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Without further examination, one can only note the similarities in isolating behavior between Asperger's and OCD patients. In Jake's particular case, the symptoms while he was a child included insistence on sameness, preference for symmetry, and systems of arranging preferred objects (Leckman, 1999)
Etiology: One can surmise that Jake is genetically predisposed to OCD through his mother. In general, OCD and some other genetically-linked psychiatric disorders can move from mother to son to daughter (i.e. change sex with each generation). OCD in the father can be enhanced through the birth of a child, and has been documented in clinical studies (Abramowitz, 2001). This may be in response to the hormonal changes of the mother, or the change in routine (and perceived risk) of the father after the birth of the child. It could also be a heightened response to post-partum depression on the part of the wife.
Jake's OCD appears to be moderate enough (though of long duration) that it can be cured. A positive in his case is that he has functioned more-or-less normally in society for a number of years. Although it is not possible to imagine that Jake would change completely to an extrovert, the objectives of treatment should be to restore Jake's ability to function with his family and in his community and work environment, while maintaining his current personality.
If one were to choose the "easy" route of prescribing a serotonin inhibitor (such as Fluoxetine) alone, there is a concern that Jake's senses would be enhanced and he could therefore increase his anxiety. In this author's opinion, it would be advisable to treat Jake with a combination of CBT, or cognitive behavioral therapy, and serotonin inhibition, such as Fluoxetine.
In addition, Jack's wife should be implicated in two ways: (1) to explain the neurobiological and genetic factors which have affected Jake -- and could have an impact on their child in later life, and (2) to assess at a surface level whether Ally has tendencies to OCD or other forms of mental illness.
CBT would benefit Jake's OCD because it does not appear to be concomitant with other mental disorders, nor with major issues in his life (such as gambling, alcoholism, or a history of abuse). CBT's main advantages are that it is focused on the specific problem, is relatively short-term, and can have a long-lasting effect on curbing the irrational fears demonstrated in victims of OCD. If Jake showed additional symptoms or a more serious manifestation of the disorder, or a more complicated etiology due to deep psychological causes, treatment with CBT might need to be accompanied by talk therapy, meditation or other methods (Marazziti, 2001).
CBT concentrates on appealing to the rational mind and analyzing the fears, proving (in a rational fashion) that the stimulus of dirty hands, or floors, or other objects, cannot harm Jake or his family. The CBT therapist would encourage Jake note when he has urges to clean -- what are the triggering events. Then the therapist would help lead Jake through a series of aversion therapy exercises, demonstrating the positive outcomes when Jake is exposed to disorder, and gradually desensitizing him to the elements which concern him, or create tension.
What could be the outcome of CBT and Fluoxetine for Jake? The simplest indication would be that Jake reduces his obsessive-compulsive behavior a good deal. But there are additional indicators of progress or success, including better peer functioning, higher self-esteme, lower separation anxiety, and willingness to attempt new things. Thus "better" has a series of meanings, both direct and indirect (Curry, 1998).
Abramowitz, J. a. (2001). Acute Onset of Obsessive-Compulsive Disorder in Males. Psychosomatics, 428-431.
Curry, J. (1998). Predicting the Outcome of Treatment. Abnormal Child Psychology, 39-52.
Farrington D, L.R. (1990). Long-term criminal outcomes of hyperactivity-impulsivity-attentional deficit and conduct problems in childhood. In L. a. Robins, Straight and Devious Pathways From Childhood to Adulthood (pp. 62-81). Cambridge: Cambridge University Press.
Gillberg, C. (1998). Asperger Syndrome and High-Functioning Autism. British Journal of Psychiatry, 200-209.
Goodman, W. a. (2000). Obsessive-Compulsive Disorder: Contemporary Issues in Treatment. London: Routledge.
Hollander, E. (1993). Obsessive-compulsive spectrum disorders: An overview. Psychiatric Annals, 355-358.
Leckman JF, G.D. (1997). Symptoms of obsessive-compulsive disorder. American Journal of Psychiatry, 911-917.
Leckman, J. (1999). Incremental Progress in Developmental Psychopathology: Simply Complex. American Journal of Psychiatry, 1495-1498.
Marazziti, D. a. (2001). Obsessive Compulsive Disorder: A Practical Guide. London: Martin Dunitz.
Winter, J. a. (2002).…[continue]
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