I am a 31-year-old housewife married to a 35-year-old businessman. He has been a good provider but I am now at the verge of wanting to separate from him after five years of marriage. It’s so hard living with him. He wants to direct and oversee every aspect of my life. Even his employees have the same complaints. He is such a perfectionist. He wants me to follow to the last detail what he had planned for me for each day of my life. I have to wipe dry the faucet and sink after each use. I have to press the toothpaste tube from the bottom end upwards every time I use it. He gets so irritable if I don’t follow what he wants. If I go out with friends, I have to tell him in detail my itinerary and I have to report to him every hour. He refuses to throw away old clothes and other things in the house which are piled up in one of our vacant rooms. My husband also has funny habits, like he keeps on washing his hands which he feels are contaminated with dirt and germs and insists that I double or even triple check if he had locked the door and turned off the lights at night. But I love my husband despite these traits. What can I do to bear with him?
Michelle
Your husband is showing the common symptoms of Obsessive-Compulsive Disorder (OCD), with a pattern of obsession with contamination followed by a compulsion of washing and an obsession of doubt followed by a compulsion of checking. There is also the element of hoarding and collecting objects which have no use or sentimental value. Your husband, based on your letter, appears to have an Obsessive-Compulsive Disorder. It would be best that you consider bringing him to a psychiatrist for professional help.
What is Obsessive Compulsive Disorder (OCD)? OCD is a type of anxiety disorder whose primary feature is the symptom of recurrent obsessions and compulsions, which are severe enough to cause marked distress to the person. The obsessions and compulsions are so time consuming and will therefore lead to disruptions of the person’s routine activities, functioning at the workplace and even cause relational problems. I have a patient whose compulsion is checking and re-checking if he has locked the front door and if he has left the car key inside the vehicle. When he has gotten exhausted from doing so, he would then order his wife or his son to take over in repeatedly doing the checking. Another patient is so obsessed with contamination with germs, she wraps her hand in tissue paper before touching the door knob of my clinic. If she forgets to bring tissue paper, she will wait until somebody else arrives to open the door since she cannot even knock at the door.
Let me define and differentiate an obsession from a compulsion. An obsession is a recurring intrusive thought while a compulsion is a conscious, recurring behavior. So an obsession is something mental whereas a compulsion is an actual behavior. Examples of obsessions are the following: Concern with bodily wastes or secretions, dirt or germs; fear that something bad will happen (fire, death, injury of self or others); scrupulous excessive praying which is out of keeping of the person’s background; preoccupation with lucky or unlucky numbers; intrusive forbidden or perverse sexual thoughts. Examples of compulsions are the following: Checking doors, locks car brakes or appliances; excessive hand washing, tooth brushing, showering or grooming; repeated rituals like going in or out of the door; excessive cleaning to remove contact from contamination; touching; ordering and arranging; counting, hoarding and collecting; licking, spitting or having a special dress pattern.
It was Sigmund Freud who originally conceptualized OCD. Freud said that a person with OCD (previously referred to as an obsessive-compulsive neurosis) regressed to the anal phase of psychosexual development. He attributed this to the "defensive retreat" once the person is overwhelmed by his anxiety-provoking oedipal wishes.
The learning theorists on the other hand, explained OCD from another perspective. They theorized that obsessions are conditioned stimuli. A neutral stimulus becomes associated with fear or anxiety by a process of conditioning by being paired with anxiety-provoking events. When the person finds out that a certain action decreases the anxiety caused by the obsession, he will then start to develop a strategy to actively avoid the stimulus by his ritualistic compulsive behaviors.
Studies on families have shown that 35 percent of the first-degree relatives of people with OCD also are suffering from OCD.
Many clinical trials have shown the effectiveness of psychopharmacology (psychiatric medication) in OCD. The standard approach is to start with clomipramine or an SSRI (Serotonin-Specific Reuptake Inhibitor) like fluoxetine, sertraline, paroxetine or fluvoxamine. It has been found that the best clinical outcomes occur when the medication with an SSRI is combined with behavior therapy. Prolonged insight psychotherapy and supportive psychotherapy have been found useful in patients who are able to work and make social adjustments. To reduce family tension and marital disorder, family therapy is likewise advised.
Congratulations to the new graduates especially to the following: UP Manila College of Medicine batch 2004; Leonard Michael Halili (San Beda College); Jolo Godino (San Beda College, elementary honor graduate); and Eugene Nicdao (UERM College of Medicine graduate).
Condolence to the family of my friend, Leonardo Reyes (percussionist of Acoustic Jive) who succumbed to pancreatic carcinoma last Saturday, April 17.