Activity Worksheet#4

D: Obsessive-Compulsive and Related Disorders

Student Name: ___________________________

Date: ___________________________

Instructor: ___________________________

Case Study
Susan is a 24-year-old, married, mother of two children, aged 2 and 5. She
has always described herself as a “neat freak,” cleaning and scrubbing the car,
the house, and even her children repeatedly. Susan has always secretly
worried that lack of cleanliness would lead to disease or contamination and
that she or her family might become deathly ill due to her negligence in
protecting them from germs.

In the past few months, Susan’s thoughts of contamination and disease have
increased as have her cleaning activities. Her children complain, and Susan’s
husband believes her cleaning is “getting out of control.” He finds Susan
cleaning in the middle of the night, and when he tries to interfere with her
cleaning, she explodes. She is sobbing and yelling and extremely agitated.
Susan is taken to the emergency department of the local hospital, given a
tentative diagnosis of OCD, and admitted to the inpatient unit.

Key Considerations
1. Assessment of Obsessive-Compulsive Disorder (OCD)
Susan’s symptoms of excessive cleaning, distress about contamination,
and difficulty controlling her behavior point to possible OCD. Assessing
the severity and impact of her obsessions and compulsions is crucial
for developing an appropriate treatment plan.
2. Impact on Daily Life and Relationships
Susan’s compulsive cleaning is interfering with her family life and
relationships, as evidenced by her children’s complaints and her
husband’s concerns. This has implications for her social functioning,
and family therapy or education may be necessary to support her loved
ones.
3. Safety and Emotional Well-being
Susan’s emotional state, including agitation, sobbing, and outbursts
when interrupted, suggests significant distress. Ensuring her safety,
 emotional stability, and providing immediate support are key
considerations during her hospitalization.

Learning Objectives
1. Understand the symptoms and diagnostic criteria of Obsessive-
Compulsive Disorder (OCD), including how it can manifest in behaviors
such as excessive cleaning and contamination fears.
2. Analyze the psychosocial impact of OCD on family dynamics and
relationships, particularly focusing on how the disorder can affect
interpersonal interactions and daily functioning.
3. Develop an appropriate care plan for individuals with OCD, including
pharmacologic and therapeutic interventions, family support strategies,
and safety measures to manage acute distress and compulsive
behaviors.

Concept: Obsessive-Compulsive Disorder (OCD) in

Adults and Families
Key Topics

1. Diagnosis and Symptomatology of OCD

2. Psychosocial and Family Dynamics
3. Treatment Approaches for OCD

Discussion Questions
1. What are the key clinical features of Obsessive-Compulsive Disorder
(OCD), and how do they differ from normal cleanliness habits?
2. How can family members support an individual with OCD while
managing their own stress and emotional responses to the person’s
compulsive behaviors?
3. What are the advantages and limitations of using cognitive-behavioral
therapy (CBT) and medication in treating OCD, and how can these
approaches be tailored to an individual’s needs?

E – Experience (Analysis of the Case)

Case Summary Recap

Susan, a 24-year-old mother of two young children, has always maintained a

high level of concern about cleanliness, which she described as being a "neat
freak." Her cleaning habits extended to her home, car, and even her children,
driven by an intense fear that a lack of cleanliness could lead to disease or
contamination. Over time, these thoughts have escalated, becoming more
frequent and distressing. As a result, her cleaning activities have also
increased. This change in behavior has started to disrupt her family life. Her
children complain, and her husband expresses concern about her behavior
becoming excessive. Susan's cleaning often takes place late at night, and
when her husband attempts to intervene, she becomes highly agitated,
sobbing and yelling. Due to the severity of her symptoms and the emotional
distress they cause, Susan is brought to the emergency department and
diagnosed with obsessive-compulsive disorder (OCD). She is subsequently
admitted to an inpatient unit for further management.

Analysis Questions

1. What are the key symptoms and behaviors displayed by Susan that
suggest a diagnosis of obsessive-compulsive disorder (OCD)?
o Describe the specific behaviors and thought patterns that align
with OCD, considering the frequency and impact of Susan’s
cleaning rituals on her daily life and family.
2. How might Susan’s compulsive cleaning and intrusive thoughts about
contamination be affecting her interpersonal relationships, particularly
with her husband and children?
o Explore how her behavior may be contributing to marital tension
and the emotional impact on her children, considering how they
might experience her obsessive cleaning habits.
3. What treatment options would be most appropriate for Susan, and why
are these treatments effective in addressing the core symptoms of
OCD?
o Discuss the potential treatment strategies for OCD, including
both pharmacological and therapeutic interventions, and explain
why these approaches are effective in managing the obsessive
thoughts and compulsive behaviors characteristic of the disorder.

