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Treatment of Symmetry-Obsessive-Compulsive Disorder

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Clinical Handbook of Obsessive-Compulsive and Related Disorders

Abstract

Symmetry and ordering obsessions and compulsions are among the most prevalent obsessive-compulsive disorder (OCD) symptom subtypes, often emerging in early childhood or adolescence. This chapter first discusses the phenomenology of this particular subtype, including distinct cognitive and emotional features that underlie symmetry-based concerns. Following is a case study describing Natalie X, a 27-year-old female patient with chronic symmetry-type OCD, the severity of which had fluctuated throughout her lifetime. She presented with persistent worries and rituals revolving around dividing objects and thoughts into gender categories of boy or girl, and she experienced considerable distress if items were not balanced across these boy/girl classes. Exposure response prevention (ERP) and cognitive therapy techniques were implemented in order to break the reinforcing cycle of Natalie’s compulsions and restructure her maladaptive automatic thoughts. Therapy occurred over 23 sessions and included psychoeducation about OCD and corresponding treatment tactics, a functional analysis of her specific triggers and behaviors, and exposures along a fear hierarchy. Motivational interviewing (MI) tactics were incorporated to enhance motivation and adherence to exposure exercises, while cognitive restructuring helped address her dysfunctional beliefs, such as overestimation of danger associated with asymmetry. Continual monitoring of symptoms and a collaborative working approach helped the therapist best tailor the cognitive and behavioral techniques towards Natalie’s needs throughout the treatment. Natalie’s symmetry symptoms and the level of impairment met criteria for remission at termination, illustrating the efficacy of ERP and cognitive therapy in treating this common subtype of OCD.

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Authors and Affiliations

  1. Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., 33146, Coral Gables, FL, USA

    Kiara R. Timpano PhD

  2. University of Miami, Coral Gables, FL, USA

    Julia Y. Carbonella MS & Demet Çek MS

  3. Nova Southeastern University, Fort Lauderdale, FL, USA

    Shelby E. Zuckerman MS

Authors
  1. Kiara R. Timpano PhD
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  2. Julia Y. Carbonella MS
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  3. Shelby E. Zuckerman MS
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  4. Demet Çek MS
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Correspondence to Kiara R. Timpano PhD .

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Editors and Affiliations

  1. Department of Pediatrics, Health Policy & Management, Psychiatry & Behavioral Neurosciences, and Psychology, University of South Florida, St. Petersburg, Florida, USA

    Eric A. Storch

  2. Departments of Pediatrics, Psychiatry and Psychology, University of South Florida, Tampa, Florida, USA

    Adam B. Lewin

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Timpano, K., Carbonella, J., Zuckerman, S., Çek, D. (2016). Treatment of Symmetry-Obsessive-Compulsive Disorder. In: Storch, E., Lewin, A. (eds) Clinical Handbook of Obsessive-Compulsive and Related Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-17139-5_6

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