Name : Howard Robard Hughes, Jr.

Gender : Male
Date of Birth : December 24, 1905
Date of Death : April 05, 1976
Chronological : 70 years, 3 months
Age
Occupation : Entrepreneur, Aviator, Aerospace Engineer, and Film Maker
Educational : Elementary graduate, High School undergraduate, College drop
Status out
Civil Status : Married
Nationality : American
Ethnicity : White
Religion : Episcopalian

I. Reason for Referral

Howard was referred because of the chronic pain he was enduring due
to injuries he sustained after an airplane crash. He was also suffering from
severe case of obsessive compulsive disorder. He was very indecisive,
obsessed with trivial details, had frequent mood swings, and was
unsuccessful in maintaining a relationship.

II. History of Present Illness

Present concern [OCD]: Symptoms/manifestations, frequency, severity
& duration
o He has compulsions.
He frequently, compulsively needs to wash his hands.
He always drinks milk with the cap of the bottle still on.
He, sometimes, cannot help but keep on repeating
phrases.
The way of the future
Show me all the blueprints
o He will not eat something he considers dirty.
o He refuses to shake hands.
o He refuses to touch objects without the use of tissue papers or
towels.
o He worries too much.
An example would be when he bugged Ava Gardners
house, including the telephones.
o He was obsessed with making and ensuring that all rivets on a
plane they were constructing were flushed flat into the surface.
o He compulsively burnt all of his clothes in the middle of the
night.
o He was seen hoarding.
He was hoarding his used tissue.
He was using milk bottles to collect his urine, and was
keeping them in display in perfect lines.
 o He seems to have fluctuating episodes, because there were
times where he seemed to be able to function properly.
o His OCD began to intensify after his accident and after
experiencing other professional and personal problems.
o It seemed like he was aware that he had a problem.
Events related to the presented problem, possible causes, triggers,
stressors, coping
o His mom was hinted to be mysophobic.
o He was also experiencing a lot of stress in life.
Stresses may be a large inheritance, the death of his
parents, too much work, and interpersonal relationships
(not all of the stressors occurred at the same times).
o The shock he received from the accident may have also been a
cause, trigger, or stressor.
Effect of illness on patients life
o At first, he seemed to have been able to cope however, as his
stressors kept on piling, including his accident, his problem with
his relationships, and his work, he found it harder to cope. This
probably caused his compulsions worsen. He even isolated
himself inside his home theatre.
Treatments
o Biological
Antidepressants (Clomipramine)
SSRIs (fluxetine, paroxetine, sertraline, and fluvoxamine)
Atypical antipsychotic
o Behavioral
Exposure and Response Prevention Therapy (ERP)
Repeated exposure of the client to their obsessions
and compulsions to prevent compulsive responses
to anxiety
o Cognitive Therapy
Through this, the patient is thought how to properly
respond to their obsessive thoughts without resulting to
their compulsions.
Relationship of the psychological illness to current medical status
o His psychological illness has made his physical health decline.
As he frequently worries over every little thing and often has
compulsive thoughts, it may have been hard on him to sleep and
complete his daily functions (Nolen-Hoeksema, 2011).

III. Past Psychiatric History

As there was not much known about the childhood of Howard Hughes,
it is hard to say whether or not he already had any mental illnesses,
disorders, or conditions at that time. However, it was noted by most that, as a
child, his mother instilled unto him her phobia for germs. This may indicate
 that he already had mysophobia when he was a child. In addition to this, it
was noted that even as a child Howard Hughes was extremely recluse.
Mysophobia and his reclusion may have worsened to a point where he
eventually developed OCD, and possibly a personality disorder, as he grew
older because of the amount of stress he faced (Howard Hughes, 2010).

IV. Medical History

He experienced a plane crash which caused a severe gash on the top
of his head, and a foot injury.
He experienced a fatal airplane crash to which he sustained significant
injuries such as a crushed collar bone, multiple cracked ribs, a crushed
chest which caused a collapsed left lung, and numerous third-degree
burns.
He experienced chronic pain.
He developed an addiction to codeine.
He had an obsessive-compulsive disorder
He had unpredictable mood swings due to his disorder.
Kidney failure was the cause of his death.

