QUESTION
Case Study: Josie Bellings,
Josie Bellings, a 34-year-old nurse, presents to your office. Her boyfriend, Robs, is with her.
“Hi,” Josie sighs deeply. “Remember your first months as a new nurse? I just finished orientation and I’m struggling to keep up now. I’m… I’m having trouble clocking in on time because I have to be certain my hands are clean before I start my shift.”
Robs breaks in. “She’s told me she sometimes washes her hands six times in a row. Maybe even seven or eight to be sure. She does this at home, too.”
Josie nods. “Yeah, he’s right. And after seeing a patient, I also have to clean the desk and computer with wipes just as many times before I can finish the chart. My charge nurse says I’m overdoing the cleanliness a bit, but I just have to do it. And it's not just cleanliness. At home, I’m the last to bed because I have to check the doors at night five to six times at night."
“Even if I’ve already locked up and she saw me do it,” puts in Robs.
“Well, I feel like I have to have some control over my world. And, um, Robs doesn’t know this, sometimes I get up after he falls asleep because I worry to the point that I will have to get up and go check one or two more times before I can go to sleep.”
Robs adds, “Actually, I did know about that, Josie. I’m also concerned because Josie will get focused on something and then not be able to shut her mind down. She perseverates and I cannot distract her for anything.”
Josie reports that she has always had these symptoms but that they are worse recently. She reports feeling depressed, mainly because of the OCD symptoms that are causing her trouble. She denies any SI, HI, or A/V hallucinations.
Here is the question to be answered!!!!
Based on the information that you have, what diagnosis would you give Josie? Please include differential diagnoses. Please match her symptoms with the corresponding DSM-5 criteria.
Her diagnosis is Obsessive Compulsive with depression .
Why is all of this important? What’s so important about having depression and OCD together? Well, it turns out that having severe depression can interfere with the effects of the most effective treatment for OCD: cognitive behavioral therapy using exposure and response prevention. As you might know, exposure therapy involves gradually confronting the situations and thoughts that trigger your obsessions; and response prevention means working on refraining from the corresponding compulsive rituals.
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Answer
Josie Bellings Case Study
Obsessive-compulsive disorder (OCD) affects an individual regardless of race, age, religion, or ethnicity. OCD causes a series of obsessions and fears that may lead a patient to perform recurrent behaviors, including compulsions and obsessions. The symptoms of OCD include addictions, such as repetitive hand-washing and checking if the doors are locked, and compulsions such as fear of being polluted by touching surfaces that have been touched by other people. In Josie's case, it is reported that the symptoms have always been present, but that they have worsened recently. This report provides a diagnosis for Josie's condition and offers further information on OCD and depression.
Josie Bellings’ report shows that she has been struggling with obsessions such as fear of being polluted by touching polluted surfaces and doubts whether the doors are locked or not at night. From our interactions, I uncovered that she checks the door locks repeatedly before retiring to bed and washes her hands frequently at work (about six times in a row). It is to be noted that amongst individuals with OCD, few people receive proper diagnosis and even treatment (Krebs et al., 2021), making it essential to observe Josie's condition keenly and provide the appropriate diagnosis.
The DSM-5 Diagnostic Criteria for OCD using different symptoms as portrayed by the patient are stipulated by Tolin (2018). According to the DSM-5 criteria, the first observations should be obsessions and compulsions. Josie's recent behaviors show the signs defined by the obsessions and compulsions such as repeated hand-washing, over cleanliness, and constantly checking door locks. The second observation according to DSM-5 criteria that is clear in Josie's condition is time-consumption since Josie takes a lot of time washing her hands and checking door locks. According to Tolin (2018), depression is the main differential diagnosis of OCD. As a result, the analysis of Josie's condition can only be diagnosed as obsessive-compulsive with depression. The diagnosis has resulted from the presence of obsessions and compulsive behaviors.
The anxiety of living with OCD may result in depression (Ford, 2021). It is common for a person with OCD to develop depression than someone with depression to develop OCD (Ford, 2021). The connection embraced between OCD and depression is paramount from a research perspective. For the basis of studies, treatment and prevention of OCD and depression can be derived from researching more on the connection between the two conditions. Additionally, for patients with OCD, being aware of depression can be significant. The apprehension can help in getting psychiatric care if depression does not become a problem.
In conclusion, obsessive-compulsive disorder symptoms such as obsessions, repetitive hand-washing, and checking if doors are locked, compulsions, the fear of being polluted from touching faces that have been touched by other people and having doubts that the doors are locked, are visible in Josie's conditions. With careful study of her case using the DSM-5 Criteria, she is diagnosed with obsessive-compulsive depression, therefore, the need to seek treatment. It is also noted the importance of having a connection between OCD and depression. The main significance is that with the patient’s awareness of depression, he/she can get treatment if the depression does not turn out to be a problem.
References
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Ford, V. (2021). The Connection Between OCD and Depression. Success TMS. Retrived 22 March 2021. from, https://successtms.com/blog/ocd-and-depression Krebs, G., Mataix-Cols, D., Rijsdijk, F., Rück, C., Lichtenstein, P., Lundström, S., ... & de la Cruz, L. F. (2021). Concurrent and prospective associations of obsessive-compulsive symptoms with suicidality in young adults: A genetically-informative study. Journal of affective disorders, 281, 422-430. Tolin, D. F., Gilliam, C., Wootton, B. M., Bowe, W., Bragdon, L. B., Davis, E., ... & Hallion, L. S. (2018). Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders. Assessment, 25(1), 3-13.
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