Case Study for a Teen Suffering from OCD
Obsessive-compulsion disorder or OCD is a relatively severe illness afflicting mostly the children and adolescents of today’s world. This paper aims to present significant information concerning the disorder in an effort to make the public understand its nature and most importantly, realize its negative implications. This will be done by creating a case study involving a 16-year-old teenager named Daniel. In doing so, it is the ultimate goal of the paper to discuss how concerned people will carry out the appropriate treatment program for OCD patients like Daniel.
Case Study for a Teen Suffering from OCD
Any person is supposed to experience an exciting and promising adolescent stage of life. It is the period where the young person leaves the childhood phase and anticipates what adulthood unfolds. This ideal condition holds true for a typical teenager but unfortunately not for one who manifests an illness called Obsessive-compulsive disorder or OCD.
In today’s modern world, the emergence and corresponding implications of OCD among the young ones and the people around them have gained an undeniable significant ground. This is for the reason that the said sickness afflicts a considerable number of children and young adults who could have just enjoying the prime
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Hence, in order to better understand OCD and its effects to adolescents, it is empirical to create a case study which is aimed at working on the condition of a specific patient. In particular, the case study will focus on the situation of 16-year-old student named Daniel whose OCD manifestations have apparently deterred his educational and social performance. Beyond recognizing the nature and impacts of OCD among adolescents, the needed treatment program which is hoped to address, if not solve, such condition is ultimately aimed specifically for Daniel who needs assistance in maximizing his high school experience.
Since Daniel is considered to be a special student, the case study will be carried out in a manner that the appropriate care and treatment plan will be implemented. Ultimately, the objective of the case study is hopefully to present a correct diagnosis about Daniel in order to successfully take away from Daniel or relieve him of the signs of OCD. The Daniel case will be performed through a series of evaluation, therapy and involvement sessions which are aimed at achieving correct medical assessment of the patient. Finally, it is the goal of the case study to provide the OCD literature with valuable tool which will work to the advantage of both OCD-stricken adolescents and concerned professionals.
OCD and its Treatment, an Overview
Having an overview of the disorder established the therapy phase. From this stage now comes the implementation of a correct preliminary medical evaluation which will then be important to the performance of what is called the cognitive-behavioral therapy of CBT. Thereafter, the psychoanalysis or rehabilitation procedure will be carried out and which is expected to resolve the problems besetting the teenage life of OCD patients like Daniel.
According to March and Mulle (1998), approximately one out of around 200 adolescents are afflicted with OCD and that in most instances, the patients’ sufferings are manifested through their respective intellectual, social and even professional operations. It is unfortunate to note, however, that despite an increased awareness about OCD particularly the emergence and application of an effective CBT, a small number of patients are given the right therapy. This is the reason why the two authors emphasized that an effective CBT for OCD patients relies on a clear identification and understanding of the disorder especially among adolescents (March & Mulle, 1998).
Citing the American Psychiatric Association’s “Diagnostic and Statistical Manual of Mental Disorders” or what is called the DSM-IV Diagnostic Criteria, March and Muller stated that OCD is exemplified by persistent fascinations and/or urges resulting to significant sufferings and/or obstructions in a person’s daily living (March & Mulle, 1998).
OCD patients manifest general obsessive and compulsive signs such as alarm over contamination, horror of injuring oneself and others and desires associated with a necessity for proportion or correctness. Impulses among children and young adults are seen through their extreme and unnecessary washing and cleaning of any part of their bodies especially their hands. Thereafter, OCD patients are equally urged to examine, count, do again, touch and organize whatever they have done. In fact, it is apparent that the patients have already created their respective habit of washing and inspecting things (March & Mulle, 1998).
Based from the said useful overview about OCD, it is now practical to clearly draw the line concerning the suitable treatment program and procedure between adults and teenagers like Daniel. This is because as March and Mulle said, a clear recognition of such variation of therapy method and application among adults and adolescents is an important factor in the efficiency or not of the medication (March & Mulle, 1998).
