Abnormal Psychology

Anxiety Disorders 299

Obsessive-Compulsive Disorder

As we saw earlier, both Howard Hughes and his mother appeared to have a fear

of Hughes contracting an illness. After his parents’ deaths, Hughes’s health con-

cerns increased, and his profound fear of germs—and the rituals and behaviors that

he used to limit what he believed were possible routes of contamination—became

famous. But the protective rituals and behaviors extended beyond himself (and

beyond rational thinking)—he made his aides and associates undertake similar pre-

cautions even though they were extreme and didn’t, in fact, decrease his risk.

He viewed anyone who came near as a potential germ carrier. Those whose move-

ments he could control—his aides, drivers, and message clerks—were required to wash

their hands and slip on thin white cotton gloves... before handing him documents

or other objects. Aides who bought newspapers or magazines were instructed to buy

three copies—Hughes took the one in the middle. To escape dust, he ordered unused

windows and doors of houses and cars sealed with masking tape.

(Bartlett & Steele, 1979, p. 175)

And it wasn’t only germ prevention that Hughes tried to control. Throughout his

life he’d been overly preoccupied with details; at one time or another, he concerned

himself with every aspect of his companies—even demanding that employees con-

duct a detailed study of the vending machines at the Hughes Aircraft Company.

For most of his adulthood, Hughes wrote detailed memos about many things.

In his 40s, he started doing so about trivial things. Here’s an excerpt from a memo

about an upcoming residential move:

Any metal items of value should be protected against deterioration by putting them in

a cabinet or a room that is dehydrated and kept dry. This is the new method of preserv-

ing metal articles.... Any keys found among his things which could not be identifi ed

were to be melted down.

(Bartlett & Steele, 1979, p. 176)

Clearly, Hughes’s preoccupations and ritualistic behaviors were not “normal.” In fact,

his preoccupations and behaviors are symptoms of obsessive-compulsive disorder.

What Is Obsessive-Compulsive Disorder?

Howard Hughes had obsessions and compulsions. Obsessions are thoughts,

impulses, or images that persist or recur, are intrusive—and therefore diffi cult to

ignore—and are inappropriate to the situation (American Psychiatric Association,

2000). For instance, Hughes had obsessions about germs—his preoccupations about

them were intrusive and persistent. Worries about actual problems (such as “How

can I pay my bills this month?” or “I don’t think I can fi nish this project by the

deadline”) are not considered obsessions.

Whereas obsessions involve thoughts, impulses, and

images, compulsions involve behaviors. A compulsion is a

repetitive behavior (such as avoiding stepping on sidewalk

cracks) or mental act (such as silently counting to 10) that a

person feels driven to carry out; a compulsion usually corre-

sponds thematically to an obsession. For instance, Howard

Hughes was obsessed by the possibility that he might be ex-

posed to germs and was compelled to behave in ways that he

believed would protect him from such germs.

The key element of obsessive-compulsive disorder

(OCD) is one or more obsessions, which may occur together

with compulsions (American Psychiatric Association, 2000;

see Table 7.13). The obsession can cause great distress and

anxiety, despite a person’s attempts to ignore or drive out

the intrusive thoughts. People with OCD recognize that

their obsessive thoughts do not originate from an external

Obsessions

Thoughts, impulses, or images that persist

or recur, are intrusive—and therefore diffi cult

to ignore—and are inappropriate to the

situation.

Compulsions

Repetitive behaviors or mental acts that a

person feels driven to carry out and that

usually correspond thematically to an

obsession.

Understanding Obsessive-Compulsive Disorder

The anxiety disorder characterized by one or

more obsessions, which may occur together

with compulsions.

OCD can literally be life-threatening. Some people

who compulsively hoard have died in fi res in

their homes. The hoarded objects took up so

much space that it was diffi cult to leave once a

fi re started, or fi refi ghters had to spend too much

time trying to get in to the house (Kaplan, 2007).

Michael Maloney/San Fransisco Chronicle/Corb