Posted by: carolg1849 | April 4, 2009

Is there a bit of OCD in all of us?

this article popped up on my google search this morning, it really interested me, explaining the difference of having these traits versus the full blown disorder and how it can in fact be a positive thing

For my son diagnosed with BPD, he certainly has obsessive tendancies, but then so do I………………….  Mine has helped me to run a profitable and successful business.  Two ends of the spectrum.  

Hope you find this interesting

FT.com / Weekend / Reportage – Is there a bit of OCD in all of us?.

By Richard Tomkins

Published: April 3 2009 20:29 | Last updated: April 3 2009 20:29

Howard Hughes
The obsessive compulsive disorder suffered by Howard Hughes began in the 1930s when he became preoccupied with peas and used a fork to arrange them by size

History’s best-known sufferer of obsessive compulsive disorder was Howard Hughes. After inheriting a successful engineering business, the multi-millionaire playboy won fame in the 1920s and 1930s as a movie mogul and for his derring-do as an aviator. But by the 1940s, he was beginning to succumb to an obsession with dirt and germs that would gradually take over his life. So great did his fear of contamination become that he cut himself off from the world and became a recluse, retreating to the isolation of expensive hotel rooms where he lived with the windows and doors taped up to keep out bacteria and flies.

Unfortunately, instead of confronting his obsessions, Hughes was rich enough to have others indulge them. His aides were given extraordinarily detailed instructions for handing him any object using a system of “insulations” he’d devised. To take his hearing aid from the bathroom cabinet, for example, they were told to:

● use six to eight tissues to turn the knob on the bathroom door;

● use six to eight new tissues to open the bathroom cabinet and remove an unused bar of soap;

● wash their hands with the soap

● use at least 15 tissues to open the door to the cabinet containing the hearing aid; and

● remove the sealed envelope containing the hearing aid with two hands using another 15 tissues in each hand.

Towards the end, weighed down by his obsessions and addicted to codeine, Hughes became increasingly emaciated and stopped cutting the nails on his hands and feet, letting them grow to grotesque length. When he died in 1976, he was so unrecognisable as the dashing celebrity whose face was once splashed on magazine covers all over the world that he had to be identified by his fingerprints.

Hughes’s sad story is so bizarre that it makes obsessive compulsive disorder, or OCD, sound equally abnormal. Yet studies have shown that 2 per cent of the general population, or one in 50 people, have full-blown OCD, meaning their symptoms meet all the accepted diagnostic criteria. The World Health Organisation ranks it among the 10 worst illnesses in the developed world in terms of its impact on income and quality of life.

But even those statistics could be only part of the picture. According to a paper appearing in last month’s American Journal of Psychiatry, an estimated 21-25 per cent of individuals could be said to have borderline OCD, meaning they have obsessions or compulsions that meet at least some of the diagnostic criteria. Admittedly, more than one-third of these people are also suffering from another anxiety disorder or depression – but according to the paper, that still leaves an estimated 13-17 per cent of otherwise “normal” people – about one in 15 of us – suffering from at least some symptoms of OCD.

So, what is this disorder? And could someone you know be at least partly afflicted?

The term “OCD” has recently displaced “anal” in contemporary slang as a way of describing people who are more than usually meticulous, pernickety or pedantic – the sort of people who are never satisfied unless things are just right. If this reflected a greater understanding of obsessive compulsive disorder, it might be no bad thing. In fact, it has simply increased the degree of misunderstanding by confusing two different conditions with almost the same name. “Anal” people do not usually have OCD at all; they simply have an obsessive compulsive personality type, meaning they’re a bit fussy. People with OCD, in contrast, are suffering from a serious anxiety disorder that greatly impinges on their lives.

While being “anal” can be an asset in some circumstances, as in a job that requires attention to detail, there are no advantages in having OCD at any level. All it does is cause distress by introducing obsessive, irrational anxieties into the sufferer’s mind, typically involving perceived dangers or appalling images of one sort or another. A defining characteristic of OCD is that sufferers believe just thinking about bad things will make them happen unless they act to prevent it; so they feel compelled to carry out little rituals which to other people look odd and unnecessary but which to them have the magical power to counteract the perceived threat. Typically, the obsessive thoughts and compulsive behaviour reinforce one another in a vicious circle, causing the condition to become ever worse until it starts to interfere seriously with the sufferer’s life.

