Difficulty: Introductory to Intermediate | Prerequisites: Basic understanding of abnormal psychology; familiarity with the DSM-V is helpful but not required.
Obsessive-Compulsive Disorder (OCD) is one of the most commonly tested anxiety-related conditions in introductory counseling courses. This case study sits at the intersection of abnormal psychology and counseling theory: it walks through a real clinical presentation, maps it onto DSM-V criteria, and applies a psychoanalytic lens to treatment planning. If you are studying for APY 2206 (Introduction to Counseling), you will need to know how to identify OCD symptoms in a client, distinguish obsessions from compulsions, and connect childhood history to adult presentation. The case also touches on oniomania (compulsive buying), which often appears alongside OCD as a related behavioural pattern.
OCD involves recurrent, intrusive thoughts (obsessions) that drive repetitive behaviours (compulsions) aimed at reducing anxiety. The DSM-V requires that these obsessions or compulsions be time-consuming (typically more than one hour per day) or cause significant distress or impairment. In this case study, the client presents with mirror-checking, compulsive shopping, difficulty discarding possessions, and perfectionism in appearance, all rooted in childhood experiences of perceived neglect and low self-esteem.
Obsession
Recurrent and persistent thoughts, urges, or images experienced as intrusive and unwanted, causing marked anxiety or distress. In simple terms, these are the unwanted thoughts that keep coming back no matter how hard someone tries to push them away.
Compulsion
Repetitive behaviours or mental acts that an individual feels driven to perform in response to an obsession, or according to rigid rules. Think of it as the action someone takes to "cancel out" the anxiety from an obsession, even when they know it does not make logical sense.
Obsessive-Compulsive Disorder (OCD)
A DSM-V classified disorder characterised by the presence of obsessions, compulsions, or both, that are time-consuming or cause clinically significant distress or impairment in functioning. In simple terms, it is when the cycle of intrusive thoughts and driven behaviours takes over enough of someone's life to interfere with daily functioning.
Oniomania (compulsive buying disorder)
A behavioural pattern characterised by an irresistible urge to shop and purchase items, often regardless of need or financial consequence. Think of it as shopping that has crossed the line from a choice to a compulsion, where the person feels they cannot stop even when they want to.
DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition)
The standard classification system used by mental health professionals to diagnose psychiatric disorders. This is the reference book clinicians use to determine whether a client's symptoms match a recognised disorder.
Defence mechanism
Unconscious psychological strategies used to protect a person from anxiety arising from unacceptable thoughts or feelings. In simple terms, these are the mind's automatic ways of shielding someone from emotional pain they cannot handle directly.
Clinically significant distress
Distress that is severe enough to impair a person's ability to function in social, occupational, or other important areas of life. This phrase is the DSM's way of saying the problem is serious enough to warrant a diagnosis, not just an occasional inconvenience.
The DSM-V places OCD under the category of Obsessive-Compulsive and Related Disorders. A client must meet the following criteria to receive a diagnosis.
Criterion A: Presence of obsessions, compulsions, or both
Obsessions are recurrent, persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and that cause marked anxiety or distress in most individuals.
The individual attempts to ignore or suppress these thoughts, urges, or images, or to neutralise them with some other thought or action (i.e. by performing a compulsion).
Criterion B: Time-consuming or functionally impairing
The obsessions or compulsions are time-consuming (the DSM-V benchmark is more than one hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Criterion C: Not attributable to substances or another medical condition
The symptoms are not caused by the physiological effects of a substance or another medical condition.
Criterion D: Not better explained by another disorder
The disturbance is not better explained by the symptoms of another mental disorder (e.g. excessive worries in generalised anxiety disorder, preoccupation with appearance in body dysmorphic disorder).
For exam purposes, the first three criteria listed in the case study are the ones most commonly tested. Criterion A defines what obsessions and compulsions look like. Criterion B sets the threshold for when they become a clinical problem.
The case study describes a 21-year-old Filipino female college student presenting for her first counseling session. Her symptoms cluster into several recognisable patterns.
Mirror-checking (appearance-related obsession)
Compulsively checks her reflection every time she sees a mirror, including while eating.
Keeps a mirror by her side at all times.
Must be "well-looked and well-dressed" before leaving her room, even for a quick trip to a nearby shop.
This pattern reflects a persistent, intrusive preoccupation with appearance that she feels compelled to act on.
Compulsive buying (oniomania)
Impulse-purchases clothing and items she does not need and often never uses.
Becomes anxious when desired items are out of stock or taken by someone else.
Social media advertisements trigger the urge to buy.
Shopping functions as a self-esteem boost, a way to feel she is improving herself and earning approval.
Difficulty discarding possessions (hoarding-related behaviour)
Struggles to throw things away or declutter.
Owns many items she has never used.
Becomes distressed at the thought of letting go of possessions.
Perfectionism in dress and self-presentation
Spends more than an hour choosing what to wear.
Repetitively checks outfits to find the "perfect" fit.
This behaviour meets the DSM-V time threshold (more than one hour per day) on its own.
Behavioural indicators observed in session
Was scrolling an online clothing shop on her phone at the start of the therapy session.
Became emotional and cried during the session.
Reported feeling lonely and isolated, living alone in her unit.
The client was diagnosed with acute onset Obsessive-Compulsive Disorder. The word "acute" here means the symptoms developed relatively recently and were not a lifelong pattern. Before these issues emerged, the client reported no prior problems with stress.