V. Family History
Howard Robard Hughes, Jr. was the only child of Allene Stone Gano
(July 14, 1883 March 29, 1922) and Howard Robard Hughes, Sr. (September
9, 1869 January 14, 1924). His mother died at the age of 38 due to
complications of ectopic pregnancy, while his father was an American
businessman who died at the age of 54 due to a heart attack.
Sadly, there were no emotional and social foundations laid for him. He
did not have similar emotional equipment as other children had. He was not
taught to socialize with other children. He only followed orders from his
parents.
Howards mother had mysophobia. She would always check her sons
body and wash it thoroughly. She made sure that Howard Jr.s body was
always clean. He was raised in an atypical manner. During his childhood, he
was not allowed to run around, play with other kids, and get dirty. Howards
father was mostly absent in his life. His father was also a philanderer.
Eventually, Howard Jr. developed hypochondria, sometimes referred as health
phobia or health anxiety. Every time he was sick, his parents were by his side.
The closeness of Howard with his mom left no room for friends. He grew up
as a shy and awkward man and did not have much social skills. This was
because of his mother, whose mysophobia and suffocating love isolated him
from others.

VI. Personal History

Howard was born as the only child of his parents. His date of birth was
uncertain but he claimed that it was Christmas Eve. His aunts signed his
affidavit birth certificate stating that he was born on December 24, 1905. But
in his baptismal record at Iowa, his birth was listed as September 24, 1905. At
an early age, Howard showed great ability in engineering. When he was 11
years old, he built the first Houstons first radio transmitter out of an electric
doorbell. When he was 12 years old, he was featured in a newspaper for
building a motorized bicycle. At a very young age, he liked mathematics,
flying, and mechanical things that made him indifferent to other students. He
took his first flying lesson at age of 14.
With the death of his parents, he was inspired to include the creation of
a medical research laboratory in his will at age 19. Hughes inherited 75% of
the family fortune and was declared an emancipated minor, enabling him to
take full control of his legacy at an age of 19. When he turned 20, he begun
to film his own movie and got married to a woman. Then, eventually, he
became known for his skills in mechanical engineering through his creation of
aircrafts.
Howard was enrolled at Prosso Elementary School in Houston. At age
14, he was enrolled at South End Junior High in Houston. Then, at age 15, he
was enrolled in an exclusive Fessenden School in West Newton,
Massachusetts. He graduated in the latter mentioned school at the 8 th grade.
After which, he was enrolled in Thacher School in Ojai Valley, California. But
when his mother died, his father decided to remove him from the school.
Later, he attended Rice University but he dropped out when his father died.
Howard Hughes was able to contribute a lot for the advancement of
aeronautics and engineering in the field of aviation. In 1932, he founded
Hughes Aircraft Company in Glendale, California. Two year later, he
developed and tested the first retractable landing gear and flushed rivets to
streamline airplane in the future. On September 13, 1935, Hughes Aircraft
built the fastest plane as Howard sets a new land speed record of 352.46 mph
at Santa Ana, California, in the Silver Bullet. In 1935, Howard proved that
high-altitude flying greatly increases airspeed through death-defying flights.
He also opened a new frontier for commercial aviation. In January 1936, he
again sets new speed record in transcontinental travel from Los Angeles to
Newark with 9 hours and 27 minutes. In 1936, he designed and perfected an
oxygen feeder that enhanced pilot safety during high-altitude flights. In
January 19, 1937, he made another transcontinental record which was the
greatest long distance speed flight from Los Angeles and Newark of 7 hours
and 28 minutes. From July 10-14, 1938, Howard flew around the world for 3
days with a new world record of 19 hours and 17 minutes. In 1939, he
