You arrive on scene of a single vehicle injury accident; paramedics are en route. A young man is outside a car that is wrapped around a tree. His clothes are bloody and he has a large laceration across his forehead. He is the only victim. He is clearly agitated; pacing, wringing his hands and is counting to seven over and over again. As you try to redirect him away from the smoking car his agitation increases and he begins screaming about the blood and the germs and tells you to back away….
Your partner is driving you crazy. Every time you leave the car he remotely locks and unlocks the doors repeatedly. In the car, everything has its place. Deviation of more than ¼” results in a readjustment. He dusts his perfectly polished shoes after every call. He wouldn’t be caught dead without gloves. Yet, his attention to detail makes him one of the best cops on the watch.
Obsessive compulsive disorder (OCD) is characterized by a subject's obsessive and repetitive intrusive thoughts followed by related compulsions (tasks or rituals) which attempt to neutralize the obsessions. It is one of several forms of an anxiety disorder. OCD symptoms cause anguish, take up a lot of time (more than an hour a day), or significantly interfere with the person's work, social life, or relationships. Unlike other compulsive behaviors (drinking or gambling) OCD compulsions do not give the person pleasure.
Most people are at least a little OCD. However, as you look at the symptoms of OCD, you need to evaluate degrees of severity. Only 2½ percent of the U.S. population has true OCD, the lifetime prevalence of the disorder is 5%. Many more people demonstrate obsessive compulsive traits. Under most circumstances, those traits will not interfere with a person's life the way that an obsessive compulsive disorder does. However, having these traits is considered as risk factors for developing the disorder.
Can you leave your home without it being totally tidy? Do you crave reassurance? Do you find yourself rechecking things? Do you re-read/re-write your reports many times? How about repeatedly counting in your head? Do you have excessive superstitions? How far out of your way do you go to avoid walking under a ladder? Do you have lucky socks or a lucky color or number you repetitively wear or play? These all could be symptoms of obsessive compulsive disorder.
OCD typically begins during adolescence or early childhood and effects men and women equally. It is a brain disorder, a medical disease that causes problems in information processing. On average, people with OCD see 3-4 doctors and spend over 9 years seeking treatment before they receive a correct diagnosis. Sufferers are generally of above-average intelligence, as the very nature of the disorder necessitates complicated thinking patterns.
The OCD Process and Diagnosis
Obsessions are recurrent and persistent thoughts, impulses, or images that cause marked anxiety or distress, which is not related to real-life problems. The sufferer attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. Compulsions are repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation. The person recognizes that the obsessive thoughts, impulses, or images are a product of his or her own mind, and the sufferer realizes that his/her obsessions or compulsions are unreasonable or excessive. The obsessions or compulsions must be time-consuming (taking up more than one hour per day) to be diagnosed as OCD. Additionally, it must cause distress or impairment in social, occupational, or school functioning.
Contamination Obsessions are obsessive concern with dirt or germs:
- environmental contaminants
- bodily waste or secretions
- fear of blood
- fear of eating certain foods
- bothered by sticky substances or residues
Symmetry, Order, Exactness and "Just Right" Obsessions:
- item placement
- fear of saying the wrong thing or not saying it "just right"
- need to know or remember
Safety, Harm and Violent Obsessions
- fear of harm to self or others due to carelessness or on impulse
- fear of being responsible for terrible events
- fear of blurting out obscenities or insults
- fear of doing something else embarrassing
- fear of violent or horrific images
- need to hoard or save things
- fear of losing objects, information, people, something symbolic
Other common obsessions include
- pathological doubting or indecisiveness
- excessive concern with functioning of, or injury, to a body part
- colors/numbers with special significance
- superstitious fears
- lucky or unlucky numbers, colors, or clothing
- intrusive/meaningless thoughts/images or nonsense sounds, words or music.
