Clinical Case Summary
The patient is a 26-year-old woman who has been experiencing severe anxiety related to cleanliness and hygiene, leading to obsessive cleaning rituals. Her fear is based on the belief that if her house is not clean at all times, her 3-year-old son will become very ill and die. The patient’s compulsion is excessive house cleaning, such as repeatedly cleaning surfaces and utensils (sterilizing crockery and cutlery before eating). She recognizes that she checks her house more than is necessary, but she cannot stop such obsessive thoughts; this, therefore, causes her to become highly anxious. The cleaning rituals provide temporary relief, but the obsessive thoughts return, creating a cycle of distress for the patient.
DSM-5 TR Diagnosis
The criteria for a diagnostic of obsessive-compulsive disorder (OCD) are met for this client in the situation presented. Obsessive-compulsive disorder is having obsessions, intrusive, unwanted thoughts, impulses, images and compulsions, repetitive behaviors, and mental acts to prevent, reduce anxiety, and prevent something wrong from happening, as listed in the DSM-5 (Brock & Hany,2020). In this case, the obsession is the fear of germs and her child getting sick, and her compulsion is the cleaning rituals and disinfecting procedures.
Pharmacological Treatment
According to clinical guidelines, SSRIs are the first line of pharmacological treatment for the treatment of all types of OCD. The SSRIs in these case scenarios are fluoxetine, fluvoxamine, and sertraline. SSRIs specifically help modulate serotonin levels in the brain, which can help regulate the obsessive thoughts and compulsive behaviors common to OCD (Brock & Hany, 2020). For example, fluoxetine has been extensively proven effective in the treatment of OCD and often has little to no side effects.
Non-Pharmacological Treatment
Exposure and response prevention is a behavioral and non-pharmacological intervention that is often recommended when treating OCD (Brock & Hany, 2020). In exposure and response prevention (ERP), the patient is gradually exposed to stimuli that would typically trigger obsessive thoughts. Then, the patient is asked not to engage in the usual ritual behavior, thus breaking the cycle.
Assessment of Treatment
Appropriateness: Both SSRIs and ERP are considered appropriate treatments for OCD (Pittenger, 2023). SSRIs can provide relief from symptoms, and ERP targets the root of the problem by disrupting the obsessive-compulsive cycle.
Cost: Prices can vary, so check prices at your local pharmacy (Pittenger, 2023). Generic SSRIs typically tend to be less expensive than the brand version.
Effectiveness: SSRIs have demonstrated effectiveness in reducing OCD symptoms. ERP has also shown efficacy in managing and alleviating symptoms when combined with medication or used alone.
Safety: It is generally safe to take SSRIs, but they might have general side effects, which the patient has to watch out for. ERP is generally safe when used under the supervision of a therapist who is familiar with the therapy.
Patient Adherence: Medication adherence may vary. Discussing potential side effects and benefits with the patient is crucial (Pittenger, 2023). ERP requires commitment, but its effectiveness in breaking the cycle of OCD may motivate adherence.
In conclusion, a combination of fluoxetine (SSRI) and ERP would likely be this patient’s best course of treatment. Regular follow-up with the patient would be required to ensure proper medication dosage and exposure.
References
Brock, H., & Hany, M. (2020). Obsessive-Compulsive Disorder (OCD). PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/31985955/
Pittenger, C. (2023). The Pharmacological Treatment of Obsessive-Compulsive Disorder. Psychiatric Clinics of North America. https://doi.org/10.1016/j.psc.2022.11.005
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