Karen - Karen Karen Rusa was a 30-year old married woman...

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Karen 1 of 5 Karen Rusa was a 30-year old married woman and the mother of four children. Although she had been having anxiety-related problems for a number of years, she had never sought professional help prior to this time. During the preceding three months, she had become increasingly depressed; her family physician finally suggested that she seek psychological services. For the past several months Karen had been experiencing intrusive, repetitive thoughts that centered around her children’s safety. She frequently found herself imagining that a serious accident had occurred, and she was unable to put these thoughts out of her mind. On one such occasion she imagined that her son, Alan, had broken his leg playing football at school. There was no reason to believe that an accident had occurred, but Karen brooded about the possibility until she finally called the school to see if Alan was all right. Even after receiving reassurance that he had not been hurt, she was somewhat surprised when he later arrived home unharmed. Karen also noted that her daily routine was seriously hampered by an extensive series of counting rituals that she performed throughout each day. Specific numbers had come to have a special meaning to Karen; she found that her preoccupation with these numbers was interfering with her ability to perform everyday activities. One example was grocery shopping. Karen believed that if she selected the first item (e.g., a box of cereal) on the shelf, something terrible would happen to her oldest child. If she selected the second item, some unknown disaster would befall her second child, and so on for the four children. The children’s ages were also important. The sixth item in a row, for example, was associated with her youngest child, who was 6 years old. Thus, specific items had to be avoided to ensure the safety of her children. Obviously, the rituals required continuing attention because the children’s ages changed. Karen’s preoccupation with numbers extended to other activities, most notably the pattern in which she smoked cigarettes and drank coffee. If she had one cigarette, she believed that she had to smoke at least four in a row or one of the children would be harmed in some way. If she drank one cup of coffee, she felt compelled to drink four. Karen acknowledged the irrationality of these rituals but, nevertheless, maintained that she felt much more comfortable when she observed them conscientiously. When she was occasionally in too great a hurry to perform the rituals, she experienced considerable anxiety in the form of a subjective feeling of dread and apprehension. She described herself as tense, jumpy, and unable to relax during these periods. Her fears were most often confirmed because something unfortunate invariably happened to one of her children within a few days after each such “failure.” The fact that minor accidents are likely to occur at a fairly high rate in any family of four children did not diminish Karen’s
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Karen - Karen Karen Rusa was a 30-year old married woman...

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