OBSESSIVE COMPULSIVE DISORDER
Paul is a 40 year old man diagnosed with Obsessive Compulsive Disorder. He has always lived with his parents and remains in the family home. He had maintained an office job for over 15 years but was reliant on his 75 year old mother to drive him to and from work. He experienced intrusive thoughts that his actions have caused, or will cause, harm to others and constantly rechecked his steps or actions.
Reason For Referral
Paul was referred for occupational therapy by his Consultant Psychiatrist due to concerns regarding his over-reliance on his ageing parents, his limited activities in daily living and a decrease in personal hygiene. Paul's safety behaviours enabled him to operate within his office at work and his bedroom at home but he avoided any other activities for fear he may cause someone harm.
Occupational Therapy Assessment
An initial Occupational Therapy Assessment was conducted which drew on a number of occupational therapy models and treatment strategies including the Model of Human Occupation, the Assessment of Motor and Process Skills (AMPS) and a more informal one to one interview.
The assessment identified that:-
- Paul's OCD and intrusive thoughts were having a significant impact on his processing skills – his process scores on the AMPS were below the level expected for someone of his age;
- Paul’s personal care had deteriorated as his intrusive thoughts impacted on his ability to get up and ready for work in the morning - he would often just get dressed without washing as he could do this whilst remaining in his room;
- Paul had never used public transport having always been reliant on his mother for transport;
- If Paul was to repeat a task the intrusive thoughts would lesson over time.
Occupational Therapy Treatment Plan
Paul participated in an Occupational Therapy Programme consisting of 24 sessions over a six month period which focussed on:-
- Enabling Paul to develop a person centred prompt list in the morning to help him improve his levels of personal care;
- Developing a graded exposure plan focussing on increasing his confidence in public places enabling him to travel to work on public transport;
- Identifying strategies to enable Paul to extend the period of time he was able to tolerate, and not act on, his intrusive thoughts/urge to check.
On completion of his Occupational Therapy programme, Paul was able to:-
- Improve his levels of self care leading to a positive impact on his relationship with colleagues at work;
- Undertake a graded activity plan with the support of his Occupational Therapist enabling him to use public transport initially with his therapist and then independently;
- Increase his confidence interacting with others and spending more time outside his room at home and being able to play and interact with his nieces.
A patient's own account of her obsessive-compulsive disorder is presented. She describes her distressing experiences, the impact of the disturbance on her and her family's life and her subsequent improvement using the technique of exposure and response prevention. The treatments available are discussed and the benefits of self-directed behavioural psychotherapy are reviewed. A comment from a general practitioner is appended.
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These references are in PubMed. This may not be the complete list of references from this article.
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