Up Close With Dr. E

Understanding obsessive compulsive disorder


In this column, you will read about the lives of three people who have obsessive-compulsive disorder. As you learn about their struggles, ask yourself these questions: Why do people hide their OCD? What would it be like to live their lives?

Rob, 32, is a pharmacy technician who has earned a reputation as the “go-to-guy.” He is 100% accurate with every prescription he fills. He never fails to return phone calls, answer customer questions, and he stays up-to-date on all new medications. During work breaks, he goes to the bathroom, where he washes his hands, over and over, to the point where his hands are chapped and bleeding. No one knows about his obsessive hand washing; Rob makes sure it is a well-kept secret. Because he never leaves work on time ­— every little job must be done perfectly — his wife has stopped planning dinners. At home, he insists on having all items of his laundry folded, in a precise and rigid way. If his wife fails to follow any of his ordering and arranging, Rob blows up, but quickly feels enormous shame, and tells her: “You never would have married me if you knew that I was like this.”

Elizabeth, 17, has a goal to be her class valedictorian, so she studies seven days a week. While taking a final exam in chemistry, she became faint and went to the school nurse. The nurse took her temperature, which was 102 degrees, and she was sent home. At home, Elizabeth begins to worry — “Will I get an A in chemistry?” She insists that her mother call the teacher, which her mother does. Even with repeated reassurance from her parents and her teacher, Elizabeth is unable to stop her obsessive worrying. That night, she tells her mother, “I have a brain tumor and I need to go to the hospital.” Elizabeth’s mother, after two days of intense pressure, has her daughter evaluated at the hospital for a brain tumor. Nothing is found in the medical evaluation. However, Elizabeth insists that she has an “undetected illness and cannot go back to school.”

Thomas is a fifth grade student who cannot leave home without performing this ritual: six taps (left hand on left leg), six taps (right hand on right leg), three taps (left foot on floor), three taps (right foot on floor). He does this secretly, in his bedroom with the door shut. At school, while performing the same behavioral pattern, two classmates observe him tapping. They nickname him “Tommy Tapper” and start to taunt him. Thomas’ tapping worsens, to the point where he cannot enter or leave a classroom unless he has performed his tapping ritual. One day, while in the school library, the two boys start in on Thomas. Thomas, unable to take it anymore, explodes and breaks down crying.

OCD, once thought to be caused by inner psychological conflicts, now is viewed as a biologically based brain disorder, involving genetic vulnerabilities. Television shows such as “Monk” and “Obsessed” have, for the first time, begun to openly discuss OCD. However, in my 20 years of treating OCD in children, adolescents and adults, it is clear to me that old ideas rooted in false beliefs about OCD persist.

One false belief is that OCD does not cause suffering. People with OCD suffer on three levels. First, the disorder itself eats away at daily life by consuming the person with out-of-control thoughts and obsessions (fears of contamination by toxins or germs; fears of deadly illness; needing to be perfect). Obsessions drive compulsions (cleaning, checking locks, hoarding all paper, tapping and excessive bathing, grooming or hand washing) which take over their life. Second, OCD patients have an additional diagnosis: clinical depression. Like a steel wrecking ball, hitting the basic structure of one’s life, OCD destroys one’s most precious assets — peace of mind, enjoyment of life, and the ability to rest and relax. Third, OCD is still viewed as a sign of moral inferiority — only bad people get OCD. This keeps OCD sufferers from being open about their symptoms, and seals in their shame.

A final false belief about OCD is that treatments do not work. This belief removes the last shred of hope held by OCD sufferers: Someday, I will be free of this horrible disorder. The reality is that modern treatments for OCD can be highly effective.

The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.


Dr. Richard Elghammer contributes his column each week to the Journal Review.