Obsessive Owen — OCD: Obsessions, Compulsions & Anxiety Relief
He has washed his hands until they bleed — because stopping makes the anxiety unbearable
Owen is late to every group because he cannot leave the sink. When a nurse turns off the water for him, he becomes visibly panicked.
Owen has obsessions (intrusive, unwanted thoughts of contamination) and compulsions (repetitive handwashing) that temporarily relieve the anxiety those thoughts create. The compulsion is not enjoyable; it is the only thing that quiets the fear, so blocking it abruptly causes panic. Nursing care allows time for the ritual early in treatment, sets limits gradually, and never shames or argues about the logic of the thought. Treatment is SSRIs (often at higher doses than for depression) plus cognitive behavioral therapy with exposure and response prevention.
Read Obsessive Owen's full story →The story arc
The setup
Owen is admitted after his handwashing grew to four hours a day and he lost his job.
The turn
A new nurse turns off the faucet mid-ritual to keep Owen on schedule, and he becomes acutely anxious and agitated.
The crisis
Owen's hands are cracked and bleeding, and he refuses to stop washing because 'the germs are still there.'
The save
The team starts an SSRI, begins exposure and response prevention with the therapist, and gradually shortens the time allowed for washing while praising nonritual activity.
NCLEX study section — OCD: Obsessions, Compulsions & Anxiety Relief
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Mental Health
Take this chapter into practice questions on the same topic.