Recognition and Collaborative Management of Contamination-Related Obsessive Compulsive Disorder in Primary Care: A Case Report

Abstract

Background: Obsessive-compulsive disorder (OCD) is frequently missed in primary care because patients may conceal symptoms or present only after substantial functional impairment. Early recognition and coordinated care can reduce disability. Case presentation: A woman in her early twenties presented with a four-year history of contamination-related intrusive thoughts and prolonged repetitive bathing. She recognised that the thoughts and rituals were excessive but experienced marked anxiety when resisting them. Bathing occupied several hours and caused recurrent lateness to school. There was no evidence of psychosis, mania, substance use or a primary medical explanation in the supplied history. Intervention and outcome: The family physician provided psychoeducation, involved the patient’s supportive spouse with her consent, referred her for cognitive behavioural therapy incorporating exposure and response prevention, and commenced paroxetine. Symptoms improved over serial follow-up, bathing time reduced to approximately 10-15 minutes and rituals ceased. Medication was later tapered and discontinued. Exact treatment duration and standardised severity scores were not supplied. Conclusion: Primary-care clinicians can improve detection by asking directly about intrusive thoughts, repetitive behaviours, time consumption and functional impairment. Effective care requires accurate diagnosis, risk assessment, evidence-based CBT/ERP, appropriate pharmacotherapy, monitoring and referral or shared care when needed.