How Psychology Can Make You A Better Boss

I reconnected this week with Dr. Elana Miller, MD, the Zen Psychiatrist. We have not met in person, but I initially found Elana while doing research for two of my prior articles, including one of my all time favorites, How Mental Illness Makes Some Executives Stronger. Many people have reached out since the initial appearance of that article. I love the way her mind thinks and her positive approach to psychology in the workplace.

To that end, Elana offered me her thoughts on the ways business people can become better by understanding the psychology of their employees’ personalities a little bit more. Must business owners and managers be psychologists to effectively lead? No—but a solid understanding certainly can’t hurt. In fact at least several of the most successful business leaders I know (including contributor Alan Hall) have earned undergraduate degrees in psychology before earning their business degrees. I’d be interested in hearing the opinions of others on this interesting trend. Meanwhile, Elana shared with me her thoughts on how we could all become better leaders and bosses by understanding a little more clearly the personality traits of our employees.

Why is understanding the personality traits of employees so important?

Elana: It’s possible to be a competent boss without understanding personality dynamics, but a little knowledge can go a long way in making you a more effective leader, and helping you to manage the interpersonal problems that inevitably come up in a more effective way. Different people are motivated by different rewards, and by understanding a person’s internal motivations you can better encourage them to do their best work.

Can you give me an example?

Elana: Each individual is unique, but certain personality traits do tend to predict certain behaviors. Let’s take the “perfectionistic” or “obsessive-compulsive” type. Many people who have achieved a high level of success in their work have obsessive or perfectionistic tendencies, because qualities such as discipline, self-control, and reliability are rewarded in our society.

Certain problems emerge for this personality type. Because they have such high standards for themselves and don’t tolerate errors well, they may have difficulty hearing negative feedback. They may procrastinate projects and miss deadlines because their standards are so high that nothing ever seems good enough. They may become rigid or moralistic if they feel they’re being treated unfairly.

How could an employer manage an obsessive or perfectionistic person better?

Dr. Elana Miller, MD (image courtesy of ZenPsychiatry.com)

Elana: The most important thing to remember is that these people can be your best asset. They want to perform at a high level and exceed your expectations. Their own expectations are probably higher than yours. They don’t want special treatment, but they expect to be fairly acknowledged and rewarded for their performance.

First, be careful about how you give feedback. These people will have a tendency to hear your feedback as criticism. They will be sensitive to any suggestion that they have let you down, even if that’s not what you intended to say.

Instead of saying, “Hey Susan, you forgot to include last week’s numbers on the report, make sure to include them next time,” say, “Hey Susan, great job on the report. Do you think next time you could include the most recent numbers? I don’t think I was clear about that before, so don’t worry that it was missing from this report. Your work has been excellent.” Take responsibility if you could be the cause of any miscommunication about expectations.

Second, if you have a problem with a perfectionistic employee who is always procrastinating, understand that it’s not coming from laziness, but rather difficulty with overly high standards. Sit down with your employee and set clear guidelines about what your expectations are, so they don’t waste time doing things that aren’t important to you. Tell them exactly where it’s okay to cut corners.

Third, let these people take on your biggest problems. There is perhaps no better person to delegate a big, logistical problem to than a perfectionist. They will worry about the problem more than you, and be very motivated to fix it. When they do, make sure to reward their efforts fairly.

What’s another personality type employers should be on the lookout for?

Elana: Another personality type to be aware of is the person with narcissistic traits. These people are, unfortunately, often the source of much of the interpersonal conflict that occurs in a workplace. They are the individuals who are arrogant, entitled, and competitive with their peers. They make sure to point out how special and superior they think they are at any opportunity. They can be manipulative and exploitative if they think it will help them get ahead. They can evoke annoyance, defensiveness, anxiety, and errors in judgment in people who work with them.

How should a boss handle this type of person?

Elana:  First, if you have a narcissistic employee who’s causing a lot of problems, you have to ask yourself, do I really need this person? Are they providing an absolutely necessary function to the company? Can they be replaced? It is unlikely you can say or do anything to stop their bad behavior. If they get the sense they’re in trouble, they might just get better at hiding it from you, but they will likely continue to frustrate and demoralize their coworkers. That is a bad situation for company morale.

Second, if firing is not an option, you have to learn to manage them. Understand that they may be frustrating a lot of people around them, so you will need to manage the conflict. Empathize with your employees who get caught in the tornado.

Most importantly, don’t let yourself get manipulated. Narcissistic people have two primary ways of dealing with conflict and getting what they want. 1) They become hostile and aggressive (more likely with coworkers), or 2) They flatter, trying to make you feel like you’re inside their special circle (more likely with you, their boss).

On the other hand, to get the narcissistic person to do their work you might need to engage in a little manipulation yourself. Say, “Look Andrew, you’re the only person I can trust with something like this, I just don’t feel anyone else can get this job done as well as you can.” You can play off their need to feel special to help them perform at a higher level.

What about those employees who always say they’re working on something, but never seem to get anything done? And when you try to talk to them directly about what’s going on, they get resistant or make excuses?

Elana: I would describe that as a “passive-aggressive” personality structure. This term is commonly misused, and does not mean someone who says one thing but means another, but rather someone who is resistant to authority in an indirect way. These people don’t deal with conflict directly. If they feel you’re giving them too much work, they won’t say it, but rather will procrastinate deliberately and dodge your calls and emails. If they don’t like going to meetings, they’ll show up chronically late, but not so late that they think you’ll say anything. The more you try to manage them, the more they passively resist. They might not even be aware they’re doing this; it’s a defense mechanism that operates on a subconscious level.

Yikes! I’ve seen a few of these – thankfully, though, in the past. How should an employer handle a passive-aggressive person?

Elana: The important thing to understand is that passive aggressiveness comes from an underlying core belief that to listen to authority is to be controlled. They resist because they are afraid of losing their independence. So it is important to avoid power struggles with these employees. Don’t micromanage them. The more you micromanage, the more they resist.

Instead, let them be in control as much as is feasible. Give them a problem and ask them to solve it without dictating exactly how. Give them a list of projects you need done and let them choose which one to tackle. Don’t obsess over punctuality if the person is getting all of their work done.

What if even with these techniques, a boss still can’t get their employee to do their work?

Elana: Then you’ve got a problem. Again, you need to ask yourself, do I need this person? Are they helping the work environment more than hurting it?

What about people who are “antisocial,” and don’t interact much with other employees?

Elana: I would actually use the term “socially avoidant” instead of antisocial, which in psychiatry refers to a whole other type of person (think your common sociopath). People are typically socially avoidant for three primary reasons. 1) They’re introverted, and too much social interaction drains them. 2) They’re socially anxious, and are so fearful of saying or doing the wrong thing and being judged that they avoid socializing altogether. 3) They’re disinterested in social interaction, and prefer to be alone.

In any of these cases, it is counterproductive to your goal of getting the best work out of your employees to force these people to socialize more. Don’t make them come to meetings where their presence is not crucial. Don’t require that they participate in company picnics and the like. Don’t put them in an open cubicle where there are always other people buzzing about.

Anytime a socially avoidant person is in a crowded environment, their energy is being drained, and their anxiety response is being activated. And anxiety is completely counterproductive to creative, focused work. If you want the best work out of these employees, leave them alone, and avoid interrupting them. If you need to check in, do it at pre-planned intervals (“I’m going to swing by at 4pm after my meeting to see how things are going”) so the person has time to mentally prepare.

Any final takeaways?

Elana: As a boss, you need to increase your abilities to work with an employee’s personality traits, not against them. And keep in mind, if an individual’s bad behavior is causing ongoing problems, let go of any illusion that you can change them. As someone who has worked in therapy with many people referred by supervisors because of work-related conflicts, I can tell you that change in personality traits comes very, very slowly, and only in the most motivated people. You need to decide if you can work with someone’s personality, or if you can’t.

Cheryl: Interesting strategies, Elana. In a future article I may be interested in discussing the appropriate and productive ways to identify challenging personality traits of prospective hires in advance. I welcome insights in the comment section of the strategies other leaders have used with success.

