Timothy Hillier was only seven years old when he began to obsess about his pillow and its position on his bed. Was it lying in the exact middle from the edges of the mattress? Were its corners aligned at a perfect 90 degrees? Were there creases in the pillowcase or was it totally flat?
Minor matters perhaps, that most of us wouldn’t even give a thought to, but for poor young Timothy it became all-encompassing.
Every night he would lie awake for hours, frequently getting out of bed to check that the pillow was still lying in the correct place. He would straighten the pillowcase and measure its distance from the bed’s edge. He would make slight adjustments and then make some more. And when he was finally satisfied he would carefully get back into bed, only to hop out again a few minutes later.
If Hillier’s pillow had been the only thing he obsessed about, his life may have been okay, but it was merely the beginning.
“I went to a Catholic school, and I was constantly tormented with obsessive thoughts about whether or not I was sinning,” Hillier told me. “I’d spend most of the day worrying about whether I was a good or a bad person, and if I was going to heaven or going to go to hell.”
Many other symptoms plagued him as he went through school: worrying about exactly how much saliva should be in his mouth before he swallowed; repeating sentences in his head over and over again; as well as persistent social phobia and anxiety around his clothes.
When Hiller was in his second year of university, studying a Bachelor of Business, his life finally reached a crisis point.
“I’d failed a subject because I couldn’t concentrate with all my distracting thoughts,” he said. “I knew I couldn’t go on like this anymore.”
Eventually Hillier wrote a note to his parents in which he described every symptom he was experiencing and his fears that he must have schizophrenia. Concerned, they took him to see a family physician who referred Hillier to a psychiatrist, and at the age of 20 he was diagnosed with obsessive compulsive disorder (OCD).
what is OCD?
According to the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V), OCD is defined as the presence of obsessions—recurrent and persistent thoughts, urges or images that are unwanted and cause anxiety; and/or the presence of compulsions; that is, repetitive behaviours the individual feels driven to perform. These behaviors or thoughts are aimed at preventing anxiety. However, they’re not connected in a realistic way with what they are trying to prevent, are time consuming, and can cause significant impairment in social settings and the workplace.
Beyond OCD estimates that 2.3 percent of the US population suffers from OCD—that’s more than five million people. Most start to show signs of it in their childhood or teenage years; it’s a condition that affects both genders equally.
There are broadly four different categories into which OCD sufferers fall. These include checkers, who will make sure that something, such as locking the door or turning the stove off, is done over and over again; counters and arrangers, who are obsessed with symmetry and spend hours ordering and counting things; and doubters, who are constantly afflicted with intrusive thoughts of a violent, sexual, or religious nature.
The most common group, however, are the cleaners, those whose lives are consumed by fears of dirt and germs and so engage in regular cleaning rituals.  Sufferers can spend hours every day in the shower or the bathroom. Alternatively, they can spend just as long cleaning their living quarters multiple times per day.
“Instead of having a shower and thinking, ‘Okay, that’s it, I’ve cleaned my body,’ they have to wash their body three times, and then it becomes five times, and then it becomes 10 or 20 times,” psychiatrist Professor Carlos Hojaij told me. “I’ve had a patient who would get so exhausted he would even sleep in the shower.”
searching for the source
The cause of OCD is unknown and likely multifactorial. Genetic, environmental and neurological factors may all play a role; some theories suggest compulsive behaviours are learned. Treatment usually involves medication or psychotherapy or a combination of both; and deep brain stimulation neurosurgery is used occasionally in severe cases.
Hillier’s current psychiatrist is Scott Blair-West, who runs a specialised OCD inpatient unit. “My view is that there is a genetic part to it, there’s a vulnerability to OCD that probably is inherited, and whether you get OCD may be determined by your environment,” he told me. “We know from PET scans that there are certain circuits of the brain—involving the caudate nucleus, the thalamus, and the frontal lobe—that are clearly affected by OCD.”
Glenn Davis has been utilizing psychotherapy in his role as a family physician for more than 40 years. “As Ignatius of Loyola said, ‘Give me a child for the first seven years and I will give you the man,’” he reminded me. “Early life can be a very anxious time for children, being at the whims of their parents and the environment. As they grow older they learn that their compulsive anxious thoughts can be relieved by ritualistic behavior. For example, worrying about cleanliness can be relieved by hand washing, and it isn’t long before the sufferer realises that their anxiety can always be relieved by the same behavior.”
help is available
Davis believes that medication, in particular a class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs) which help to regulate serotonin levels in the brain, should generally be used as initial treatment for OCD. “Your thought processes are tempered so your behavior changes,” he said. “You may not even need to see a psychologist.”
Others disagree. Hojaij urges caution with a medication-first, talk-later approach. “We can only talk about treatment if you have a proper diagnosis,” he says. He recommends that patients suspected of having OCD should be initially referred to a psychiatrist to help exclude organic diseases, such as tumor or stroke, that can sometimes mimic features of OCD.
do I have OCD?
As I undertook research for this article I began to worry about some of my own behaviors. The way I triple-check that the refrigerator door is closed; my need to have my clothes arranged by color; the anxiety I feel whenever the kitchen is messy, to the point where I try and avoid cooking anything. Did these, plus other personal foibles, mean that I might have OCD?
“One of the characteristics that is often seen in highly functioning people is a highly developed consciousness, so that person may be very conscious about themselves, very conscious in their work, and these kinds of people may have a certain level of anxiety,” Hojaij said, in an attempt to reassure me. “Sometimes this type of personality can be a little bit exaggerated, and they may be called ‘control freaks’ by others. And in these kinds of cases it’s not a disease, it’s just an aspect of personality.”
People with obsessive–compulsive personality traits share many features of OCD, however there are important differences. People with OCD usually have insight that their thoughts and behaviors are unreasonable, they are distressed by their actions, and they waste time on their obsessions and compulsions. Whereas those with obsessive–compulsive personality traits believe that their way is the right way to do things, they are usually comforted by adhering to their own rules and routines, and they are often quite time efficient.
Indeed, obsessive–compulsive traits such as perfectionism, attention to detail, and perseverance can make people highly productive in the work place. On the other hand, they can just as easily be an impediment.
Dr Gayle Maloney, who operates an OCD clinic in Perth, Australia, says that of the doctors and lawyers she has seen suffering from OCD, the most frequently occurring obsessions and compulsions relate to perfectionism and associated repetitive checking rituals.
“When symptoms start to impede a person’s day-to-day functioning, they may benefit from an assessment,” she told me. “A clinical psychologist or psychiatrist can focus on a specific type of cognitive-behavioural therapy, known as Exposure and Response Prevention (ERP) treatment, which is used to teach an OCD sufferer anxiety-based strategies to reduce their obsessive thoughts and to prevent engaging in their compulsions. For some sufferers, ERP is sufficient. For others, ERP needs to be combined with medication.”
For Hillier, both medication as well as regular visits to his psychiatrist has been necessary for his OCD management.
“It’s important to talk about ongoing symptoms,” Hillier said. “For example if I’m having a thought around my clothes not fitting or the sun annoying me, I have to make sure that I’m not giving in to it. You’ve just got to keep on top of it. Exposing yourself, doing the right things.”
Hillier acknowledges he still has a long way to go. “I have a good job but I don’t really have the capacity to take on anything too stressful—my OCD does wear me down,” he said.
Despite these ongoing challenges Hillier remains upbeat. He is a community mental health ambassador and runs corporate awareness workshops for companies, teaching managers how to help staff who may be struggling with OCD.
This article first appeared in The Australian. Reprinted with the author’s permission.