Our December 2022 Case Conference was led by our clinician-scientist Astridiah Primacita Ramadhani, M.Psi., Psikolog, who has experience treating obsessive-compulsive disorder, borderline personality disorder, and major depressive disorder. Astrid presented the case of Sari (pseudonym) a 30-year-old female.
Sari came to IndoPsyCare after she began to experience stress following a serious family disagreement about her choice of partner. Sari had previously attended sessions with psychologists and psychiatrists and received a diagnosis of generalized anxiety disorder.
Sari’s Symptoms
These diagnoses were offered to explain her symptoms, including hand tremors, repetitive blinking, and clenching teeth. Throughout her sessions, Sari demonstrated twitches and erratic movements.
Nevertheless, contrary to her previous diagnoses, Sari was diagnosed with OCD, scoring 30 on the Yale-Brown Obsessive Compulsive Scale. Her severe OCD manifested in symptoms of:
- Harm OCD: Sari feared harming her family or being responsible for a terrible happenstance
- Moral OCD as she was excessively concerned with right/wrong
- Sensorimotor OCD: her motor tics induced intrusive, sudden, intense and frequent distress She also performed compulsions: including ruminating, motor tics, and avoidance.
ERP Treatment
Sari underwent ERP therapy for an hour each week and continued taking her medication.
Astrid also worked alongside her psychiatrist in the UK, who was familiar with her condition. Sari’s therapy included exposing her to things that induced stress and triggered her tics. For instance, she was instructed to use words such as “papa,” “rebellious”, “rebellious child” “parents disapprove,” and “mother and father are angry and disappointed”.
Moreover, she was also tasked with verbalizing her mother’s name and writing it alongside angry cartoons. Furthermore, Sari carried out self-guided ERP, which involved fighting her compulsive urge to avoid by checking her family’s Whatsapp group and reading messages from her mother.
Astrid guided her through these exposures and taught her distraction techniques to prevent rumination.
Clinician-Scientist Insights
Though her sessions are ongoing, the case has provided Astrid with valuable insight.
- Clinicians should have a wide range of knowledge regarding the manifestation of different disorders, as they may appear simultaneously. When approaching cases of OCD, a multifaceted approach to treatment is often required.
- Clinicians should be creative when planning exposure tasks and be mindful of the difficulty level ascribed to each assignment.
- Distraction is productive if it prevents you from giving in to compulsions, but it is harmful if performed as part of a compulsion (i.e., to avoid fear-inducing stimuli).
- Patients do not always realize they are experiencing symptoms, and psychotherapists should inquire regarding their patient’s thoughts when they suspect their condition is declining.
