Allen, a 22-year old gay man, came to a mental health clinic for treatment of anxiety. He worked full-time as a janitor and engaged in a very few activities outside of work. When asked about anxiety, Allen said he was worried about contracting diseases such as HIV.
Aware of a strong disinfectant smell, the mental health care provider asked Allen if he had any special cleaning behaviors linked to his concern about getting HIV. Allen said that he avoided touching almost anything outside of his home. He said that if he even came close to things that he thought might have been in contact with the virus, he had to wash his hands many times with bleach. He often washed his hands up to 30 times a day, spending hours on this routine. Physical contact was quite difficult. Shopping for groceries and taking the subway were big problems, and he had almost given up trying to go to social events or engage in romantic relationships.
When asked if he had other worries, Allen said that he was bothered by sudden images of hitting someone, fears that he would say things that might be offensive or wrong, and concerns about upsetting his neighbors. To ease the anxiety caused by these thoughts, he often replayed prior conversations in his mind, kept diaries to record what he said and often apologized for fear he might have sounded offensive. When he showered, he made sure the water in the tub only reached a certain level. He was afraid that if he was not careful, he would flood his neighbors.
Allen used gloves at work and performed well. He spent most of his free time at home. Although he enjoyed the company of others, the fear of having to touch something if he was invited to a meal or to another person’s home was too much for him to handle. He knew that his fears and urges were “kinda crazy,” but he felt they were out of his control.
Allen was diagnosed with OCD. He had many obsessions, including ones related to contamination (fear of contracting HIV), aggressions (intrusive image of hitting someone) and symmetry (exactness in the level of water). These caused Allen to spend hours on his OCD routines and to avoid leaving his apartment, engaging in social relationships and performing basic errands.
He also has had many compulsions: excessive hand washing, a checking (keeping diaries), repeating (often clarifying what he said) and mental compulsions (replaying prior conversations in his mind).
The symptoms also got in the way of Allen’s normal daily tasks. Even though he was able to work, his job choice may have been swayed by his symptoms (few other jobs would allow him to always wear gloves and use bleach). Not only did his symptoms consume much of his time, but he appeared to be lonely, isolated man whose quality of life had been greatly affected by his OCD.
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This patient story is excerpted from Understanding Mental Disorders: Your Guide to DSM-5.
Understanding Mental Disorders is a consumer guide designed to promote education and understanding among anyone who has been touched by mental illness.