Skip to content
2000
  1. Home
  2. A-Z Publications
  3. Current Psychiatry Research and Reviews
  4. Fast Track Articles
  5. Fast Track Article
image of Severe Obsessive‒compulsive Disorder of Transformation in a 13-year-old Adolescent: A Case Report

Abstract

Introduction

Obsessive-compulsive Disorder (OCD) with transformation obsession is a rare psychiatric disorder that can pose various diagnostic difficulties and treatment challenges. Scientific research focusing on this disorder in adolescents is scarce. In this work, we present the case of a teenage girl who was treated for severe OCD with transformation obsession. The psychiatric management of this adolescent was performed on an outpatient basis and took place in the juvenile department at Saint Ylie Hospital (France). We hope that our work will add to the existing data on the psychiatric management of this condition in adolescents. In this work, we used the Diagnostic and Statistical Manual of Mental Disorders 5th version for the evaluation of psychiatric disorders and the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) to assess the severity of symptoms.

Case Presentation

The patient (13 years old) experienced persistent, intrusive, and distressing ideas about transforming into another person. Despite knowing how unreal these ideas were, she feared they would come true. She had rituals that she felt compelled to carry out to help her manage her worries temporarily. She also experienced involuntary non-rhythmic movements of the facial muscles simultaneously. The patient was diagnosed with OCD with good insight and comorbid tics. Initially, the total CY-BOCS score was 40/40. Psychosis was considered a differential diagnosis due to the atypicality of the clinical manifestation, but it was ruled out after a thorough clinical evaluation. Psychotherapeutic management was not possible before adequate pharmaceutical treatment was started because of invasive and distressing symptoms. The pharmacological management led to the administration of a combination of fluoxetine at a dose of 40mg with olanzapine at a dose of 5mg after a partial response to fluoxetine alone. Weekly individual Cognitive Behavioral Therapy (CBT) was started as soon as the adolescent's condition allowed and included psychoeducation, muscle relaxation techniques, cognitive restructuring, Exposure and Response Prevention (ERP), self-affirmation work, and relapse prevention. At the same time, parents also benefited from psychoeducational interventions. The evolution was marked by total clinical remission and clear psychometric improvement. The total CY-BOCS score ranged from 40/40 to 07/40 after 5 months of CBT. No adverse effects were reported throughout the treatment.

Conclusion

This case shows the possibility of unusual and severe OCD in adolescents. It also highlights the importance of careful diagnosis so as not to be mistaken and consider it a psychosis. The management of this type of OCD requires the combination of two pharmacological treatments before starting individual CBT and psychoeducational intervention for parents. This combination allows a complete clinical remission after a few months. It is preferable that further clinical trials be conducted to protocolize the management of this type of OCD.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/cprr/10.2174/0126660822351945241215171316
2025-01-13
2025-04-24

