Using functional analysis to disentangle diagnostic complexities: A case of mucus-related health anxiety

• We discuss challenges in diagnosis and treatment of a middle-aged male with unusual and intrusive somatic concerns and safety behaviors.
• Sixteen sessions of cognitive-behavioral therapy with exposure and response prevention were employed.
• Frequency and severity of obsessions and safety behaviors decreased by the end of treatment, and treatment gains were maintained at one-month follow-up.
• The case highlights the importance of examining uncommon clinical cases to advance conceptualization and treatment of obsessive-compulsive related disorders.

This case report examines the unusual symptom presentation of a middle-aged, Caucasian man referred for treatment of intrusive somatic concerns and behaviors involving mucous sensations. Although the patient's symptoms overlapped phenomenologically and functionally with multiple disorders, including obsessive-compulsive disorder, hypochondriasis, panic disorder and tic disorder, the patient did not meet criteria for any one. This case challenged the DSM-IV nosology and supports the shift to conceptualize obsessive-compulsive disorder and other related disorders as comprising a spectrum or family of disorders. Despite complexities in diagnosis, treatment was tailored to the patient's unique symptom set and employed cognitive behavioral therapy with exposure and response prevention. Across 16 sessions of treatment, the patient's somatic obsessions and intrusive safety and reassurance seeking improved. His total score on the Yale-Brown Obsessive Compulsive Scale – Second edition decreased from 43 at the start of treatment to 17 at the end of treatment, with gains maintained at one-month follow-up. Frequency of emergency-room visits decreased, respectively, from 22 to 0 in the month preceding and following treatment. This case highlights the importance of continued examination of uncommon cases to further advance conceptualization and treatment of obsessive-compulsive related disorders.