Although there are many possible obsessions, the most common of them fall into a surprisingly small number of categories. The best known is Howard Hughes syndrome – the fear of dirt and germs, commonly linked with compulsive handwashing and cleaning. Another common one is the fear of harming others or coming to harm oneself, often accompanied by compulsive safety checking – repeatedly making sure the door is locked, the cooker is turned off and the iron is unplugged. Many sufferers are obsessed with a need for symmetry, which results in compulsive rearranging of things. Others are tormented by thoughts that they will carry out some horrifying act of a violent, sexual or blasphemous nature, and often try to block out or neutralise these thoughts with mental rituals such as counting or the repetition of certain words or phrases.

. . .

“I’ve grown up with it because my dad’s also a sufferer, but his obsessions are different from mine. His are with cleaning; mine are with even numbers and things like that,” says Katie Stevens, a 20-year-old living in Redruth, south-west Cornwall. “It really started to get out of hand when I was about 16. There were some bereavements in the family and there was so much going on – so many things to be organised and so much happening so fast – that it was something I felt I could control. Now, it’s the worst it’s ever been. It affects my everyday life, my work, my driving – everything, really, because everything I do, I have to do in even numbers.

four peas on a plate
‘Everything I do, I have to do in even numbers. I have to have an even number of peas on my plate, something as silly as that’

“For example, having just an ordinary cup of tea, you might pick it up and have a sip with your left hand, then you put it down and do the same with your right hand. Even if you only have one sugar, you put one sugar in with your right hand and then just pretend to do it with your left hand so you feel symmetrical. It’s the same with food – I have to have an even number of peas on my plate, something as silly as that. If I’m driving and I wind down the window, I have to lean over and do it with my other hand too so there isn’t that feeling of oddness. When I change gears with my left hand I have to lean over and touch the gearstick with my right and pretend to do the same thing again so I get that feeling of evenness and symmetry.”

At work, Katie has everything on her desk laid out evenly and even has a matching pair of linked computer screens instead of just the one. “My colleagues know about it and they support me as much as they can. But there’s only so far they can understand because to them, they’re just thoughts that you can easily block out whereas for people who suffer from obsessive compulsive disorder, it’s much harder than that. It’s like someone screaming at you that you have to do this regardless of what anyone says. If you don’t do the rituals, there’s a sense of panic, anger and real distress and you feel like everything’s just going to fall apart.

“We’re very sheltered down here – not a lot gets past Devon into Cornwall – so not many people know about it and there are no support groups or anything like that. It’s the same with counselling. Most people treat OCD with cognitive behaviour therapy but that’s not offered in Cornwall so you have to travel a long way to get it.” Once diagnosed, Katie started on medication but it brought on intrusive thoughts: “I had urges such as, for example, you’d be driving on the motorway and all of a sudden you’d get this urge to let go of the steering wheel and see where the car takes you, or you’d be standing at the top of the stairs and start wondering what would happen if you just let yourself fall.” She is now on a different medication but still has her obsession with symmetry. “It doesn’t dissolve it, it just masks it a bit. I’m still struggling with it.” She is about to get married, “so I’m having to make sure everything at the wedding will be symmetrical and just right – the tables, the arrangements, the flowers, the decorations and so on. The way the food comes out, it will all have to look exactly the same on each plate, so it’s going to be a huge pressure on the kitchen.”

. . .

On the other side of the country, 33-year-old Chris Brotherton of King’s Lynn, Norfolk, has also been wrestling with OCD since his teens. His started with upsetting thoughts that wouldn’t go away: he was working towards a medical qualification in a hospital “and I kept imagining myself tripping patients up or hurting them or tipping them out of their wheelchairs. It was something completely out of character for me and I had no idea why it was happening. I honestly thought I was evil.”

Most people have bizarre and abhorrent thoughts that pop into their minds, only to be dismissed and forgotten. The problem for OCD sufferers is that the thoughts come and stay, torturing the victim with nightmarish visions that they will actually carry out some unspeakable act – which, all the evidence shows, they never do.

