Transformation obsessions in Obsessive-Compulsive Disorder

Abstract

Introduction

Transformation obsessions denote an under-reported symptom of obsessive-compulsive disorder (OCD), characterised by an excessive fear of turning into another person/object/animal or acquiring unwanted characteristics. Relative to other OCD symptoms, little is known about its clinical presentation. This case report attempts to add information on clinical presentation.

Case summary

A 28-year-old male of suburban area of West-Bengal with hypothyroidism for 10 years presented in 2021 with chief complaints of repeated washing and bathing since 2011, repeated thoughts that he has become someone else since 2013, repeated thoughts that his penis is replaced by his brother’s penis since 2020.Patient avoided meeting, touching, uttering name or using any items touched by his brother due to the fear of turning into his brother. Illness has insidious onset, continuous course deteriorating progress. The patient had normal speech productivity, obsessive thought of dirt and compulsive acts of washing, obsessive thoughts of turning into his brother, obsessive thoughts of his penis being changed, mental and proxy compulsions. These symptoms failed to respond to Tab. Fluvoxamine 200mg, Tab. Clomipramine 75mg, Tab. Risperidone 3mg.Patient was started on Fluoxetine 60mg, Tab. Clomipramine 100 mg and Tab. Aripiprazole 20mg.This regime being continued for last 1 year has shown significant improvement in his psychopathology as noted on the clinical rating scales and subjective report.

Discussion

This case highlights ‘fear of morphing/ transformation obsessions’ in adults. There occurs psychological dirtiness and urges to wash which arise in the absence of direct contact with a noxious substance, or following contact with something others would not deem contaminating leading to this obsession.