Obsession has been a recurring theme in literature and motion pictures. Shakespeare’s Hamlet was obsessed with death. In Melville’s Moby Dick, Captain Ahab displayed the epitome of an obsession. He was fixated on revenge against Moby Dick, the ferocious sperm whale that had destroyed Ahab’s previous ship and cost him the lower part of his leg. Ahab ranted, “…I'll chase him round Good Hope, and round the horn, and r
ound the Norway maelstrom, and round perdition's flames before I give him up.” In Basic Instinct, Sharon Stone’s character Catherine Tramell was erotically obsessed with the detective, Nick Curran played by Michael Douglas.
Charles Dickens had a habit of rearranging furniture whenever he stayed in a hotel room and inspecting his children's bedrooms every morning, leaving behind notes when he was not satisfied with their tidiness. Michael Slater, emeritus professor of Victorian literature at Birkbeck college, London, suggests that Little Dorrit, the main character in Dickens's novel of the same name, reflected his own character. "There she is, the epitome of neatness, in the squalid atmosphere of the Marshalsea prison…. sweeping and cleaning and tidying all the time.”
Adrian Monk, the television detective portrayed by Tony Salhoub is uncomfortable with many aspects of the world around him, which he perceives as being tainted and disorderly, creating humorous vignettes within the main story lines. While we find amusement at some of his phobias, true Obsessive Compulsive Disorder causes great distress, which distinguishes the condition from Obsessive Compulsive Personality Disorder, in which the individual experiences no special discomfort as a consequence of the obsession about an idea, or compulsion to engage in a specific ritual. Moreoever, people with OCD often exert great effort to suppress or control their obsession or compulsion, while those with OCPD do not.
Most individuals with autism spectrum disorders display aspects of OCD to some degree, while some clearly meet the diagnostic criteria for the disorder and often profit from the same medications as others with OCD. When a preferred routine or ritual is disrupted, often meltdowns occur, in some cases including severe tantrums, aggression and self injury. A little girl with Asperger disorder with whom we worked, screamed and scratched her face if her preferred bedtime routine was altered.
Among typical populations OCD begins as early as the age of two, but most often begins in the late teens for males and the early twenties for females. Studies have placed the prevalence between one and three percent. Family studies have demonstrated that OCD is familial, and results from twin studies demonstrate that the familiality is due in part to genetic factors. Most experts believe multiple genes are involved in aspects of OCD, so it unlikely a single “smoking gun” gene will be identified.
It has been argued that OC traits may have historically conferred advantages in an evolutionary sense to human kind. The majority of compulsions such as checking, washing, counting, needing to confess, hoarding and requiring precision, all carry the potential to benefit society. A series of studies by John Constantino (shown here), Richard Todd and
colleagues strongly suggest some components of autistic traits are broadly expressed within the general population, including lack of some social skills, shyness and ridigidy or compulsiveness.
Simon Baron-Cohen proposed individuals with autism exhibit what he described as the extreme male brain, characterized by a drive to systematize, while being deficit in empathy. He points out that typical males have on average superior skills in spatial relation tasks, while females are generally better at perspective taking than males. He has further suggested that men and women both of whom carry genes increasing suspectibility to autism, are more likely to marry and have children, than they are to marry and procreate with someone who does not carry autism susceptibility genes. "My new theory is that it's not just a genetic condition," he says, "but it might be the result of two particular types of parents, who are both contributing genes. This might be controversially received….But the genetic theory has a lot of evidence, and what we are now testing is that if two "systemizers" have a child, this will increase the risk of the child having autism.”
This controversial idea (assortative mating) may, in part, explain the higher than expected prevalence of high functioning autism and Asperger syndrome over the past two decades. Many more high paying jobs for individuals with strong systematizing skills in computer science, information technology and financial services, began becoming available around 1990 with the high tech “boom.” This increased the chances that like-minded couples would meet one another, marry and have children than in the past. Women who are also systematizers may be more likely to be attracted to and tolerate less socially competent men who are also systematizers. Not surprisingly, they create children who are little systematizers, much like themselves.
I reviewed the occupations of 23 pairs of parents of children with autism spectrum disorders served by the Minnesota Early Autism Project over the first 3 years of operation, and found that in 71% of families at least one parent was employed in computer and/or IT, financial or statistical fields or medical sciences. In 1/4th of the families both parents had computer or technical occupations. The remaining couples were employed in education, social work, construction or service jobs (some of which had technical components). This occupation pattern seems unlikely be attributable to chance.
Under some circumstances it may be advantageous for an individual to possess some compulsive traits. Consider the skills necessary to be a good computer programmer. In addition to being intelligent, it requires: (1) attention to detail (2) focusing on parts rather than “the big picture,” (3) perfectionism, intolerance for errors (4) willingness to repeat similar or the same routines over and over (5) willingness to stick to rules (6) excessive devotion to work and production (7) reluctance to delegate tasks. In the past, most of our ancestors had occupations that required more flexibility, adjusting to changes in weather patterns, infestations of insects damaging crops and changes in entrepreneurial opportunities. Aside from repetitive factory work, most jobs required flexibility in response to changing circumstances. But characteristics that make one a good computer programmer may not be optimal for being a spouse or parent, which heaven knows, requires a great deal of flexibility. But then again, if one’s spouse is like-minded, maybe everything is copacetic. It isn’t really a new idea after all. In 1599, in The Dictionarie in Spanish and English, which was complied by the English lexicographer John Minsheu, the phrase “Birdes of a feather will flocke togither.”
BehaveNet Clinical Capsule Obsessive Compulsive Personality Disorder DSM IV-TR = 300.3;http://www.behavenet.com/capsules/disorders/o-cd.htm
BehaveNet Clinical Capsule Obsessive Compulsive Personality Disorder DSM IV-TR = 301.4; http://www.behavenet.com/capsules/disorders/o-cpd.htm
Baron-Cohen, S. (1999) The extreme-male-brain theory of autism. Tager-Flusberg, H, (ed) Neurodevelopmental Disorders. MIT Press (1999)
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Monk TV Series. USA network. Andy Breckman et al. Executive Producers. Universal Cable Productions in association with Mandeville Films and ABC Studios
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