This work describes the case of a 16-year-old boy who came to therapy with a diagnosis of Obsessive Compulsive Disorder for which he had already undertaken a pharmacological cure and a psychotherapeutic path without improvement of symptoms. His obsessive symptoms were associated with the fear of being contaminated by maternal breath. From the first meetings, however, a greater complexity of the picture and the presence of a schizotypal comorbid disorder has been hypothesized, as bizarre behaviors and a serious impairment of social and scholastic functioning emerge. The intervention was carried out by activating two settings and involved Luca (20 sessions) and parents (10 sessions). In the article we will
describe the formulation of the case, differentiating the interventions on obsessive symptoms from the procedures used to deal with schizotypal symptoms.
The improvement of Obsessive Compulsive Disorder was observed already with the sharing of the internal profile and working on the fear of contamination with cognitive restructuring interventions. In parallel, the treatment focused on increasing self-care and changing dysfunctional habits, having a decisive effect on the reduction of rituals, the perception of self-efficacy and social withdrawal.
The intervention with the parents aimed to reducing the criticism and contemptuous attitudes towards Luca through cognitive restructuring interventions and validation techniques, which led to a partial reduction of the same. In parallel, the treatment aimed to encourage understanding and acceptance of Luca’s functioning as well as the recognition of his emotional needs.