by Dr. Judyth Reichenberg-Ullman and Dr. Robert Ullman
Jim was a clean-cut sixteen-year-old from the Midwest sporting a crew cut. Suffering from a deathly fear of getting dirty, especially around his own house, he explained: “I feel like I’m not clean and I want to wash my hands. Almost every day my anxiety goes up. My stomach tightens a little and I get kind of nervous. I tell myself that nothing is really dirty. I try to convince myself that nothing is wrong. It builds up inside and I feel like I have to wash. I feel quite uncomfortable until I can wash. After a while, it may go down without washing. I used to wash a lot more. Now I’ve lowered the amount of time I wash. Sometimes I can wash for a while, then I get frustrated and it gets worse. Sometimes I can wash and feel clean, but sometimes I have to wash twice. I wash once and it doesn’t feel right, so I have to wash again. It feels like my hands are dirty and my stomach feels funny-it tightens up and the tightness goes into my chest, like a butterfly feeling. I feel quite a lot of anxiety if the thing I touch is dirty. In my house, the stuff upstairs and in the basement is dirtier. I used to caddy for the golf course. The stuff I used then feels dirtier.”
Jim continued his story, “What set the whole thing off was that me and my friend were riding our bikes home from caddying. On the side of the road was a page of advertising from a dirtier magazine. My friend stopped, picked it up, put it in his pocket and brought it to my room. That’s how my room came to be dirty. He set it down on a shelf in my closet., Then he threw it away. I remember a couple days later my anxiety was bad, and I started washing more. I had a sore throat at the time, but it went away.”
Jim’s mom continued the story. “He was washing his hands hundreds of times a day. After several months, a round of antibiotics stopped the acceleration of the OCD (obsessive-compulsive disorder). Any kind of infection exacerbates it, which is difficult since he gets an infection every four to six weeks. He won’t go in his room. He will hardly touch anything in the house. He won’t even touch suitcases. Just knowing he was really dirty would make him wash a lot.”
When asked what seemed dirty to him, Jim explained that “germs and bacteria and stuff” were especially dirty. His anxiety became worse whenever he had an infection. ” If I get sick, it is hard to shorten things, and I may wash more. I tell myself to get out of the bathroom, but my anxiety overrides it. Whenever I get sick, I get frustrated because the anxiety is worse.”
When questioned about dreams, Jim replied that he did not dream very frequently, but that when he did, the dreams were mostly about being with friends or occasionally dreams of being chased by someone trying to kill him. According to his mom, Jim talked of fighting dreams- he and a friend against the bad guys. In another dream Jim was sitting in his biology class and there was a big, pink snake in his desk that he feared would bite him. The substitute teacher would not listen to Jim . The snake escaped, Jim attempted to to hide it, but finally the teacher caught the snake and placed it in a fish tank.
A year ago Jim slept regularly thirteen or fourteen hours a night; recent it was less. Jim was not very cooperative and refused to dress himself. His mom, a nurse, explained, “He panics if he takes his toothbrush into the bathroom.” When dressing, Jim felt compelled to touch a wash cloth before touching each piece of clothing. The wash cloth apparently symbolized washing for Jim, so that the clothing seemed clean to him. It became clear, as the case unfolded, that Jim’s obsessiveness was quite extreme. Jim insisted that his parents turn the water on and off for him when he washed. He would literally not touch anything in the house but two chairs. Jim washed whenever the family dog touched him. Various places in the house were either clean, partially clean or dirty according to Jim and he considered only two places to be absolutely clean. The place where he did his homework luckily remained clean to him. Jim’s rituals all centered around the issue of cleanliness. Before bed Jim would leave his shoes in the kitchen and his clothes in his mom’s room. His mom would have to hand him things. If things were not done exactly right, Jim would accuse, “You just made me dirty!” Very argumentative, Jim blamed her relentlessly.
When we asked what ‘clean’ meant to him, Jim replied that in order for something to be clean it could not have any dirty bacteria or dirt on it. To ‘wash’ meant “when you wash your hands with soap and water and dry them off, and your hands are clean.” Jim could use a wash cloth or a spray bottle if he wanted to wash quickly.
As a younger child, Jim used to wash his hands normally. His mom described him as a very happy, beautiful child until kindergarten. Developmentally slow, Jim had difficulty with numbers and the alphabet, and had an “I don’t know and I don’t care attitude.” Artistic and creative, Jim easily entertained himself. Even before the OCD, Jim had been a perfectionist. As a young child, he would not even attempt to put together a puzzle unless he could do it perfectly. If he took a test, he demanded of himself a perfect score. Jim felt much less inclined to engage in compulsive hand washing outside the house, although he did mention some contamination issues at school.
Jim had been diagnosed with a PANDAS-like syndrome (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). This is a rare disorder, causing OCD or Tourette Syndrome after strep infections. The criteria for this illness are:
- the presence of OCD or tic disorder
- pediatric onset of symptoms (age 3 to prepuberty)
- abrupt onset or dramatic exacerbation of symptoms
- symptom exacerbation related to a strep infection
- neurological abnormalities during the exacerbation periods, which could include unwarranted fears, fidgeting and difficulties at school.
