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Chenie B.


Advanced Abnormal Psychology

MS Psychology

Bess is a young professional who has a strict ritual in her daily living. She works

as an accountant in a large manufacturing firm and she is described as perfectionist.

Though being a perfectionist is acceptable in her work and is regarded as functional,
her social life is being affected and she only has few friends.
She grew up in her mothers care and she described her childhood as unhappy.
She was trained to be organized and to observe the virtue of cleanliness that she
eventually acquired as she gets old. She developed variety of rituals and obsessive
thoughts that came to the point of her fear of being contaminated in public places. Bess
seems to have an Obsessive- Compulsive Disorder.
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by
unreasonable thoughts and fears (obsessions) that lead an individual to do repetitive
behaviors (compulsions). With obsessive-compulsive disorder, an individual may realize
that his/her obsessions aren't reasonable, and he/she may try to ignore them or stop
them. But that only increases his/her distress and anxiety. Ultimately, he/she will feel
driven to perform compulsive acts in an effort to ease your stressful feelings (Mayo

Identifying Information
Bess is 27 year-old, upper-middle class woman. She is attractive and she is

successful in her field. She lives by herself in a well-kept apartment in one of the best
sections in town. She would work late and comes home for dinner. She would watch
television or read until she gets sleepy. But she usually needs alcohol or sleeping pills
to go to sleep.

Bess is an only child and her parents were divorced when she was 10 years old.
She was raised by her mother who was demanding and had a sporadic contact with her
father. But she often expresses her love for Bess and often spends time with her. Bess
does not recall a time spent with her mother that is warm or fun. On the other hand,
Bess loves to visit her father in the nearby city. He is a happy person and more relaxed
with the world. His father had not been successful in life and he moved through a series
of jobs. He would attend Bess happily when she visits him but they rarely see each
other because her mother would subvert their communication.
Recently, Bess lives alone and she spends much time with her cleansing ritual
and obsessive thoughts about using the toilet, sexual issues or encountering the
possibility of being contaminated in public areas.

Her rituals widened that her

functioning became more impaired. Thus, these behaviors intrude on her ability to carry
out her work, the thing that only gives her source of meaning and satisfaction. She then
referred herself for help.

Background of Information
Bess mother focused on activities that would improve her.

She will set up

lessons for Bess and they would fight over whether Bess was doing well on her lessons
or not. They also struggle on the issue on cleanliness and neatness. She would nag at
Bess when she discovered that Bess things are not in order. She always emphasized
that cleanliness is very important. She also made sure that Bess washed her hands
thoroughly whenever she went to the bathroom or touch herself, for any reason, in the
genital area. She emphasized that being disorder would hurt Bess as she got older.
Though Bess resisted her mother at home she still grew up with her mothers
value system in school and her social life was not healthy. She was not involved in any
class and school activities and she would go home after preparing her lessons. As she
moved into late adolescence, she started to think of erotic fantasies. To control these
fantasies she

preoccupied herself with activities to divert her attention. She drooled

herself with crossword puzzles and jigsaw puzzles.

However, she experienced

unexpected pregnancy when she was a senior high that she was dictated by her mother
to have it aborted.

She was then sent to Europe and when she came back her

boyfriend had another lover. Until then she was still confused and her anxiety was not
address regarding dating, marriage, having a family and other related matters.
To handle her anxieties, she threw herself harder to her work. At the same time,
she also began to experience symptoms that focused around the issue of cleanliness.
She developed a thorough cleansing ritual that would set off upon touching her genital
or anal area. She will first remove her clothing in a pre-established sequence. She will
check her clothing for any contamination. She will then scrub her body from feet up to
her head with particular washcloths in each area of the body. When she suspected that
her clothing is contaminated, she will then put it to the laundry and those items that are
clean will be put in vacant area. She will then dress up in the opposite order from which
she took her clothes off.

When there will be any deviation from the order of her

dressing up, she will go through entire sequence again. She would do this four to five
times on certain evenings.
These rituals impaired Bess functioning, especially to her work. She spends
much time with her rituals though she knew that these behaviors are absurd. She still
wants to go through these cleansing rituals and did not question nor correct them.

