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A fictional composite case by Leo A. Kominek, Ph.D.
Vera is a 36-year-old married woman with no children. She hasn't had any children because the thought of bringing any more disorder into her life was beyond her imagination.
Vera has struggled with obsessions (persistent and repetitive disturbing thoughts, images, or impulses) and compulsions (the need to perform some ritual or routine to help relieve the anxiety caused by the obsessions) for many years, starting in childhood.
Vera remembers her parent saying that when she was in fourth grade she never was quite satisfied that she was "clean enough." When Vera played with other children she often felt the need to run home and wash her hands.
Vera states, "I would feel extremely anxious until I was convinced I had scrubbed all their germs off my body." This caused some teasing from classmates, but did not start to seriously interfere with her day-to-day routines until the latter part of her senior year in high school.
In High School something happened the vastly increased the scope of her compulsive behavior. An avid reader, Vera suddenly had difficulty reading her assignments because she would have to reread a sentence or paragraph several times just to make certain that she did not miss a single word. She just had this nagging feeling that she had forgotten to read something.
Later on the counting started. If she read the front page of a newspaper she could not put it down until she has read every single article three times. She is not sure why she had to do this, but if she didn't her anxiety became overwhelming.
Vera says, "After I finished and my anxiety was relieved, I realized how ridiculous my behavior was. But somehow this didn't help the next time I read the paper".
Now checking is also a problem for Vera. She makes her lunch in a very meticulous and ordered fashion and then places in her lunch bag, folding the top of the bag three times. She then puts it into the refrigerator, but continually comes back and rechecks the bag to make sure everything is there and she hasn't forgotten anything. She can easily repeat this ritual 10-20 times.
When Vera drives to work and happens to hit a bump she fears that she may have run over someone with the car. She has to stop her car, get out, and walk around it several times, carefully checking to be sure there isn't a body underneath. She is terrified of harming others.
The fear of contamination continues to plague Vera. The simple act of shaking hands with a friend or colleague can leave her so riddled with anxiety that she feels incapable of functioning until she is able to wash off the imagined germs.
Asked to describe how she felt after touching someone she says, "Imagine how you would feel if you stuck your hand in a pile of cow dung and were told you couldn't wash it off for a week." Vera's symptoms of OCD have become increasingly pervasive over time and have permeated all aspects of her life.
Recent evidence suggests biological factors are a major contributor to the development of OCD. Medication can help with this disorder. The most successful non-drug therapy for OCD is exposure therapy, a type of behavioral therapy. Vera now knows that there are treatments that may very well help her deal with OCD.
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