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Jackie Hogue

Melvin Udall
Approximate Age: 60
Identifying Information and Referral Statement
Melvin Udall is a single, 60 year old man living alone in an apartment. Mr. Udall is a successful
author, Mr. Udall has previously seen a psychiatrist for Obsessive Compulsive Behaviors where
he was prescribed a medication. Obsessive Compulsive Disorder is a type of Anxiety disorder
according to the DSM-5. Obsessions are thought that a person cannot eradicate from their minds
that could be considered inappropriate or disgusting/disturbing. Compulsions are actions that
person tends to repeat in response to the obsessive thinking. Usually the compulsion is meant to
sooth the obsession. The act of completely the compulsion (which may sometimes be presented
as a lengthy ritual) is meant to subside the persons anxiety from thinking of the obsession
(Butcher, J., Hooley, J., & Mineka, S., 2013). The type of medication that Mr. Udall had been
prescribed is unclear at this time. Up until recently, he was not taking the medications. His
decision to take the medicine was influenced by a new romantic relationship with a woman
named Carol. Mr. Udall is a self-referral. Mr. Udall wishes to help gain control of his OCD
behaviors to better strengthen his interpersonal relationships. He fears his compulsions may
destroy any tentative relationship he has developed recently (Brooks, J., (Director), 1997).
Presenting Complaint
Mr. Udall wishes to help gain control over his Obsessive Compulsive behaviors (refer to section
Identifying Information and Referral Statement for definition). He expresses that his behavior
interferes with everyday life, for example, Mr. Udall avoids cracks and stepping on them. He

becomes distressed at the sight of tiled floors due to the amount of cracks. Mr. Udall exhibits a
mild germ phobia, based on his extreme distressed to being touched, and the fact that he brings
his own plastic silverware when he goes out to ear. Additionally, Mr. Udall excessively washed
his hands, usually using water that is overly hot. Mr. Udall also compulsively locks the doors to
his apartment at least three times upon entering his home. He also struggles with personal
contact. Mr. Udall relies heavily on routines, such as going to the same dinner, sitting in the same
seat and having the same waitress. Mr. Udall expresses that he wishes to lead a more normal life,
where his relationships will not be impacted due to his behaviors. Mr. Udall has also expressed
that he has been having trouble sleeping, and clearing his head. He stated that he hasnt felt like
himself recently, and that he has been physically achy and nauseous (Brooks, J., (Director),
1997).
History of Presenting Complaint
The initially onset of Mr. Udalls OCD behaviors is unclear at this time, although he has revealed
that the relationship with his father is rocky. He has no mention of a mother or mother figure. His
relationship with his father was described as distant, his father spent his time in his own room
with little engagement with Mr. Udall. His father was also strict, for example, Mr. Udalls father
used to repeatedly hit Mr. Udalls hands with a ruler if he made a mistake on the piano. Mr.
Udalls apartment is also organized and extremely neat and clean. All of his books, CDs,
magazines, etc. are placed in stacks around his apartments even in height and amount. Mr. Udall
functions efficiently. He keeps up with hygiene, and eating properly. His behavior is mostly
effecting his relationships in life. 3 months prior to the meeting with Mr. Udall, his behaviors
were far more extreme. He excessively washed his hands with water that was too hot. He locked
the doors to his apartment immediately upon returning, which he would turn the locks three

times. He follows a strict routine, including going to the same diner, the same booth, with the
same waitress, even providing his own silverware. Mr. Udall even admits to forcing people from
his booth at times where he should be eating in that spot. He also walks down the sidewalk,
careful to avoid cracks with no consideration to the other people on the sidewalks. He becomes
distressed when floors are tiled. As time progressed, Mr. Udall developed a relationship with his
neighbor Simons dog Verdell. The relationship with the dog seemed to open Mr. Udall up more
compassionately even though he struggles with emotions of his own. He also became less
distressed at the distruptions of his routines, washed his hands less, forgot to lock the doors upon
entering his apartment, and walking on cracks. Mr. Udall has seen a psychiatrist before for his
OCD behaviors. How many appointments Mr. Udall has attended is unclear at this time. He was
also prescribed a medication that is also unknown. Until recently, Mr. Udall refused to take the
medications (Brooks, J., (Director) 1997).
Medical
Mr. Udall has previously seen a psychiatrist, although the amounts of appointments are unclear.
Mr. Udall was diagnosed with OCD as his is aware of his own behaviors. He was prescribed an
unknown medication, and recently began to take this medication (Brooks, J., (Director) 1997).
Personal History
There is no information on Mr. Udalls birth and infancy. He has not reported a mother or a
mother figure in his life. He has made no mention of family members other than a father. In his
adolescents, Mr. Udall mentioned that his father was very distant to him. His father preferred to
stay to himself, and rarely made an attempt at a relationship with his son. Mr. Udall also

