obsessive compulsive disorder ( ocd ) is a common psychiatric disorder ( 2% - 3% of the general population ) which is diagnosed easily most of the time by the psychiatrist or even the physician .
it is sometimes very difficult to properly diagnose a person for ocd based only on an interview .
the presentation of ocd may be so atypical or unusual that the patients may be referred to different specialties before the actual diagnosis can be made .
neuropsychological studies have consistently found cognitive impairment in the domains of memory and attention in patients of ocd .
anxiety , lack of confidence , indecisiveness , associated clinical symptoms of ocd , along with impaired memory and attention , may further complicate or interfere in the delivery of information .
a 36-year - old man used to request multiple repetitions of spoken words in order to understand what was said .
he was then referred to a neurologist and a general physician for evaluation of neurological cause of his symptoms . even after multiple consultations with the ent , neurology and medicine specialists , no organic pathology to explain his symptoms could be detected .
the patient lost considerable time and money because of delay in diagnosis caused by the atypical presentation to specialties other than psychiatry .
at last , the patient was referred to the department of psychiatry for further evaluation .
the patient 's chief complaints were difficulty in hearing , grasping or comprehending the components of conversations , interactions or clinical interviews at once .
he had this problem for the last 6 months . during the interview , almost every question or the instruction had to be repeated slowly 2 to 3 times or more to make him understand .
he was anxious and expressed regret repeatedly for the inconvenience caused to the doctor because of his disability .
initially the patient was put on mirtazapine 15 mg / day and clonazepam 0.75 mg / day , keeping in mind the possibility of anxiety disorder nos ( not otherwise specified ) .
mental state examination of the patient revealed impaired attention and concentration with depressive and anxiety symptoms .
the possibility of ocd , predominantly obsessive type , was kept on the basis of answers of leading questions , and he was put on fluoxetine 60 mg / day ( titrated from 40 to 60 mg ) and clonazepam 0.5 mg / day .
there was drastic improvement in all the presenting symptoms , including his ability to grasp and comprehend conversation , along with improvement in anxiety symptoms and clarity in thinking over a period of 6 weeks .
the patient was then able to report his pre - treatment problem and the level of improvement comprehensively .
he accepted that he was unable to understand or express his own problem before treatment . according to him ,
there were thoughts keeping his mind busy all the time , to the extent that he was unable to think or communicate his problem effectively . according to him ,
initially he used to make frequent unsuccessful attempts to get rid of these excessive and unnecessary thoughts . according to the wife of the patient , after treatment the patient was able to hear clearly .
the diagnosis could be confirmed as ocd on the basis of patient 's spontaneous elaboration of symptoms and the level of improvement .
in this case , the presentation of ocd is atypical , as the chief complaint was problem in hearing .
he was able to hear on normal volume of sound , but the sentences needed to be repeated multiple times .
moreover , no ent - related or neurological cause of hearing impairment was found in the patient . though hearing difficulty was not his chief subjective problem , he consulted the ent doctor only after repeated and forced advice by his wife and relatives .
the hearing problem as perceived by the patient 's friends and relatives was basically a misinterpretation of the patient 's problem secondary to his psychiatric illness .
also the patient was unable to express his actual problem at the time of presentation .
the patient used to ask for repetition of the spoken sentences multiple times in order to grasp the components of interaction because of his significantly impaired attention .
however , there could be the other possibility that this behavior could be a compulsive act of the patient to confirm his doubts .
the patient could not express his problem elaborately , which was one of the reasons for not being able to make an early diagnosis .
there were multiple factors that had complicated and hindered the narration of history by the patient .
lack of clarity of thoughts and associated clinical symptoms of ocd ( especially predominantly obsessive type ) , indecisiveness , anxiety , lack of confidence , along with impaired memory and attention , were the possible factors in this case , as also reported in different studies .  
the patient could express details of his illness comprehensively once his above - mentioned signs and symptoms improved significantly .
his wife and relatives also reported improvement in his hearing , which was actually the improvement in his attention and ocd symptoms .
such an atypical presentation may lead to misdiagnosis , delay in diagnosis , loss of time and money as the patient may present to other specialties instead of psychiatry .
high suspicion for diagnosis of ocd and response to treatment may help in managing such cases .
obsessive compulsive disorder is usually easily recognized , but sometimes its presentation is so atypical or bizarre that the problem comes to notice as being a psychiatric disorder after multiple consultations in different specialties .
but if proper evaluation is done , such cases can easily be recognized and treated effectively .
 obsessive compulsive disorder ( ocd ) is a common psychiatric disorder which is easily recognized . 
 however , sometimes patients of ocd present in such an atypical or bizarre way that their problem comes to notice as being a psychiatric disorder after multiple consultations in different specialties . 
 we are reporting a case of a man who had first sought opinion in the department of ear , nose and throat ( ent ) for hearing impairment . 
 he was then referred to a neurologist and a general physician for evaluation of neurological cause of his symptom . 
 as no pathology related to ent or neurology could be detected , he was referred to the department of psychiatry . 
 the patient 's chief complaints were difficulty in hearing and inability to understand at once . 
 he could be diagnosed as a case of ocd after meticulous evaluation and studying his response to treatment . 
 there was significant improvement in all the presenting symptoms over a period of 6 weeks on 60 mg of fluoxetine . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION