From surgical treatment to psychiatric progress in refractory obsessive-compulsive disorder: A case report

Obsessive-compulsive disorder (OCD) can cause physical complications, and psychiatric treatment sometimes improves these complications. However, it remains unclear whether managing a physical complication can contribute to the improvement of psychiatric symptoms or may alter the trajectory of psychiatric treatment.

We report on a woman in her 50s with severe, long-standing, treatment-resistant OCD centered on contamination fears and compulsive defecation rituals. She rarely sought psychiatric help, and her symptoms worsened. Her compulsions led to rectal prolapse and fecal incontinence, which in turn exacerbated her OCD in a vicious cycle. After laparoscopic rectopexy resolved her incontinence, a marked reduction in repetitive cleaning behaviors occurred, including decreased time spent in the toilet and reduced toilet paper use. The physical improvement was followed by psychiatric engagement, regular outpatient visits, and subsequent therapeutic progress.

This case illustrates that a physical intervention could do more than alleviate somatic distress; it could act as a catalyst for psychiatric care. By breaking the cycle between a physical symptom and a compulsive behaviors, the surgical treatment created a crucial opening for establishing trust and motivation. This highlights the importance of integrated, cross-disciplinary collaboration in managing complex OCD cases where somatic and psychiatric symptoms are deeply intertwined.