The treatment of choice for OCD has been found to be behaviour therapy, with, if necessary, adjunct treatment using serotonin reuptake inhibiting drugs (e.g., clomipramine). The type of behaviour therapy that is most useful is exposure and response prevention, that is, the deliberate exposure to obsessional cues and prevention of the compulsive behaviours the sufferer typically engages in. The person habituates to the obsessional cues and thus their feeling of anxiety or discomfort is reduced.

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