perfected the power-boosting radio receivers and transmitters in
contemporary aircraft. From 1941-1943, he designed revolutionary
ammunition feed chuted for 50-caliber machine guns, doubling the rate of
fire. While from 1946-1949, as a principal shareholder of TWA, he designed
the first cost-effective routes to Europe and South Pacific. In April 5, 1947, he
climbed back into the XF-11 for a successful test flight. In November 2, 1947,
he proved the critics wrong when he was able to make the Hercules (HK-1) fly
for less than 60 seconds. Around 1940, he built Hughes Electronics into the
single largest supplier of weapons systems for US Air Force and Navy. From
1941-1956, he built Hughes Aircraft from a 4 man operation into an 80,000
employee powerhouse that includes Hughes Electronics and Hughes
Helicopters. Back in 1949, he developed the all-weather Interceptor. Then,
from 1950-1956, he conceived and manufactured the air-to-air missile, and
invented and mass produced the navigational control system of the F-102
interceptor. Then, from 1959-1964, Howard built TH55A helicopter. In 1960,
he pioneered and produced the unmanned satellite prototypes.
Howard Hughes was also able also to contribute to the improvement of
movie making. From the years 1932 1962, Howard kept on producing
movies. These were Swell Hogan, Everybodys Acting, Two Arabian Knights,
The Racket, The Mating Call, The Hells Angels, The Age of Love, Cock of the
Air, The Front Page, Sky Devils, and Scarface. He produced The Outlaw in
1943. In 1947, he produced Sins of Harold Diddlebock. In May 1948, Howard
took control of RKO Pictures. He produced movies of his own from 1949-1957.
These movies were The Big Steal, Holiday Affair, Outrage, Stromboli,
Vendetta, Where Danger Lives, Best of the Bad Men, Double Dynamite, Flying
Leathernecks, Gambling House, Hard, Fast and Beautiful, His Kind of Woman,
My Forbidden Past, Road Block, Two Tickets to Broadway, The Whip Hand, The
Las Vegas Story, Macao, One Minute to Zero, Androcles and the Lion, Angel
Face, The French Line, Susan Slept Here, Son of Sindbad, Underwater, The
Conqueror, and The Jet Pilot.
On June 1, 1925 he got married to Ella Rice in Houston and decided to
live in Los Angeles, but they got divorced on December 29, 1929. He again
got married to Jean Peters on January 12, 1957 but they got divorced on June
18, 1971 in Hawthorne, Nevada. Terry Moore claimed to have been secretly
married to Howard in Mexico in 1949 and never divorced but it was alleged.
Moreover, Howard never had a child.
In 1936 and 1938, Howard received a Harmon trophy for being an
outstanding Aviator. He also received Congressional Gold Medal in 1941 in
recognition of his achievements in advancing the science of aviation and thus
bringing great credit to his country and throughout the world. Collier Trophy
was given in 1938 to Howard and to his crew for their successful around the
world flight. Then, he received Octave Chanute Award in 1940 for his
outstanding contribution as a pilot to the advancement of arts, science and
technology, and aeronautics. He also received the American Legion Award in
1952. Aviation Hall of Fame was given to Howard in 1973. After several years,
International Aerospace Hall of Fame was awarded to Howard in 1987. Just
this 2003, Nevada Business Hall of Fame was awarded to Howard.
Howards hobbies were to design aircrafts and fly them in the sky. In
his everyday living, he does transactions with different people. While his
interests were to play golf, play the saxophone, produce movies, and date
 women. He also loves milk, steaks, ice cream, and Hershey chocolates. His
favorite movie was Ice Station Zebra.
Howard was known for being an exaggerated nationalist, an anti rabid
communist, a political briber, an anti-Semite, a consummate playboy, a
shrewd and cunning businessman, a paranoid madman, and a major drug
addict. But despite his undesirable traits, there is still a good side to him. He
helped the people around him in financial aspects, even to the extent of
helping them in their medication and bailing them when needed. He hires
people who have nowhere to go and who no one would accept. He is a kind
and gentle person.

