James is a fifteen year old African American male who lives with his mother in a middle class neighborhood bordering a major metropolitan area. He is the only child and attends the tenth grade at a local public high school. His mother works as a letter carrier for the U.S. postal system. Jamesâ€™ mother has a history of undiagnosed generalized anxiety. In fact, when she is particularly anxious and tense, his mother occasionally yells at James and then apologizes when she is feeling somewhat calmer. She is afraid that she will hurt him and does not understand why he is so worried and fearful all the time.
James has no known medical problems. However, James has a great deal of difficulty concentrating on and completing any of his school work. He wants to do well and his mother supports his educational success. However, he is constantly distracted by powerful and strange thoughts, such as counting how many times he blinks and how many steps it takes to get to the hallway. He feels compelled to avoid stepping on any floor tiles with dirt on them because he doesn’t want to get germs on his feet. The possibility that germs could be on door handles or windows also forces him to avoid touching them unless he first uses a cloth (which he carries with him always) to clean them off. In fact, if he misplaces or forgets to bring a clean cloth with him, he feels a great deal of anxiety, feels paralyzed, and may get physically ill.
Other classmates make fun of him and call him “crazy.” Increasingly, James has been staying home from school because he is embarrassed and upset with himself. His mother is also concerned about his absences from school, but does not know how to make him go to school. His teachers are concerned about his absences and poor academic performance. They give James support, as much as they can, but they don’t understand his behavior either.
Adapted from: The Pennsylvania Child Welfare Training Program
Specific symptoms that lead you to the diagnosis:
Psychosocial or environmental issues: