Shared or induced obsessive compulsive disorder: Is it a reality?
The second case is about a 20-year-old female patient from urban area seen in psychiatry OPD with the complaints of excessive preoccupation with cleanliness and repeated hand washing since 1 year.\nThe patient was apparently alright 1 year back. She belonged to a nuclear family including her parents. Her father reported that she was excessively attached to her mother. Patient's mother was suffering from OCD, moderate to severe in degree, since 10 years and was under treatment from same hospital. She had predominant obsessions of contamination. Her response to treatment was not good. She was not a dominating figure.\nThe patient was excessively close to her mother. She used to help her mother in household activities and would also take care that adequate cleanliness is maintained so that her mother is not distressed. In her attempts to help her mother, she was excessively involved in compulsive rituals.\nSince last 1 year the patient herself started doubting her work. She would perform the cleaning activities repeatedly to reduce her own distress. She used to spend 2-3 h a day to clean the house leading to disruption in her daily activities. She would try to resist the obsessions and compulsions but had little control over it. Her total Y-BOCS score was 18.\nPatient had no other psychiatric co-morbidities. She was not suffering from any medical or surgical illness and her past history was not significant.\nPatient was studying in the 2nd year of her undergraduate training in engineering. Her pre-morbid personality assessment showed that she was anxious, submissive, social and cooperative.\nOn mental status examination her mood was anxious with appropriate affect and thought evaluation revealed obsessions of contamination. She had insight into her illness.\nWe advised separation of the patient from her mother by considering the probability of induced OCD. Patient's father cooperated for the same. We suggested the patient to stay at the college hostel for 6 months. She was allowed to talk to her parents on phone. She insisted on spending the Sundays with parents. We allowed that in the 2nd month of separation. The patient had significant distress for the 1st month. She was anxious about her mother's health. At the end of the 2nd month of separation patient showed 30-40% reduction in her symptoms. Her Y-BOCS score was 12. We continued the separation for next 4 months with monthly follow-up. At the end of 6 months, the patient had significant improvement. Patient decided to stay in hostel for her further education and to stay with her parents on weekends.