Problem
A 56-year-old man named Emil seeks therapy from you. He tells you that his symptoms began gradually and that he had always been thought of as an anxious person who worried a lot about things throughout his life. He tells you that around 10 years ago, following a few life stressors, his anxiety and intrusive thoughts greatly deteriorated. For example, he said he was really scared he'd get HIV by touching doorknobs, even though he tells you this was "irrational." He claims he started excessively washing his hands. He claims he experienced a severe fear that he would be held accountable for someone breaking into the house because he had left something unlocked. He claims that this dread caused him to continuously check doors and windows in a particular order before going to bed, which caused friction with his wife. He claims that his fear of making a mistake also causes him to be cautious while submitting work for his job, which results in him being punished occasionally.
Emil claims that he has sought therapy because his symptoms are growing worse. For instance, he currently washes his hands till the soap bar is gone, and as a result, his hands are cracked from being so dry. He claims to regularly check his house's windows and doors throughout the day, not just at night, and to occasionally drive home from work to make sure everything was indeed closed. He claims he has the impulse to clean the entire house if he sees even a small amount of dust on the floor, and he frequently gives in to that urge.
Since these symptoms are depleting his confidence and taking up more of his time, Emil displays great anxiety about them. He is also becoming more and more distracted at work and in his personal life.
1) Outline their symptoms and make an educated guess on their diagnosis.
2) Using the DSM criteria, describe in detail how this person fits the criteria for diagnosis.
3) What are some of the factors that could have contributed to their mental illness (biology, cognition, and social/systemic factors all contribute to the development of a mental health disorder)?
4) Biologically, what is going on in the brain and body?
5) What role do cultural factors play in the diagnosis, treatment and stigma of this disorder?