mentioned how he was a strict parent. His father would hit his hands with a ruler if he made a
mistake on the piano (Brooks, J., (Director) 1997).
Family Constellation
Mr. Udall does not have many significant relationships. He is mostly rude to the people that he
speaks too. Mr. Udall comes off superior, defensive and rude. He gave no indication that his
father is still alive or that he has any relationship with him. Recently, Mr. Udall began a
relationship with the waitress that would serve him at the dinner he routinely visits. Her name is
Carol, she is a single mother of a boy who is frequently sick. Her son has an extreme case of
asthma and struggles to breath, making trips to the hospital often. Mr. Udall also has a tentative
relationship with his neighbor Simon, who is gay. Mr. Udall over insults the man using his sexual
orientation against him, although after an incident in which Simon was beaten in his own home,
Mr. Udall allowed him to stay in his apartment when he lost his home due to being unable to pay
rent (Brooks, J., (Director) 1997).
Clinical Descriptions, Impressions, and Observations
Mr. Udall is a high functioning man with OCD and Anxiety such as personal space. Mr. Udall
becomes distressed when touched by other people, and expresses his fear of germs by
excessively washing his hands and bringing his own silverware to restaurants. His Obsessive
Compulsive Disorder behavior shows as he refused to step on cracks and becomes visibly
distressed with tiled floors. He locks the door to his apartment upon returning, relocking the door
multiple times in a row. Mr. Udall also becomes incredibly distressed at the disruption to his
routines. For example, Mr. Udall has agreed to have a doctor visit Carols (the waitress at the
specific diner he must eat at) son at home and pay for the visits in order to take care of her son

better so she may return to work and continue being his waitress. He functions well with
everyday living but struggles in interpersonal relationship aspects of his life. Mr. Udall has
expressed that he wished to gain better control of his Obsessive Compulsive Disorder behaviors,
which he aware of, and is aware of how it is considered abnormal to most people. He has
expressed that he wishes to have better relationships with people and therefore wishes to seek
treatment for his behaviors. In the assessment itself, Mr. Udall was not very polite, and very
abrasive (Brooks, J., (Director) 1997).
Tentative Diagnosis
I think that Mr. Udall suffers from a comorbidity of Obsessive Compulsive Disorder which is a
form of anxiety disorder. The compulsions are actions that are often repeated in order to sooth a
persons anxiety over an obsession, which is a reoccurring thought or image that tends to be
inappropriate and disturbing. The person feel that he or she has no choice but to complete the
compulsion to stop the obsession (Butcher, J., Hooley, J., & Mineka, S., 2013). The OCD is
defined by his behaviors of repeatedly locking the doors multiple times upon entering his
apartment, and walking away from cracks. The disorder is also apparent due to his love for
routines, including going to the same diner at the same time at the same seat with the same
waitress. When his routine is broken, Mr. Udall become distressed, and verbally lashes out.
Including if someone were to be in his seat the diner at the time of his meal (Brooks, J.,
(Director) 1997). I believe there is comorbidity in Mr. Udall with a germ phobia. A specific
phobia is defined as a strong or persistent fear in the presence of the phobia object or situation
(Butcher, J., Hooley, J., & Mineka, S., 2013). For Mr. Udall, I believe that with his OCD, he has
a phobia of germs. This is expressed by excessively washing his hands, and using incredibly hot
temperatures to do so. He becomes distressed and experiences great anxiety when people touch

him and he also brings plastic silverware with him to a restaurant in fear that the establishment
hasnt effectively cleaned theirs (Brooks, J., (Director) 1997). His symptoms for a phobia of
germs include the phobic object or situation is actively avoided or endured with intense fear or
anxiety, the fear, anxiety or avoidance causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning, and the phobic object or situation
almost always provokes immediate fear or anxiety (Butcher, J., Hooley, J., & Mineka, S., 2013).
Initial Treatment Recommendations
I believe that Mr. Udall should continue on with his medications. He has stated that since he
began on his medicine again, he has locked the door less frequently, and even has stepped on
cracks on the sidewalk. His ability to form relationships has developed tremendously from three
months ago, as now he is in a relationship with a woman, and formed a friendship with his
neighbor (Brooks, J., (Director) 1997). While medication is one treatment plan that I believe
works, behavioral therapy would also benefit Mr. Udall. Exposure and Response prevention may
seem fit. Exposure and Response prevention is when Mr. Udall will be exposed to a stimuli that
he finds disturbing or disgusting. He will then rate how he feels on a 0 to 100 scale. He will then
have to repeatedly expose himself to a stimuli that distresses him, like walking on cracks or
using and or touching another restaurants silverware without completely a compulsion
afterwards. Eventually he will feel the anxiety dissipate after a period of time, where he will be
able to understand that he does not need to complete these compulsions (Butcher. J., Hooley, J.,
& Mineka, S., 2013).

Initial Prognosis

I think that Mr. Udall will not forever be hindered by his OCD behaviors and his phobia of
germs. Prior to this assessment, his compulsions and disorder were fairly disruptive in his life
and far worse than they are now. He has already shown improvement by taking the medication
prescribed to him by a different psychiatrist. He has expressed that he has not locked his doors
before and even walked on cracks which is a major improvement for him. A major factor to his
prognosis is that he sought out help himself, because he wishes to better his relationships. His
willingness to get better effects whether he will actually become better. If he continues to take his
medications and progress in behavioral therapies, he may rid himself of compulsions.

Citation:
Butcher, J., Hooley, J., & Mineka, S. (2013). Panic, Anxiety, Obsessions and Their Disorders. In
Abnormal Psychology (pp. 163 - 210). New Jersey: Pearson Education.
Brooks, J. (Director). (1997). As Good As It Gets [Motion picture on DVD]. United States of
America.