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Clinical Crossroads
April 25, 2001

A 45-Year-Old Woman With Obsessive-Compulsive Disorder

Author Affiliations

Author Affiliation: Dr Jenike is Professor of Psychiatry, Harvard Medical School; Associate Chief of Psychiatry, Massachusetts General Hospital, Boston; and Director of the OCD Institute at McLean Hospital, Belmont, Mass.

 

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, Richard A. Parker, MD, and Risa B. Burns, MD; Erin E. Hartman, MS, is managing editor.
Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor.

JAMA. 2001;285(16):2121-2128. doi:10.1001/jama.285.16.2121

DR PARKER: Mrs T is a 45-year-old woman who has obsessive-compulsive disorder (OCD). Though currently disabled secondary to her OCD, she decided to discontinue all psychiatric medications because of adverse effects. She is married with a healthy teenaged daughter. Her commercial insurance has completely covered her extensive outpatient and inpatient therapies.

Although Mrs T did not know it then, in retrospect, she sees clues of OCD in her childhood behaviors. She recalls spending hours at the age of 5 years counting the sides of squares on her bedroom wallpaper. When she was 9 years old, her house was robbed, triggering rituals such as checking under the beds and inspecting closets around the house. Mrs T recalled that these actions seemed to reassure her that no one in her family would get hurt. A few years later, graphic antismoking commercials increased her anxiety that her father, a smoker, would die of lung cancer. While watching television with others present, she would do counting rituals in her head, so others would not know she was doing it. She felt a need to "control things."

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