Monthly Archives: February 2016

Feb 18 2016

Obsessive Compulsive Disorder and Obsessive Compulsive Personality Disorder

monk

 

Most of you have probably seen a character on tv who suffers from obsessive-compulsive disorder. Baby boomers can refer to The Odd Couple and the character of Felix Unger. You younger folks have probably seen Monk and its iconic character Adrian Monk. Just how well these shows depicted this disorder is complicated. First off, we need to distinguish between Obsessive-Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD).

N.B.: I just realized that a new The Odd Couple has been shown on CBS. I didn’t see it, so I can’t make any comment.

felixunger

 

Obsessive-Compulsive Disorder (OCD)

According to the National Institute of Mental Health, OCD is a chronic and long-lasting disorder that involves uncontrollable recurring thoughts (obsessions) and behaviors (compulsions). The sufferer feels compelled to repeat these thoughts and behaviors again and again, even though he/she realizes they are absurd. Typical obsessions include:

  • Fear of germs
  • Having things in symmetrical or perfect order
  • Fear of dirt
  • Superstitious ideas about lucky or unlucky numbers

You can find more here.

Compulsions are repetitive behaviors the person with OCD does in response to the obsessive thoughts. So the above obsessions could lead to:

  • Excessive hand washing
  • Ordering or arranging things in a specific, precise way
  • Excessive cleaning
  • Compulsive counting

Part of the definition for OCD is that the behaviors and/or thoughts take up at least an hour out of the day and that they cause significant problems in daily life. The person with OCD can’t control these thoughts and behaviors despite awareness that they are excessive. It’s also important to remember that the person with OCD doesn’t get pleasure out of these thoughts and behaviors, although they might feel some relief from anxiety when they have performed the compulsive behavior.

The onset of OCD  is often in childhood or early adulthood, usually before the age of 25. Symptoms typically wax and wane.

Treatments include both medications and therapy. Medications often used include selective serotonin reuptake inhibitors (SSRIs) like Prozac, Paxil and Zoloft. Sometimes atypical antipsychotics like Risperdal or Abilify are used. Cognitive Behavioral therapy (CBT) is often used in the treatment of OCD. The prognosis is good, particularly for children and adolescents.


Obsessive Compulsive Personality Disorder (OCPD)

While Obsessive Compulsive Personality Disorder (OCPD) shares some features with OCD, it is different. The person with OCD finds their thoughts and behaviors unwanted, while the person with OCPD believes their thoughts and behaviors are correct. These individuals are preoccupied with

  • Rules
  • Orderliness
  • Control

It typically begins in the teen years or early 20s, somewhat later than seen with OCD.

People with OCPD can become quite upset when others try to interfere with their rigid routines. Often anger is not expressed directly and may instead express anxiety or frustrations, feelings that they believe are more appropriate.

The key is a need to be perfect, but it is this perfectionism that often leads the person to fail to complete tasks. Emotional closeness is difficult, since the person with OCPD often feels a lack of control in intimate relationships. Flexibility is not to be found in this individual. According to MedLine Plus, other signs of OCPD include:

  • Over-devotion to work
  • Not being able to throw things away, even when the objects have no value
  • Lack of flexibility
  • Lack of generosity
  • Not wanting to allow other people to do things
  • Not willing to show affection
  • Preoccupation with details, rules, and lists

Treatment often involves either psychotherapy or medications or both. The prognosis is fair.

 

TV Portrayals

So, what have the writers of Monk and The Odd Couple gotten right and what have they gotten wrong? Let’s look first at Adrian Monk. (Please note that I’m getting a lot of my information about the show from Wikipedia.) First off, many of the funny behaviors Monk displays are the result not of OCD or OCPD, but of his multiple phobias. It is true, however, that some of the phobias may actually be more like obsessions. The backstory here is that Monk developed his psychological problems after his wife was killed. Thus, the age of onset is somewhat out of limits for either OCD or OCPD. The dramatic precipitant is also quite unusual for these disorders. The episode in which Monk takes a “new” medication and is instantly “cured” in more than a little problematic. As noted on Health24.com, Monk’s multitude of symptoms are not typical and smack of excessiveness. OCD is hard enough to live with. The authors, however, do point out that the show raised awareness and treated Monk sympathetically, so there are some redeeming factors here.

Turning now to The Odd Couple’s Felix Unger, we see a man obsessed with neatness and order, who is also a hypochondriac. He doesn’t seem to enjoy much in life and his marriage is in shambles due to his behavior. The preoccupation with cleanliness and order sounds a lot like OCPD. The strained interpersonal relationships is quite consistent with this disorder. This portrayal is much more understated than Monk and comes across as more realistic. The movie came out in 1968, long before the current definition of either OCD or OCPD.