For Chris, his thoughts were so disturbing that he left his medical training – “I thought I just wasn’t supposed to be around people” – and took another job, initially in catering. Things then quietened down for a while – until he married, bought a house and had children. With the increase in family responsibilities, his OCD returned, but this time in a different form. “The violent thoughts faded into the background and I ended up worrying about security. I had to be the last one in bed because that way I could check the house and make sure it was all locked up.

“It started off very small. I’d check the door a couple of times, then go to bed. But by the time my second daughter was born, my wife would be going to bed at about 11 o’clock and I’d be up till 2 or 3 o’clock in the morning checking doors and locks. Two doors and four windows – that’s all it was. I’d shake the door handle 13 times, then check the window 13 times, then I’d get maybe five minutes’ peace until I had to start all over again, and I’d have to keep doing that until exhaustion literally forced me to bed.”

David Beckham
Three years ago, David Beckham admitted to repetitive behaviours, such as lining up his soft-drink cans and spending hours straightening the furniture.

Eventually, he sought help and about five years ago his OCD was diagnosed. To treat it, he was given a course of cognitive behaviour therapy, or more specifically, a form of it called exposure and ritual prevention (ERP), in which people are exposed to their fears but gradually reduce their ritualistic response to them – for example, cutting the number of times they check the doors and windows from 13 to 12, then 11 and so on. “You can’t get rid of the obsession itself. You can only reduce the way you react to it,” says Chris. “But once you’ve got that under control, the obsession itself starts to die down. It’s still there but it’s as if you’ve taken its power away, so it doesn’t distress you as much.”

So that was the end of it? If only. Chris says things went well for a while; then, of all things, his wife developed OCD, and the feeling that he was responsible for it brought his own back – this time, as in his teens, in the form of violent, intrusive thoughts. “It’s as if every time I conquer one part of it, it changes into something else, like a little demon that suddenly realises one trick’s not working and decides to try another. So now, it’s trying the thoughts again, and I’m starting to work on those.”

What sort of thoughts does he have? Chris hesitates. “That I’m going to come downstairs and find my family slaughtered.” By whom? Another long pause. “That’s swings and roundabouts as to who does it,” he says, sounding increasingly distressed. “Sometimes it’s someone else, and…” By now, he is struggling to get his words out. “Sometimes it’s me.”

Usually, Chris says, his compulsive reaction to these obsessive thoughts is to keep mentally repeating a mantra to block them out. Part of his therapy is to stop doing this and instead let the thoughts in, gradually exposing himself to them in the hope that they’ll lose their power. “Just speaking to you about the thoughts like this is part of the therapy,” he says, “because I’m having to talk about them and confront them.”

. . .

It is no consolation at all for Chris Brotherton and Katie Stevens, but they are in distinguished company. According to David Veale, a consultant psychiatrist at The Maudsley Hospital in south London and co-author of the self-help guideOvercoming Obsessive Compulsive Disorder, the English writer and lexicographer Dr Samuel Johnson is one of many famous historical figures who suffered from OCD in the days before it was known as such; his biographer James Boswell described how, among other things, Dr Johnson would perform highly ritualised movements when passing over the threshold of a door. The author John Bunyan apparently suffered from intrusive thoughts, describing how “whole floods of blasphemies, both against God, Christ and the Scriptures, were poured upon my spirit, to my great confusion and astonishment”. Charles Dickens may also have been a mild sufferer, rearranging the furniture in any room in which he stayed to get it into exactly the “right” position and touching objects three times for luck.

More recently the footballer David Beckham has spoken in a television interview about his obsession with symmetry. “I have to have everything in a straight line or everything has to be in pairs,” he said. “I’ll put my Pepsi cans in the fridge and if there’s one too many then I’ll put it in another cupboard somewhere.”

Interestingly, although researchers doubt whether OCD has changed in prevalence over the centuries, it does seem to have changed in character. In more pious times, obsessions typically involved intrusive blasphemous thoughts or the fear of committing sacrilege. Nowadays, the themes reflect modern-day concerns: worries about health and safety, for example, or the fear of becoming a paedophile.