Additional reporting for this article was provided by Elana Miller, MD, a psychiatrist who writes at zenpsychiatry.com about integrating western medicine with eastern philosophy. Readers can reach Elana directly and find her newsletters here.

The 10 Most Common Workplace Anxiety Dreams

 

 

 

 

 

 

 

Pure OCD: a rude awakening

On a spring night when I was 15 the mental image of a naked child entered my head and the corners of my world folded in. I put down my cutlery. My throat was closing over. Dad sat across from me, 10,000 miles away, and Mum was hunting draughts at the window.

Stoned and smiling, my brother sat next to me, resting his elbows on teenage knees too high for the table. He looked sidelong at Mum and Dad to check they weren’t watching as he teased the dog with a tiny piece of meat. She patted a furry paw on his leg and let out a little squeak, and he looked at me for my surefire grin of complicity. I knew it was funny. It was definitely funny. But the giggles didn’t come, this time.

The image flickered again as he popped the lid of the ketchup bottle in and out, before shaking it and pouring a lake on to his plate. I picked some mashed broccoli seeds from the tablecloth as the image flashed brighter and my ribcage tightened – giant insect legs squeezing me for the first time. I rose and said, “Thank you for the meal.” The dog danced around my feet as I reached for the kitchen cupboard where we kept the leash.

The street was dark and cold, and the dog strained against the collar. Someone was burning bracken and the air was mossy. In the wood I couldn’t see my feet, just two iridescent eyes flashing between the trees. I turned the topsoil of my mind for an answer about what the image meant, but the possibilities made me dizzy, and I had to sit on a wall. Beyond the trees, the noise of distant traffic was the noise of everyone else, everywhere, and it frightened me.

The more I tried to stop thinking about the image, the quicker it flickered. I pulled my thighs up to my chest and pressed my eye sockets hard against my knees, breathing hard. When the dog licked my ankle I raised my head and gasped, as if breaking from water. I mouthed the words slowly to the dark, “What if I’m a paedo?” And with that question I was sucked inside my head, where I spent the next decade, fretting at the unanswerable like a fly on a lamp.

I have pure O, or pure OCD, a little-known type of obsessive-compulsive disorder. People with pure O experience repetitive thoughts, doubts and mental images about things such as sex, blasphemy and murder. Needless to say, I don’t feel too “pure” when I’ve woken every morning for a fortnight to the crystalline thought of assholes.

Purely obsessional OCD is so-called because the compulsions are largely invisible, and not often acted out in the more obvious, better-known ways such as cleaning or hand washing. Pretty much everything about pure O is secretive. These are things you’re not even supposed to think about, let alone talk about. How would a teenage boy tell his parents that he thought about having sex with his sister, a thousand times a day? What if you were a mother and you kept having thoughts about drowning your baby in the bath? Or a gay man who kept having thoughts about vaginas when you made love to your husband? How would you begin to talk about it? You’d keep it secret for years; for your whole life, perhaps.

This is why it’s difficult to say how many people have pure O. One estimate puts the figure at 1% of the global population, or 630,000 in the UK alone; but it could be significantly higher, as many people with the condition don’t even realise they have it. Why would they? If a boy was suddenly seized by repetitive thoughts about shagging his sister with, say, the narrow end of an avocado, would he automatically assume he had a neurotic disorder? How could he possibly know that messages were misfiring in his brain and preventing him from dismissing the kind of what-the-fuck thoughts most people shrug off without worry? He wouldn’t. He’d assume he had a deep-rooted personal problem.

In an effort to resolve it, he might Google the meaning behind his thoughts. He might deliberately conjure mental images of his sister while monitoring how he felt: aroused or repulsed? Excited or horrified? He might start ignoring her calls, or give up guacamole for ever. He might spend 10, 16, 20 hours a day in a spiral of rumination and problem solving, trying to figure out what the hell was happening to him.

He wouldn’t understand this yet, because he wouldn’t know that he had pure O, but all these attempts to rid himself of doubt and anxiety would merely be compulsions. And because he was so terrified of someone discovering his shameful obsession with incest (and avocados) he’d strive for normality. Even though the World Health Organisation considers OCD one of the top 10 most debilitating conditions in terms of quality of life, not a soul would know.

After my first panic attack on that spring night in the wood, my mind started spinning. Am I a paedophile? This was the big, pressing question of my adolescence, bigger than the Kickers-or-Pods question, bigger, even, than the Keanu-or-Leo question.

In a bid to answer it and purge the anxiety, I began to dissect my memory for clues about my identity. I analysed every pretend kiss and cuddle I’d had at sleepovers; when my friends and I had re-enacted Neighbours weddings, pressing our faces together and giggling at the “kiss the bride” bit. Or when we’d renamed Barbie and Ken as Fanny and Dick and made them “make babies” in a shoebox. All these filthy sparkles of a child’s imagination were twisted into something threatening, because they seemed to support my obsessive fears about my capacity for depravity.


Rose Bretécher
‘My friends and I were playing bingo and I started seeing images of their tits in my head.’ Photograph: Linda Brownlee for the Guardian

By the time I sat my GCSEs, the images and thoughts were flashing up like searchlights in my face, 24/7. During long exams, every second stroke of my pen marked the flicker of some forbidden obscenity in my brain. Sometimes I got up in the night and had five seconds of forgetfulness. But by the time I’d stepped blinking into the bathroom, the thoughts had always caught up. The next day there’d be teeth marks in the toilet roll where I’d stopped myself from screaming.

Church was the worst. There was the penitential rite, the confession and absolution. Mea culpa. My fault. There I was, every week, a child, saying the words and trembling: “I confess to almighty God, and to you, my brothers and sisters, that I have greatly sinned, in my thoughts and in my words”. I was at fault because God had said so. Barbie and Ken had been my fault, kiss-the-bride had been my fault. My thoughts, even, my unstoppable thoughts – they, too, were my fault.

So I’d lie in bed on Sunday nights murmuring that line over and over. I have greatly sinned in my thoughts; I have greatly sinned in my thoughts. And I’d slip into sleep on the damp pillow, trying to focus on the sound of my parents’ heavy sleepbreathing in the next room, or on the ceiling’s fluorescent stars; on anything that was outside of me.

I wasn’t always obsessed with paedophilia, though. As is common with OCD, the theme of my obsessions changed, and I was 17 when I first noticed the inexplicable new thoughts creeping in. My friends and I were playing bingo in the old Dudley hippodrome and I started seeing images of their tits in my head. I tried not to think about what I’d seen. But each time I pressed the soft ball of the red bingo marker on to the paper, I saw the images again; I couldn’t look up from the page.

Back at home that night, I sat down to watch the most innocuous TV programme I could find – Ray Mears – hoping to snatch a few minutes’ respite from the thoughts. But as the camera panned down across a cliff face, each crevice became a startlingly detailed vagina. I froze and spat a mouthful of crème caramel back into the plastic pot. “Am I gay?” I whispered.

Within minutes the question had taken on a pathological urgency, and I was scouring my memory for an answer. Peeking at the breastfeeding women outside nursery, all those years ago. Did that mean I was gay? Kiss-the-bride? From then on, every minute of every day, I wasn’t seeing naked children, I was seeing naked everyone, compelled to figure out which thoughts turned me on the most. The dinner lady or the headmaster? The lollipop lady or the policeman? Cherie Blair or Tony Blair?

I was meticulous. I’d buy Attitude and Diva, spread them out on my bed and sit there waiting for an answer to rise up from the centrefolds. At university in Leeds I would “try out” gayness some days, bouncing to campus like Pinocchio to school; other days I’d be unequivocally straight. I’d describe my gay thoughts to my friends and use their reactions to gauge the plausibility of my homosexuality. I’d browse profiles on lesbian dating sites, trying to imagine myself kissing each stranger’s face. I’d oscillate between these periods of intense immersion in sexual content and periods of avoidance, during which I wouldn’t watch TV or read the paper, to starve the sex out of my head, the anxiety from my chest.

And so went the next seven years of my life, or my “life”, I should say. Because when the pure O exploded, my life grew inverted commas and flew away. All that was left was an effigy of a young woman and a neon pink MySpace profile.