VII. Biopsychosocial Formulation

BIO

Genetics: Research suggests that genes can play a role in the development of
the disorder. There are strong evidences proving that obsessive-compulsive
disorder runs in families (Summerfeldt & Antony, 2002). Hughess mother
was noted to have an obsession with germs, which he may have inherited.

PSYCHO

Personality traits: Research has shown that several general personality traits
may be linked to some forms of obsessive-compulsive disorder (Summerfeldt
& Antony, 2002). One of these is anxiety, or the predisposition to be made
anxious more easily or more frequently. In line with this, Howard Hughes was
reportedly upset by matter that he wrote a detailed memorandum to his crew
on how to fix the problem. Moreover, in his book, Just Tell Me When to Cry,
Fleischer explained that Hughes was fixated on trivial details and was
alternately indecisive and obstinate. He also revealed that Hughes was
having unpredictable mood swings.

Another trait which is sometimes associated with OCD is perfectionism,

particularly when it entails excessively high or rigid standards for oneself.
Howard Hughes reported symptoms seemed to coincide with his entrance
into the aviation industry where there is a need for perfection.

Life Experiences: Life stress situates people with OCD at risk for worsening of
their symptoms (Summerfeldt & Antony, 2002). During stressful periods,
people with OCD often report increased obsessions and having a greater
difficulty resisting compulsions. The stress experienced by Howard Hughes
from inheriting a large company after being orphaned worsened or caused
the onset of OCD. This industry placed him in stressful environments
composed of high-cost contracts under time constraints that could have
worsen his symptoms.
 SOCIAL

Several studies have reported that anxiety is associated with a lack of social
connections and a sense of a more threatening environment (Summerfeldt &
Antony, 2002). Hence, Howards childhood was rife with poor grades and poor
social skills. He did not have much social skills because of the closeness he
had with his mother which, as a result, left no room for his friends. He did not
have the same emotional equipment as other children had. Also, he was not
taught to socialize with other children.

VIII. Multi-Axial Diagnosis

Axis I : Obsessive Compulsive Disorder

: Generalized Anxiety Disorder
: Specific Phobia
: Opiod Dependence
Axis : Paranoid Personality Disorder
II
Axis : Chronic Pain, currently self-medicating with Codeine
III
Axis : Psychosocial stressors: ongoing legal case
IV
Axis : Current GAF: 40
V
IX. Differential Diagnosis
The main differential diagnosis is depression and many patients with
OCD have comorbid depressive symptoms. Other differentials include phobic
disorders, anorexia nervosa, obsessive or anakastic personality and
occasionally schizophrenia. The symptoms of OCD are seen in other
conditions such as Tourette's syndrome, autism and frontal lobe lesions.
Obsessive-compulsive-related disorders (OCRD) and a range of disorders
share characteristics with OCD (e.g. in symptom profile, biology and
treatment outcome). OCRDs include body dysmorphic disorder (BDD -
concerns of imagined ugliness), hypochondriasis (concerns about imagined
illness), eating disorders and impulse control disorders such as
trichotillomania (hair pulling) (OCD, n.d.).

X. Comprehensive Treatment Plan

Obsessive Compulsive Disorder can be treated or managed with

behavioral therapies which would decrease the compulsive behaviors. In
modern times, more ways of treating OCD has been discovered such as
Electroconvulsive therapy and psychosurgery. Also, there are drugs that can
be taken for treatment. Some examples would be parocetine and sertraline.

In Howard Hughes case, the treatment given to him was not specified.
However, it can be seen that he was given mild behavioral therapy indirectly.
 Behavioral therapy is a technique wherein the patient is gradually exposed to
his or her anxiety and is expected to respond to it accordingly. In the movie
"The Aviator", Howard Hughes was shown with Ava Gardner doing a mild
behavioral therapy. Howard Hughes was gradually exposed to what to his
perception was an unclean sink, where Ava told him to wash his face. He was
told by Ava that nothing in this world is clean. However, this did not stop
Hughes' OCD. His OCD continued until his death. Also, it was told he was
taking other drugs to reduce chronic pains, not for his OCD.

XI. References

Howard Hughes. (n.d.). Retrieved August 20, 2013 from

http://en.wikipedia.org/wiki/Howard_Hughes

Howard Hughes, a Theoretical Case Study. (2010). Retrieved August 20, 2013
from
http://edufracked.wordpress.com/2010/04/21/howard-hughes-a-
theoretical-casestudy/

Newell, M. (2011). Howard Hughes: Madman or genius? [PowerPoint slides].

Retrieved from http://prezi.com/on8sq-jq-i6m/howard-hughes/

Nolen-Hoeksema, S. (2011). Abnormal Psychology (5th ed.). Philippines: Mc-

Graw Hill Education (Asia).

OCD: Differential diagnosis and screening questions. (n.d.). South West

London and St. George. Retrieved September 3, 2013, from
http://www.swlstg-tr.nhs.uk/for-health-professionals/ocd-
guide/differential-diagnosis-and-screening-questions/

Rojas, J. (2009). The legendary Howard Hughes: His genius, visions, passions
and mystique. Retrieved from http://hrhughesjr.webs.com/

Summerfeldt, L.J., & Antony, M.M. (2002). Obsessive-Compulsive Disorder

(OCD). Retrieved
August 20, 2013 from http://anxiety.stjoes.ca/obsessive.htm

Obsessive-Compulsive Disorder. (2013). Retrieved August 20, 2013 from

http://health.nytimes.com/health/guides/disease/obsessive-compulsive
disorder/riskfactors.html