Abstract
Abstract Sexual obsessions are common in adolescents with obsessive compulsive disorder (OCD), but how to address these obsessions in a developmentally sensitive manner remains under-explored. This report presents the case of an adolescent who experienced unwanted sexual imagery, undergoing conventional exposure and response prevention, which was subsequently augmented with imagery-based techniques. This approach was associated with remission in symptoms of OCD and marked improvements in symptoms of anxiety and depression. The imagery-based approach was well received and valued as key to treatment success by the adolescent. This raises the tantalising possibility that working directly with images can fuel treatment innovation in tackling sexual (and non-sexual) obsessions in youth OCD. Key learning aims (1) Sexual obsessions are common in adolescent obsessive compulsive disorder (OCD). (2) Little guidance is available on how to conduct exposure and response prevention sensitively for sexual obsessions in adolescent OCD. (3) Imagery-based techniques can be used effectively for reducing sexual obsessions. (4) Imagery-based techniques delivered by videoconferencing can be acceptable for young people.
Highlights
In this report, a 15-year-old adolescent completed a course of cognitive behavioural therapy (CBT) for obsessive compulsive disorder (OCD)
This report presented the case of a 15-year-old adolescent, Tom, who underwent 13 sessions of weekly CBT for OCD with unwanted sexual obsessions as his most distressing symptoms
The treatment protocol began with exposure and response prevention (ERP) – the conventional approach for youth OCD – and was later augmented with imagery-based techniques
Summary
A 15-year-old adolescent completed a course of cognitive behavioural therapy (CBT) for obsessive compulsive disorder (OCD). Tom is a 15-year-old White British young person from a middle-class family living in England He was referred to a Child and Adolescent Mental Health Service by his GP, who described that Tom is spending 6–12 hours a day with obsessions causing significant impairments to his quality of life. Tom and his mum Ruth attended the assessment together. Tom reported needing to complete a number of overt compulsions at home and school He would wash his hands throughout the day and had a particular washing routine.
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