DR PARKER: Mrs T is a 45-year-old woman who
has obsessive-compulsive disorder (OCD). Though currently disabled secondary
to her OCD, she decided to discontinue all psychiatric medications because
of adverse effects. She is married with a healthy teenaged daughter. Her commercial
insurance has completely covered her extensive outpatient and inpatient therapies.
Although Mrs T did not know it then, in retrospect, she sees clues of
OCD in her childhood behaviors. She recalls spending hours at the age of 5
years counting the sides of squares on her bedroom wallpaper. When she was
9 years old, her house was robbed, triggering rituals such as checking under
the beds and inspecting closets around the house. Mrs T recalled that these
actions seemed to reassure her that no one in her family would get hurt. A
few years later, graphic antismoking commercials increased her anxiety that
her father, a smoker, would die of lung cancer. While watching television
with others present, she would do counting rituals in her head, so others
would not know she was doing it. She felt a need to "control things."