Sexual orientation doubts are common among straight and gay sufferers of pure O, and the obsession has an extra sting its tail. Because the mental anguish and experimentation involved so closely resemble a coming out process, they often get misinterpreted as such by sufferers, and by those around them. I certainly got stung, and the confusion was dizzying. I had no reason, moral or personal, to be afraid. I was ardently pro gay rights, and I always thought lesbianism was totally hot. So why was I so terrified?

I didn’t understand that I had the “doubting disease”, as OCD is otherwise known. I didn’t know that it was the uncertainty itself that was frightening, the possibility that I might never know my “true identity”. Neither did I understand that my soul-searching behaviour was actually making my thoughts worse. I was wholly ignorant of the bitter irony that in constantly seeking certainty, pure O-ers render themselves more uncertain. As OCD expert Dr Steven Phillipson writes in Thinking the Unthinkable, “The tremendous effort one puts into escaping the unwanted thoughts or preventing their recurrence (eg hiding knives), in effect, reinforces its importance to the non-conscious brain and, thereby, feeds the vicious cycle… Becoming upset over a thought places a mental marker on it and increases the likelihood of the thought recurring.”

I didn’t understand that the only way to treat pure O is to stop acting out compulsions and break the vicious cycle. So it spun ceaselessly under every moment, churning up jobs and relationships. On the first day of a placement at the BBC, I hid in the toilets because the whole news room had appeared to me naked. I split up with a boyfriend because every time I kissed him I saw the Ray Mears cliff face in his eyes. My memories of that time are Pure O memories.

By 20, I believed I was locked in an irrecoverable sexual identity crisis. I’d quit uni and was contemplating suicide daily. Embodying the rank irrationality at the heart of OCD, I would rather have died than lived indefinitely with the doubt. Then, one day, when I was Googling the meaning behind the comedically graphic sexual content in my dreams, I landed on a Wikipedia page about pure O, and, hardly able to breathe, gasped as I read my symptoms. Repetitive distressing thoughts? Check. Thoughts antithetical to desires? Check. Extreme anxiety? Inability to dismiss thoughts? Constant rumination? Check. Check. Check. This was it. The proof that I was neither a closet case nor a homophobe, that I’d never been a paedophile. I was just ill. I had a diagnosis!

I consumed the information voraciously. Pure O commonly starts between early adolescence and your mid-twenties. Pure O thoughts are referred to as “spikes” by the OCD community. Spikes: of course! They do spike. Pure O is often combined with major depression and other anxiety disorders. The condition is widely mistreated due to a lack of awareness and training in the medical profession.

After a few days I knew some bits of the Wikipedia article by heart, and started reciting them as rebuffs to my obsessions. Every time I had an intrusive thought I’d shout it down with the retort: “It’s not me, it’s my OCD.” My brain, finally convinced of the truth, would surely cease its indecision. For about a week I thought it had.


Rose Bretécher
‘I was a studious patient, diligently watching porn three times a day.’ Photograph: Linda Brownlee for the Guardian

But soon the thoughts and images flared up again, and the insect in my chest tightened its legs around me, tighter than before. Because no matter how much you reason with OCD, it always finds a loophole and redoubles its ferocity. Soon I was back online, reading the same articles for my next fix, until I once again reached a precarious sense of certainty about who I was.

Eventually I went to the doctor with my self-diagnosis. First I got referred for person-centred therapy, in which a counsellor tried to get me to come to terms with my latent homosexuality. Then I went for psychodynamic therapy, where I was diagnosed with pure O before being prompted to explore and analyse the route of my thoughts, à la Freud – effectively encouraging me to engage in compulsive soul searching. This was the wrong approach: analysis only made my obsessive thoughts more deeply entrenched.

Then, after a six-month wait, I received cognitive restructuring therapy, which used rationalisation to prove that my thoughts couldn’t be true, based on x, y, z evidence. While highly effective in the treatment of depression and some other anxiety disorders, cognitive restructuring of obsessive compulsive thoughts is woefully detrimental, for the cyclical rumination it encourages. You cannot out-logic OCD.

Sufferers of OCD will go for up to 10 years without effective treatment. I met a few in group therapy: a father terrified he might abuse his children, a young girl convinced she might burn the house down, a woman who thought she would run people over if she got behind the wheel. They shared my story: lifetimes of secrecy and ruinous therapy. Enter an online pure O forum and you’ll hear voices screaming as if from under ice, spewing their obsessions onto the page or offering kind-hearted but disastrous advice to others. Week on week, in this country and all over the world, misguided therapists are systematically making these individuals’ OCD worse.

After four years in Leeds, I moved to London. I met a boy and fell deeply in love. I drove across the world in a double-decker bus. I met Jake Gyllenhaal on a music video shoot and watched his face melt into a chubby vagina in my vision. I sat in the Melbourne mansion belonging to the founders of Lonely Planet, imagining them fucking across the patio. I nearly overdosed.

In truth, I owe much to Gyllenhaal’s vagina face, because the suicidal spiral it prompted was the necessary catalyst for my seeking private therapy. I chose an OCD specialist at a world-leading centre for the treatment of anxiety disorders in New York. Every Monday for a year I had a 45-minute session of exposure and response prevention (ERP) therapy on Skype, in which I was exposed to sexual images of gradually increasing explicitness. I had to let my thoughts wash over me unresisted, while my anxiety shouted and screamed and had me ripping my cuticles in strips from my thumbs.

I was a studious patient, diligently watching porn three times a day for months and months. I watched so much porn I could identify the production company by the luxuriance of pubic muffs or lack thereof. Eventually, thanks to an awe-inspiring phenomenon called neuroplasticity – which means we can bring about physical changes in our brains’ neural pathways and synapses by changing our behaviour – I began to get used to the anxiety and to relax my need for an answer.

While recovery rates are excellent with the right therapy, there is no neat panacea for pure O, and the final act of stoicism for anyone post-therapy is accepting the possibility of having the condition for ever – while conversely accepting that their obsessions may, in fact, reflect reality. I wrote every word of this article reminding myself that it might be a cover-up for who I really am. It has been an incredibly liberating experience.

Since I was 15, pure O has underscored everything I’ve done, and I may never be without it. But in a small way, I’ve come to love it for the far-reaching wisdoms lurking within its fetid little heart. When we try to fight our thoughts, pure O shows, we only make them stronger. It is only when we give ourselves the freedom to be uncertain and insecure, that we reach a deeper sense of who we are.

In the past four months since I finished therapy, there have been moments when the pure O has lifted, imperceptibly, like rising light, and I’ve had no thoughts in my mind; felt nothing but the quiet joy of concentration or the shimmer of my boyfriend’s touch. If it wasn’t for the comparative cacophony of pure O, I wonder, would these moments feel so impossibly beautiful in their sheer, simple unthinkingness?

• Rose Bretécher is a pseudonym.

Myths & Truths about Tourette Syndrome

Myths  Truths about Tourette SyndromeMany myths and mysteries surround Tourette syndrome — everything from how the disorder manifests to how it’s treated to what causes it in the first place. Past research has found that even physicians and psychologists hold bogus beliefs about the disorder.

Described in 1884 by French physician Georges Gilles de la Tourette, Tourette syndrome is a neurobiological disorder characterized by sudden involuntary movements and vocal outbursts or tics.

It affects about 6 in 1,000 individuals, according to Douglas W. Woods, PhD, a clinical psychologist and researcher who specializes in behavior therapy for kids and adults with Tourette syndrome.

Individuals may experience simple motor tics, such as repetitive eye blinking, nose twitching or head jerking. They also may experience complex tics, such as touching, tapping and rubbing. Vocal tics may include sniffing, grunting and throat clearing.

Tics can cause a whole host of problems, such as numbness, repetitive strain injuries, and even paralysis, said Woods, also head of the department of psychology at Texas AM University.

It’s common for people with Tourette syndrome to have other disorders, including obsessive-compulsive disorder and attention deficit-hyperactivity disorder, he said. The prevalence of ADHD in kids with Tourette syndrome may be as high as 60 to 70 percent.

