Family-Based Exposure and Response Prevention (ERP) for Purely Compulsive (Pure-C) OCD in Adolescence: A Case Study
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Pure-C OCD is a new emerging domain of OCD, depicting purely compulsive behaviors in the absence of any obsession. This case study examines the efficacy of family-based exposure and response prevention (ERP) and solution-focused therapy (SFT) for a 19-year-old male with purely compulsive OCD, characterized by sensory-driven rituals (e.g., excessive handwashing, ritualized showering) without comorbid obsessions. Pre-treatment assessment revealed a Y-BOCS compulsion score of 15 (moderate severity), with compulsions supported by "not just right" sensations rather than fear-based obsessions. Key themes in the anxiety hierarchy were avoidance related to touching his body and using the washroom, ritualistic handwashing and showering, disruption in daily life activities, and avoidance of contact of body parts with each other during sleep. A diagnosis of F42.2. obsessive-compulsive disorder (OCD), with fair insight, was given. The patient’s childhood perfectionistic tendencies, age of onset, and familial history of compulsive traits served as predisposing factors. The first episode was precipitated by academic stress and hygiene-focused media coverage of COVID-19. Familial conflicts, enabling behavior of the family, and avoidance perpetuated the symptoms. However, fair insight, motivation, familial support, and moderate severity predicted a positive prognosis. Based on the symptoms and contributing factors, an eclectic approach was used, where high-intensity Family-based ERP was the primary intervention. It targeted six mini-anxiety hierarchies, each focusing on a specific theme. The solution-focused therapy (SFT) was then used to improve problem-solving skills related to academic stress and assertiveness training for familial conflicts. For long-term benefits, relapse prevention was applied. Overall treatment took 8 months, and a total of 95 sessions were conducted. It showed an average 80% improvement. The findings aligned with earlier literature and served as a guide for future research and therapists for dealing with Pure-C OCD. Limitations include long-term follow-up to assess the maintenance of achieved goals.
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