Successful Treatment of Refractory Obsessive-Compulsive Disorder

By Shusta, Shielagh R. | American Journal of Psychotherapy, Summer 1999 | Go to article overview

Successful Treatment of Refractory Obsessive-Compulsive Disorder


Shusta, Shielagh R., American Journal of Psychotherapy


A case study is presented of a 40-year-old man with obsessive-compulsive disorder (OCD). He had been treated with long-term institutional placement electroconvulsive therapy, exhaustive pharmacotherapy. and psychodynamic and cognitive-behavioral psychotherapy. Nothing had relieved his excessive. hand washing and door checking. Records from previous treatment revealed, diagnosis of dissociative identity disorder (DID). This information led to reconceptualization of the OCD symptoms as manifestations of the patient's ego fragmentation. When his fragments were catalogued and addressed, all overt OCD symptoms abated within weeks. It is believed that the patient's most anxious ego fragment communicated dread from the background of the patient's psyche, the executive component only being aware ofthe anxiety and not the triggering stimulus. The patient was taught to address this fragment verbally to elicit its cooperation, whereupon the fragment stopped sounding alarm, creating anxiety and driving the patient to check and recheck, wash and rewash. Symptoms have returned only when the patient has suspended his announcing behavior and have abated when this was resumed. Connections between OCD and DID are addressed. Conclusion: patients exhibiting refractory OCD symptoms should be assessed for dissociative symptomatology.

INTRODUCTION

The thoughts and behaviors characteristic of obsessive-compulsive disorder (OCD) can be extremely difficult to eradicate. Obsessions are defined as recurrent and persistent distressing thoughts, impulses or images, not due to real-life worries alone, that cannot be suppressed or ignored by these patients and that are perceived by them as originating from within their own minds. Compulsions are defined as repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession or to comply with rigid rules. These behaviors are aimed at relieving or reducing distress. Typical compulsions are hand washing, counting or ordering of items, checking of door locks or stove knobs, repetitive rubbing, touching or blinking. Patients suffering from OCD can become so incapacitated by their obsessions and compulsions that by the time they finally seek treatment, they are close to despair.

Until effective psychotropic medications were developed, psychodynamic therapies alone were used with unpredictable results. Because the obsessive patient was seen psychodynamically as "rigid" by definition, clinicians found them quite resistant to treatment. For this reason, successful alleviation of obsessive-compulsive symptoms typically took years of intensive and often mutually frustrating treatment (1). Then, as they emerged, a variety of medications were tried, and the first to achieve widespread use and frequent success was the tricyclic antidepressant, clomipramine (Anafranil). Such medical interventions have enabled patients to better utilize psychotherapy and shorten the lag between starting treatment and beginning to experience some relief. There are side effects and potential caveats to the use of tricyclics (2), which prevented some OCD patients from being helped, however, Many newer medications have been introduced and tried, but none had the successes of clomipramine until the advent of the newer selective serotonin reuptake inhibitor antidepressants (SSRIs). All the various SSRIs have been studied in the treatment of OCD, and each has proven effective in many cases (2-4). Fluvoxamine (Luvox) was one of the first SSRIs studied, and it produced excellent results. Research has indicated that fluvoxamine is as effective as clomipramine and presents fewer side effects (5). Sertraline (Zoloft) has also been cited as working as well as or better than clomipramine (6). Fineberg (6) stated that OCD, long considered a refractory disorder, has in the last 15 years become rapidly and effectively treatable, thanks to clomipramine and the SSRIs. Psychotherapy has remained a viable treatment for OCD but has generally been seen in psychiatry as secondary to pharmacotherapy because the latter has been so dramatically and rapidly effective in many cases.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Successful Treatment of Refractory Obsessive-Compulsive Disorder
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.