So, what causes OCD? If only we knew. According to David Mataix-Cols, a clinical psychologist specialising in OCD research at the Institute of Psychiatry, King’s College London, “people are very polarised in this field, as they are with many mental disorders”. Opinions, he says, tend to fall into two main camps: the biological and the psychological.

Those in the biological camp think OCD is caused by an abnormality in the brain, with many fingers pointing at the possibility of an imbalance in the chemical neurotransmitter serotonin. There is no direct evidence for this but the fact that anti-depressants, which act on the brain’s serotonin levels, also alleviate OCD has led people to hypothesise that serotonin is at least part of the answer.

Those in the psychological camp, says Mataix-Cols, think OCD is a learnt behaviour. Most of us worry about hygiene to some extent and feel the need to wash and clean. But because of past experiences or the way they were brought up, people with OCD develop false beliefs that such minor concerns are real threats and over-react to them accordingly. The behaviour is perpetuated because it “works” – the compulsions appear to prevent the dreaded events occurring.

As so often, it’s the old nature-versus-nurture argument – either you’re born with OCD, or it’s a result of your environment. But another possibility, says Mataix-Cols, is that it’s both. Apparently, there is a tendency for OCD to run in families – roughly 50 per cent of cases appear to be explained by a genetic component, or “nature”. But, says Mataix-Cols: “obviously that leaves another 50 per cent not explained by genes, so there might also be some environmental, learning, nurture aspect to them.” In other words, while some sufferers may have a biological vulnerability that makes them more prone to OCD, it also appears that they need environmental factors (past experiences or a stressful event) to trigger it. And in sufferers without a known biological vulnerability, perhaps environmental factors alone, if sufficiently disturbing or traumatic, are enough to cause it.

Paul Gascoigne
In 2005, Paul Gascoigne said that he had become obsessed with cleanliness

Unfortunately, without knowing exactly what causes OCD, there is no sure-fire cure. Even so, it can be successfully managed. The most effective option is usually ERP, of the kind tried by Chris Brotherton, with anti-depressants as a possible alternative. Mataix-Cols says that for the 30-40 per cent of sufferers who do not fully benefit from ERP, other forms of cognitive behaviour therapy are being tested that aim not only to eliminate the rituals people perform in response to their obsessions, but also challenge the obsessions themselves. “If someone has obsessive thoughts about harming someone, the experiment might be about deliberately trying to harm someone just by thinking about it, because people with OCD sometimes believe just thinking about something will make it happen. So the experiment would be, OK, let’s think about killing this person, let’s deliberately try to kill him with our minds, which is something patients are terrified about; and then, by doing this, they gradually realise that their fears may be exaggerated.”

But what if the person really does die? The idea is absurd, but don’t be surprised if it popped into your mind. To a degree, we all believe we have magical thoughts, meaning we fear making things come true just by thinking them. Says Veale: “If I asked you to wish your loved ones dead in a road traffic accident, you’d probably be reluctant to do it. People don’t like to wish or think about bad things because they’re afraid that somehow, if they do, then they might make them happen.”

So is there a bit of OCD in all of us? It wouldn’t be surprising, says Veale. “That’s the case with many different mental disorders. When you think of depression, there’s an awful lot of sadness and depression out there but that doesn’t necessarily mean people are clinically depressed. It’s the same with anxiety disorders – there’s an awful lot of anxiety out there but that doesn’t necessarily mean that all of it is significantly distressing or handicapping in people’s lives.”

. . .

Obsessed, obsessive and obsession are over-used words. People talk about someone being obsessed with recycling or being an obsessive gambler; there is even a perfume called Obsession. But it is not enough to be preoccupied or infatuated with something to qualify as an OCD sufferer. With OCD, the obsessions have to be unwanted, unwelcome and anxiety-provoking – they can never bring satisfaction or pleasure. They also have to cause a repetitive behaviour or ritual aimed at preventing some dreaded event or situation, and this behaviour must be irrational or excessive. On top of that, the obsessions and compulsions have to interfere significantly with the sufferer’s life and/or take up at least one hour a day.

