Modified electroconvulsive therapy for severe malnutrition secondary to obsessive-compulsive disorder: A case report

Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition marked by intrusive thoughts and repetitive behaviors. In rare cases, severe contamination or defecation fears lead to extreme dietary restriction and life-threatening malnutrition. Although a handful of cases have been reported, none describe the use of modified electroconvulsive therapy (mECT) in this setting. This report details the first known case of mECT for refractory OCD complicated by critical malnutrition.

A 54-year-old woman with longstanding contamination obsessions who had undergone prior trials of selective serotonin reuptake inhibitors (SSRIs) and exposure-and-response-prevention (ERP)-based cognitive-behavioral therapy (CBT) developed a rapid worsening of defecation fears following the death of her primary psychiatrist. To avoid perceived fecal contamination, she progressively restricted her diet, losing weight from 52 to 32.1 kg (body mass index [BMI] 13.1) and escalating to a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 39/40. Hospitalization for nutritional rehabilitation did not prevent further weight loss; therefore, mECT was initiated on Day 14 under general anesthesia, delivering 19 sessions in total. Symptoms improved rapidly: by the 13th session, her Y-BOCS score had fallen to 18/40, and she was able to consistently resume adequate oral intake. At the 10-month follow-up, she maintained a weight of 50.3 kg and a stable psychiatric status on paroxetine and CBT.

mECT offers a rapid, effective intervention for treatment-refractory OCD complicated by critical malnutrition, achieving prompt symptom relief while simultaneously facilitating nutritional rehabilitation.