It is an accustomed action with her, to seem thus washing her hands: I have known her continue in this a quarter of an hour.
—William Shakespeare, Macbeth
A 25-year-old man was brought to the psychiatric inpatient unit because of worsening bizarre, stereotypical behavior; he walked back and forth while crossing through door thresholds, for example, and licked his fingers and wiped his face multiple times before answering questions during the admission interview.
The patient was disheveled, responded to questions with short, quick answers, and exhibited a very concrete thought process and prominent executive dysfunction. When asked, he could not explain why he needed to go back and forth when walking across door thresholds, but said that he felt extremely anxious if he did not perform the ritual. Until recently, he had been a successful college student, despite some behavioral eccentricities, but was no longer able to keep up with the work. He had been pacing repeatedly around the college campus and ultimately was expelled, which precipitated the current inpatient admission.
He reported no previous mania, drug abuse, or psychosis. The patient felt sad and overwhelmed by his inability to control his rituals but remained hopeful that at some point he would be able to return to his studies.
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Cite this: Obsessive-Compulsive Disorder: Neurobiology and the Latest in Treatment - Medscape - May 17, 2017.