A comprehensive knowledge and understanding of OCD forms part of the overall evaluation and treatment management of OCD. Essential to this therapy program and implementation is the externalization or the clear separation of OCD as it relates to an adolescent his or her family members. Citing the narrative treatment strategies by White (1986), March and Mulle characterized OCD as a horrible and harsh neurobehavioral disorder that is manipulated both by the young ones and adult members of the family. Based from this principle, the family in general as well as the medical professional concerned and the young OCD patient himself eventually form a team which, under a common and combined objective, is hoped to treat OCD and provide a child or an adolescent with a normal life.
Applying this separation process to the condition of Daniel, it is worthy to initially take into consideration that the mother of the subject is herself experiencing an illness. Daniel’s mother has been diagnosed with a related psychological condition called the bipolar disorder which is characterized by apparent extreme and frantic depression. Since it is understandable and evident that manifestations of mental instability and mood swings were passed on from the mother to her son Daniel, it is first essential that the mother be treated separately for her illness because it is the only way that she may be able to help Daniel with his own battle with OCD hence the mother also undergoing treatment is recommended.
A good indication that the condition of Daniel’s mother is treatable is the fact that she and her husband have separated for five year but were recently reunited. This means that what the mother only needs is her continued and assured relationship with Daniel’s father. Another positive factor to consider concerning the psychological condition of the mother is the fact that she is from Russia while her husband is from India yet they developed a union despite culture differences and this led to the birth of Daniel who was born in the United States. The significance of the mentioned factors should not be taken for granted for the reason that the family background is a vital component in the treatment and eventual cure of Daniel.
Daniel’s case may be further studied along the line of two treatment exposures which are the gradual and intensive. It is obvious that just like the typical young OCD patients; Daniel prefers the normal gradual exposure kind of therapy. Deterred by his apprehension, Daniel will be appropriately treated through a slow but sure treatment exposure which may be carried out in regular sessions.
Such type of gradual exposure is expected to work to the advantage of Daniel because he will be provided with a significant level of control of himself and his actions unlike the intensive treatment exposure which is dependent only on a specified therapy-assisted session. Since Daniel’s tolerance to anxiety is low, it is beneficial for him to undergo a foreseeable, convenient and most importantly, effective treatment exposure.
Taking a closer consideration of Daniel’s condition, it is useful to regard that his intelligence quotient or IQ is 73 and that while his reading and math grades are at average levels; his primary concern is in his personal and social aspects. Additionally, although Daniel normally respects older people, there still left in him which makes him distrustful of adults.
It is in the said condition where the gradual exposure therapy is aimed to work because Daniel will be provided with an opportunity to take control of himself and with regular sessions, his perspective and interaction towards adults are hoped to be corrected. Thereafter, Daniel needs to undergo a higher degree of exposure treatment so that his drive for eventual healing is encouraged through notable and immediate improvements which can be specifically attributed to his better relationship to older people.
Aside from Daniel’s academic problems, his social instability and deficiencies also make him want to quit school. Rather than being friendly or associating with other students, he frequently says things which make the rest of the class laugh at him and for this he feels alienated from the group. As a consequence, the students in Daniel’s school label him as an odd person and they shy away from him. In turn, Daniel blows kisses at other students and waves at them during class which make his condition more laughable.
Based from these circumstances, it is now apparent that Daniel’s OCD manifestations only make him more different from other and, in effect, this makes him never a part of any group and even exhibits no leadership abilities. As he appeared to have limited social judgment, Daniel becomes more depressed, feels isolated and alone.
While the desire of Daniel to work in one of his father’s gas station is worthy to note, he must made to realize that this should not, in any way, hinders him from continuing his education. Hence, it is important for Daniel to be advised of not quitting school and be reminded of the benefits of education especially for his condition. While he dislikes school and thinks that his teachers pick on him and juts look for negative things about him, it should always be made clear to him that these are not the real scenarios.
