Comorbid Obsessive Compulsive and Major Depressive Disorder

PM is a 43-year-old married female referred by her primary care physician for a psychiatric consultation because of a failure to improve on fluvoxamine. She reported intrusive ideas including fears of contamination, a need for exactness and symmetry, a fear of not saying the right thing, and hoarding obsessions. Her compulsions included excessive grooming rituals, ordering and arranging, and mental reviewing. Some of the examples of her symptoms included having to load the dishwasher exactly—if her husband loaded it then she would have to reload it. She brushed her teeth over a period of 15 minutes in an exact and ritualized manner. If she was interrupted she had to start all over again. She took showers 45 minutes in length. She was also a pack rat with difficulty throwing things away.