Case report: Functional assessment of behavior in complex diagnoses: A transdiagnostic approach

“Nadine,” a 10‐year‐old female, was referred by her outpatient psychiatrist to the Bradley Hospital Partial Hospital Program for OCD and Related Disorders (OCD PHP) for intensive treatment of her unusual, dangerous, and obsession‐like interests, combined with frequent, severe, and developmentally inappropriate tantrum outbursts. These symptoms continued to elicit chronically high levels of family distress and impairment, despite years of interdisciplinary treatments. Nadine expressed a fascination with sharp objects, including knives. Her verbal and nonverbal behaviors reflected her experience of feeling compelled to interact with sharp objects, placing her parents in a constant state of “high‐alert” risk monitoring and management. Her fixations and unsafe behaviors had previously resulted in multiple hospitalizations to remove objects that she “could not resist” swallowing or pressing into her ears. Nadine's ongoing high risk of harm to herself, parents, and peers required constant monitoring at home and at her therapeutic school. Additionally, these and co‐occurring symptoms led Nadine's parents to engage in extremely high levels of accommodation, in which they modified their own behaviors and family lifestyle in attempts to reduce Nadine's distress and circumvent her unsafe behaviors and tantrum outbursts. For example, they removed sharp objects from Nadine's immediate environment, both in and out of their home, and at times avoided entering otherwise safe and positive environments because of potential exposure to sharps, such as going out to stores, restaurants, or peer playdates.