These criteria are laid down in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published in the US and used to a varying extent around the world. But as Mataix-Cols points out, “The definition’s entirely arbitrary. It’s just some blokes getting together in America and saying that if you spend more than one hour a day doing rituals, and if those rituals are distressing and interfere with your everyday life, then you’ve got it. If not, you don’t. But what we’ve found is that there’s a very large prevalence of OCD symptoms in people who don’t fit this definition.”

Mataix-Cols is one of the co-authors of the paper in last month’s American Journal of Psychiatry concluding that OCD symptoms are surprisingly common in the adult population. (It is based on a longitudinal study of the health and behaviour of 1,037 children born in New Zealand in the early 1970s.) The symptoms are the same as those with full-blown OCD – typically, obsessions with contamination, danger, symmetry or shameful thoughts – but, either because they take up less than an hour a day or are only moderately distressing, they don’t qualify for full clinical diagnosis or treatment.

We need to be careful about disease-mongering or over-medicalising people who do not want or need any help. But for those who are distressed by their symptoms, there is an argument that more should be done. Says Mataix-Cols: “One of the main findings of this study is that people who have obsessions and compulsions early in life are at greater risk of developing full-blown OCD in the future. This is important because it opens the gate to preventive work. So if these findings are confirmed by other studies, then there would be a case for trying to identify all these sub-clinical people and giving them some simple strategies or treatments that would prevent them from developing it.”

. . .

Even then, one big problem will remain: getting people to come forward. Many sufferers try to hide their symptoms, either because they’re embarrassed or because they don’t want to be thought of as mad. Incredibly, studies show that the average time elapsing between onset and treatment is 17 years – and even then, most cases come to light only when people have sought help for another anxiety order or depression and turn out to have OCD too.

Winona Ryder
Winona Ryder is another public figure who has exhibited some of the symptoms of OCD

Back in King’s Lynn, Chris Brotherton says: “I think it’s much more widespread than people would think because we’re so good at hiding it. We become experts at hiding our own tricks and traits. I work in a factory where there are only 80 people and yet I know six people there who definitely have OCD – three that are diagnosed and three that we know of but who can’t face up to the diagnosis.”

According to Joel Rose, director of the charity OCD Action: “Some people recognise they’ve got a problem but are afraid of getting it dealt with. Instead, they develop their own strategies for working around their compulsions. They live a life where they just accept that they’ve got to set out three hours earlier [to allow for repeated checking of door locks, electrical appliances and so on] or allow an extra hour or two to do such-and-such a task.

“There’s a strong message that needs to go out: first, that OCD is not uncommon and if you have it, you’re not alone, and second, that it’s relatively treatable. Between cognitive behaviour therapy and medication, there’s a good chance of being able to manage and contain it in a way that’s not detrimental to your quality of life. And the sooner you get on to that process, the less of your life you spend suffering from it.”

Richard Tomkins is the FT’s chief feature writer

OCD Action can be contacted on 0845 390 6232 or at www.ocdaction.org.uk

………………………………………………….

The 21st-century anal retentives

Someone with an obsessive compulsive personality is what Sigmund Freud called anal retentive. According to Freud, in the anal stage of pyschosexual development, children took pleasure in learning to use the toilet. Too much punishment at this stage could cause anal fixation in later life, with two possible outcomes: either an anal expulsive personality, careless and lacking in self-control, or an anal retentive one – orderly, fastidious and tight.

Says David Veale, a consultant psychiatrist at The Maudsley Hospital in south London: “I think everyone knows people who at one level have an obsessive compulsive personality. They tend to be somewhat perfectionist, very conscientious, perhaps somewhat rigid in their routines, maybe slightly unemotional, tending to collect and hoard, and maybe having high morals and standards.” None of this is abnormal, he says – unless it “gets out of hand and interferes with your life and becomes distressing enough for yourself or others”.

While an obsessive compulsive personality may have its downsides, it is not all bad. In more pronounced cases, says Veale, people may find it difficult to be creative, be open to new experiences, have fun or experience emotion; they may even be a bit miserly. On the other hand, you would not want an auditor or an airline pilot to be anything other than conscientious and meticulous, and if you were about to undergo brain surgery, you would probably prefer the surgeon to be anal retentive rather than anal expulsive, if the latter meant careless and lacking in self-control.

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