Severe Obsessive‒compulsive Disorder of Transformation in a 13-year-old Adolescent: A Case Report
Authors: Kerkeni Ali , PONS Charles Olivier 
Published: January 2025

Introduction:
Obsessive-compulsive Disorder (OCD) with transformation obsession
is a rare psychiatric disorder that can pose various diagnostic difficulties and treatment
challenges. Scientific research focusing on this disorder in adolescents is scarce. In this
work, we present the case of a teenage girl who was treated for severe OCD with transformation
obsession. The psychiatric management of this adolescent was performed on an outpatient
basis and took place in the juvenile department at Saint Ylie Hospital (France). We
hope that our work will add to the existing data on the psychiatric management of this condition
in adolescents. In this work, we used the Diagnostic and Statistical Manual of Mental Disorders
5th version for the evaluation of psychiatric disorders and the Children's Yale-Brown
Obsessive Compulsive Scale (CY-BOCS) to assess the severity of symptoms.

Case Presentation:
The patient (13 years old) experienced persistent, intrusive, and distressing
ideas about transforming into another person. Despite knowing how unreal these ideas
were, she feared they would come true. She had rituals that she felt compelled to carry out to
help her manage her worries temporarily. She also experienced involuntary non-rhythmic
movements of the facial muscles simultaneously. The patient was diagnosed with OCD with
good insight and comorbid tics. Initially, the total CY-BOCS score was 40/40. Psychosis was
considered a differential diagnosis due to the atypicality of the clinical manifestation, but it
was ruled out after a thorough clinical evaluation. Psychotherapeutic management was not
possible before adequate pharmaceutical treatment was started because of invasive and distressing
symptoms. The pharmacological management led to the administration of a combination
of fluoxetine at a dose of 40mg with olanzapine at a dose of 5mg after a partial response
to fluoxetine alone. Weekly individual Cognitive Behavioral Therapy (CBT) was started as
soon as the adolescent's condition allowed and included psychoeducation, muscle relaxation
techniques, cognitive restructuring, Exposure and Response Prevention (ERP), self-affirmation
work, and relapse prevention. At the same time, parents also benefited from psychoeducational
interventions. The evolution was marked by total clinical remission and clear psychometric
improvement. The total CY-BOCS score ranged from 40/40 to 07/40 after 5 months
of CBT. No adverse effects were reported throughout the treatment.

Conclusion:
This case shows the possibility of unusual and severe OCD in adolescents. It also
highlights the importance of careful diagnosis so as not to be mistaken and consider it a
psychosis. The management of this type of OCD requires the combination of two pharmacological
treatments before starting individual CBT and psychoeducational intervention for parents.
This combination allows a complete clinical remission after a few months. It is preferable
that further clinical trials be conducted to protocolize the management of this type of
OCD.