Case Study: Josie Bellings

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Josie Bellings, a 34-year-old nurse, presents to your office. Her boyfriend, Robs, is with her.

“Hi,” Josie sighs deeply. “Remember your first months as a new nurse? I just finished orientation and I’m struggling to keep up now. I’m… I’m having trouble clocking in on time because I have to be certain my hands are clean before I start my shift.”

Robs breaks in. “She’s told me she sometimes washes her hands six times in a row. Maybe even seven or eight to be sure. She does this at home, too.”

Josie nods. “Yeah, he’s right. And after seeing a patient, I also have to clean the desk and computer with wipes just as many times before I can finish the chart. My charge nurse says I’m overdoing the cleanliness a bit, but I just have to do it. And it’s not just cleanliness. At home, I’m the last to bed because I have to check the doors at night five to six times at night.”

“Even if I’ve already locked up and she saw me do it,” puts in Robs.

“Well, I feel like I have to have some control over my world. And, um, Robs doesn’t know this, sometimes I get up after he falls asleep because I worry to the point that I will have to get up and go check one or two more times before I can go to sleep.”

Robs adds, “Actually, I did know about that, Josie. I’m also concerned because Josie will get focused on something and then not be able to shut her mind down. She perseverates and I cannot distract her for anything.”

Josie reports that she has always had these symptoms but that they are worse recently. She reports feeling depressed, mainly because of the OCD symptoms that are causing her trouble. She denies any SI, HI, or A/V hallucinations.
Here is the question to be answered!!!!
Based on the information that you have, what diagnosis would you give Josie? Please include differential diagnoses. Please match her symptoms with the corresponding DSM-5 criteria.
Her diagnosis is Obsessive Compulsive with depression .
Why is all of this important? What’s so important about having depression and OCD together? Well, it turns out that having severe depression can interfere with the effects of the most effective treatment for OCD: cognitive behavioral therapy using exposure and response prevention. As you might know, exposure therapy involves gradually confronting the situations and thoughts that trigger your obsessions; and response prevention means working on refraining from the corresponding compulsive rituals.

Sample Solution

mbiguous and hard for a leader to understand whether they have it or how then can gain it. It becomes the responsibility of the organisation to have policies in place to provide leaders with some positional power, usually by establishing a clear hierarchal structure. By establishing a hierarchy, the leader is perceived by the group to be able to make demands and expect compliance from them giving the leader legitimate power (French and Raven, 1959). Secondly, by providing the leader with the ability to reward compliance and punish non compliance from the group, the leader has reward and coercive power (French and Raven, 1959). To obtain complete power over the group the leader must gain the trust and belief of the group that they are capable of success, by ensuring the group are both satisfied and meeting performance goals.
The importance of establishing a hierarchy became evident during the planning stage of the outdoor management course for the red team, the coordinators within the team assumed leadership roles but were unable to gain positional power due to the team being a peer group (Pettinger, 2007). The leaders selected had little authority and influence over the group as everyone was perceived to have the same rank, status and occupation, hence the leaders had none of French and Ravens five bases of power (Pettinger, 2007). The result was leaders with no positional power over the group, so could not direct the group with the method of leadership required for the situation. The task had significant constraints, particularly a short time frame and a large group size, for this situation Chelladurai recommends an autocratic leadership style would be most favourable (Chelladurai and Madella, 2006). The leaders attempted an autocratic leadership style, setting individual tasks for the group, however due to the poor leader member relations and lack of positional power the leadership structure quickly became a democracy. The product was an extremely unproductive workforce initially because of the time spent discussing how was best to approach the task. Because of how the leaders were perceived by the group there was little mutual trust, respect or confidence that the leaders were making the correct decisions, and as a result any management style they tried to implement would have been

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