Tics typically start in childhood, peak between 10 and 12 years old and decrease by early adulthood. But this isn’t the case for everyone. According to this review: “By late adolescence or young adulthood, over one third of TS patients are virtually tic-free, less than half have minimal to mild tics, and less than a quarter have persistently moderate to severe tics.”

Below, we clear up the more common misconceptions about Tourette syndrome.

1. Myth: Everyone with Tourette syndrome blurts out obscenities.

Fact: Many people believe that swearing is a defining symptom of Tourette syndrome. And this makes sense: It’s probably the most common symptom portrayed on television and in movies. However, only 10 to 15 percent of people with Tourette syndrome experience it, Woods said.

2. Myth: Bad parenting causes tics.

Fact: “We know for sure that Tourette’s is genetically based,” Woods said. Scientists haven’t been able to isolate a specific gene. Rather, they believe that multiple genes interact in predisposing a person to the disorder. Twin studies have found a concordance rate of approximately 70 percent in identical twins and 20 percent in fraternal twins, he said.

In people with Tourette syndrome, there appears to be a dysfunction in the basal ganglia, which is involved in motor control. Specifically, the basal ganglia “don’t inhibit movement the way they should. The unwanted movements that get out would normally be stopped.”

Environment also plays a role. “Tics are very sensitive to what goes on around them.” Tics can worsen whenever kids are stressed out, anxious or even excited. For some kids, concentrating on another activity “can make tics go away.”

3. Myth: The only treatment for Tourette syndrome is medication.

Fact: “Many kids with tics don’t need treatment,” Woods said. Whether a child gets treatment depends on the severity of their tics and how much they interfere in their daily life. When a child does need treatment, behavior therapy can help.

The comprehensive behavioral intervention for tics (CBIT) teaches kids to recognize when they’re about to tic and to use a competing behavior. Individuals with Tourette syndrome typically experience a premonitory urge, a physical sensation that occurs immediately before a tic. It may feel like an itch, pressure or tickle, Woods said.

In his book The World’s Strongest Librarian, author Josh Hanagarne likens it to the urge to sneeze: “There’s a pressure that builds up in my eyes if I want to blink, in my forehead if I want to wrinkle it, in my shoulders if I want to jerk them up toward my ears, in my tongue if I need to feel the edge of it slide against a molar, in my throat if I need to hum or yell or whistle. The urge can also be everywhere at once, which results in a tic where I flex every part of my body, hard and fast.”

When kids feel the urge, they can perform a behavior that interferes with the tic. As the authors of this journal article write: “For example, if a patient has the urge to engage in a shoulder tic, the competing response might involve isometric tensing of arm muscles while pushing the elbow against the torso. Thus, the competing response encourages the patient to respond to the urge to tic in a new way.”

CBIT also helps kids spot and cope successfully with the stressors that worsen their tics. Research has shown positive effects for CBIT in both kids and adults. For instance, this study found that CBIT decreased the severity of kids’ tics. This study also found a decrease in tics in adults who received CBIT.

Unfortunately, behavior therapy isn’t widely available. Medication is used more frequently to treat tics. Doctors typically prescribe clonidine or guanfacine as the first line of treatment, Woods said. They also may prescribe atypical antipsychotics, such as risperidone, he added.

4. Myth: Teaching kids to suppress one tic will trigger more or different tics.

Fact: Research has found that when kids successfully suppress their tics, they don’t experience an increase in tics. One study even found that after the suppression condition, tics decreased by 17 percent when compared to the baseline.

Research also has shown that treating one type of tic does not increase other types. In this study kids received treatment for vocal tics, while motor tics were left untreated. The motor tics did not increase. In fact, there was actually a 26 percent decrease in motor tics.

While Tourette syndrome tics can be bothersome and intrusive, they tend to shrink in severity or dissipate altogether over time. For kids and adults whose symptoms are especially disruptive or don’t go away, effective treatment is available.

Further Reading

  • Learn more about Tourette syndrome at the website for the Tourette Syndrome Association.
  • This article in the APA’s Monitor on Psychology explores the advances in behavior therapy for Tourette syndrome in greater detail.

 

Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 26 Aug 2013
    Published on PsychCentral.com. All rights reserved.

 

Phenomena:

A great long-form narrative demands at least one irresistible character. If a writer finds a protagonist who is quirky, contradictory, charming, sadistic, or interesting in any other way, the reader will follow that character through any number of complex ideas.

In OBSESSED: The Compulsions and Creations of Dr. Jeffrey Schwartz, released this past weekend, writer Steve Volk finds that special character and describes him beautifully. According to Volk’s depiction, Schwartz is a socially awkward, belligerent psychiatrist whose research has been unfairly shunned by the scientific establishment. He is an unsung hero whose revolutionary behavioral therapy has rescued thousands of people from the irrational fears and repetitive behaviors of obsessive-compulsive disorder (OCD). If his success continues, Schwartz may even rescue the withering concept of free will.

Great long-form science writing is not only about the yarn, however. It’s also about pulling away from the character’s seductive orbit in order to put his or her ideas into a wider scientific context. And Obsessed, unfortunately, doesn’t do that well. Volk tells a slanted truth about Schwartz, the man, and about how his work fits into the larger field of anxiety research. That shortcoming is particularly disappointing given that Obsessed is the debut long-form e-book of an established science magazine, Discover.

It’s obvious from the first few pages of Obsessed that Volk, a senior writer at Philadelphia Magazine, is a master of narrative. If there was ever a dull moment in the book’s 13,000-plus words, I don’t remember it.

I worry, though, that because of its compelling and seemingly authoritative story, readers will come away from the book with inaccurate ideas about anxiety disorders and how the mind works.

Take Schwartz’s therapy, for example, which is a combination of mindfulness—a technique borrowed from Buddhist meditation in which you try to detach yourself from your emotions by focusing on breathing or some other innocuous behavior—and reappraisal, or explicitly focusing on naming and re-framing your emotions. Volk describes Schwartz’s therapy as novel and even revolutionary—a thorn in the side of the psychiatric establishment and its beloved pharmaceuticals.

But Volk largely ignores the fact that Schwartz’s approach is only a slight variation of other kinds of cognitive behavioral therapies (including exposure therapy, which Schwartz oddly villifies). These treatments have been around for decades and are firmly established among psychiatrists as effective for some people with anxiety disorders.

So the fact that Schwartz’s therapy works for many people with OCD is not at all surprising. The brain changes with our day-to-day experiences—it’s why even adults can learn new things, and yes, why some people with addiction, depression, and anxiety disorders can overcome them without drugs. There aren’t many neuroscientists or psychiatrists who would disagree with that.

Where Schwartz stirs up trouble, Volk explains, is in his leap from the existence of an adaptable brain to the existence of free will:

“We’re talking about people with a biological brain disorder,” says Schwartz, “who learn through the use of neuroplasticity to change their brain function! That’s free will in action!”

It is a claim that flies in the face of most modern neuroscientific research, which suggests an ever-increasing number of our “choices” are somehow hard-wired into us—from which candidate we vote for to which flavor of ice cream tops our cone.

But there are actually lots of neuroscientists who believe in free will. (Even David Eagleman, one of the three scientists whom Volk puts in the anti-free-will camp, is on the fence about it.) It’s an age-old question that people have debated forever. I suspect that Schwartz’s colleagues don’t like him for two of his other, crazier ideas, neither of which is adequately challenged in the book.

The first is Schwartz’s theory about the physical processes underlying free will. In one head-spinning chapter, Volk explains how a combination of wave-particle duality, quantum Zeno, and Hebb’s law might prove that the mind is separate from the brain. Volk tells us that “this is an idea in its infancy”, yet neglects to include any outside comments from independent physicists or neuroscientists. The reader is left with no sense of how plausible—or crackpot—this theory is.

The second overlooked part of Schwartz’s biography is his recent conversion to Christianity. Here’s how Volk describes it:

The most important new development in Schwartz’s life underscores the schism between the champion of free will and the academics who oppose him: Schwartz has become a devoted Christian, his faith formed in great part by reading the essays of Deitrich Bonhoeffer, the German Lutheran pastor executed by the Nazis for insurrection. His faith seems odd at first—the young Jew, turned Buddhist, scientist and then Christian. But in the life-story of Deitrich Bonhoeffer, Schwartz’s guidepost for Christianity, there is a finer and firmer example of Schwartz’s own tough-mindedness. Bonhoeffer believed so strongly he died for it, openly opposing the Hitler regime that ultimately assassinated him.

