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.
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."
Jenike MA. A 45-Year-Old Woman With Obsessive-Compulsive Disorder. JAMA. 2001;285(16):2121-2128. doi:10.1001/jama.285.16.2121