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Vicky is a 27-year-old single woman who lives alone and works for a technology company. Vicky grew up on a midwestern small farm with frugal parents. An
the authoritarian father rarely said much to her except to criticize her behavior. She
tried to be perfect at school, often recopying papers several times and thus failing
to get them in on lime, which meant only a B or C grade. Once when she got a 98
on a paper and was hopeful of getting praise at home, her father said: “What are
what are you going to do about getting 100 next time?” By college Vicky was a straight A
student, but her father still didn’t praise her. Growing up, she was overly organized
with everything in its place in her room and lists posted everywhere. Vicky resisted
going to bed until work on the lists was done or she was exhausted and gave up.
In the past few years, Vicky has had trouble getting rid of things. She tries to set
things aside for charity, but eventually takes things out, one by one, and puts them
back inside the house, thinking maybe she will use them some day. Although she is
wealthy, she is frugal with her money.
Vicky spends hours trying to get projects at work perfect. When assigned to a
project with a coworker, she does most or all of the work herself, because she thinks
coworkers won’t do it correctly. Sometimes she realizes coworkers are having fun on
the weekend while she has no time for leisure activities. Once in awhile she misses
a project deadline due to trying to perfect the work.
A former coworker and friend with a romantic interest in Vicky has repeatedly
invited her to visit him in another city. Finally, Vicky accepts since she will have her
My own room and a housekeeper will be tl1ere. The friend takes her to a museum to
see a European art collection on loan. Vicky insists on viewing tile paintings starting
at the entrance and going right to left, seeing each painting, reading each plaque,
and making a note about it. By the time tl1e museum closes, they have not gotten
close to tile collection they came to see. Before going out to eat, Vicky insists her
a friend changed his shirt to match his pants and then changed his tic. She organizes his
ties by color and after some indecision selects one. Before Vicky leaves, her friend
tells her he cares for her and gently asks her to see a therapist about her perfectionism and need to cobol.Â
. CASE STUdy ·1
Case Study On Monday afternoon, Vicky presents in the nurse’s office of the company where
she works asking the nurse to take her blood pressure and complaining of feeling
dizzy. The nurse notices that Vicky has rearranged the magazines in the office waiting area and has brought a large stack of what looks like work with her. The nurse
asks her about the stack of papers. Vicky says she is behind schedule since she was
out of town over the weekend. She shares that she thought maybe she would have
time to do some work while waiting to see the nurse. Vicky’s blood pressure is within
normal limits, as are the rest of the vital signs. The nurse observes that the client
looks thin and seems anxious. When the nurse assesses Vicky’s health practices and
asks about diet, Vicky says: “Oh, I eat well, but sometimes I skip lunch to get some
work done or l forget to eat breakfast when I get busy doing work before I come to
work.” She admits to getting four to five hours of sleep nightly. The nurse asks Vicky
about turning some of this work over to her team members and going home to rest.
Vicky seems anxious and even angry as she replies: “No one else can get it right.”
Then she bursts into tears and says: “A friend of mine says I am a perfectionist and
controlling and I should get some help. He doesn’t really understand. Do you think
I see a therapist? I really don’t have time.”
Questions
1. If you were the nurse talking with Vicky, how
would you respond to her statements about her
friend’s thoughts on her perfectionism, need Lo
control, and need to see a therapist, as well as her
question to you on whether she should see a therapist or not?
2. What behaviors did Vicky exhibit in the waiting
room and nurse’s office that might clue the nurse
to assess further for behaviors matching traits of
Obsessive-Compulsive Persona.Ii ty Disorder?
3. If you were the nurse, what other assessments
would you want to do at this time?
4. What are the traits of Obsessive-Compulsive
Personality? Whal behaviors does Vicky have that
match these traits? What are the criteria for a diagnosis of OCPD by a professional qualified to make a
diagnosis?
5. Obsessive-Compulsive Personality Disorder
sow1ds a lot like Obsessive-Compulsive Disorder.
Are they two different disorders or not? Discuss how
OCPD and OCD are alike and how they are different.
6. Is there any difference in the reported prevalence of this disorder in males compared to females?
7. If Vicky goes to a therapist, the therapist will
probably ask about her family and her experiences growing up. Does childhood family environment possibly play a role in the development of
Obsessive-Compulsive Personality Disorder? Was
Vicky’s father’s behavior possibly culturally influenced in any way?
8. Are environmental factors the accepted cause of
Obsessive-Compulsive Disorder?
9. Using Erickson’s psychosocial development
theory, what developmental stage is this client in
and how could that p lay a role in her wanting to
modify her b ehavior by working with a therapist?
10. What nursing diagnoses would you write for this
client?
11. What interventions do professional counselors,
therapists, or psychiatric nurse clinicians use in
working with clients who have traits of OCPD or
a diagnosis of Lhis disorder? What interventions
would be helpful on the part of the industrial nurse
in this case?
SCIENCE
HEALTH SCIENCE
NURSING
NUR 154