What’s never mentioned, however, is that in accepting Christ, Schwartz also seems to have rejected evolution. He is one of several hundred scientists to sign A Scientific Dissent from Darwinism, a document put together by the Discovery Institute, a conservative Christian think tank that lobbies for creationism. The signatories of that document, including Schwartz, endorse the statement: “We are skeptical of claims for the ability of random mutation and natural selection to account for the complexity of life.”

With that kind of public rejection of a fundamental law of biology, is it any wonder that some scientists are skeptical of Schwartz’s other ideas? And doesn’t his alignment with creationists deserve at least a mention in a story of his scientific career?

Jeffrey Schwartz is a character, and one that I thoroughly enjoyed getting to know. But ultimately, the man’s obsessions corrupted his work—and Volk’s work, too.

*

Maia Szalavitz contributed much to the reporting and thinking behind this review

This review also appears at Download the Universe, a site for science e-book reviews

Can Having a Baby Give You Obsessive Compulsive Disorder?

ocd

Photo credit: iStockPhoto

The baby blues are a very, very real thing. So is postpartum depression, which is more than just a little case of new mom sadness. Postpartum depression (PPD) can lead to feelings of inadequacy, cause a lack of bonding between mom and baby, and even self-harm, harm to the child, or suicide. Luckily, awareness of the topic in recent years has increased and there’s even a center focused solely on perinatal mood disorders.

A lesser known effect of new motherhood is the onset of anxiety disorders like obsessive compulsive disorder (OCD). Just like the baby blues doesn’t always equal full blown PPD, a desire to be neat and tidy or upset when you’re house is a mess doesn’t mean OCD.

Only 2-3% of people suffer from OCD, but a new study in The Journal of Reproductive Medicine has shown 11% of new moms experience these symptoms. Postpartum OCD tends to come on rapidly and is often centered around a new mom’s obsessive thoughts about accidently hurting her baby or undesirable thoughts of intentionally causing harm to her baby. These repetitive and intrusive thoughts can include things about worry the baby could die in her sleep or choking and not being able to save her, or they could include thoughts of dropping, shaking, yelling, or drowning the baby. Most women with postpartum OCD do not actually act on these thoughts, meaning they resist the thoughts even though the are obsessive.

That’s the “obsessive” side of OCD: thoughts the postpartum mother can’t get rid of or doesn’t want to have. The “compulsive” side is constantly checking on the baby during the night, praying over and over, and continuously looking up “symptoms” on the internet.

If you’re thinking these sound like normal new parent behaviors, you’re right, they are. A main difference here is that these behaviors interfere with normal life.

The exact cause of postpartum OCD is unknown. One thought is that it’s an effect of hormonal changes during pregnancy, particularly oxytocin and progesterone. Another theory is that it’s normal new parent thoughts taken to a heightened level due to the sudden onset of responsibility. Meaning negative thoughts about your baby is normal, but people experience postpartum OCD don’t accept that.

So what can new moms do if they’re experiencing symptoms of postpartum OCD? Get treatment! Treatment for postpartum OCD is the same as traditional OCD: medication and talk therapy. Specifically, serotonin reuptake inhibitors (the same medication used to treat some depression) and cognitive behavioral therapy are effective in treating the disorder. It’s not yet known what the effects of medications may be on a breastfeeding baby. Although it’s important for mothers to get the help they need, doctors caution against using medication to unnecessarily treat normal behavior and feelings.

The previously cited study also found that half of the moms with postpartum OCD had improved by 6 months, although some moms we’re just beginning the onset at that time. Approximately 75% of moms with postpartum OCD also experienced depression.

Is Charles Wireko-Brobbey’s aka Tarzan Hatred And Obsession An Illness?

It is often said ‘Hatred Often Times Lay In Wait in The Darkness of Desire’: like “Mental” illness. The general public should understand the role of manic depressive disorder and paranoia in crimes of genocide.

 

Dr. Wireko-Brobbey is obsessed with NPP. He hates the leadership to death, is outright rudeness to the Party and its Leadership, and always trying to flirt with opponents and saboteurs to the point that he thinks it is not odd.

 

Tarzan tries to make friends with the Party’s opponents and asks to be invited out. He talks behind the Party’s back, goes on his wild sessions and ranting description, tries to spew evil things and a campaign to vilify the Party. He has been caught between his own damning crusade by looking through a negative mirror and stuff. When he does talk about the Party he always gives some backhand compliment.

 

Anywhere he ends up together with the Party, he goes out of his way and tries to cut in when the Party is speaking to someone or about issues of importance.

 

The NPP Party has tried being nice but he just gets worse. Tarzan is also a compulsive liar and I even think once he was not able to get hold of the Campaign Manager-ship, hell broke loose around every household belonging to the NPP.

 

What the hell is his problem? Why won’t Dr. Wireko-Brobbey just leave the NPP alone? Sometimes the things Tarzan says and does scare some of us about the “proverbial death skeleton” that haunts and hound people. Tarzan just obsessively hates the Party which gave him the platform to prominence.

 

Even well-behaved opponents find most of his utterances very weird. Some are of the opinion that his reason and the choices that he constantly raises up lacks logic and even find his sudden outburst and interest in them weird.

 

I can’t figure out why the Party cannot get him off its back? Can’t the NPP Party do anything? I don’t think this sort of hate is normal. I mean it is one thing to dislike someone but he spends so much of his time hating the Party and its Leadership that it just doesn’t seem normal, any diagnosis?

 

He sounds like he is completely jealous of the Leadership. I think it is about time the leadership gets him straightened up properly. There is the need to call him out in front of a lot of people not only the NEC and scolded.

 

What the Leadership should realize is that sometimes it takes a big event (such as public embarrassment) before someone like that learns their lesson. Like what was meted out to “Sir John”.

 

As attention seekers like that needs to be cornered and preached to. Just make sure it is a very public display so they are sure to remember it.

 

It will be in the good interest of the Party to get this malicious PhD off its back. We should recognize that obsessing over anything is an illness. It can drive you (and others around you) mad.

 

Maybe it should be pointed out to him in a confrontation that his obsession over the Party and its Leadership could mean that he is bipolar (having maniac or depressed periods) or having two different ideas and he should get that in check.

 

Hate and obsession to me, is what causes a lot of mental illness or stress. Yes, chemical imbalances in the brain can cause mental illness; especially some of the more genetically based ones, like schizophrenia and OCD (Obsession Compulsive Disorder).

 

On the other hand one can say; but what about depression, anxiety, eating disorders, injuring one’s self, etc.? Yes, those can all be caused by genetics as well, or loss, or many factors but to a large extent a considerable majority are also caused by hate. Sometimes mental illness can be prevented if people were not put down, bullied, called names, teased, ridiculed, abused, or made to feel unimportant, undervalued or worthless.

 

All that I want to drive home is simple, that obsessive-compulsive disorder (OCD), a type of anxiety disorder, is a potentially disabling illness that traps people in endless cycles of repetitive thoughts and behaviors. People with OCD are plagued by recurring and distressing thoughts, fears, or images (obsessions) they cannot control. All is due in part because of our inordinate passion to hate.

 

The anxiety (nervousness) produced by these thoughts leads to an urgent need to perform certain rituals or routines (compulsions). The compulsive rituals are performed in an attempt to prevent the obsessive thoughts or make them go away.

 

Although the tendency may temporarily alleviate anxiety, the person must perform the preference again when the obsessive thoughts return. This OCD cycle can develop to the point of taking up hours of the person’s day and significantly interfering with normal activities. People with OCD may be aware that their obsessions and compulsions are senseless or unrealistic, but they cannot stop them.

 

Why should people moderate their bashing or saying of things to such people?

 

Just listen to Dr. Charles Wereko-Brobbey he has warned Ghanaians not to trust any of the petitioners who filed the 2012 presidential petition when they talk about peace.

