Roy Adaptation Model Applied to OCD Case Study

Patient History and Presenting Concerns

Tory is a 28-year-old professional in the HR division of a managing firm who suffers from debilitating obsessive-compulsive disorder (OCD). For the past few months her condition has intruded into every sector of her personal and professional life, causing her to miss work. She is also experiencing recurring suicidal thoughts over the past two weeks. She has considered jumping from her apartment window, though she says she would not actually do it — she simply imagines herself doing so and fears that she might act on the impulse if she does not regain control of herself. For years, work was the only comfort in her life, and now even that is in danger of being lost.

Tory is an only child whose parents divorced when she was 7. Her father moved to a different city, and Tory was raised by her stern Methodist mother, who required that she devote herself to her studies and excel academically. Tory preferred her father, who was more relaxed about life, but the tension between her parents meant she rarely spent much time with him. Her mother was very emphatic about cleanliness and instilled an obsession with it in Tory from an early age.

As Tory matured, she began to experience strong sexual feelings she did not know how to interpret, given her Methodist upbringing. She was confused by them and did not dare speak to her mother about them. In college she began seeing a young man who wanted to engage in sexual intercourse. She resisted for as long as she could, but eventually gave in and became pregnant. Her mother required that she have an abortion, after which she and her mother traveled to Europe for a year. When they returned, the young man had moved on to someone else — an outcome her mother had hoped for. Tory buried herself in her work, but over the following years her condition worsened.

She developed a dressing and undressing routine in which every article of clothing had to be put on or taken off in a specific order. This ritual had intensified recently, with Tory sometimes spending half the day engaged in it, unable to stop even though she recognized how debilitating it had become. Because of this condition she was missing work, unable to leave the house, obsessing over cleanliness in her appearance, and unable to function on any professional or social level.

Her disease is a psychosocial condition rooted in her history with her mother and appears to have been intensified by the abortion she had at age 21. Her physical health is otherwise good, with no presenting illnesses other than her OCD. However, her suicidal thoughts suggest she may be in a state of despair about her condition. Her environment is lonely: she lives alone in a rented apartment in the city, has no friends, and her only social contact is at work — where she is often so focused on her job that she does not truly socialize. She has virtually no contact with either parent. She presented herself for treatment because she fears she may be "losing her mind," as she put it.

Nursing Care Framework and Self-Concept Mode

Nursing care in Tory's case would focus on the self-concept group identity mode and would incorporate family therapy, involving both of Tory's parents to help address her OCD, depression, and suicidal thoughts. The aim would be to alter the stimuli present in Tory's life and strengthen adaptive processes so that adaptive behaviors can be triggered, enabling Tory to move out of her OCD and suicidal ideation toward a more stable state. The stimuli that should be addressed include increased contact with her family and the development of a support group, as virtually no support network currently exists for Tory. As Roy (1980) notes, the Adaptive Model takes a humanistic approach to valuing the person's life. In Tory's case, value must not only be identified within her life but actively added — through the introduction of friendship and familial support into her environment — which can then serve as stimuli for generating more positive behaviors and attitudes and combating her depression, suicidal thoughts, and OCD.

The questions that would need to be explored include how Tory's family identifies itself and what its goals are — both for itself as a group and for its individual members. This will be difficult to assess given the family's fractured dynamic, but with effort and understanding the family members may be able to work together to address the problems facing it. The family's values are complicated: the mother clearly values a strict adherence to social mores, whereas the father is more relaxed. Tory herself does not know what to value. She is submissive to her mother but prefers her father because of his relaxed and accepting disposition.

Physiological Mode and Environmental Needs

The physiological mode would focus on the extent to which the family is able to help Tory meet her basic needs. Can she shop for herself and provide food for herself? Are Tory's parents able to provide for themselves? From the assessment it appears that they are, and that they could help Tory with her needs. Because persons are co-extensive with their surroundings, it is imperative to engage Tory's environment and the people within it — to identify potential friends at work who may be willing to help and come to Tory's aid, representing untapped potential waiting to be realized (Roy, 1997). This would be helpful in eliminating Tory's seclusion. She has effectively sealed herself off from the world and, even though she knows what she is doing is dysfunctional, she cannot stop.

She acknowledges presenting herself for treatment almost on a whim, as though something outside herself compelled her to do so — she did not deliberate on it, but simply walked into the hospital and confessed everything calmly, wondering whether there is any hope for her. She also fears that this same impulsive quality could cause her to jump from her apartment window, which makes her all the more afraid to be alone. This is a sign that Tory is ready to develop an interdependence mode of engagement that can provide the right set of positive stimuli for her to begin improving (Roy, 1997).

Conclusion: Pathways to Adaptive Recovery

Tory's health is dependent upon her receiving some fresh stimuli that can serve as regulators of her psychology. Her self-concept has been severely damaged by her abortion at her mother's urging. She has closed off internally and is now consumed by a compulsive dressing and undressing ritual that occupies much of her day. She presented herself in a state of near despair, ashamed of what she has been doing and of her inability to stop. She fears for her psychological well-being as well as for her physical safety. She sees her life deteriorating and spiraling out of control.

According to the Roy Adaptation Model, Tory can cope more effectively with her disease by developing an interdependency system with her parents, who could help balance her needs between firmness and strength — provided by her mother — and love and compassion — provided by her father. The cultivation of this support system could help restore Tory's equilibrium and give her the means to emerge from her self-imposed exile and re-engage with the world around her (Roy, 1980).

References

Rambo, B. (2004). Adaptive Nursing. Philadelphia: W.B. Saunders Company.

Roy, C. (1980). The Roy Adaptation Model. In J. P. Riehl & C. Roy (Eds.), Conceptual Models for Nursing Practice. Norwalk: Appleton Century Crofts.

Roy, C. (1997). Future of the Roy Model: Challenge to redefine adaptation. Nursing Science Quarterly, 10(1), 42–48.

Roy, C., & Florczak, K. (2011). Research based on the Roy Adaptation Model: Last 25 years. Nursing Science Quarterly, 24(4), 312–320.