WGU D571 Psychopathology Task 3:
DSM-5-TR Case Analysis of Howard
Hughes in The Aviator | 2026 Update
with complete solutions.
1. Preliminary Case Formulation
a. Demographic & Presenting Problem
Howard Hughes is a 42-year-old, Caucasian, unmarried male of immense wealth
and professional stature as an aviator, film producer, and industrialist. His chief
complaint, as reported by his accountant who brought him to the clinic, is a
profound and debilitating fear, stated as: "There is no safe place; there is no safe
place". He has been living in self-imposed solitary confinement in a single, "germ-
free" room of his mansion, which is sealed off with masking tape at the entrances.
b. History of Present Illness
Mr. Hughes has suffered from numerous obsessions and compulsions for several
years, with symptoms becoming progressively more severe and incapacitating. His
central obsession is an intense fear of germs (contamination), which has evolved
into a severe phobia. Key behaviors include:
• Compulsive Decontamination: He uses tissues to pick up any item, refuses
to use dishes or glassware, and incinerates his entire wardrobe if he believes
he has been exposed to anyone who is sick.
• Ritualized Hygiene: He demands that friends and employees adhere to
strict, elaborate hygiene practices.
• Rigidity & Repetition: Any deviation from his strict routines forces him to
start over from the beginning; he often gets "stuck" in uncontrollable bouts
of compulsions.
, • Panic & Avoidance: He experiences daily panic attacks driven by extreme
fear of dirt, mess, or any perceived disorder. He is terrified of having a panic
attack in public, which contributes to his increasing isolation and avoidance
of appearing in public.
• Perfectionism: In his professional work, he is driven and perfectionistic,
often going massively over time and budget to complete a film or design an
airplane to his exacting specifications.
He is brought to the clinic by his accountant, as he adamantly denies having a
mental illness, though he is vaguely aware that some of his behavior might appear
disturbed.
c. Past Psychiatric & Medical History
There is no reported history of prior mental health treatment, despite symptoms
having been present for years. He has a long history of minor physical illnesses
since childhood. His mother, driven by a fear of life-threatening diseases,
frequently sought treatment for him. At age 13, he developed a medically
unexplained paralysis that confined him to a wheelchair for two months. He
currently experiences chronic pain from multiple plane crashes, which have
resulted in serious facial, leg, and internal injuries. He is taking pain medication
from multiple prescribers.
d. Psychosocial History
Mr. Hughes is an only child who enjoyed a close relationship with his parents. His
mother died unexpectedly when he was 16, and his father died of a heart attack two
years later, leaving him orphaned as a teenager. The film depicts a critical early
memory: as a child, his mother warned him about an epidemic and told him he was
not safe, a scene widely interpreted as a possible source for his later contamination
fears. He is a highly successful and driven individual, but his severe OCD
symptoms increasingly jeopardize his business dealings, delay aeronautical
projects, and destroy his personal relationships.
e. Mental Status Exam
Upon presentation, Mr. Hughes is highly anxious, distractible, and appears visibly
distressed. He is preoccupied with his internal fear of contamination and seems
, unable to focus on the clinician's questions for long periods. His speech is
pressured at times, and he engages in repetitive, ritualistic behaviors during the
interview, such as excessive hand washing. He demonstrates poor eye contact and
appears socially withdrawn, preferring to avoid any direct interaction. His insight
into his condition is severely limited, as he firmly believes his fears are rational
and his compulsive actions are necessary for his survival.
2. DSM-5-TR Diagnosis and Differential Diagnosis
Primary Diagnosis
F42 Obsessive-Compulsive Disorder (OCD), with absent insight/delusional
beliefs
Howard Hughes's presentation most clearly meets the full DSM-5-TR criteria for
OCD, as detailed in the table below.
DSM-5-TR Criterion Application to Howard Hughes's Case
Obsessions: Recurrent, persistent, and intrusive fears of
contamination by germs, dirt, or disease. Compulsions: Repeti
A. Presence of obsessions,
behaviors performed in response to the obsession, including
compulsions, or both
excessive hand washing (until they bleed), elaborate cleaning
rituals, incinerating clothing, and using tissues to touch objects
His symptoms are extremely time-consuming, occupying man
hours each day with rituals. They cause marked distress (daily
B. Time-consuming or
panic attacks, severe anxiety) and lead to significant functional
clinically significant
impairment, including jeopardizing his businesses, delaying
distress/impairment
projects, destroying relationships, and resulting in near-total se
isolation.
