Cognitive-Behavioral Therapy with Exposure and Response Prevention for Contamination-Related Obsessive-Compulsive Disorder: A Case Study

Abstract

This case study describes the assessment, formulation, and cognitive-behavioral treatment of Ms. A, a 26-year-old married mother of two young children from Lahore, Pakistan, who presented with a 3-year history of contamination obsessions, excessive handwashing and cleaning, checking, avoidance, and repeated reassurance seeking from her husband. Symptoms began after her infant son was hospitalized with gastroenteritis and intensified after the birth of her daughter. Assessment comprised a detailed clinical history from the client and her husband, mental status examination, risk screening, 1 week of self-monitoring, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and the Rotter Incomplete Sentences Blank (RISB). Baseline Y-BOCS severity was 27, and the RISB adjustment score of 143 exceeded the conventional cutoff, with themes of responsibility, guilt, and fear for her children’s health. A DSM-5-TR diagnosis of obsessive-compulsive disorder, with good or fair insight, was established through clinical interview against diagnostic criteria. The case was conceptualized using a 5Ps framework and Salkovskis’s cognitive-behavioral model of inflated responsibility. Treatment consisted of 12 weekly sessions of cognitive-behavioral therapy centered on graded exposure and response prevention, supported by psychoeducation, reduction of family accommodation, cognitive restructuring, and relapse prevention. At post-treatment, the Y-BOCS score fell to 14 (a 48.15% reduction), daily handwashing decreased from about 27 to 9 episodes, and reassurance seeking fell from about 12 to 2 requests per day, although residual symptoms remained. The case highlights the value of formulation-driven exposure and family involvement in treating contamination-related obsessive-compulsive disorder in young mothers.