Secret rage has roots in obsessive compulsion
Say you are in your 20s or 30s. You have your whole life ahead of you. You love your work as a teacher; you love your pupils. At least, you used to. For the past two years or so, you have been living a life of quiet desperation. Every day at school, images pop into your mind unbidden, images of unspeakable violence directed at your students. They are so distressing, so opposite to your gentle nature, that you suspect there is something terribly wrong with you, that you might in fact be crazy. You try to will the images away, but they keep coming.
Or imagine you are a doctor with a thriving family practice. Since your early 40s you have been bombarded with thoughts of sexually touching your patients. So intense and frequent are these thoughts that you can't concentrate. You start to spend as little time as possible with your patients, a part of your job you used to love. And your formerly approachable bedside manner is increasingly distracted and cursory. You feel as though your life is unravelling.
You haven't told anybody about what's going on inside your head, not even close friends or family, because you're afraid if you do, not only might they think you a bad person, they might report you to authorities. Once fun-loving and energetic, you now frequently call in sick and avoid social settings as much as possible. You feel depressed, anxious, and entirely alone.
In fact, there are others like you, many more than you think. What you are experiencing has a name. And preliminary results from a study out of the UBC Anxiety Disorders Clinic show that it can be treated.
It's called primary obsession and it's a form of obsessive compulsive disorder without the visible compulsions. OCD gained exposure when Jack Nicholson portrayed the obsessively handwashing, door-locking Melvin Udall in the 1997 movie As Good as It Gets, for which he and costar Helen Hunt won Academy awards. Primary obsession is OCD's lesser-known cousin, and while it has been on the books for about 20 years as an official disorder, very little is known about treating it. The reason for this is that PO manifests in thoughts, images, or impulses, while standard OCD treatments have focused on dealing with compulsive behaviour.
An Anxiety Disorders Clinic press release on the study emphasizes that there are no documented cases of anyone with PO acting on such thoughts or images. In fact, people who suffer from the disorder tend to be more highly principled and have higher moral codes than the rest of us, says Melisa Robichaud, the postdoctoral fellow responsible for daily administration of the study, and this may have something to do with its pathology. "These thoughts or images are very distressful to these people because they go entirely against their value systems," Robichaud said in a telephone interview with the Georgia Straight. "People who are gentle by nature will have violent thoughts, for example. Or people who are highly religious will experience the impulse to yell out blasphemies in church."
According to Robichaud, the disorder typically involves one of three themes: sex, as in unwanted thoughts involving homosexuality, aggressive sexual behaviour, child molestation, or bestiality; aggression, as in unwanted images of violence involving strangers or loves ones; and religion, as in blasphemous thoughts.
Little is known about the causes of primary obsession, although it's speculated that genetics may be involved and that stress can trigger the onset. It affects men and women equally, and though it's more common in people in their 20s and 30s, no age group is exempt.
Because it tends to go unreported and undiagnosed, its prevalence has been underestimated. Robichaud says that based on reported cases, it's estimated that about five percent of people with OCD have primary obsession. She adds that given that two out of every 100 people in the general population have OCD, costing Canada alone billions to diagnose and treat, the incidence of PO is significant enough to worry about.
The Anxiety Disorders Clinic study, funded by the Canadian Institute of Health Research, has been going on for the past four years and has provided two different treatments to more than 70 sufferers of PO. One method tackles the interpretation of the offending thoughts or images; the other focuses on dealing with the stress caused by such thoughts or images. The goal is to see which is more effective over the long term and whether certain people respond better to one over the other. Details on the treatments can be found at www.ocdtreatment.ca/.
Results so far are very promising, according to Robichaud: "They are clinically significant," she said. "Three-quarters of participants are doing so much better that it makes a practical difference in their lives. They are functionally much better and their lives are opening up again."
The study is accepting new patients until April 14 to undergo the free treatments. Robichaud is the first contact for participants during a two- to three-hour assessment. Once accepted, they commit to 13 one-hour sessions, once a week, as well as follow-up sessions six and 12 months after their final treatment. People interested in participating can call 604-822-7676.
For Robichaud, the preliminary results are heartening to say the least. "It's so sad to listen to people who are good, good people describing themselves as horrible." For those with the disorder, they provide a glimmer of hope-and the promise of having their lives back again.