 

He says and describes Nana Akufo-Addo, Jake Obetsebi Lamptey and Dr. Bawumia as leaders who have no love for peace. He is quoted to have said:

 

“We can’t trust the petitioners. They openly say that they are ready to accept the verdict, but behind closed doors, their message is entirely different,” he emphatically stated on OKAY FM.

 

He ended his direct swipe on the petitioners by summarizing their actions as “talking peace but preparing for war”.

 

In my opinion, it was unwarranted and this is what causes pain. This is what causes low self-esteem and low self confidence and shame and fear and guilt for being yourself and hopelessness. This is what makes the world a difficult place for some people to be in. This is what causes some people to be depressed, have anxiety, starve themselves or puke or even kill themselves.

 

Whether these things are coming from classmates, parents, siblings, teachers, or whoever – it is bullying and it is emotional abuse! No one deserves it. There is no excuse for it.

 

One should ask Charles Wireko-Brobbey why he is dishing out all these senseless talk; and also ask himself why he is doing that.

 

Where did you learn the hate? Where did you learn that it is right to hate? Why are you hurting someone else? Were you ever on the receiving end of this? If yes, how did that make you feel?

 

Recognize that if you are talking to and treating someone in this way, you need help too. Whatever is causing you to act this way towards another person is coming from somewhere.

 

Don’t perpetuate the hate. It hurts everyone. If you are a tormenting, you need just as much help as the people you are hurting.

 

Think about it.

 

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Know more about OCD

Steve Jobs and Leonardo Di Caprio portraying Howard HughesHundreds of years ago, people believed that those affected by OCD (or obsessive compulsive disorder) were possessed by the devil. Now though, the condition is well known and many celebrities like Leonardo Di Caprio, Cameron Diaz have publicly admitted to be suffering from it. The Hollywood magnum opus starring Di Caprio and directed by Martin Scorsese Aviator, based on Hollywood film producer and aviator Howard Hughes’ also dealt with the subject. It’s a little known fact that even Steve Jobs was obsessive about keeping things clean, and also so obsessed with perfection that he just couldn’t buy furniture; he simply didn’t like anything! His universal demand for flawless design certainly reflected some symptoms of OCD (though he was never diagnosed) which brings us to the question:

What exactly is OCD?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviours one feels compelled to perform. The thoughts are intrusive in nature, unpleasant and distressing which causes uneasiness, apprehension, fear, or worry. The repetitive behaviours are aimed at reducing the associated anxiety.

Also read: OCD: All you need to know

How do you know if you have OCD or not?

Even though, a lot of people have obsessive thoughts and perform compulsive behaviour, not all of them have OCD. With OCD, these thoughts and behaviours lead to extreme distress, take up a lot of time; interfere with daily life and affects relationships. While many people who do not suffer from OCD may perform actions often associated with OCD (such as ensuring the angles at which the curtains are drawn or ensuring correct punctuation marks all the time), the distinction with clinically significant OCD lies in the fact that the person who suffers from OCD must perform these actions; otherwise they will experience significant psychological distress.

A standard test to examine the severity of your OCD is the Yale-Brown Obsessive Compulsive test.

Also read: Diagnosis and treatment of OCD

What are some ways to treat or control OCD?

Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-Compulsive Behaviour offers the following four steps for dealing with OCD:

  • RELABEL – Recognize that the intrusive obsessive thoughts and urges are the result of OCD. For example, train yourself to say, ‘I don’t think or feel that my hands are dirty. I’m having an obsession that my hands are dirty.’ Or, ‘I don’t feel that I have the need to wash my hands. I’m having a compulsive urge to perform the compulsion of washing my hands.’
  • REATTRIBUTE – Realize that the intensity and intrusiveness of the thought or urge is caused by OCD; it is probably related to a biochemical imbalance in the brain. Tell yourself, ‘It’s not me—it’s my OCD,’ to remind you that OCD thoughts and urges are not meaningful, but are false messages from the brain.
  • REFOCUS – Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes. Do behaviour. Say to yourself, ‘I’m experiencing a symptom of OCD. I need to do something else.’
  • REVALUE – Do not take the OCD thought at face value. It is not significant in itself. Tell yourself, ‘That’s just my stupid obsession. It has no meaning. That’s just my brain. There’s no need to pay attention to it.’ Remember: You can’t make the thought go away, but neither do you need to pay attention to it. You can learn to go on to the next behaviour.

Along with this, one can also try group or family therapy. Unfortunately, till now there is no permanent cure for OCD. One must continue to take medication for it or practice therapy to keep themselves in control. Otherwise, the symptoms may resurface again.

Read in more detail: Four steps to deal with OCD and prognosis

 

