Case history
Case history #1
A 32-year-old man presents describing an intense fear of germs. He continually experiences thoughts about contracting an illness by coming into contact with things in the environment, such as doorknobs or seats in public places. His intense fear of germs has resulted in repetitive hand washing. He describes brief relief after hand washing but, because his thoughts about contamination keep returning, he states that he "cannot help but wash again for hours a day." Both of his hands are red, raw, and cracked and he had to leave his job because of his fear of sitting down in public places. He has been taking a serotonin reuptake inhibitor since age 26 without any appreciable effect, and he has not recognised that his thoughts and behaviours were irrational. He also exhibits a high level of impulsivity.
Case history #2
A 45-year-old woman presents describing obsessive concerns that she has harmed or will accidentally harm someone. Her most debilitating symptoms occur in the context of driving. She reports being troubled by obsessions and compulsions for approximately 4 hours each day. When she drives over a pothole or speed bump, she experiences overwhelming uncertainty about whether she may have accidentally run over a child. In an attempt to ease the anxiety she drives back and forth on her street in order to search for any indication that a child has been injured. When she completes these compulsions, she returns to her home and engages in checking compulsions for any evidence of blood or clothing under her car or on her tyres. She then calls her husband repeatedly at work to ask for reassurance that she has not harmed anyone. Although she is aware that her concerns are irrational, she finds it very difficult to resist her impulses to engage in these rituals.
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