  • From This Site

    /content/journals/cprr/10.2174/0126660822351945241215171316
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. Uhre C.F. Uhre V.F. Lønfeldt N.N. Pretzmann L. Vangkilde S. Plessen K.J. Gluud C. Jakobsen J.C. Pagsberg A.K. Systematic review and meta-analysis: Cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents. J. Am. Acad. Child Adolesc. Psychiatry 2020 59 1 64 77 10.1016/j.jaac.2019.08.480 31589909
    [Google Scholar]
  2. Heyman I. Fombonne E. Simmons H. Ford T. Meltzer H. Goodman R. Prevalence of obsessive–compulsive disorder in the British nationwide survey of child mental health. Br. J. Psychiatry 2001 179 4 324 329 10.1192/bjp.179.4.324 11581112
    [Google Scholar]
  3. Rasmussen S.A. Eisen J.L. The epidemiology and clinical features of obsessive compulsive disorder. Psychiatr. Clin. North Am. 1992 15 4 743 758 10.1016/S0193‑953X(18)30205‑3 1461792
    [Google Scholar]
  4. Geller D.A. Biederman J. Jones J. Shapiro S. Schwartz S. Park K.S. Obsessive-compulsive disorder in children and adolescents: A review. Harv. Rev. Psychiatry 1998 5 5 260 273 10.3109/10673229809000309 9493948
    [Google Scholar]
  5. Geller D.A. Biederman J. Faraone S. Agranat A. Cradock K. Hagermoser L. Kim G. Frazier J. Coffey B.J. Developmental aspects of obsessive compulsive disorder: Findings in children, adolescents, and adults. J. Nerv. Ment. Dis. 2001 189 7 471 477 10.1097/00005053‑200107000‑00009 11504325
    [Google Scholar]
  6. Vivan A.S. Rodrigues L. Wendt G. Bicca M.G. Braga D.T. Cordioli A.V. Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: A population-based study. Rev. Bras. Psiquiatr. 2013 36 2 111 118 10.1590/1516‑4446‑2013‑1113 24165685
    [Google Scholar]
  7. Fernández De La Cruz L. Barrow F. Bolhuis K. Krebs G. Volz C. Nakatani E. Sexual obsessions in pediatric obsessive-compulsive disorder: Clinical characteristics and treatment outcomes. Depress. Anxiety 2013 30 732 740 10.1002/da.22097 23532924
    [Google Scholar]
  8. Bloch M.H. Landeros-Weisenberger A. Rosario M.C. Pittenger C. Leckman J.F. Meta-analysis of the symptom structure of obsessive-compulsive disorder. Am. J. Psychiatry 2008 165 12 1532 1542 10.1176/appi.ajp.2008.08020320 18923068
    [Google Scholar]
  9. Monzani B. Jassi A. Heyman I. Turner C. Volz C. Krebs G. Transformation obsessions in paediatric obsessive-compulsive disorder: Clinical characteristics and treatment response to cognitive behaviour therapy. J. Behav. Ther. Exp. Psychiatry 2015 48 75 81 10.1016/j.jbtep.2015.02.004 25753746
    [Google Scholar]
  10. Volz C. Heyman I. Case series: Transformation obsession in young people with obsessive-compulsive disorder (OCD). J. Am. Acad. Child Adolesc. Psychiatry 2007 46 6 766 772 10.1097/chi.0b013e3180465a2e 17513989
    [Google Scholar]
  11. Bettess Z. Albertella L. Destree L. Rosário M.C. Ferrão Y.A. Miguel E.C. Fontenelle L.F. Clinical characteristics of transformation obsessions in obsessive-compulsive disorder: A psychopathological study. Aust. N. Z. J. Psychiatry 2023 57 1 130 139 10.1177/00048674221084241 35303769
    [Google Scholar]
  12. Skoog G. Skoog I. A 40-year follow-up of patients with obsessive-compulsive disorder [see commetns]. Arch. Gen. Psychiatry 1999 56 2 121 127 10.1001/archpsyc.56.2.121 10025435
    [Google Scholar]
  13. Krebs G. Heyman I. Obsessive-compulsive disorder in children and adolescents. Arch. Dis. Child. 2015 100 5 495 499 10.1136/archdischild‑2014‑306934 25398447
    [Google Scholar]
  14. Demaria F. Pontillo M. Tata M.C. Gargiullo P. Mancini F. Vicari S. Psychoeducation focused on family accommodation: A practical intervention for parents of children and adolescents with obsessive-compulsive disorder. Ital. J. Pediatr. 2021 47 1 224 10.1186/s13052‑021‑01177‑3 34742338
    [Google Scholar]
  15. Micali N. Heyman I. Perez M. Hilton K. Nakatani E. Turner C. Mataix-Cols D. Long-term outcomes of obsessive–compulsive disorder: Follow-up of 142 children and adolescents. Br. J. Psychiatry 2010 197 2 128 134 10.1192/bjp.bp.109.075317 20679265
