Avoidance of an unexpected calamity is what we strive for. Insurance providers charge their premiums based on an actuary’s estimate of the likelihood of an event befalling us. Depending on the type of insurance we are buying, they consider where we live, the age of our home, our gender, age and lifestyle so they can chart the likelihood of a fire, flood, fall, death, automobile accident or an unexpected natural disaster like an earthquake.
Living in a flood plain? Either you are denied insurance altogether or have to pay a higher cost. If you are a male over 55 years old who smokes, you are looking at double digit or more premium costs compared to females under 55 with no smoking history.
We live our lives hoping to avoid trauma or harm to ourselves or others and by buying insurance to minimize our losses if we suffer personal or property damage. But, sometimes our best laid plans are not good enough.
Recently, while away on a trip, my wife and I experienced a busted pipe. Because it went undiscovered for a while, it resulted in 18 inches of water in the room below the leak and caused the wrecking of several rooms along with damage to the flooring, furniture and personal belongings. What a mess!
We have subsequently warned our children and acquaintances what we now know so they can prevent what we went through and avoid the same mistake we made. We now warn everyone about what we learned. Our experience gives us some street credit and believability.
But sometimes the perceived danger of a worrisome future event that causes anxiety is not so catastrophic. Some of my therapy clients and those I evaluate as a forensic are consumed with the more mundane everyday events that don’t even raise an eyebrow for others.
Neatniks and perfectionism
Some examples of perfectionism include straightening items on a desk, arranging and rearranging items in a closet so the colors match, or being sure that the temperature setting is an odd number (69 versus 70 or 71 versus 72). One police officer I saw after a traumatic collision in which he was the injured party was so consumed with having to touch the back of a chair three times before walking past it, and having to arrange his clothing the evening before, along with arranging a backup outfit, struggled when he had to leave his home. Now that’s an extreme!
Movie and television examples
Do you remember the movie with Jack Nicholson and Helen Hunt in “As Good As It Gets?” Or the television series with Tony Shalhoub, as “Monk?” Both were excellent examples of persons troubled with Obsessive Compulsive Disorder (OCD) issues. Both were comedic examples, but there is nothing funny about OCD.
As a therapist I ask through Sophoclean questioning, “have you thought through the steps you’re taking and the likelihood of anything truly catastrophic happening if you didn’t adjust the dial or not take the extra steps to allay your anxiety?”
As a forensic, I ask if the plaintiff has always had the same thinking, feeling or behavior or did the accident change their way of dealing with the anxiety that they are now struggling with in their life post injury?
One percent to three percent
OCD is an anxiety disorder, and it can come about due to a personality disorder or as a result of trauma. It occurs in 1 percent to 3 percent of the population and 2.3% in veterans.
OCD, according to the Baylor College of Medicine blog and in keeping with the American Psychiatric Association 2013 Diagnostic Statistical Manual, Fifth Edition, TR, is defined in part as:
- The presence of obsessions and compulsions. It’s different from perfectionism, because perfectionism does not have at its core an accompanying level of anxiety or fear of catastrophe if the outcome is not perfect.
Obsessions are thoughts or images, while compulsions are the behaviors or actions taken to control the thoughts or images. Compulsions are the behaviors those persons with OCD use to quell their anxiety.
Shelia Cavanaugh says OCD is…“like having mental hiccups. Mostly we can function despite the hiccups but we’re exhausted attempting to carry on as if they didn’t exist.”
- The presence of obsessions, or the recurrent, intrusive thoughts or images which are unwanted, are a part of the symptoms and which the individual attempts to avoid. After a tragic fire (the plaintiff, who I’ll call Zak, but that’s not his real name) was literally consumed with anxiety around fire. Zak even imagined that plugging in an appliance cord into a wall outlet would set fire to his house, because seeing the electricity in the form of a spark when plugging in anything reminded him of the fire which burned 34% of his body. Zak never had such a fear before his injury, but his trauma caused his OCD reaction and he refused to plug in anything in his home for years after his trauma.
- Those who experience OCD have urges to perform mental or behavioral rituals in response to their thoughts (obsessions) to neutralize their anxieties. Sports figures and entertainment performers are notorious for superstitious behaviors (kissing religious symbols, touching their head gear, wearing certain clothing repeatedly). While similar to OCD compulsions, superstitious behaviors are situationally motivated (OCD symptoms can generalize and expand to multiple situations) but superstitious behaviors are typically focused on a specific event, e.g., hitting a home run or an entertainer overcoming performance anxiety by wearing a favorite good luck charm because they magically believe they can only overcome their anxiety with their special apparel and the superstitious behavior does not otherwise interfere with the sports figure or entertainer’s everyday activities (when not at the ball park or on stage singing).
- Obsessions and compulsions for the person with OCD (not the superstitious or the perfectionist) will take more than an hour of their day and cause clinically significant distress (for example, not being able to leave their home or their behaviors take on such bizarre rituals they become too socially embarrassed, and they refuse to be in public situations).
Howie Mandel’s public disclosure
Howie Mandel, comedian and the TV game show host on “Deal or No Deal,” advertises his OCD in an advertisement and seems genuine about his concern. He promotes NODC, of which he is a financial partner.
David Beckham says “I think everyone has a bit of OCD in them. It’s just a matter of degree.”
Persons with OCD rarely have one symptom. Not unusually, they fall into the same category, that is straightening, organizing, pairing, grouping specific numbers of items together, or items have to have symmetry to name a few (lines have to be straight, pictures or blinds have to be at the same level, objects the person sees as going together have to be next to each other such as colors or shirts or dresses have to be “squared off” and not randomly put together).
David Beckham is an international soccer star and admits to several OCD symptoms. He too has multiple symptoms including needing to keep items in a straight line, pairing items and organizing them by color and type. He also has three identical refrigerators, one for salad, one for drinks and one for other foods. The storage in the refrigerators have to be symmetrically aligned and there has to be a specific grouping of even-numbered items.
OCD is different from obsession compulsive. Everyone can have their own preferences for cleanliness and orderliness. A person with OCD is one who has anxiety when the cleanliness and orderliness becomes dysfunctional and interrupts one or more hours of their day. Obsessive compulsive but without rigidity and without spending an hour or more each day on dealing with the symptoms is not considered to have (the “D”) a disorder.
OCD is treatable. Medication can help along with cognitive behavior therapy as administered by a therapist has been found to be a good intervention strategy combination to treat the condition.
Persons with OCD are focused on future negative outcomes. They have thoughts that are disruptive because the thoughts can be triggered out of their control or prompting and can be morbid. The morbidity and repetitiveness can be so disruptive they cannot otherwise concentrate. The person tries what they can to stop the thoughts and that’s where the compulsive behavior comes into play. The person may have tried a particular series of behaviors, like stepping over a sidewalk crack, or tapping three times or placing a key in a lock and removing it and then putting it back in again because they have succeeded in interrupting their thoughts in the past and they magically believe their behavior can prevent their imagined dire events from happening. Unfortunately, the behavior doesn’t stop the obsessional thought altogether and new routines have to be added. As time goes on their rules for relieving themselves of the thoughts become stricter and their patterns of behavior become more demanding.
Persons with OCD avoid public exposure or where their compulsions are triggered. When a person has OCD there is hope. The International OCD Foundation is one such resource for those in need.
Be well. Stay safe.
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