Obsessive Compulsive Disorder Presenting for Redundant Clothing.

This is a case report of a 15-year-old girl who presented with redundant clothing. On evaluation, it was found that she had obsessive compulsive disorder (OCD), and redundant clothing was a symptom of OCD, which has hitherto not been reported.

INTRODUCTION

Obsessive compulsive disorder (OCD) manifests with a plethora of symptoms. Childhood and adolescent onset OCD is often associated with much atypical presentations.[1] We for the first time reporting a case of OCD with redundant clothing as the primary manifestation of the disorder.

CASE REPORT

The present case report is regarding a 15-year-old school-going girl, coming to the hospital with the complaint of wearing multiple layers of clothes at a time.

On probing, she came with the explanation that the problem started 1 year ago, after she started moving closely with a senior boy in her school. Since the boy was ‘fairer’ than her, her friends used to tease her for the same. Sooner, she became concerning much about the skin colour. She started fearing of her skin turning darker on exposure to day light. She started getting this thought again and again even during her routine tasks and failed to control it, even though she considered it to be irrational. To reduce the anxiety, she started wearing 4-5 layers of clothes, even during hot climate and would cover maximum part of her face with head scarf. She tried her best to resist this behaviour, but often failed. She hid this clothing pattern from the knowledge of others but could not forego her parents notice.

On further probing, she came out with other symptoms comprising washing, checking, repeating questions, fear of telling wrong, which were distressing to her, for the last 5 years. Family took these behaviours as normal and never felt any need of medical assistance. Current unusual behaviour of redundant clothing compelled them to seek psychiatrist advice.

She was treated with Tab. Sertraline 50 mg/day. Psycho education was also given to alleviate anxiety of the patient and family. During the first follow-up after 2 weeks, she showed remarkable improvement and came to the hospital normally dressed. Her preoccupation with skin colour also reduced to a great extent. Objectively, her Children's Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score dropped from 33 to 14. She maintained with recovering course in her latest follow-up at 1 month.

DISCUSSION

Redundant clothing is often noted in patients with psychotic illnesses. Some have even cited it as an observable marker for diagnosing Schizophrenia[2] with hypothesis of dysfunctional central and peripheral thermoregulation as well as circadian rhythm, cognitive decline and antipsychotic use.[3] Present case is a clear cut manifestation of OCD with no signs of physiological/autonomic disturbance. The current case must encourage psychiatrists to restrain from diagnosing before evaluating the behavioural phenomenon.