How the DSM-V criteria map onto this case:
Criterion A (obsessions): persistent preoccupation with appearance, intrusive urges to buy, anxiety when items are unavailable.
Criterion A (compulsions): mirror-checking, repetitive outfit selection, compulsive purchasing, inability to discard items.
Criterion B (time/impairment): outfit-checking alone exceeds one hour daily; shopping behaviour causes financial strain and emotional distress; difficulty discarding items creates clutter and distress.
The stressor identified:
The case identifies oniomania (compulsive buying) as the primary stressor driving increased anxiety. The compulsive buying is itself a compulsion, performed to neutralise feelings of low self-esteem and perceived inadequacy rooted in childhood experiences of neglect and unfavourable comparison with siblings.
Childhood history contributing to the presentation:
Parents consistently compared her unfavourably to her eldest sister (appearance, skin colour).
Extended family judged her clothing and appearance.
She compensated by excelling academically ("Most Behave" awards, honour student).
Developed social withdrawal: preferred staying home, confided in a stuffed toy rather than people.
Reported recurring dreams of teeth falling out during secondary school, a common anxiety-related dream theme.
Clinicians in private practice and community mental health settings encounter OCD presentations regularly. The mirror-checking and compulsive buying patterns in this case study are not unusual, particularly among young adults navigating self-image concerns. Counselors use the DSM-V criteria as a checklist during intake sessions to determine whether a client's behaviours cross the threshold from ordinary habits into clinical territory. The one-hour-per-day benchmark is a practical screening question that therapists ask directly.
Students often think OCD is just about being "neat" or "organised." The disorder is defined by distress and impairment, not by tidiness. A person with OCD may present as disorganised (anal expulsive) rather than meticulous.
Students sometimes confuse obsessions with compulsions. Obsessions are the intrusive thoughts; compulsions are the behaviours performed in response. The distinction matters on exams.
Compulsive buying (oniomania) is sometimes dismissed as a lifestyle choice. In a clinical context, it functions as a compulsion: a driven behaviour performed to reduce anxiety, not a deliberate preference.
Students may assume OCD must be present from childhood. This case demonstrates acute onset, meaning the clinical presentation developed later in life, even though underlying risk factors (childhood neglect, low self-esteem) were longstanding.
⚠️ Know the three DSM-V criteria quoted in the case study verbatim. Exam questions often ask you to match client behaviours to specific criteria.
⚠️ Be able to distinguish between an obsession and a compulsion using examples from a case. In this case: the obsession is the persistent preoccupation with appearance; the compulsion is the mirror-checking and outfit-changing.
⚠️ The one-hour-per-day threshold is a commonly tested benchmark. Know that it applies to the time spent on obsessions, compulsions, or both combined.
⚠️ Understand that oniomania (compulsive buying) can function as a compulsion within an OCD framework. Exams may present a shopping scenario and ask you to identify the underlying clinical mechanism.
⚠️ Childhood history is not part of the DSM-V diagnostic criteria for OCD, but it is relevant to case conceptualisation and treatment planning. Do not conflate developmental history with diagnostic criteria.
True or False: A compulsion is an intrusive, unwanted thought that causes anxiety. (False. That is an obsession. A compulsion is the behaviour performed in response.)
Fill in the blank: The DSM-V time threshold for OCD is obsessions or compulsions taking more than ______ per day. (One hour.)
True or False: Oniomania is the clinical term for compulsive buying. (True.)
True or False: A client must have both obsessions and compulsions to be diagnosed with OCD. (False. The DSM-V requires the presence of obsessions, compulsions, or both.)
Fill in the blank: In this case study, the client's compulsive shopping functions as a way to boost her ______. (Self-esteem.)
Q: According to the DSM-V, what are the two components of Criterion A for OCD?
A: First, the presence of recurrent, persistent, intrusive, and unwanted thoughts, urges, or images that cause marked anxiety or distress. Second, the individual's attempts to ignore, suppress, or neutralise them by performing a compulsion.
Q: In the case study, which specific behaviours meet the DSM-V definition of a compulsion?
A: Mirror-checking, spending more than an hour selecting outfits, compulsive purchasing of clothes and items she does not need, and difficulty discarding possessions.
Q: What is oniomania, and how does it relate to OCD in this case?
A: Oniomania is compulsive buying disorder. In this case, compulsive shopping serves as a compulsion, a driven behaviour performed to reduce anxiety and temporarily boost self-esteem.
Q: What childhood experiences contributed to the client's current presentation?
A: She was consistently compared unfavourably to her eldest sister by her parents and extended family, particularly regarding appearance and skin colour. This led to perceived neglect, low self-esteem, social withdrawal, and compensatory academic achievement.
Q: How does the DSM-V distinguish between OCD and ordinary habits or preferences?
A: The DSM-V requires that obsessions or compulsions be time-consuming (more than one hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Ordinary habits do not meet this threshold.
This material connects directly to abnormal psychology coursework on anxiety disorders, since OCD was previously classified under anxiety disorders before the DSM-V gave it a separate category. Understanding the distinction helps with exam questions that ask about the DSM-V reorganisation.
The childhood history in this case (perceived neglect, unfavourable comparison, compensatory achievement) is relevant to developmental psychology and theories of attachment. Students studying Erikson's psychosocial stages or Bowlby's attachment theory will recognise the patterns.
The psychoanalytic treatment approach used in this case (covered in Part 2 of these study notes) links to your coursework on counseling theories and therapeutic modalities.
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