Obsessive Compulsive Disorder case

Callie is a 32-year-old female who was diagnosed with OCD at age 7. She has managed the
condition successfully with medication for most of her life. Recently, Callie began to
experience a recurrence in OCD symptoms. She reported that she is still taking her
medication as directed, but she has experienced some significant transitions over the past
six months. Callie sought therapy to help her sort out what is going on in her life and gain
control of her OCD.

Callie recently separated from her husband of 8 years. They have joint custody of their two
children, ages 5 and 7. Callie and her husband decided to keep the primary residence to
prevent the children from moving between two homes every week. Instead, Callie stays in
the house with the children for one week, then goes to her parents’ home the next week
while her husband stays with the children at home. She returns at the end of the week, then
moves back to her parents’ home at the end of that week.

While this agreement seems to work well for the children, it is taking a huge emotional toll
on Callie. She is having difficulty sleeping, mood changes, increased anxiety, and ‘new’
OCD symptoms. Callie reports difficulty focusing at work, which results in difficulty
keeping up with deadlines and workload. This results in feelings of insecurity, fear, and
shame resurrected by old struggles with the feeling she is ‘not good enough’.

Callie also reports that spending time away from her children and home creates fear and
doubt about how well they are cared for when she is not there. She has developed a routine
for the children and believes that structure and consistency are requirements for good
parenting. Callie knows that her husband is less organized and persistent than she,
especially when it comes to parenting and household management, two of their biggest
problems as a couple.

When she is away from the children and home, Callie is bombarded with intrusive thoughts
about their well being. She calls her husband numerous times during the day to remind him
of things she is afraid he will forget. In the evening, she calls a few times every hour to see
how things are going and get reassurance from her husband that he is following ‘the plan’
she has left for him in excruciating detail.

History
Callie reportedly began exhibiting symptoms of OCD as a young child. She required a high
degree of order in her environment to feel secure. Callie’s parents had her evaluated at the
suggestion of her Kindergarten teacher due to her need for constant reassurance and to
organize things in the classroom. Reportedly, any change in her routine at home or school
resulted in extreme anxiety and agitation.

The psychologist who performed the battery of test was hesitant to diagnose Callie at age
four. He gave her a provisional diagnosis of ‘probable OCD’ and worked closely with
Callie, her parents, and teachers during her first four years of school.
In fourth grade, Callie changed schools and psychologists. This transition was challenging
for her, as was the loss of control over her surroundings. She was given a firm diagnosis of
OCD and began taking medication. She had medication adjustments over the years but has
not been off medication except during pregnancy, a time that she described as ‘maddening’.

Intervention
Callie came to therapy for help with her obsessive thoughts (“The children are not
okay/safe/well — we are ruining their lives with our inconsistencies.”) and compulsive
actions (calling her husband, the school, the nanny dozens of times each day for
reassurance that the children were getting what they needed at that moment).

Callie also saw her psychiatrist for a medication evaluation. He adjusted her dose of Prozac
and Trazadone and added Lorazepam PRN during the day.

Therapy consisted of CBT (cognitive-behavioral therapy) that included response/ritual

prevention. Callie became more able to tolerate ‘not knowing’ if the children were okay
over time. Initially, we set up designated times for her husband and the nanny to check-in
with her as most parents would when away from their children (before school, after school,
and before bed). Callie spoke with the children each morning before they left for school to
wish them a good day and tell them she loved them. After school, they touched base to talk
about their day and plans for the evening. Before bed, they called her to say good night. She
did not call them or the adults who were responsible for them.

With time, she felt less anxious between check-in calls A big part of her therapy involved
challenging irrational beliefs and negative self-talk. When she began to worry, she referred
to her ‘cheat sheet’ that outlined questions to challenge her obsessive thoughts and
reminded her that her children have been fine without ‘perfect structure’ in the past.

She also joined a self-help group for women with OCD. There she learned ways to distract
herself when she felt compelled to reach for the phone. Callie also began to practice
mindfulness meditation. By practicing mindfulness three times per day for 5-10 minutes,
she learned to be more aware of her surrounding, tune into her senses and let go of
unwanted thoughts.

Results
Within six months, Callie was sleeping well without medication. She used her daytime anti-
anxiety medication very rarely and continued to take Prozac daily. Her work performance
returned to normal. She began to build a life with friends and enjoyed her ‘weeks off’ from
full-time parenting more as a result.

She continued to practice mindfulness daily, which she believes is the most effective
technique for OCD. The check-in calls continued three times daily, and they have instituted
the calls with the children’s father on his weeks away to keep him involved.