Q: I am far from organized and orderly in my life, so you
wouldn't think of me as obsessive-compulsive, but I do have a
symptom that I've been told may indicate OCD. Even during my work
day (commercial litigation for a medium-sized firm), I cannot fully
shake the thought that I might inadvertently do some kind of harm
to our baby. This is despite the fact that my wife, who has taken a
break from her career to be at home with the baby, is a great,
attentive mother, and that I have never actually done anything
harmful to any child (or to any adult beyond a scale that would
apply to pretty much anyone).
A: To begin with, there is a difference between Obsessive
Compulsive Personality (a type of personality disorder) and
Obsessive Compulsive Disorder (OCD). People with the personality
disorder tend to have an exaggerated need for order, detail and
inflexible obedience to rules. People with OCD are filled with
anxiety about persistent, disturbing thoughts (obsessions) and feel
compelled to engage in a recurrent behavior (such as checking to be
sure the gas stove was turned off, or washing hands many times a
day out of a fear of germs) to provide momentary relief.
Sometimes, as in your case, there is an obsession without a
compulsion (I'm not diagnosing you long-distance -- there are other
conditions associated with ruminating and worrying, but let's
assume that it's obsessive OCD for the sake of this Q&A).
Traditional therapies, such as those focusing on developing
insight, may or may not do much for OCD, and for many individuals,
regardless of treatment, the symptoms continue on and off
indefinitely. But in most cases symptoms can be significantly
reduced with specialized treatment.
The main forms of treatment are:
- Cognitive Behavior Therapy (CBT) of a specific sort, working
with your thought patterns.
- Behavior Therapy (not so cognitive) in which the idea is to
extinguish unhelpful behaviors (very effective for compulsions;
less easily applied to obsessions).
- Medications -- many but not all sufferers get significant
relief from SSRI antidepressants.
- Support organizations -- comforting in feeling less alone or
different and sharing coping strategies with others (e.g., through
the International OCD Foundation.
As you suggest, you are no more likely to harm your baby than
anyone else -- maybe less so, since you are so conscious of and
concerned about the matter. Unfortunately, such reassurances or
mere facts tend not to carry much weight when up against persistent
obsessive worries. The person with OCD knows that the thoughts are
not rational, but finds it incredibly difficult to let them go.
Although there are probably days when your obsessions weigh so
heavily that it's hard to focus on work, in general OCD does not
prevent a lawyer from doing high quality professional work.
There are some cutting edge OCD-focused treatment programs in
the Boston area. We would be glad to help you connect with these
therapies if you care to come for an initial (free) evaluative
session at LCL.
Dr. Jeff Fortgang is a licensed psychologist and
licensed alcohol and drug counselor on staff at Lawyers Concerned
for Lawyers of Massachusetts, where he and his colleagues provide
confidential consultation to lawyers and law students, and offer
presentations.