Tuesday, September 9, 2008

Mickey OCD's

FOND DU LAC, Wis. - A 54-year-old man says his obsessive-compulsive disorder drove him to eat 23,000 Big Macs in 36 years. Fifty-four-year-old Don Gorske says he hit the milestone last month, continuing a pleasurable obsession that began May 17, 1972 when he got his first car.

Gorske has kept every burger receipt in a box. He says he was always fascinated with numbers, and watching McDonald's track its number of customers motivated him to track his own consumption.

The only day he skipped a Big Mac was the day his mother died, to respect her request.

The correctional-institution employee says he doesn't care when people call his Big Mac obsession crazy. He says he's in love with the burgers, which are the highlights of his days.


Some thoughts:

1. Do the math. He's averaging almost two per day.
2. Apparently he has written a 205 page book about this. Because of his OCD, he types only using one finger, and double spaces between each word.
3. He's physically fit. (6 foot, 180). Still, I'd love to see an echocardiogram on this guy.
4. Yes, he's in "Super Size Me."

Shrink Think:
Obsessive Compulsive Disorder is an anxiety spectrum disorder characterized by repetitive, and often anxiety provoking thoughts (Obsessions) and repetitive or ritualistic behaviors (Compulsions). The symptoms should be severe enough to cause a disturbance to "normal" functioning, or to cause significant distress to the individual. I have many patients who have described the difficulty with stopping the compulsive behavior as like trying to stifle a sneeze. (Curiously, I have heard the same comment about tics in Tourette's Syndrome). If a compulsive behavior is missed, sometimes the individual will have to perform a secondary behavior to "make up for" the missed compulsion. This is called "undoing." An example is a person who has to count the stairs, and goes back two steps, if he misses one. Classic OCD patterns include counting routines, germ phobias rituals, and checking (locks, doors, etc.)

Some of the more curious OCD patterns I have seen include:

Grooming: washing each body part 33 times. This made for a long morning routine.

Galeophobia: fear of sharks with OCD. This individual would ruminate about sharks, and have specific undoings when hearing the word "shark" or other trigger words, such as "ocean." Taking a bath was out of the question for many years.

Demonic Possession: A young individual would think the name of the devil repetitively, and that the devil would be in inanimate objects of a certain shape or color, if he did not use his undoing. The pattern of requiring specific numbers, lack of extreme severity, (relatively speaking in Psychiatric terms!), overall awareness of this patterns, and positive treatment response to conventional therapy helped differentiate this diagnosis from schizophrenia or schizotypal personality disorder.

Common treatments include medications, such as SSRI's (Prozac type medications), usually at fairly higher dosages, and behavioral therapy. One example of behavioral therapy is systematic desensitization, for example as with germ phobia rituals, desensitizing the individual with dirt on their hands, and increasing the amount of time that he can tolerate it. Many persons with OCD do not seek out treatment, and try, often successfully, to just work around it.

As with many anxiety symptoms, there is a continuum, upon which most of us exist. Simple phobias, preference towards certain patterns, etc. are often all part of the wonderful variety in life: While I am not one who is usually attuned to organization, I have all of my CD's organized alphabetically, with each CD in the case positioned that one can read the title of the CD when it is opened.

Thoughts? Or, care to share your Obsessions and/or Compulsions?


Dreaming again said...

Both of my children have OCD and TS.

My oldest, soon after being diagnosed, was reading some information about it that I'd given him, looked up and exclaimed "I'm normal in my abnormalities!"

That, has been both of my children's life motto's.

While they know that their brains misfire to cause them to compuslively wash their hands, say things 'just right' jerk their heads or hands, kick feet or any number of movements, sounds, thoughts that won't go away (mixing the 2 disorders together here) they both know that for a kid with TS/OCD they are perfectly normal.

Self esteem in tact ...they go on with their day.

With the eldest (now 19 (dx'd at age 8) we've used medication for both TS & OCD he's now in college and still on medications with no sign of the disorders letting up, but rather increasing.