Another relevant factor in Daniel’s treatment is his lack of desire to take Abilify as his required medication. Since he has already acknowledged that such drug makes him feel less hyper, this condition should be emphasized to him in order for him to realize the goodness of taking said drug to his treatment. This is also where his parents must exercise their authority wherein they must ensure that Daniel takes his medicine even if the latter does not want to. In fact, Daniel’s schools has called on the attention of his parents concerning his behavior in school hence it is now up to the parents to perform their functions of properly guiding Daniel through his medication and overall treatment program.
Daniel’s OCD Treatment Program
After all the above-mentioned have been considered, it is now assumed that Daniel has already finished a comprehensive assessment. However, March and Mulle explained that such evaluation is only a part of the entire treatment method. This is because the whole treatment protocol is ideal to be carried out in a series of therapy sessions. In every treatment session, there is a need for declaration of objectives, a cautious evaluation of the previous sessions, presentation of fresh details, the carrying out of what is called the therapist-supported “nuts and bolts,” assignment for the weeks to come and supervising processes (March & Mulle, 1998).
March and Mulle further identified the four steps of the treatment protocol. Based from the said therapy method, it will now be helpful for Daniel to be provided with psychoeducation as the first step and which will be done in two sessions in the initial week of the treatment program. Thereafter, Daniel needs to undergo a cognitive training or CT as the program’s step two and which will start in the initial week and goes on in the succeeding week. Step three will require Daniel to experience mapping OCD and which should be finished within the two sessions of the program’s second week. Out of the three steps, the last step will be established where Daniel will be given a rigorous gradual exposure plus response prevention or E/RP for the rest of the session weeks (March and Mulle, 1998).
All the components of the treatment program must be identified such as the need for parents to also contribute and perform their functions as well as the various logistical considerations like the rate and number of treatment sessions, session venues, duration of the sessions, constant communication, consideration of a therapist’s treatment style and most importantly the manner of evaluating the result of the treatment. Once all of these clearly exist, Daniel is now prepared for his actual OCD treatment program which will be done in a sequence of therapy sessions.
It is extremely important that Daniel will be provided with an accurate application of what March and Mulle have drawn as an exposure-based therapy of OCD hence the need for a session-by-session OCD treatment. The first four sessions immediately establish the phase for starting the exposure style of therapy and Daniel needs to finish this in the initial two weeks if the session is placed at two for every week. The rest of the treatment sessions will be made on a weekly pattern.
The first session of Daniel’s OCD treatment program requires the formation of a neurobehavioral structure. As my “special student,” I have to exert extra effort in knowing Daniel more wherein I may start with what he likes and dislikes as well as his preferred activities. I could start by discussing with Daniel what I learned that helping his father in his gas station business is one of his interests. Then I will tell him that overcoming his OCD is, in effect, helping his father because this will make his father really happy thereby improving the family business.
With this, Daniel is hoped to show a manifestation of calming down and from there he may eventually but slowly reveal his obsessions and compulsions which by now clearly appears to me as his educational worries particularly his academic grades and low IQ. I will discuss further to Daniel that such obsessions are being coupled with his urges to blow kisses and waving at his classmates during class time. I will also explain to Daniel that his worries are definitely unnecessary and unhealthy ideas which go together with his ill desires and emotions.
There is also a need for me to tell Daniel that his obsessions are accompanied by his impulses which are activities aimed at throwing away his obsessions thus relieving him of its negative implications. With this I intend to, in effect, simply make Daniel realizes that his fascinations are unwarranted and that their absence will eventually release him from the accompanying ill effects of obsessions which, in fact, turn out to be just his urges just to correct his worries hence the activity turned out well.
It will also be essential and helpful to invite Daniel to provide OCD with a bad label in order to motivate him to his objective to get rid off his OCD and eventually be treated of said illness. In case he does not give a specific name for his illness, I will imply that he needs to be fully aware that he is sick so that he may acknowledge the need to be treated and that this indication will be a sign of good start.
Hence, the first session of the treatment program may be summed up with the requirement to achieve several objectives such as the formation of good connection between Daniel and me, provision of a neurobehavioral structure, enlightenment of the therapy procedure and introduction of story symbols or images.