Help Center Enslaved Teen, Family Says

     SALT LAKE CITY (CN) – A “charlatan behavior modification facility” took a girl’s “desperate and deluded” mother for $100,000, made the girl wash stairs with toothbrushes, and forced her to listen to stories about rape and bestiality, she claims in court.
     Sarah Artim and her mother, Nancy Artim, sued Cross Creek Manor, and its operator, the World Wide Association of Specialty Programs, in Federal Court. The six causes of action include fraud and slavery.
     “This case is about a 15-year-old girl’s being unlawfully locked up for 16 months in a private prison in Utah,” the lawsuit states. “Doing this to her daughter cost a desperate mother almost $100,000, paid to a charlatan behavior modification facility called Cross Creek Manor in St. George, Utah. It is part of a major Utah industry that preys on desperate parents and charges enormous fees to treat their children worse than any felon in a Utah correctional facility. When the parent runs out of money, and the child is released, she will be far worse off than when she was forcibly committed, and her developing adolescent mind will be forever impaired. The retribution she here seeks will not begin to repair the harm she has suffered, or the money spent by her mother to help her.”
     The Artims say in the complaint that Sarah was sent to Cross Creek for treatment of anorexia, obsessive-compulsive disorder and anxiety.
     “On or about January 2007, Nancy Artim signed an enrollment agreement with Cross Creek Manor along with a demanded [sic] of $4,500 month for the 16 months that Sarah was at Cross Creek, and additional amounts totaling approximately $100,000, which eventually forced Nancy into bankruptcy. In consideration of the money paid, Nancy had to transfer to Cross Creek full and complete possession, custody, and control of her minor daughter, Sarah Artim.
     “The written adhesion agreement provided that Nancy would sign a power of attorney transferring custody of Sarah for the duration of the agreement, and nevertheless accept responsibility for all expenses, damaged property, run away retrieval expenses, nursing and medical care, and release Cross Creek and its employees or contractors from any liability for injury to or death of Sarah.
     “The agreement gave Cross Creek full authority to strip search Sarah by removing all of her clothing so as visually to inspect her person and body cavities. Cross Creek had the right to physically control and detain Sarah by any restraint deemed necessary, which it did. Should she escape, Cross Creek could enlist any and all enforcement agencies to capture and return her to Cross Creek at Nancy’s expense.
     “Cross Creek was authorized to obtain medical care and records, and engage any medical, dental, psychiatric, and hospital, ambulance or other health related care at Nancy’s expense. Cross Creek agreed that it understood that Sarah was a minor placed in its custody and control without her consent. Sarah thus belonged to Cross Creek.”
     Cross Creek is surrounded by tall fences and parents saw only what staff wanted them to see, the Artims say.
     “Even in the outside area the parents were trapped into seeing only what the staff wanted them to see as the fences were 12 to 16 [feet] tall. They made the children do manual labor like washing the stairs with toothbrushes. There were isolation rooms for punishment,” the 34-page complaint states.
     Sarah was not allowed to go to the bathroom without permission; she was allowed to call her parents only once a week, while a therapist listened; and was forced to listen to group members’ “unbearable” stories about “rape, bestiality, incest, molestation, drug use, death, abandonment and many other things,” she says in the complaint.
     The lawsuit cites a letter from Sarah, now 22.
     “I believe my 15-month stay has damaged me more than any event in my life thus far. I feel passionately that Cross Creek, and or places similar too it should be shut down so no other kid has to go through the things myself and fellow classmates were put through. Like I said it has been many years since my completion of Cross Creek and many events I have simply tucked away because they are painful, but I’m going to do my best to give examples of reasons why this place should no longer operate. It has taken me many years to heal, and get my life back on track. It honestly is still a work in progress to get over.”
     Six pages later, the letter states: “One point in my therapy I was put on one month of silence where I could only speak to my therapist. I was put on it because my therapist said I didn’t share enough in group and I wasn’t working on my issues enough. This was one of the most traumatic things I’ve ever been put through. My freedom of choice was not only taken away but now my interaction with people and my voice. During this time was also my sixteenth birthday. I was eventually taken off when I started to give aggressive feedback to a girl in my group who was struggling to adopt the beliefs of the program.
     “I believe through the group therapy the therapist was able to set up a dynamic that forced students to attack anyone not conforming and were rewarded by being told they are making changes and doing good. By doing this we all became brainwashed and adopting their beliefs. I learned to just go on autopilot and do whatever I was told so that I could return home. Therapist/staff constantly encouraged us to tell on others who weren’t following rules, and to almost shame people into conforming. Feedback was used not to help, but to destroy girls with already self-esteem that was on the floor. They wanted our self-esteem to be low so they could form us into what they wanted us to become, and so we wouldn’t question any other their methods.
     “To graduate the program you must complete six levels and graduate at least 8 seminars. You must graduate each of the seminars to move up to the other. If you do not graduate your seminar you will be in the program at least another 2 months because they only take place every two months. They tell you to graduate these seminars is simple all you have to do is be honest and share. That was not my experience.
     “The seminars consisted of strange, confusing rules to follow (that if you break one the facilitator will most likely eliminate you from the seminar).
     “Exercises that consisted of things like beating chairs and screaming, being forced to share things you had done that were ‘bad’ in your past.
     “Not being allowed to use the restroom under any circumstance unless on a break, which were few and far in between.
     “The facilitators were always very strong, intimidating, loud, powerful speakers, who would constantly bring up how we had destroyed our families and were ungrateful. They would start the seminars out always bringing us down and forcing us into tears and stories giving us the hope of showing them we’ve changed and deserve to graduate and go back home. …
     “Looking back and talking about my experiences makes me sad and sick. No matter what I say or how I described my stay there, I don’t feel anyone will ever understand. I was a robot for a long time I did as I was told and morphed into what a ‘good’ student was supposed to be. When I got home I couldn’t even go into public for long periods of time without crying. I was overwhelmed, anxious and scared to break nonexistent rules. I had nightmares about going back the first few months. I came back 40 pounds heavier from lack of exercise and constant manipulation through food and fatty snacks. My self-esteem was even lower then when I had been sent away. I dealt with constant shame that I wasn’t better and didn’t change enough for my family. We were constantly told if we did what the program said we would come back happy, healthy successful people and when I wasn’t I fell into a deep depression and felt I couldn’t relate to anyone anymore not even lifelong childhood friends, family or anyone. “Cross Creek took weak girls such as myself, filled our head with lies and manipulated us and our parent’s weakness because we were all in vulnerable situations. They made constant promises that if we graduated the program we would be most likely to succeed in life and told our parents if we left before we would just become worse off and they even threatened we’d die. I graduated and truly believe I am worse off for attending such a place. Anytime I look back on my time spent there I have a huge knot in my stomach that reminds me of all the pain. I don’t revisit my memories spent there because all it brings me back to what a sad, hurt, lonely and scared girl I was. I never want another girl to go through the emotional trials Cross Creek brings.”
     Nancy Artim says in the lawsuit that she “bitterly regretted” sending Sarah to Cross Creek.
     “The consequences of her stay there had a profound adverse effect upon her life and family, with which both mother and daughter are still struggling many years later,” the complaint states.
      Hundreds of parents sued the World Wide Association of Specialty Programs and Schools in 2011, claiming a group of boarding schools tortured their children by locking them in dog cages, forcing them to lie in feces and eat vomit, masturbating them and denying the troubled teens any religion “except for the Mormon faith.”
     Sarah and Nancy Artim seek punitive damages for slavery, breach of contract, fraud and conspiracy.
     They are represented by Thomas Burton. 

Excoriation: What Is It and Why Is It in the DSM-V?

excoriation-skin-picking-1223127The Diagnostic and Statistical Manual of Mental Disorders serves as the “bible” of mental health practitioners, who rely on it to match diagnostic criteria with behaviors. The American Psychiatric Association periodically examines trends in mental health conditions and recent scientific evidence to revamp the criteria. The latest edition, the DSM-V, is slated for release in May 2013, and the APA recently approved several changes.

Among the new diagnoses is excoriation, which is associated with chronic skin-picking. The issue is most common among women between the ages of 30 and 45. It’s classified as an impulse control disorder and is related to obsessive compulsion.

What Is Excoriation?
Although excoriation disorder is the name of the new “official” diagnosis, the issue has been studied for years—sometimes called neurotic excoriation, compulsive skin-picking, dermatillomania, and psychogenic skin-picking. The issue was not included in previous editions of the DSM because it is believed to sometimes be a symptom of another issue.

Skin-picking is common among people with autism spectrum as well as obsessive compulsion. When it does not co-occur with another issue, however, it qualifies for its own diagnosis. Symptoms of the issue include compulsive skin-picking that leads to injuries or wounds as well as stress. Skin-picking is relatively common. Some people pick their skin to the point of bleeding or pain by popping pimples, picking at hangnails, or peeling scabs.

Controversy Surrounding Diagnosis
Whenever the APA adopts new diagnoses or symptoms, there is always some controversy, and excoriation is no exception. Although the diagnosis has received considerably less attention than some other changes, some mental health experts have expressed concern. Because excoriation often is a symptom of an underlying issue, a separate diagnosis might stigmatize people by giving them multiple diagnoses when only one is necessary.

Some clinicians have argued that excoriation does not meet the criteria for a mental health diagnosis and is more akin to a habit. By creating diagnostic criteria for a habit, the DSM might eventually have to include other habits. However, excoriation does sometimes occur on its own, and people with the condition can experience considerable distress, so the APA opted to include it.

How Excoriation Is Treated
When compulsive skin-picking occurs, it’s important to rule out a potential medical cause such as allergies or infection. Occasionally, skin conditions can superficially resemble symptoms of excoriation. Further, excoriation can cause dermatological problems, so patients frequently need dermatological treatment along with mental health treatment.

Antidepressants are the first line of treatment for excoriation. Opioid antagonist medications, which interfere with the body’s ability to respond to endorphins and opioids, also are sometimes effective. Because compulsive skin-picking often co-occurs with anxiety, anti-anxiety medications can be helpful.

Psychotherapy that helps people develop better approaches for dealing with anxiety, enables them to develop better impulse control, and helps patients cope with changes to appearance as a result of excoriation is also a typical part of treatment.

References:

  1. American Psychological Association. APA concise dictionary of psychology. Washington, DC: American Psychological Association, 2009. Print.
  2. Brauser, D. (2012, December 3). Experts react to DSM-5 Approval. Medscape Reference. Retrieved from http://www.medscape.com/viewarticle/775526
  3. Colman, A. M. (2006). Oxford dictionary of psychology. New York, NY: Oxford University Press.
  4. Neurotic excoriations. (2012, June 27). Medscape Reference. Retrieved from http://emedicine.medscape.com/article/1122042-overview
  5. Neurotic excoriation. (n.d.). SkinPick. Retrieved from http://www.skinpick.com/neurotic-excoriation

A happy ending

“A lot of things happened in those months,� he recalls. “I never slept. I’d go to Toronto for a week because I thought people were chasing me. I walked the streets and met homeless people. I was spending so much money, when I was done my high, my credit cards were maxed.

“I’d spend $18 on a Lone Star dinner and throw down a $100 tip. I was buying people things all the time, often strangers, so I’d avoid my family because they’d try to stop me. …

“My mind was open and clear and I felt great. I was doing inventions, joined two pyramid companies, started my own ministry to help others with their faith,� he says, laughing. “If you can imagine that. In April of that year, I hit my peak and thought I was the second coming of Jesus Christ.�

Within two months, however, his first real low hit and with it, suicidal thoughts. A diagnosis of bipolar disorder by his doctor was later confirmed by Ottawa Hospital Civic campus psychiatrist, Dr. Peter Boyles, who started him on lithium to treat the illness.

