CASE:
I. Demographic Profile
Name :
Age
:
Gender
:
Occupation :
Civil Status :
Highest Educational Attainment
:
II. Background
Karen Rusa is a 30-year old woman who is married and has four children. She
has suffered from anxiety for several years but only tried to get help after a long period
of time. Over the courseof several months, Rusa has been experiencing repetitive, and
invasive thoughts about the safety of her children. Rusa would find herself imagining
situations where her children would be hurt in some situation, causing her to reach out
to see the condition of her children. Rusa also stated that her rituals with counting have
severely affected her daily life.
Despite Rusa's understanding and acknowledgment of her obsessive behavior
she feels comfortable when they are performed and anxiety when she does not.
Alongside the OCD Rusa also is dissatisfied with her marriage and is having issues
managing her children. Rusa's husband is not working due to a serious health condition.
He was able to persuade her to believe that all household chores and taking care of him
are her responsibility. Rusa was getting little to no help from her husband when it comes
to the children. The two youngest had behavioral problems that she could not manage.
The oldest of the two would regularly fight with each other over body image issues.
Rusa has become more and more agitated over these situations and thus will retreat to
her bedroom to cry.
III. Reason for Referral
Karen was being referred by her family physician to a psychological practitioner
due to her increasingly depression. However, what is more alarming is that behind of
her depressed mood is her unusual behavior such as experiencing intrusive, repetitive
thoughts that leads her to ritualistic behaviors.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental
Disorders. 5th Edition. Washington, DC: American Psychiatric Association; 2013.
Plante, T. G. (2010). Contemporary Clinical Psychology, Ch. 9: John Wiley & Sons, Inc..
IV. Diagnosis and Justification
Based on the case presented and the consideration of the given facts, the
diagnosis of the client will be fully anchored in the DSM–5 Considering the case of the
client, her behavior problem may be qualified for Obsessive-Compulsive Disorder.
However, it will not become an official diagnosis unless the case will be assessed and
evaluated thoroughly. In this regard, the psychologist in training will
have further
investigation about the case and the given facts.
DSM - 5
Obsessive – Compulsive Disorder code 300.3 (F42)
A. Presence of obsessions, compulsions, or both:
Karen had met both obsessions and compulsions.
A.1. Obsessions are defined by (A.1.1.) and (A.1.2.):
A.1.1. Recurrent and persistent thoughts, urges, or images that are experienced, at
sometime during the disturbance, as intrusive and unwanted, and that in most
individualscause marked anxiety or distress.
A.1.2. The individual attempts to ignore or suppress such thoughts, urges, or images, or
toneutralize them with some other thought or action (i.e., by performing a compulsion).
Justification: Karen had been experiencing intrusive, repetitive thoughts that
centered on her children’s safety. She frequently found herself imagining that a serious
accident had occurred, and she was unable to put these thoughts out of her mind.
A.2. Compulsion are defined by (A.2.1.) and (A.2.2.):
A.2.1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental
acts (e.g.,p, counting, repeating words silently) that the individual feels driven
to performin response to an obsession or according to rules that must be applied
rigidly.
A.2.2. The behaviors or mental acts are aimed at preventing or reducing anxiety
or distress,or preventing some dreaded event or situation;
Justification: Due to her obsessions, she also has intensive series of
counting rituals that she performed throughout each day. In addition, her
preoccupation with numbers extended to her other activities, most especially
when she smoked cigarettesand drink coffee. If she had one cigarette, she had to
smoke at least 4 in a row or one of the children would be harmed in some way. If she
drank one cup of coffee, she compelled to drink 4.
B. The obsessions or compulsions are time-consuming (e.g., take more than 1
hour perday) or cause clinically significant distress or impairment in social,
occupational, orother important areas of functioning.
Justification: For Karen, she found that her preoccupation with these
numbers was time consuming and interfering with her ability to perform every day
activities.
C. The obsessive-compulsive symptoms are not attributable to the physiological
effectsof a substance (e.g., a drug of abuse, a medication) or another medical
condition.
Justification: Based on the case provided, there were no substances that
have been reported that would have caused her symptoms.
The disturbance is not better explained by
the symptoms of another mental disorder
(e.g.,
excessive worries, as in generalized anxiety
disorder; preoccupation with appearance,
as in
body
dysmorphic
disorder;
difficulty
discarding or parting with
possessions,
as in
hoarding disorder; hair pulling, as in
trichotillomania [hair
pulling disorder];
skin
picking, as in excoriation [skin
picking]
disorder;
stereotypes
, as in stereotypic
movement disorder; ritualized eating behavior,
as in eating disorder
s; preoccupation
with
substances or gambling, as in substance
related
and addictive disorders; preoccupation
with
having an illness, as in illness anxiety disorder;
sexual urges or fantasies,
as in paraphilic
disorders; impulses, as in disruptive, impulse
control,
and
conduct
disorders;
guilty
ruminations, as in major depressive disorder;
thought insertion or delusional
preoccupations,
as in schizophrenia spectrum and other
psychotic disorders; or
repetitive patterns of
behavior, as in autism spectrum disor
der).
D.