Role of Parental Conflict and Primal Scene Exposure in the Manifestation of Unique Obsessive-Compulsive Symptoms in a 9 years old child

Abstract

Obsessive Compulsive Disorder is a common psychiatric disorder in children where the presentation is often unique. The aim of the present study is to explore and demonstrate the impact of repeated primal scene exposure and over involved parenting on the development of psychopathology in a child. A 9 years old male child came with the presenting complaints of intense jealousy and insecurity on seeing parents together, aggressive behaviour and increased sexual behaviour following multiple exposures to primal scenes and conflicts between the parents.  There was also an obsession about being abandoned; triggered by any form of parental intimacy. Child also reported intense distress for his inability to control his behaviour. He showed significant improvement with SSRIs and rigorous child based cognitive behaviour therapy (14 sessions). This unique presentation aids in understanding the process of symptom formation in a child in terms of model-based psychopathology and demonstrates the role of an individualized, structured therapeutic programme.

Key words: Childhood OCD, Primal exposure, parental conflict, Child-based CBT, Psychopathology formulation