The day of the diagnosis, Nihmey says he returned to his parents’ house, “darted into the basement and stayed there for two months. It was immobilizing to see my friends moving on with life, getting married, buying houses, having kids.�

Yet even as the depression lifted with the support of his parents and his deep faith in God, Nihmey was overwhelmed by anxiety and obsessions, notably with hell and hitchhikers who he would constantly stop to pick up, regardless of how inconvenient it was to him.

Once, on driving home from Toronto, he became obsessed with helping two young women whose wiper blades had broken in a storm. After offering to help, then driving off, he became so convinced they’d be stranded, he got on and off the highway four times searching for them. In the end, the four-and-a-half-hour trip home took nine hours.

Between 2005 and 2009, he struggled with hypomania, an extremely active and volatile state of mind that would hit every few days. During those periods, he lived in fast-forward, speeding everywhere, talking constantly and quickly, being argumentative and rarely sleeping.

Over time, however, life and his mental state stabilized enough for him to write his latest book, which was published last February.

“It took me five years to write, which is a bit longer than normal, but I was doing it during a tough period.

“But I’ve never felt healthier than I do now. Health can happen, but it takes faith, hope, never giving up and perseverance, love and strong support, courage, discipline, responsibility and, of course, a lot of hard work,� he observes. “There’s only one other thing that will take you to the next level … and that’s you.�

America was built by obsessive compulsives

I want to start a national conversation about how this character type is well suited to superior achievement. And I also seek to inject the element of irrationality into our understanding of obsession. In Outliers, Malcolm Gladwell talks about how it takes “10,000 hours” of practice for someone like Bill Gates to become a computer whiz in high school. But obsessionality often involves more than just doing the same thing over and over again; in its clinical sense—the way the American Psychiatric Association defines it in the DSM—it goes hand-in-glove with certain quirks. Steve Jobs, whom I discuss in my prologue, was a cleanliness nut. Back in the 1980s, he used to don white gloves and do frequent dust checks on the floor of the Apple factory. And whenever he saw a few specks, he would yell at his plant manager to clean them up. Jobs’s rationale was that if his company didn’t have the discipline to keep everything spic and span, it wouldn’t be able to design “insanely great products.” It’s ironic that the most successful obsessives—who, by definition, love control—tend to be a little bit out of control. But somehow this eccentric behavior is often crucial to helping them attain their lofty goals.

Cook: There are people who are debilitated by obsessive thoughts. Can you explain what precisely you mean by obsessive, and explain when it can have a positive influence?

Kendall: The term obsessive is thrown around a lot. Many people will say, “Oh, I have to clean up my kitchen now because I have a little OCD.” But by “obsessive,” I don’t mean people who have obsessive-compulsive disorder (OCD). OCD can be incapacitating, and those who suffer from this disorder are unlikely to start Apple or fly across the Atlantic on a piece of wood like Charles Lindbergh. These people are haunted by thoughts that just won’t go away; someone with OCD might be constantly worried that the house will burn down; as a result, he or she might be afraid to go out even after checking a thousand times that the burner on the stove is off. The icons covered in my book are saddled (or blessed) with a related condition called obsessive-compulsive personality disorder (OCPD). While the obsessions and compulsions in both disorders can revolve around the same things—such as cleanliness or order—OCD is an anxiety disorder and OCPD is a character disorder. Rather being impaired by their intrusive thoughts, those with OCPD celebrate them. Like Steve Jobs, Henry Heinz prided himself on his company’s clean factory; for decades, his plant in Pittsburgh was a must-see destination for tourists. My icons were productive obsessives; they found a way to channel that which they couldn’t stop thinking about into some spectacular achievement. As a boy, Ted Williams thought of nothing else but hitting. As he once said, “When I wasn’t eating or sleeping, I was practicing my swing.”

That said, there is also another misconception about obsessives. Business consultants such as Jim Collins, author of Good to Great, argue that they are better suited to following than to leading. Given that they are good organizers, so goes the familiar refrain, they make better CFOs than good CEOs. And that is true for some. But a small sub-set of obsessives—such as the super-achievers I write about—can also be innovators. Ted Williams developed a new approach to hitting. Until he came on the scene in the late 1930s, the typical power hitter was someone like Babe Ruth, who was undisciplined at the plate. Williams turned hitting into a science; in fact, the treatise he wrote after his retirement was called The Science of Hitting. The Red Sox Hall of Famer studied everything; no detail was too small. He analyzed the slope of the batter’s box in all the big league parks; he went to an MIT physics lab to learn about the impact of a bat on a ball. Realizing that a walk is as good as a hit, he refused to swing at any pitch that was even a fraction of an inch off the plate. He was essentially doing sabermetrics a half century before the stats guru, Bill James. Likewise, Estee Lauder forever changed the beauty business. She was obsessed with touching faces; as a little girl, she couldn’t stop putting make-up on her friends. And she introduced the department store mini-makeover, which has been the cornerstone of this industry for the last half century.

Cook: What common themes did you in the childhoods and early careers of the people you profile?

Kendall: Obsessive-compulsive personality disorder, in contrast to most other psychiatric disorders, is remarkably consistent throughout the life span. Someone who has it at 5 is very likely to have it at 85. And it tends to arise in response to difficult circumstances early in life. The icons I profile all encountered major stressors in childhood, such as neglect, parental mental illness, severe family discord and medical illness. One of the reasons Ted Williams bonded so intensely with his bat as a boy in San Diego is that neither of his parents was ever around all that much. His mother was a religious zealot, who rode the bus day and night trying to save the town’s drunks and prostitutes. And his father was a semi-employed photographer who was often out carousing. Like Williams, Lindbergh also had parents who were constantly fighting with one another. And rather than reaching out to other people for connection, Lindbergh turned to machines. As a teenager, the “Lone Eagle” had no friends—his mother had to pay neighborhood kids to play with him. His favorite pastime was driving the family’s Model T; at fifteen, he served as the chauffeur for his father, a longtime Congressman from Minnesota. Similarly, by the age of 5, Melvil Dewey—author of the Dewey Decimal Classification System, the 19th century’s premier search engine (the Google of its day)—was already organizing the spices in his mother’s pantry.

For each of these obsessive innovators, the obsessions become a solution to an existential crisis. By turning to his bat, Williams found a way out of his chaotic family life. In contrast, his younger brother, who was short and didn’t possess any athletic talent, became a juvenile delinquent. Dewey’s mother was 42 at the time of his birth; and that was ancient in the mid-19th century. She had little time for him, and whatever bonding he received as a boy came at the hands of an older sister. The love of order is often the child’s way to gain a sense of control in a situation where they have little actual control. Fortunately, for Dewey, he was able to channel his love of order into his vocation. Not only did he organize America’s printed matter, he also helped to found both the American Library Association and the world’s first library school at Columbia University.

Cook: What policy implications does your book have?

Kendall: My book highlights a central problem with current psychiatric classification. At present, the DSM, psychiatry’s bible, focuses only on the downside of particular mental health conditions—such as OCPD. But there is a pressing need for both clinicians and the public to understand that there can also be an upside to being wired a certain way. Those with OCPD, as I have discovered time and time again, happen to have remarkable strengths; they possess enormous drive and persistence and are very detail-oriented. The same goes for those with a related condition—“Aspies” or high-functioning autistics. They too tend to encounter difficulty in interpersonal relationships, but can perform very well in repetitive tasks such as software testing. The challenge that those with such mental illnesses face is not to become more “normal,” but to find a way to channel their obsessionality productively.

Are you a scientist who specializes in neuroscience, cognitive science, or psychology? And have you read a recent peer-reviewed paper that you would like to write about? Please send suggestions to Mind Matters editor Gareth Cook, a Pulitzer prize-winning journalist and regular contributor to NewYorker.com. Gareth is also the series editor of Best American Infographics, and can be reached at garethideas AT gmail.com or Twitter @garethideas.