[The Treatment of Long-Standing Obsessive-Compulsive Disorder in an Intensive Specialized Program: A Case Study].

Abstract

Obsessive-compulsive disorder (OCD) is a disabling condition for which exposure and response prevention (ERP) is the first-line psychotherapeutic treatment. Despite strong evidence supporting its efficacy, many individuals with OCD do not receive specialized care, resulting in lengthy, costly, and often ineffective treatment trajectories. This case report describes a 66-year-old woman with a more than 40-year history of OCD who participated in an intensive, specialized ERP program delivered within a university hospital setting. Assessments conducted at pretreatment, post-treatment, and at a 2-month follow-up examined symptom severity, functional impairment, treatment acceptability, expectations for improvement, and willingness to tolerate discomfort associated with exposure-based work. Following two weeks of intensive intervention, the patient demonstrated a substantial reduction in OCD symptom severity, marked improvements in daily functioning, and a significant decrease in ritualistic behaviors. These clinical gains were maintained and further consolidated at the 2-month follow-up, alongside sustained confidence in the treatment approach and continued engagement in exposure-based strategies. These findings are consistent with evidence supporting the effectiveness of intensive ERP programs, including for individuals with longstanding OCD. This case underscores the critical need to expand access to specialized OCD services and to enhance clinician training in evidence-based interventions in Québec. More broadly, it illustrates that chronicity should not be equated with therapeutic resistance, but often reflects limited access to appropriate, specialized care.