In the next few sessions, I will introduce Daniel with what is called the cognitive training wherein the main objective is to improve Daniel’s sense of effectiveness as well as value as a son and student, certainty in his thoughts and actions, being in charge and self-recognition. In doing so, it is also targeted that during these sessions that Daniel’s knowledge about his illness will be reinforced with correct theories and corresponding therapy concerning OCD.
The said succeeding sessions will likewise involve what March and Mulle called as “bossing back OCD” treatment approach (March & Mulle 1998). Through such method, Daniel’s attitude towards his sickness and personal efforts to fight OCD will be enhanced especially with the help of his parents, people in his school and concerned professionals who will all be Daniel’s partners in his struggle against OCD.
Based from the given positive coping techniques provided by March and Mulle, the continuing sessions will determine if Daniel is slowly benefiting from such cognitive “tool kit” which he used during the previous sessions (March & Mulle, 1998). In particular, Daniel will be appraised that the earlier activities, where his exposure and reaction deterrence undertakings were carried out, already serve as his “tool kit” which will definitely help him in his attempts to fight his illness.
Another one or two more sessions will be allotted to mapping Daniel’s OCD treatment program. It is in this part where the patient’s experience with his illness will be clearly drawn through the use of chart or any diagram which will record Daniel’s progress or failures since the therapy was started until such time that he is able to complete the whole treatment plan. Such mapping involves the identification and recognition of particular condition and characteristic by which Daniel manifest OCD. This includes his fascinations, urges, triggering elements of the disorder, attitude to avoid the conduct of the treatment and lastly, the implications of OCD to Daniel.
In implementing these mapping sessions, it is aimed that the motivational ladder of Daniel’s OCD will be created and presented in a narrative perspective for the easy understanding of the patient. Additionally, the mapping may be carried out with the use of some cartographic symbols which will depict the situations when Daniel is not manifesting OCD, during his winning periods against the illness and also the times when he seems to appear weak in his fight against his condition.
It is the fundamental goal of the mapping sessions for Daniel to reach what March and Mulle called the transition zone (March & Mulle, 1998). Being the central portion of the treatment program, Daniel’s eventual transition zone will be achieved as soon as he reach the time when he feels that he already has some accomplishments in fighting back his condition. I will also work out the Daniel’s transition zone by giving him a dependable attitude until such time he is ready for gradual and more intense therapy sessions.
The last few sessions comprise the treatment program’s fourth step where the central and essential qualities and objectives of the cognitive-behavioral treatment will be fully applied. It is this remaining sessions that Daniel exposure and response prevention about his OCD will be put in their final stages. Applying this in the case of Daniel, his fascination of working in the gas station of his father will be done in order to enhance his psychosocial attributes while his anxiety of taking his medicine must be overcome by making him accept the benefit of such drug and realize it is essential to make him well. Thereafter, Daniel’s response prevention may be carried out in a way that he will be made to refuse to do his anxiety-driven urges of blowing kisses and waving at his classmates. When all the objectives of the sessions have been met, Daniel’s treatment program will be concluded with a commencement rite where his parents, teachers and friends will be invited to witness Daniel’s victory over OCD.
OCD among adolescents is definitely a serious concern which needs to be addressed and not neglected. Through the above case study formulated in response to Daniel’s disorder, it is expected that concerned people surrounding a child with OCD will be made to realize the needed efforts and involvement that they have to share in order to help the patient fight OCD. Based or using the very valuable cognitive-behavioral treatment manual formulated by March and Mulle, attempts to treat and resolve the condition of Daniel were carried out in an easy manner. This is because the manuals’ theories or principles, pieces of information and other related useful materials have ultimately proven to be effective tools in the understanding and implementation of Daniel’s therapy program.
March, J.S. & Mulle, K. (1998). OCD in Children and Adolescents: A Cognitive-behavioral Treatment Manual. New York, NY: Guilford Press.