Compulsive thoughts or behaviors are carried out to reduce the anxiety of the person's obsessions. Common compulsions include:
- excessive grooming/cleaning
- saving, collecting or hoarding
- touching, tapping or rubbing certain objects repeatedly
- repetition of special words or images mentally
- special prayers
- mental counting
- excessive list making
- excessive reviewing
- blinking or staring rituals
- excessive checking of drawers, door locks and appliances to be sure they are shut, locked or turned off
- repetition of normal activities, such as going in and out of a door, sitting down and getting up from a chair
- ordering and arranging items in certain ways
- seeking constant reassurance and approval
- needing to confess
- excessive rereading or rewriting
- superstitious behaviors
- ritualized eating behaviors
- excessive checking oneself for signs of a catastrophic disease
Some people with the disorder still maintain successful careers and relationships as many find ways to hide or suppress their obsessive-compulsive behavior related to feelings of shame/embarrassment. The list of celebrities with this disorder is impressive: Ludwig von Beethoven, Jose Conseco, Winston Churchill, Francis Ford Coppola, Carrie Fisher, Margot Kidder, J.P. Morgan, Axl Rose, Cole Porter, Roseanne Barr, Michelangelo, Stanley Kubrick, Harrison Ford, Billy Bob Thornton, Warren Zevon, Kathie Lee Gifford, Howard Stern, Cameron Diaz, Albert Einstein, Charlie Sheen and Michael Jackson. Donald Trump is terrified of germs. He refuses to touch the ground floor button of a lift and avoids shaking hands with people--especially teachers. He is quoted as saying, "I'm going to do everything in my power not to shake hands with teachers. They have 17,000 germs per square inch on their desk. That's ten times the germ rate of those in other professions”. David Beckham is obsessed with symmetry, if there's three of something; he has to hide the third somewhere out of sight.
Treatment for OCD involves a combination of psychopharmacology and behavioral therapy. A type of behavioral therapy known as "exposure and response prevention" has been proven very effective in treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety. Medication treatments include selective serotonin reuptake inhibitors (SSRIs), such as Paxil and Luvox, as well as tricyclic antidepressants. Deep brain stimulation (through electrodes in a pacemaker like set-up) is used in severe cases who have not responded to traditional treatments.
Tips for Law Enforcement Officers on Scene
Crisis situations are obviously much more overwhelming for anyone who suffers with OCD.
- Make contact face to face.
- Use a soft, gentle approach.
- Treat the sufferer with respect, patience, and dignity.
- Remain calm and factual but caring and supportive.
- Evaluate the situation for individual safety and the safety of dependents
- Evaluate the need for paramedic response.
- Go slowly and expect gradual changes.
- Reassure the person that others will try to help and work with him/her.
- Attempt to involve family or close friends.
- Work with other agencies to maximize resources.
- Make appropriate referrals to CPS or APS as deemed relevant
- Evaluate for voluntary or involuntary psychiatric admission. Does the individual present as a danger to themselves or others? Is the individual to provide for his or her basic personal needs for food, clothing or shelter?
- Provide Hotline Numbers: OCD Hotline: 1-800NEWS4OCD (1-800-639-7462)
Anxiety Hotline: 1-888-ANXIETY (1-888-269-4389)
Obsessive Compulsive Disorder/Traits--Self Test
Answer: Yes, Often, Sometimes, Never
- I have upsetting thoughts or images enter my mind again and again.
- I feel like I can't stop these thoughts or images, even though I want to.
- I have things I have to do excessively or thoughts I must think repeatedly to feel comfortable
- I have a hard time stopping myself from doing things again and again, (counting, checking on things).
- I wash myself or things around me excessively.
- I repeat things many times to make sure they are done properly.
- I rearrange objects excessively; things have to be in a certain order.
- I feel like my home, car, wardrobe has to have symmetry.
- I redo things often until it feels right.
- I avoid situations or people because I am worried about hurting them by word or actions.
- I keep useless items because I feel I can't throw them away
- I am excessively afraid of losing important objects.
- I make excessive mental or written lists.
- I am excessively concerned about germs and diseases.
- I check myself frequently for evidence of illness.
- I worry a lot about terrible things that could happen if I'm not careful.
- I have unwanted urges to hurt someone but know I never would. .
- Certain numbers, colors, clothes are extremely important to me related to luck or unluckiness.
- I have rituals about eating, dressing, cleaning, eye contact.
- I have superstitious beliefs that I must act on.
- I need constant reassurance.
- I experience intrusive music, sounds, nonsense words.
- I repeat activities like going in and out of a door numerous times.
- I have an excessive fear that blood or other human secretions, animals or insects will contaminate me.
- I always feel like I have to get things off my chest, confess.
Do any of these apply to you? More than one? How many? Sorry, there is no magical scoring. These are the signs and symptoms of OCD. The question is: how do the obsessive thoughts and compulsive responses affect your ability to function professionally, socially, or in a relationship? If you worry you may have OCD, you at least have the traits. If the OCD process takes more than an hour of your day, is embarrassing or uncomfortable to do, or negatively affects aspects of your life remember that treatment is available, and that you are not alone.