    [Google Scholar]
  16. Kerkeni A. Abbes W. Tfifha M. Mahdhaoui W. Abbes M. Rejeb I. Ghanmi L. Particularities of suicide attempts among adolescents in the region of southern tunisia. Eur. Psychiatry 2021 64 S1 S216 S217 10.1192/j.eurpsy.2021.577
    [Google Scholar]
  17. Mathes B.M. Morabito D.M. Schmidt N.B. Epidemiological and clinical gender differences in OCD. Curr. Psychiatry Rep. 2019 21 5 36 10.1007/s11920‑019‑1015‑2 31016410
    [Google Scholar]
  18. Ayadi H. Boudabous J. Kerkeni A. Kraiem M. Yaich S. Moalla Y. Tunisian validation of the children’s depression inventory-2 in school-based children. Curr. Psychiatry Res. Rev. 2024 20 10.2174/0126660822272709231213062846
    [Google Scholar]
  19. Avasthi A. Sharma A. Grover S. Clinical practice guidelines for the management of obsessive-compulsive disorder in children and adolescents. Indian J. Psychiatry 2019 61 8 Suppl. 2 306 316 10.4103/psychiatry.IndianJPsychiatry_554_18 30745705
    [Google Scholar]
  20. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association 5th ed 2013 10.1176/appi.books.9780890425596
    [Google Scholar]
  21. Scahill L. Riddle M.A. McSWIGGIN-HARDIN M.A.U.R.E.E.N. Ort S. King R.A. Goodman W.K. Cicchetti D. Leckman J.F. Children’s yale-brown obsessive compulsive scale: Reliability and validity. J. Am. Acad. Child Adolesc. Psychiatry 1997 36 6 844 852 10.1097/00004583‑199706000‑00023 9183141
    [Google Scholar]
  22. Murray L. Creswell C. Cooper P.J. The development of anxiety disorders in childhood: An integrative review. Psychol. Med. 2009 39 9 1413 1423 10.1017/S0033291709005157 19215631
    [Google Scholar]
  23. Eggum N.D. Eisenberg N. Reiser M. Spinrad T.L. Valiente C. Sallquist J. Michalik N.M. Liew J. Relations over time among children’s shyness, emotionality, and internalizing problems. Soc. Dev. 2012 21 1 109 129 10.1111/j.1467‑9507.2011.00618.x 22383862
    [Google Scholar]
  24. Insel T.R. Akiskal H.S. Obsessive-compulsive disorder with psychotic features: A phenomenologic analysis. Am. J. Psychiatry 1986 143 12 1527 1533 10.1176/ajp.143.12.1527 3789205
    [Google Scholar]
  25. Sharma P. Pratap A. Transformation obsessions in obsessive-compulsive disorder. Indian J. Psychiatry 2022 64 585 10.4103/0019‑5545.341702
    [Google Scholar]
  26. Bloch M.H. Landeros-Weisenberger A. Kelmendi B. Coric V. Bracken M.B. Leckman J.F. A systematic review: Antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol. Psychiatry 2006 11 7 622 632 10.1038/sj.mp.4001823 16585942
    [Google Scholar]
  27. Bloch M.H. Storch E.A. Assessment and management of treatment-refractory obsessive-compulsive disorder in children. J. Am. Acad. Child Adolesc. Psychiatry 2015 54 4 251 262 10.1016/j.jaac.2015.01.011 25791142
    [Google Scholar]
  28. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The pediatric OCD treatment study (POTS) randomized controlled trial. JAMA 2004 292 16 1969 1976 10.1001/jama.292.16.1969 15507582
    [Google Scholar]
  29. Geller D.A. March J. Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. J. Am. Acad. Child Adolesc. Psychiatry 2012 51 1 98 113 10.1016/j.jaac.2011.09.019 22176943
    [Google Scholar]
/content/journals/cprr/10.2174/0126660822351945241215171316
Loading
Severe Obsessive‒compulsive Disorder of Transformation in a 13-year-old Adolescent: A Case Report
Bentham Science Publishers ; https://doi.org/10.2174/0126660822351945241215171316
/content/journals/cprr/10.2174/0126660822351945241215171316
/content/journals/cprr/10.2174/0126660822351945241215171316
Loading

Data & Media loading...


  • Article Type:     Case Report
Keywords: obsessive-compulsive disorder ; cognitive behavioral therapy ; fear ; case report ; antipsychotic agents ; selective serotonin reuptake inhibitors ; Adolescent

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test