 

The OCD/OCPD Character

If you chose to include a character with OCD/OCPD in your story, go for it. These disorders can provide a lot of conflict and difficulties for your story. You don’t need to restrict these disorders to secondary characters either. They could provide excellent “flaws” for your protagonist. In the tv show Monk, the titular character’s OCD/OCPD is supposed to help him see details that others miss. At the same time, it complicates his solving the crimes due to the impact of his illnesses on daily functioning. We can also look to Felix Unger to see how OCD/OCPD can impact interpersonal relationships.

What about giving your antagonist OCD/OCPD? Handled well, this could provide some sympathy for the antagonist. If the antagonist has OCD, he/she is aware his/her behavior is excessive but can’t seem to stop. If the antagonist has OCPD, he/she would believe that his/her behavior is appropriate and right. Either way, these disorders can give quite a bit of dimension to your character.

My advice is to avoid the excessiveness seen in Adrian Monk. OCD and OCPD are fertile grounds for character features and don’t need to be overdone.

 

 

 

References:

Everyday Health: http://www.everydayhealth.com/anxiety-disorders/experts-common- obessions-and-compulsions.aspx

MedLine Plus: https://www.nlm.nih.gov/medlineplus/ency/article/000942.htm

National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/obsessive- compulsive-disorder-ocd/index.shtml

Ilse Pauw (Clinical psychologist) and Olivia Rose-Innes, Health24, November 2005,             http://www.health24.com/Mental-Health/Disorders/Monks-OCD-Fact-or-fiction- 20120721

Stanford University: http://ocd.stanford.edu/about/

Wikipedia: Monk (TV Series) https://en.wikipedia.org/wiki/Monk_%28TV_series%29

 

 

 

 

 

Feb 11 2016

I’m Back: Psychotic vs Psychopathic

I’m back. I know it’s been a long time since I’ve posted anything, but often life intervenes in ways we don’t always anticipate.

I’d like to talk today about the difference between “psychotic” and “psychopathic.” Trust me, there’s a vast difference. In the media, however, the two are often used interchangeably. They’re not. Let’s take a look at the differences.

 

Psychotic

 

This is a term used that refers to someone who is suffering from a serious mental illness such as schizophrenia or other such disorders. It implies that the sufferer has lost touch with reality and is experiencing delusions and/or hallucinations. According to MedLine Plus: (https://www.nlm.nih.gov/medlineplus/psychoticdisorders.html)

            Psychotic disorders are severe mental disorders that cause abnormal thinking and  perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages.  Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there.

 

Psychopathic

 

This term refers to someone who has a serious personality disorder often referred to as Antisocial Personality Disorder. According to Psychology Today (https://www.psychologytoday.com/basics/psychopathy) , psychopaths often appear almost normal.

            Psychopathy is among the most difficult disorders to spot. The psychopath can appear normal, even charming. Underneath, they lack conscience and empathy, making them   manipulative, volatile and often (but by no means always) criminal. They are an object of  popular fascination and clinical anguish: adult psychopathy is largely impervious to treatment, though programs are in place to treat callous, unemotional youth in hopes of preventing them from maturing into psychopaths.

 

Psychotic vs Psychopathic

 

As you can see, they really are different. It is true that the psychopath will often display some disordered thinking, usually narcissistic. We can also see disordered thinking in the fantasies held by psychopathic serial killers. Most professionals would agree that these fantasies don’t quite reach the criteria to be called delusions. (I know, that sounds like hair splitting and it may just be so.)

One important distinction for you crime writers out there: psychotic killers are usually “disorganized” while the psychopathic is more often “organized.” Psychotic killers are going to have a much more difficult time planning out “the perfect crime.” Not to say they can’t do some pretty extensive planning. They can. The mass murder at the Aurora, CO, movie theater involved multiple weapons, tear gas, and tactical clothing, to say nothing of the explosives rigged in the shooter’s home. That all sounds pretty organized, doesn’t it? Still, Holmes was caught in the parking lot, waiting around and watching the chaos. That doesn’t sound very logical or organized.

 

On the other hand, let’s look at the Ted Bundy, the quintessential psychopathic serial killer. He operated during the 1970s and is often described as charming and manipulative. He cared nothing for his victims and totally lacked empathy or remorse. Towards the end, he did become less organized which led to his capture and trial. At no time, however, did Bundy evidence anything like delusions or hallucinations. From what I’ve read, he maintained his manipulative behavior right up to the end.

 

Takeaway

 

What’s the bottom line here?

*   A Psychotic and a Psychopath are NOT the same.

Yes, you can have a character making the error, but I ask you, please have another character correct the error. I don’t think any one of us wants to perpetuate false information. You can use the distinction to further your story’s search for a killer (assuming you’re writing a mystery or thriller).

 

Suggested Assignments

 

  1. Develop a dialog in which one character corrects another for believing psychotic and psychopathic are the same.

 

  1. Develop a character who is either psychotic or psychopathic. Show the character in a brief vignette.

 

Feel free to ask any questions you might have. I’d be happy to help.