Jim fit the criteria, except for his age at onset, which was fifteen, and he did not have a tic disorder (which is not absolutely necessary for the diagnosis). He had pulled his hair in sixth grade when frustrated with his schoolwork. When asked about his difficulty with schoolwork, Jim replied, “I’m so stupid!” In fact, his memory had been affected by his condition, and he did require extra help with his homework.
Analysis and Followup
Jim received a dose of of Syphilinum 1M. Two months later he reported some improvement. “I have shortened some of the rituals quite a bit and feeling like I have to wash is not bothering me as much. I’m more cheerful. I’m sick of not touching some of the things I felt I couldn’t touch. Everyone else can touch things so why shouldn’t I? I still need to wash my hands, but only once to feel clean, and I can turn the water on and off myself. I’m not using as many wash cloths. If I touch something that isn’t clean, I get a tight feeling in my stomach or chest, but less than before.”
Jim was still avoiding many places in his home, but could go into the basement. He nearly eliminated his bedtime ritual and seemed happier and more cooperative. Before he argued for hours; now his attitude was more manageable. Jim antidoted the medicine by using an antibiotic cream, but responded quickly to a second dose. Jim’s tendency toward infection was improved and the aggravation of the OCD symptoms during the infection was not as significant.
After six more weeks, Jim was improving every day. He went to the beach and acted nearly normally. Now Jim was able to lift a variety of items out of the car and carried the beach towels. Capable of performing all of his own self-care tasks, Jim insisted that his mom to hand him a towel and open and close the shower door. Previously Jim went through hundreds of wash cloths a day; now one was sufficient. Other gains were being able to walk through the garage, to turn on the television and VCR himself, and to feel comfortable sitting on more pieces of furniture in the house. Unloading the dishwasher, serving himself food, and eating tacos with his hands, all impossible before were now within his repertoire. Jim could also sit in the back seat of the car, use a seatbelt and turn on the radio, all of which were not possible before.
When asked about his progress, Jim said, “I don’t think of everything as dirty as it was. It is easier. I am freer to move around. I am not as scared of places. I can stay there more and do things. I enjoy taking care of myself now. My anxiety has dropped a lot. Last week I had a cold, but it didn’t affect my anxiety that much. My bedroom still seems dirty, but I am thinking of going in there now.”
Jim continued to make progress. We gave him another dose of Syphilinum 1M after three months because of a partial relapse. Jim had been sleeping in his room now for nearly two months, put up new pictures on the wall, and was able to put his clothes in the closet himself. Jim could also fill the lawnmower with gasoline and to use a napkin, which he earlier considered dirty, and even used a towel normally.
Jim still had some limitations. He would not open or close the front door by himself, and the garage door still seemed dirty sometimes. Otherwise he was much better. Jim still cleaned a bit excessively, but to nowhere near the same degree as before homeopathic treatment. His mom reported that life was now liveable for the first time in several years. Jim still tended to get a cold or flu every four to six weeks.
Jim’s progress leveled off over the next few months. We gave him two doses of Syphilinum 1M for minor relapses. “I feel pretty comfortable in the house. Certain places in my room are still uncomfortable. We are going to move, which is okay with me. Things don’t seem as dirty. I am not doing a lot of hand washing. I can touch doorknobs now. I went on a camping trip without any problems and I am appearing in a play at school.”
Two months later, after moving to a different state, Jim continued to progress. He had felt contaminated after moving items from his room, but upon arriving at the new house, the change did him a lot of good. We repeated the Syphilinum. Jim succeeded at making new friends at school, and his schoolwork was going well.
Over the next few months, Jim’s OCD symptoms were much reduced, but he continued to get minor illnesses. At the end of the school year, he suffered a month-long cold, at which time his OCD worsened. Jim wanted to see how long he could go without a dose of medicine, so he did not tell his mom. While he had the cold, he spent a little more time in the bathroom, wanted to change his clothes more frequently, and avoided clearing the table. If he had to clean the bathroom sink, he felt somewhat contaminated. After a repetition of the Syphilinum, all of these symptoms went away. Jim obtained a summer job as a grocery bagger, which did not cause him any problems.
Everything went well for Jim until the fall, when he was hit by an SUV that backed into him in the parking lot of the grocery store. He wasn’t badly hurt. A few doses of Arnica and some visits to the chiropractor were all that he needed Six weeks later, Jim’s schoolwork was going well, and he was getting As and Bs. Doorknobs and bathrooms were acceptable to him and nothing felt off limits or dirty. He was dusting and vacuuming now. Jim preferred not to clean the toilet, but would it if his mother nagged him. Jim needed one more dose of medicine for a slight relapse.
Jim’s response to Syphilinum was dramatic, though it took more than a year for him to become close to normal again. Because his immune system had been weakened by the disease, he caught colds and influenza easily, which then exacerbated his OCD symptoms. These exacerbations became less and less as his homeopathic treatment continued. Though he continued to have acute illnesses, Jim was able to recover from them more easily and with less obsessiveness. We can expect that over the next year of treatment, Jim’s immune system will strengthen, making colds and flu a rarer occurrence.
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