--------- + Page 1 of 2 ZOOM K Working with Clients with Compulsive Disorders: The Case of Marjorie Marjorie is a 24-year-old, Caribbean American female. She was born in the West Indies. Her family immigrated to the United States when she was four years old and later became American citizens. Marjorie has four siblings: two older brothers, who live with their families in other states, and two younger sisters, who live at home with Marjorie and her mother. Her father passed away when she was 15 years old. Marjorie is unmarried, has no children, and has only a few social acquaintances from work and her church. Generally, Marjorie is in good physical health; she has never been hospitalized nor has she received past psychiatric treatment. She is employed part-time as an administrative assistant at her church with an annual salary of $18,500. Marjorie attended college for three semesters but had to drop out for financial reasons. She would like to go back to school and complete her degree, but recently she has experienced difficultly managing her daily living activities, including her job responsibilities. As a teenager, Marjorie began experiencing discomfort touching what she believed were "filthy" objects: toilet seats, outdoor seating areas, desk chairs, light switches--anything that had public contact. As her condition became more severe, she found herself needing to leave work several times a day, believing she was contaminated and needing to take a hot shower and change clothes. To feel safe and secure, Marjorie cleans the house from top to bottom several times a week. She washes her clothes on a daily basis, and she washes her hands 20-30 times a day until they are nearly raw. When Marjorie is at home, she is consumed with her bathing and cleaning rituals, showering for approximately one hour several times a day, using three to four washcloths. She changes clothes several times a day and avoids meeting new people for fear of physical contact that might contaminate her. She does not like to have strangers in the house because they "bring in germs." Marjorie recalls how she used to help her mother clean house while growing up. This always brought favorable attention from her parents, particularly her father. Her father always commented on how special she was because she was the "little helper in the house. After her father passed away, Marjorie deeply missed the special attention she had received. Whenever she thought about him, she began to feel anxious and would begin her cleaning rituals, which helped her feel connected with his memory and gave her a feeling of control over her life. Marjorie stated that her mother was aware that her behaviors might not be normal but that she had made no effort to seek professional support for her daughter because she did not trust hospitals, especially because her husband died in a hospital. She believes that Marjorie will ultimately outgrow any problems, stating, "No child of mine has a mental problem!" Marjorie's cleaning practices became more frequent concurrent with her compulsive thoughts about needing to feel secure and in control. Marjorie's siblings became more concerned about her, and her employer expressed concern that she risked losing her job due to her increasing need to leave mid-shift. Her sister was able to talk Marjorie into making an appointment at the local mental health clinic. Upon the initial encounter, Marjorie presents as physically tired, quite thin, and very anxious. During introductions, she did not shake hands with you, nor did she look at you directly. During Page 1 of 2 ZOOM + --------- K on how special she was because she was the little helper in the house. After her father passed away, Marjorie deeply missed the special attention she had received. Whenever she thought about him, she began to feel anxious and would begin her cleaning rituals, which helped her feel connected with his memory and gave her a feeling of control over her life. Marjorie stated that her mother was aware that her behaviors might not be "normal" but that she had made no effort to seek professional support for her daughter because she did not trust hospitals, especially because her husband died in a hospital. She believes that Marjorie will ultimately outgrow any problems, stating, No child of mine has a mental problem!" Marjorie's cleaning practices became more frequent concurrent with her compulsive thoughts about needing to feel secure and in control. Marjorie's siblings became more concerned about her, and her employer expressed concern that she risked losing her job due to her increasing need to leave mid-shift. Her sister was able to talk Marjorie into making an appointment at the local mental health clinic. Upon the initial encounter, Marjorie presents as physically tired, quite thin, and very anxious. During introductions, she did not shake hands with you, nor did she look at you directly. During intake, a general psychological assessment was completed. The Yale-Brown Obsessive- Compulsive Scale (Y-BOCS) was used as part of the assessment which supported a preliminary diagnosis of clinical obsessive-compulsive disorder (OCD). In this initial session with Marjorie, she talked about the situations or objects that gave her the greatest anxiety. It is anticipated that work with Marjorie could take considerable time and effort to get her to express her interpretations of the obsessions, to develop the appropriate strategies and techniques to reduce the frequency of obsessed thoughts and compulsive behaviors, and to positively associate with her social networks once again.