Before eating a meal, a patient with obsessive compulsive disorder must wash her hands for 20 minutes, comb her hair with 200 strokes, and switch the bathroom light on and off 50 times. What is the most appropriate goal of care for this patient?

Systematically decrease the number of repetitions of rituals and the amount of time spent performing them

Explanation

•When caring for a patient with OCD, the goal is to systematically decrease the undesirable behavior by reducing the amount of repetitions and time spent. This should be done gradually to allow the patient time to cope. Therapy may not completely extinguish certain behaviors.

•Obsessive compulsive disorder is characterized by pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency.

•Expecting to omit one behavior each day is unrealistic because the patient may have used ritualistic behaviors to reduce anxiety for a long time. Drugs may become a source of obsession and must be used with caution. Allowing time for rituals would perpetuate the undesirable behaviors.

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