Academic journal article Indian Journal of Psychiatry

Rapid, Illegible Handwriting as a Symptom of Obsessive-Compulsive Disorder

Academic journal article Indian Journal of Psychiatry

Rapid, Illegible Handwriting as a Symptom of Obsessive-Compulsive Disorder

Article excerpt

Byline: Amar. Bavle, Chittaranjan. Andrade, M. Vidhyavathi

This is a case report of a 13 year male child who had co-morbid OCD and trichotillomania. On evaluation, he had rapid, illegible handwriting as a symptom of OCD, which has hitherto not been reported.

Introduction

Obsessive-compulsive disorder (OCD) is a pleomorphic illness with preoccupation with order, dirt, religion and sex as common themes for obsessions and counting, cleaning, checking and washing as common themes for compulsions. [sup][1] Unusual themes have also been described; musical obsessions [sup][2] and starvation compulsions, [sup][3] are just two examples. We describe, for perhaps the 1 [sup]st time in literature, rapid, illegible handwriting as a hidden compulsion that resulted in poor academic grades in an adolescent with OCD.

Case Report

The present case report is about a 13-year-old boy with a 5-year history of OCD and comorbid trichotillomania presented for evaluation of poor response to medications (fluoxetine 60 mg/day and clomipramine 75 mg/day, separately and together) to which he had been adequately compliant during the past 5 years. His chief OCD symptoms comprised touching objects, repeating questions and sentences and insisting that his family members answer questions or repeat sentences; these occupied 3-4 h every day and he would throw tantrums if his compulsive needs and behaviors were thwarted. His trichotillomania symptoms included hair pulling from legs, nose, eyebrows and scalp, associated with right temporal and left occipital alopecia areata.

A functional assessment revealed that although he was considered clever in school, his grades were always poor. On probing, it emerged that he had an obsessive fear of being unable to complete his test papers within the allotted time and so experienced a compulsive urge to write fast. Whereas he was always the first to complete his answer paper in examinations, his handwriting was so poor as to be almost completely illegible; and so he always obtained poor marks. Compulsively rapid handwriting soon generalized from examination settings to all settings.

He was treated with a combination of fluvoxamine (final dose, 300 mg/day) and clomipramine (final dose, 75 mg/day). He was also started on cognitive behavior therapy (CBT) with his mother inducted as a co-therapist in order to continue sessions at home. …

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