Alissa was referred for psychological evaluation at this time by her therapist…Alissa has a long history of outpatient treatment including an inpatient hospitalization at the end of December of 1992. Alissa has utilized a variety of medications including: Prozac, Pamelor, Anafranil, and is currently taking Wellbutrin. Alissa was referred for this evaluation due to concerns about her OCD and possible ADD.
The family system includes an autistic brother who has proved challenging for all family members. For a time period Alissa functioned as the caretaker for the brother…Alissa has had a difficult relationship with her father. The father reportedly has several indicators of a possible psychiatric disorder. Alissa’s mother will spend many hours a week working.
Alissa has had depressive and suicidal symptoms starting in the fourth grade…Throughout the meeting with Alissa it became apparent that she has had serious psychiatric symptoms for many years. Her condition is quite serious and of a chronic nature…At the time of this evaluation, she had reddened hands which she attributed to dry skin. Due to the OCD, this examiner speculates that the hand condition does reflect excessive hand washing. She stated that as a younger child she would wash her hands frequently, including before and after eating, and before and after using the bathroom.
Symptoms that Alissa currently endorsed include checking to make sure that she has turned off the lights on her car. Due to the distance involved it is a major inconvenience for her to go to the classroom building at college to the parking lot to check on her car. She did go to this extreme measure and when she got to the car realized that she had turned the lights off even though she was not consciously aware of doing so. At other times she will have to check numerous times to ascertain the exact location of her purse. At home she counts a short flight of steps constantly whether she is ascending or descending the steps. This seems to be a strongly ingrained ritual. This examiner believes that there are other examples of obsessive/compulsive thoughts and behaviors that Alissa is not acknowledging at this time…She does describe the checking behavior in terms of feeling she “has to” check.
Yes, it is true that I was very depressed at a young age. I remember people telling my mother that they have never seen such a young child so depressed before and that I needed help. But there weren’t many programs available to special needs siblings. I felt incredibly alone and disconnected from my peers. I started seeing a therapist in my late teens.
It was especially hard in grade school because my autistic brother was in the same school as me. They had a special ed room that was shared with the library. I don’t know whose dumb ass idea that was. It was never quiet in the library, although we were told to be. That probably made my brother’s behavior all the more shocking.
When I would go in for library, my brother was oftentimes flailing around as if he was possessed inside of the big ‘naughty’ box they put him in that was located between the classrooms. This caused my classmates to point, snicker, and laugh. It made me feel angry, sorrowful, and ashamed. He was MY brother. It was very painful.
I think I developed rituals to help me cope, to feel like I had an iota of control over my life. The hand washing ritual started when I was in middle school after I was almost attacked in the parking lot while I waited in the car for my mom to finish up with her support group for parents of special needs children. The support group was held in the library and sometimes the library closed before the meeting was done and I would meet my mom in the car. That hot summer night I felt like I was suffocating in the locked car while those guys tried desperately to get in. It was so hot, but I didn’t dare open a window. The car handles were dirty. I felt dirty. Hand washing made me feel clean and cleansed.
You would think that I would have issues with libraries or books. Sheesh!
I like to have clean hands, but I haven’t obsessively washed them in decades. I like things clean and I like to feel like I have control even if I don’t. My parents are hoarders. Our house was always chaotic and messy.
It’s strange how I can be obsessive without being addictive since they seem so similar. But I don’t want anything external to control me, yet sometimes the internal things still do. Sometimes I still have to check things..
To be continued…