Shared or induced obsessive compulsive disorder: Is it a reality?
A 50-year-old female patient from rural area was seen in psychiatry OPD with the complaints of repeated checking of doors, gas knobs and electrical switches, excessive involvement in cleanliness such as cleaning floors, utensils and bathing idols of God. This started 5 years back and had increased over last 2-3 years.\nThe patient was staying with her husband, two children and mother-in-law. Patient's mother-in-law was 70 years old. She was under treatment for OCD since last 40 years with poor response to treatment. She was debilitated and bed-ridden since last 5 years due to complications of osteoarthritis. It was not possible for her to perform her compulsive activities due to arthritis, which in turn would result in increase in her distress. Hence she started forcing the patient to perform the compulsive rituals for her. The patient was submissive. The patient could not refuse her dominating mother-in-law for performing cleaning activities. For the initial few years the patient started performing compulsions with a lot of resistance. Gradually her resistance reduced and since 2-3 years she started doubting her own work.\nShe started spending 5-6 h a day in doubting her work and performing compulsive rituals. She had significant distress and interference in her life due to obsessions and compulsions. She tried to resist the obsessions and compulsions but had little control over it. Her total Y-BOCS score was 30.\nPatient was started on tablet sertraline 100 mg/day and the dose was increased to 200 mg/day on follow-up. The patient was also treated with tablet clonazepam 0.5 mg/day for first 4 weeks.\nWe advised separation from her mother-in-law considering her illness as shared OCD. The patient and her family members were not willing for separation in view of the mother-in-law's medical condition. There is no other caretaker for mother-in-law apart from the patient. Pharmacotherapy reduced patient's restlessness, but there was no significant improvement in her obsessive compulsive symptoms even after 6 months of treatment.