The case study under consideration is the case of Bess, a 27-year old single woman who works as an accountant at a manufacturing firm. Bess was brought up by a single mother who was obsessed with cleanness and whose primary objective was control over her daughter’s life. After Bess’s mother’s serious intervention into the course of her life (arranging an abortion even without asking her daughter about her intentions), Bess was absorbed in her studies and later in her work. In a while, Bess started developing certain patterns of behavior similar to her mother’s and gradually became obsessed with cleanness and order. With time, however, she developed different rituals and obsessive thoughts of her own, though all they were based on the issue of cleanness. Bess has a psychological disorder, namely obsessive-compulsive disorder (OCD) and a more detailed analysis of her case will help to explain the biological, emotional, cognitive, and behavioral components of her disorder.
First of all, Bess’s disorder has a biological component, though in her case it is more genetic than biological. There exists considerable evidence that OCD can be caused by biological factors among which “serotonin dysregulation is well-documented, as are brain changes, including increased blood flow to the orbital-frontal lobes and the basal ganglia” (Bonder, 2004, p. 132). Proper metabolism of serotonin is vital for the communication between the cortex and the basal ganglia, which is why dysfunctions of the serotonergic system often lead to mental diseases. The patterns of brain activity of OCD patients differ significantly from those which healthy people have, which accounts for their specific behavior. Since none of such biological changes was registered in the case of Bess, her disorder was caused by heredity which may also play a role (Bonder, 2004). Bess’s mother was obsessed with cleanness and her OCD could possibly have some of the abovementioned biological components. Bess, who was born healthy, inherited the obsession, though without specific brain dysfunctions. This being the reason, Bess became obsessed with cleanness and with time developed her own patterns of obsessive behavior.
In addition, the emotional component is also of great importance in OCD. Since OCD is primarily a psychological disorder, emotional factors play a key role in the formation of the disease. In the case of OCD, emotional defense is a frequent cause of the disease. OCD patients often find it hard to express their emotions: “They use several defenses to avoid coming into contact with their conflicts and attendant emotions. One of these defense emotions is intellectualization” (Roukema, 2003, p. 79). This defense mechanism turns people suffering from OCD into diligent students who easily absorb information and memorize statistics and different quotes. Such behavior can be observed in Bess’s case whose disease started progressing presumably after her mother forcing her to make an abortion when at high school. Back then, Bess was completely taken up with studies. She became one of the best students at school and started developing a habit of perfectionism which further spread not only to her studies but to her life as well. Desire to be the best accompanied her throughout her life and though her profession (accountant) as such regards perfectionism as good quality, Bess still was too career-oriented because job absorbed most of her time (Meyer, 2005). Thus, Bess’s studies and job later served as her defense mechanism which she developed in the course of her OCD.
Furthermore, Bess’s OCD is worth discussing with regards to its cognitive component. Reinecke & Clark (2003) state that OC symptoms are related to the patients’ thoughts and beliefs, as well as they, show a strong correlation “with depression, anxiety, and worry symptoms, and … with other cognitive domains of OCD such as tolerance of uncertainty, control of thoughts, and overestimation of threat” (p. 99). These features usually root in the patients’ childhood and are a result of their upbringing. For instance, Bess’s mother was rather authoritative; she often inculcated guilt on her daughter and deprived her of any possibility to solve conflicts by herself (Meyer, 2005). From childhood, Bess’s mother emphasized the necessity of cleanness and made her daughter wash her hands several times a day, especially after visiting the bathroom. Even as a child Bess tried to oppose her and got everything disorderly as soon as her mother took her attention away. The cognitive component of her disease started developing with her mother’s constant repeating that such behavior would hurt Bess when she grows up; at this, the mother never said how exactly it would hurt her (Meyer, 2005). This is the main reason for the anxiety Bess experienced when feeling a necessity to put her clothes in a specific order or when exhibiting similar obsessive behavior.
Finally, OCD has certain behavioral components, compulsions, which make the obsessive patients act in a definite way. The most common compulsions include “washing, cleaning, checking, counting, repeating actions, ordering (e.g. insisting that items be stored in a particular manner), confessing (e.g. repeatedly describing past misconduct), and requesting assurances” (Boyd, 2007, p. 418). These compulsions do not bring any pleasure to the patients with some of the individuals even trying to resist them. However, the anxiety which an OCD patient experiences when resisting the compulsion is intolerable and lasts until the action is not performed in a specific sequence or for a definite number of times. One of the most widespread compulsions is the fear of contamination which “focuses on dirt or germs … other materials may be feared as well, such as toxic chemicals, poison, radiation, and heavy metals” (Boyd, 2007, p. 418). In the case of Bess, the compulsions were washing and cleaning; this included showering, cleaning of the house, washing hands, taking off and putting on the clothes in a specific sequence; besides, Bess had a fear of contamination because she always captiously looked for contamination before putting her clothes into the wardrobe. Thus, washing and cleaning are the main behavioral components of Bess’s OCD which account for her abnormal obsessive behavior.
In sum, OCD has different biological, emotional, cognitive, and behavioral components which are used to classify this disease. A consideration of Bess’s case has shown that generic, rather than biological factors resulted in her disease because the obsession with cleanness and order was inherited from her mother. Emotionally, Bess tried to distract herself from the obsession by getting absorbed first with her studies and then with her job. The cognitive component of her disease developed with her mother threatening her with serious consequences if Bess refused to wash her hands or put everything orderly as a child. This is why Bess developed her compulsions, namely washing, cleaning, and fear of contamination.
References
Bonder, B. (2004). Psychopathology and function. Thorofare, NJ: SLACK Incorporated.
Boyd, M.A. (2007). Psychiatric nursing: contemporary practice. London: Lippincott Williams & Wilkins.
Reinecke, M.A. & Clark, D.A. (2003). Cognitive therapy across the lifespan. Cambridge: Cambridge University Press.
Roukema, R.W. (2003). Counseling for the soul in distress: what every religious counselor should know about emotional and mental illness. New York: Routledge.