DSM-5-TR Case Analysis of Howard
Hughes in The Aviator | 2026 Update
with complete solutions.
1. Preliminary Case Formulation
a. Demographic & Presenting Problem
Howard Hughes is a 42-year-old, Caucasian, unmarried male of immense wealth
and professional stature as an aviator, film producer, and industrialist. His chief
complaint, as reported by his accountant who brought him to the clinic, is a
profound and debilitating fear, stated as: "There is no safe place; there is no safe
place". He has been living in self-imposed solitary confinement in a single, "germ-
free" room of his mansion, which is sealed off with masking tape at the entrances.
b. History of Present Illness
Mr. Hughes has suffered from numerous obsessions and compulsions for several
years, with symptoms becoming progressively more severe and incapacitating. His
central obsession is an intense fear of germs (contamination), which has evolved
into a severe phobia. Key behaviors include:
• Compulsive Decontamination: He uses tissues to pick up any item, refuses
to use dishes or glassware, and incinerates his entire wardrobe if he believes
he has been exposed to anyone who is sick.
• Ritualized Hygiene: He demands that friends and employees adhere to
strict, elaborate hygiene practices.
• Rigidity & Repetition: Any deviation from his strict routines forces him to
start over from the beginning; he often gets "stuck" in uncontrollable bouts
of compulsions.
, • Panic & Avoidance: He experiences daily panic attacks driven by extreme
fear of dirt, mess, or any perceived disorder. He is terrified of having a panic
attack in public, which contributes to his increasing isolation and avoidance
of appearing in public.
• Perfectionism: In his professional work, he is driven and perfectionistic,
often going massively over time and budget to complete a film or design an
airplane to his exacting specifications.
He is brought to the clinic by his accountant, as he adamantly denies having a
mental illness, though he is vaguely aware that some of his behavior might appear
disturbed.
c. Past Psychiatric & Medical History
There is no reported history of prior mental health treatment, despite symptoms
having been present for years. He has a long history of minor physical illnesses
since childhood. His mother, driven by a fear of life-threatening diseases,
frequently sought treatment for him. At age 13, he developed a medically
unexplained paralysis that confined him to a wheelchair for two months. He
currently experiences chronic pain from multiple plane crashes, which have
resulted in serious facial, leg, and internal injuries. He is taking pain medication
from multiple prescribers.
d. Psychosocial History
Mr. Hughes is an only child who enjoyed a close relationship with his parents. His
mother died unexpectedly when he was 16, and his father died of a heart attack two
years later, leaving him orphaned as a teenager. The film depicts a critical early
memory: as a child, his mother warned him about an epidemic and told him he was
not safe, a scene widely interpreted as a possible source for his later contamination
fears. He is a highly successful and driven individual, but his severe OCD
symptoms increasingly jeopardize his business dealings, delay aeronautical
projects, and destroy his personal relationships.
e. Mental Status Exam
Upon presentation, Mr. Hughes is highly anxious, distractible, and appears visibly
distressed. He is preoccupied with his internal fear of contamination and seems
, unable to focus on the clinician's questions for long periods. His speech is
pressured at times, and he engages in repetitive, ritualistic behaviors during the
interview, such as excessive hand washing. He demonstrates poor eye contact and
appears socially withdrawn, preferring to avoid any direct interaction. His insight
into his condition is severely limited, as he firmly believes his fears are rational
and his compulsive actions are necessary for his survival.
2. DSM-5-TR Diagnosis and Differential Diagnosis
Primary Diagnosis
F42 Obsessive-Compulsive Disorder (OCD), with absent insight/delusional
beliefs
Howard Hughes's presentation most clearly meets the full DSM-5-TR criteria for
OCD, as detailed in the table below.
DSM-5-TR Criterion Application to Howard Hughes's Case
Obsessions: Recurrent, persistent, and intrusive fears of
contamination by germs, dirt, or disease. Compulsions: Repeti
A. Presence of obsessions,
behaviors performed in response to the obsession, including
compulsions, or both
excessive hand washing (until they bleed), elaborate cleaning
rituals, incinerating clothing, and using tissues to touch objects
His symptoms are extremely time-consuming, occupying man
hours each day with rituals. They cause marked distress (daily
B. Time-consuming or
panic attacks, severe anxiety) and lead to significant functional
clinically significant
impairment, including jeopardizing his businesses, delaying
distress/impairment
projects, destroying relationships, and resulting in near-total se
isolation.
