Navigating Severe Obsessive-Compulsive Disorder (OCD) With Food Obsessions: A Case Report on Diagnostic Complexity and Atypical Presentation

This case report discusses a 29-year-old male with severe obsessive-compulsive disorder (OCD) who presented with food-related obsessions and compulsions, leading to extreme malnutrition, reflected in a dangerously low body mass index of 13.7 kg/m². His obsessions revolved around keeping his digestive tract completely empty to avoid illness. To achieve this, he restricted his food intake, spent long hours in the toilet, and engaged in excessive washing. These behaviors resulted in significant physical deterioration that eventually required emergency medical intervention. Unfortunately, the initiation of treatment led to refeeding syndrome, which further complicated the case. Due to his unique symptoms and acute presentation, this case highlights the diagnostic and therapeutic challenges posed by atypical presentations of OCD. It reinforces the importance of a multidisciplinary team involving medical, psychiatric, and nutritional departments working collaboratively. Close monitoring for complications, such as refeeding syndrome, is essential. Psychoeducation for both patients and families remains crucial to support adherence to the treatment plan and improve outcomes.