Multiaxial Diagnosis
Axis I

Clinical Disorders
300.3 Obsessive- Compulsive Disorder


Either obsessions or compulsions:

Obsessions as defined by (1), (2), (3), and (4):
(1) recurrent and persistent thoughts, impulses, or images that are
experienced, at some time during the disturbance, as intrusive and
inappropriate and that cause marked anxiety or distress

* Bess had a continuous anxiety regarding dating, marriage, having

a family and other related matters.
* Bess has obsessive thoughts on using the toilet, sexual issues
and encountering the possibility of being contaminated in the public
(2) the thoughts, impulses, or images are not simply excessive worries
about real life problems
* Bess experience during her late adolescence, being preoccupied
with erotic fantasies that may led to masturbation, and her abortion
contributed to her anxiety.
* She had been struggling to understand these thoughts because it
was really vague for her and she had no one to talk to regarding
this matter because even her abortion was her mothers decision.
(3) the person attempts to ignore or suppress such thoughts, impulses, or
images, or to neutralize them with some other thought or action
* When Bess was still adolescent, she diverted her attention to
crossword puzzles and jigsaw puzzles.
* As her anxiety continues as she aged, she made herself busy with
her work.
(4) the person recognizes that the obsessional thoughts, impulses, or
images are a product of his or her own mind (not imposed from without as
in thought insertion)
* Bess is aware of the absurdity of her behaviors but she still feel
that she has to go through it.
Compulsions as defined by (1) and (1):
(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental
acts (e.g., praying, counting, repeating words silently) that the person
feels driven to perform in response to an obsession, or according to
rules that must be applied rigidly

* Bess developed a pattern on cleaning that is thorough and done

whenever she touches her genital or anal area.
* She has a cleansing ritual that follows a pattern. She has to see
to it that the pattern is follow or she will go through the entire
sequence again if she will miss something.
(2) the behaviors or mental acts are aimed at preventing or reducing
distress or preventing some dreaded event or situation; however, these
behaviors or mental acts either are not connected in a realistic way with
what they are designed to neutralize or prevent or are dearly excessive
* Bess follows her cleansing ritual every night because of her
obsessive thought of the possible contamination in public places.
* As she removes each article of clothing, she will examine it for
any indication of contamination.

At some point during the course of the disorder, the person has
recognized that the obsessions or compulsions are excessive or
* Bess was aware of the absurdity of her behaviors and these had
already intruded her functioning, especially to her work. Thus, she
submitted herself for help.


The obsessions or compulsions cause marked distress, are time

consuming (take more than 1 hour a day), or significantly interfere with the
person's normal routine, occupational (or academic) functioning, or usual
social activities or relationships.
* Bess rituals consumed most of her time that she even can go
through it four to five times in a row on certain evenings.
* It impaired her social, occupational and her personal routines
since it consumes her time and energy.


If another Axis I disorder is present, the content of the obsessions or

compulsions is not restricted to it (e.g.. preoccupation with food in the
presence of an Eating Disorder; hair pulling in the presence of
Trichotillomania; concern with appearance in the presence of Body

Dysmorphic Disorder; preoccupation with drugs in the presence of a

Substance Use Disorder; preoccupation with having a serious illness in
the presence of Hypochondriasis; preoccupation with sexual urges or
fantasies in the presence of a Paraphilia; or guilty ruminations in the
presence of Major Depressive Disorder).
* There is no specified data applicable for this criterion.

The disturbance is not due to the direct physiological effects of a

substance (e.g. drug of abuse, a medication) or a general medical
* In the case, there is no data regarding physiological effects or
general medical condition.

Axis II

Personality Disorders and Mental Retardation

V71.09 -

No Diagnosis

Axis III

No Diagnosis

Axis IV

Psychosocial and Environmental Problems

a. Problem with primary support group

Her mother and father were not in good harmony as she

grew up.

Her mother was demanding and was did not establish a

warm relationship with Bess.

b. Social Problem

Bess only have few friends. Her social life was unhappy.

She never attended school activities nor went out with

her friends.

c. Educational Problem

None specified.

d. Occupational Problem

Her behaviors began to intrude her ability ot carry out

her work.

This statement implied that Bess functioning was


She cannot work well compared before

because her rituals consumes much of her time. She is

much preoccupied with her obsessive thoughts on being
contaminated in the public places.
e. Housing Problem

There is no data specified in the case.

f. Economic Problem

Bess is successful and she belongs in the upper-middle

class. Thus, this would imply that she has no economic

g. Problems with access to health care services

There is no sufficient data in the case.

h. Problems related to interaction with the legal system/crime

None specified

i. Other problems

Axis V

None specified

Global Assessment of Functioning Scale

Score: 40, current

Bess has a major impairment in her work and in her

social life, especially with regards to the opposite sex.

Bess is recommended undergo psychotherapy. Cognitive behavioral
therapy may help her. Cognitive behavioral therapy involves retraining her
thought patterns and routines so that compulsive behaviors are no longer
necessary (Mayo Clinic). She may also undergo behavior therapy; exposure and
response prevention, and family therapy.

Mayo Clinic. Obsessive-Compulsive Disorder; Definition.

Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Text Revision.
2000. Washington, D.C. American Psychiatric Association.