Shared or induced obsessive compulsive disorder: Is it a reality?
The first case was a 27 year old married woman from a rural area, seen in a psychiatry out-patient department (OPD) with the complaints of preoccupation with contamination and cleanliness, apprehension about lizards falling in food and washing hands and utensils repeatedly since 3 years.\nShe was living in a joint family which consisted of her husband, father-in-law and mother-in-law. Her mother-in-law was a dominating person. Patient's husband was a submissive type of person generally obeying his mother.\nAs per the observation and history given by her relatives, the mother-in-law was suffering from OCD with predominant obsessions of contamination since 7 years. She had no insight into her illness and was not willing for treatment. Patient could not adjust well with her mother-in-law for the initial 2 years after her marriage. The mother-in-law would satisfy her own obsessions by compelling the patient to wash the house, utensils and clothes repeatedly. The patient would be repeatedly scolded by her mother-in-law for mistakes in the household chores regarding cleanliness. The patient tried her best to follow her instructions with lot of mental resistance for 2 years.\nSince 3 years the patient started doubting her own work. She used to get repeated thoughts of contamination, which made her perform the cleaning activities frequently to reduce her anxiety. Over 1 year the patient's compulsive activities increased to such an extent that she started spending more than 5-6 h in a day washing utensils and clothes while the mother-in-law would spend most of her day time in cleaning the house. She used to experience the obsessions for about 5-6 h daily. She had serious distress and disruption in her daily functioning due to the obsessions and compulsions. She tried to resist the obsessions and compulsions but had little control over it. The Yale-Brown obsessive compulsive scale (Y-BOCS) was used to measure the severity of her symptoms.[] Her total Y-BOCS score was 28.\nShe had no other psychiatric comorbidities. She was not suffering from any significant medical or surgical illness. There was no past history of any significant psychiatric problem. Family history was not significant.\nShe was the eldest among three siblings. Her parents were educated and supportive of her and her sisters. The patient was educated up to higher secondary. Her performance in school was average. Her adolescence was without any significant psychological problems. She had been married since 5 years. Her pre-morbid personality assessment revealed her as quiet, submissive, suggestible and cooperative.\nOn mental status examination, her mood was anxious with appropriate affect and thought evaluation revealed obsessions of contamination and ideas of helplessness due to the obsessions. She had insight into her illness.\nPatient was treated with tablet escitalopram 10 mg OD and tablet clonazepam 0.5 mg OD. The dose of Escitalopram was increased to 20 mg/day after 15 days. Clonazepam was reduced and then subsequently tapered off. Patient was assessed every 2 weeks. She did not report any significant improvement for 3 months. We advised separation of the patient from her mother-in-law by considering this illness as an induced OCD without any further change in medications. After 1 month of separation, patient's obsessions and compulsions were reduced by around 60%. Escitalopram 20 mg/day was continued over this duration. She was not willing for any psychotherapy and hence this could not be undertaken. Medications were tapered and stopped over the next 6 months. During this period, she continued to stay separated from her mother-in-law. She was further assessed every month for next 6 months. The residual obsessions improved completely over 3 months. She has no obsessions and compulsions since last 3 months.