Guided Reflection Questions

1. Personal Reflection:
Reflect on how you might respond if you were in Susan’s shoes. How
would you feel if a fear of contamination or disease became so
overwhelming that it interfered with your daily life and relationships?
 What coping strategies or support systems do you think could help in
such a situation, based on your own experiences?
2. Professional Reflection:
As a healthcare provider, how would you approach caring for a patient
like Susan who is experiencing severe distress due to obsessive-
compulsive behaviors? What steps would you take to ensure you
provide compassionate care while also addressing the underlying
psychological disorder? Consider both your professional role and the
importance of empathy in patient interactions.
3. Ethical Reflection:
In cases like Susan’s, where a mental health disorder is impacting
family dynamics, what ethical considerations come into play regarding
treatment and family involvement? How might you navigate the
delicate balance between respecting Susan’s autonomy and involving
her family in her care, particularly if they are struggling to cope with
her symptoms?

Intervention Planning Activity: Create a Care

Plan
Instructions: Develop a simple care plan for Susan that includes the
following:

 Short-term goals:
What immediate interventions should be implemented to address
Susan’s acute symptoms and safety?
 Long-term goals:
What sustainable strategies can help Susan manage her OCD over time?
 Support system involvement:
How can Susan’s family, healthcare team, and community resources
contribute to her recovery?

Evaluation: Assessing Learning and

Application
Self-Assessment Questions

1. Understanding OCD:
o How well do you understand the key features of obsessive-
compulsive disorder (OCD)? Explain the difference between the
obsessions (intrusive thoughts) and compulsions (ritualistic
behaviors) in the context of Susan’s symptoms.
 o Can you identify the factors that may have contributed to
Susan’s increased symptoms over the past few months? Reflect
on how OCD might be exacerbated by stressors in Susan’s life.
2. Intervention Planning:
o Reflect on the intervention strategies discussed for treating
Susan’s OCD. Which approach (CBT, pharmacotherapy, family
therapy, etc.) do you believe would be most beneficial for Susan,
and why? How would you prioritize the implementation of these
strategies?
o Evaluate your comfort level with utilizing Cognitive Behavioral
Therapy (CBT) or Exposure and Response Prevention (ERP)
techniques. How can you enhance your skills in using these
interventions with clients like Susan?
3. Self-Care and Empathy:
o Considering the emotional strain Susan's behaviors are putting
on her family, how would you maintain a balance between
empathizing with her struggles and supporting the family?
Reflect on how you can help families of individuals with OCD
understand the disorder and provide constructive support.
o How can you take care of yourself emotionally and
professionally when dealing with patients whose compulsive
behaviors are disruptive and emotionally charged?

Group Discussion Prompts

1. Understanding and Diagnosing OCD:
o Based on Susan’s case, what would be the first steps in making
a definitive diagnosis of OCD? What diagnostic tools or
assessments would be helpful to further evaluate her condition?
o How would you differentiate between normal cleaning behaviors
and the kind of compulsive cleaning seen in OCD? Discuss the
impact of this difference on Susan’s daily life and relationships.
2. Treatment Approach and Implementation:
o As a group, discuss the most appropriate interventions for Susan,
particularly focusing on the role of Cognitive Behavioral Therapy
(CBT). How would you explain the process of Exposure and
Response Prevention (ERP) to Susan in a way that helps her
understand the therapeutic approach?
o What challenges do you foresee in implementing these
interventions with a patient like Susan, and how would you
address them? Consider both practical challenges (e.g., family
dynamics) and emotional challenges (e.g., patient resistance).
3. Family Involvement and Support:
o Discuss the potential role of Susan’s family in her treatment.
How would you involve her husband and children in the
 treatment process while maintaining Susan’s privacy and
respecting her autonomy?
o In what ways can you support family members who are
struggling with their loved one’s OCD behaviors? Consider the
importance of psychoeducation, emotional support, and
boundary-setting.
4. Ethical Considerations and Reflection:
o What ethical dilemmas might arise when treating a patient with
OCD whose behaviors significantly impact the family dynamic?
Discuss the balance between respecting Susan’s autonomy and
ensuring the well-being of her family members.
o Reflect on the importance of self-care for healthcare providers
when managing emotionally charged cases such as Susan’s.
How can healthcare providers maintain professional boundaries
and empathy in such cases?

References
1. American Psychiatric Association. (2022). Diagnostic and Statistical
Manual of Mental Disorders, 5th ed., Text Revision (DSM-5-TR).
Arlington, VA: American Psychiatric Publishing.
2. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical
Psychiatry (12th ed.). Philadelphia: Wolters Kluwer.
3. Obsessive-Compulsive Disorder (OCD) – Symptoms and Causes. Mayo
Clinic