The youngest we only used medication for TS, although he is no longer on medication, he still is in special education for severe learning disabilities and a sophomore in high school. He is, in a leadership program, and none of his peers know he recieves special education modfications. (mainstreamed program)

For his OCD, we were able to use behavior modification. He now does his own behavior modification and we rarely even have to help him come up with methods to help him.

My children and their journey have inspired me to go back to school to get a degree in psychology.

Doc said...

Welcome dreaming!

That's a fabulous sharing, and I can hear the well deserved pride you have for your kids! And I'm sure that they know that "for a kid", period, they are perfectly normal.

Tourette's and OCD is a bit of a tricky combination from a pharmacological treatment perspective, as the medications used for one often exacerbate the other, or just give sedation. That is why non-pharmacotherapies should be a mainstay in treatment.

I am seeing a higher frequency of individuals with this combination being diagnosed as Asperger's syndrome or high functioning Autism. While I'm always a stauch proponent of not concerning with the label, but the individual, I do think that there may be some overlap in these areas. (Conversely, I have also "rediagnosed" a number of patients with OCD/TS who were being diagnosed as Autism/Aspergers, as this latter diagnosis is currently en vogue).

Congratulations and good luck on your pursuit of a psychology degree. I have one of those, as well as my medical degree, and internship, and residency diplomas--but you will find, as I have, that the degrees are well and good, but it's the life experiences that will be the backbone of your therapy practice, if you choose that path.

Do stop by again!

Jared At The Doctor Job said...

Wow that's about 1100 calories and 65 grams of fat daily on Big Macs alone. Weighing 180, he must work out a lot or have great metabolism.

Doc said...

Add in French Fries and he should be a mountain. I don't know how often he went for the fries, but those are little carb bombs.

I'd say he has good genes, first and foremost.

BTW, welcome! and stop by anytime.

purplesque said...

I have to confess I find OCD one of the most difficult disorders to treat. One of my patients is obsessed with envelopes; he cannot pass one by without opening it. He is afraid that something bad might happen to a family member if he stops doing it. What do you think about EMDR as a treatment?

p.s.Its wonderful to find another psychiatrist who blogs..great posts.

Anonymous said...

I find the mail too stressful to open these days, since it's currently full of threats from collection agencies about medical bills I can't pay.

Would your patient be willing to open my mail and solve the problems I'm avoiding?

I think there's enough of it laying around here to keep him happy for months.

Anonymous said...

(Now for an attempt to be On Topic)

I have a friend with OCD who has to wipe with a certain number of toilet paper squares before she feels clean. Unfortunately, she keeps doubting her count and has to start over and over.

This wouldn't be so bad, I suppose, if she didn't routinely flood the bathroom in the process. She also has serious germ phobia (probably obvious from the last paragraph) that causes her to go into anxiety meltdown when this happens. I've known her to spend most of a day washing and rewashing the floor tile with bleach.

She's doing much better now on an SSRI.

Doc said...

Welcome purplesque!
Funny you should mention EMDR, I was giving a a grand rounds today, and that exact question came up regarding PTSD. EMDR (Eye Movement Desensitization and Reprocessing), for those in the non-shrink world is a form of therapy in which specific sensitive areas (often traumatic memories) are reprocessed by recall while focusing the eyes on an object (such as a point of light) which oscillates left and right. The idea is to diffuse the way the brain processes the specific trauma, to detach it from a specific automatic reaction, and make the recall more generalized and therefore more processable. There are many studies that show the efficacy of such therapy, although there is debate regarding efficacy compared to other forms of therapy. Unless there is a specific traumatizing event (perhaps triggering or causing the OCD), I would not imagine that EMDR would be too effective a therapy in OCD. I think that behavioral desensitization would have more bang for the buck.

Thanks for the comment, and drop by anytime, I'd like to get some more shrinks in da house!

Doc said...

It sounds like opening your mail would add PTSD to the OCD, with the trauma of the medical bills! A hint regarding any hospital bills (for those that have any), get a detailed summary of each charge. You may find many things that were not provided services (for example, bathrobe, slippers, pharmacy charges) which you can have removed from the bill.

Your friend is a good example of the symptoms we've discussed. I am often amazed at how bad the effect of the symptoms on one's life will get before they seek treatment. I'm glad she's doing better.
Do drop by again.