Psychodiagnostics: Obsessive-Compulsive Disorder

Biopsychosocial History, Presenting Problems, and Symptoms

The client of this case is Francisco, a 45-year-old Latino man, married to a Caucasian man. He was raised in a traditional Catholic family, the members of which became shocked after his sexuality acceptance at the age of late 30s. After three-month depression and communication with a priest, his mother supported the son, but the father still refuses to talk. As a result, Francisco has intrusive images that his father dies. To control the episodes and block out the images, the patient closes his eyes, says “no, no, no”, and bounces three times. Francisco is an IT manager at a finance company, and he understands that his behavior bothers some people. Such repetitive habits do nothing to treat his obsession, but they help to believe that nothing bad could happen. High heart rate, hyperventilation, muscle tension, and an irresistible urge to do repetitive actions are the presenting symptoms of the patient. The symptoms of panic attacks and worries that people are bothered with his behavior should be assessed.

Differential Diagnoses and Final Diagnosis

Tics and stereotyped movements introduce the condition that may be identified as a differential diagnosis. The client reports nonrhythmic motor movements that have to be repeated several times (American Psychiatric Association, 2013). However, in this disease, his repetitive habits should not have a purpose, and Francisco states that he always has a goal to reduce the duration of crazy images. Panic disorder can be diagnosed because of the presence of such symptoms as sweating, fear of going crazy, and muscle tension (American Psychiatric Association, 2013). The duration and origins of the patient’s behavior are used not to choose this diagnosis as a final option, and additional assessment is required.

The signs of obsessive-compulsive personality disorder, like the intention to control something and perform the same activities a certain number of times, also matter. Still, the lack of personality traits like excessive perfectionism or the need to control the environment allows saving cognitive flexibility and judgment of his behavior as a crazy one (Thamby & Khanna, 2019). However, repetitive irrational behaviors, saying a particular word for a particular period, and performing a kind of ritualistic movements to predict something bad are the signs of obsessive-compulsive disorder (OCD) that is characterized by obsessions and compulsions without personality traits being identified.

Contributing Factors to the Client’s Condition

Francisco’s family sticks to Catholic beliefs, which makes a family factor as one of the major contributions to his condition. The patient graduated from school and college and continued developing close relationships with his large family. Almost all his relatives were able to manage their lives and created traditional families. Therefore, his decision to connect his life with a man was a shock for the entire family and changed the way Francisco talked to them. The environment does not have such an impact on the client’s health like his family has. The man cannot get rid of a thought that his sexuality brings discomfort to his father’s life and thinks that his death is the only moment when the two men might come to an agreement.

Clinical Treatment

After a detailed assessment of the client’s symptoms and choosing OCD as a final diagnosis, a treatment plan has to be settled. In this case, Francisco does not require hospital treatment because of no suicidal risks and dangerous behaviors (Reddy et al., 2017). The combination of pharmacological and non-pharmacological therapies is crucial. Clomipramine (150 mg) is a recommended first-line treatment of the OCD patient if no cardiac or neurological side effects are observed (Reddy et al., 2017). Cognitive behavioral therapy will help to discuss the roots of obsessions and discuss the situation with a professional healthcare giver. According to Reddy et al. (2017), electroconvulsive therapy (ECT) should not be offered as a treatment option for OCD patients but used as a method to deal with comorbid conditions like psychosis. Francisco does not demonstrate such mental health signs, and this form of treatment needs to be removed.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

Reddy, Y. J., Sundar, A. S., Narayanaswamy, J. C., & Math, S. B. (2017). Clinical practice guidelines for obsessive-compulsive disorder. Indian Journal of Psychiatry, 59(1), 74-90. Web.

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Thamby, A., & Khanna, S. (2019). The role of personality disorders in obsessive-compulsive disorder. Indian Journal of Psychiatry, 61(1), 114-118. Web.

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