Case Study: Josie Bellings, Part 1

Based on the information that you have, what diagnosis would you give Josie? Please include differential diagnoses. Please match her symptoms with the corresponding DSM-5 criteria.

Josie Bellings, a 34-year-old nurse, presents to your office. Her boyfriend, Robs, is with her.

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“Hi,” Josie sighs deeply. “Remember your first months as a new nurse? I just finished orientation and I’m struggling to keep up now. I’m… I’m having trouble clocking in on time because I have to be certain my hands are clean before I start my shift.”

Robs breaks in. “She’s told me she sometimes washes her hands six times in a row. Maybe even seven or eight to be sure. She does this at home, too.”

Josie nods. “Yeah, he’s right. And after seeing a patient, I also have to clean the desk and computer with wipes just as many times before I can finish the chart. My charge nurse says I’m overdoing the cleanliness a bit, but I just have to do it. And it’s not just cleanliness. At home, I’m the last to bed because I have to check the doors at night five to six times at night.”

“Even if I’ve already locked up and she saw me do it,” puts in Robs.

“Well, I feel like I have to have some control over my world. And, um, Robs doesn’t know this, sometimes I get up after he falls asleep because I worry to the point that I will have to get up and go check one or two more times before I can go to sleep.”

Robs adds, “Actually, I did know about that, Josie. I’m also concerned because Josie will get focused on something and then not be able to shut her mind down. She perseverates and I cannot distract her for anything.”

Josie reports that she has always had these symptoms but that they are worse recently. She reports feeling depressed, mainly because of the OCD symptoms that are causing her trouble. She denies any SI, HI, or A/V hallucinations

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