The OCD Project (2010)
Summer television has arrived and with it comes the barrage of new and returning unscripted reality programs. 57 and 65, respectively, to be precise. One can probably identify numerous implicit psych issues embedded in some of the reality shows, and likely more so in their cast members. I don’t watch Jersey Shore, Bridezillas, or Toddlers and Tiaras, but I’m sure that the DSM-IV applies to some individuals on those shows as much as an instruction manual titled “How to Clean Up an Oil Spill” to BP.
Obsessive Compulsive Disorder (OCD) is the focus of the new voyeuristic reality series The OCD Project. It airs on VH1 and follows a group of six strangers diagnosed with quite severe OCD, who are forced to live together under one roof to receive intensive exposure therapy treatment. It’s Intervention meets Fear Factor. Dr. David Tolin, a PhD clinical psychologist who specializes in anxiety disorders, plays the host and head therapist on the show.
OCD is an anxiety disorder characterized by intrusive thoughts and repetitive behaviors. Obsessions are persistent anxiety-provoking thoughts that invade one’s conscious awareness; they are distressingly difficult to ignore like seeing a pregnant woman drinking a 40 and smoking a pack of Marlboros. Obsessions commonly have a fearful theme that either neglecting to do something or making a mistake will lead to some sort of catastrophe. For example, “If I don’t check if the front door is locked 6 times before I leave the house, then I’ll get into a car accident today.” Other types of obsessions may center on a fear of contamination, a need for exactness or symmetry, irrational saving and hoarding, or unpleasant aggressive impulses and sexual imagery.
Compulsions are repetitive behaviors performed intentionally to neutralize or alleviate the anxiety resulting from the obsessions. These rituals may range from subtle mental acts like counting or repeating numbers to more obvious physical acts like excessive hand-washing, checking, or rearranging objects. Compulsive behaviors consume time and interfere with routine activities, often to the point of severe functional debilitation. Imagine if the Iron Chef had OCD relating to a fear of contamination and had to wash his hands every time he felt germs defiled them. What type of cuisine, if any, would be prepared then?
Interestingly, many famous and successful celebrities live with OCD. Billy Bob Thorton reportedly obsesses about repetition, Cameron Diaz doorknobs, Howie Mandel germs, and David Beckham symmetry and evenness. In his role as Howard Hughes (who also suffered from OCD) in The Aviator, Leonardo DiCaprio channeled his childhood obsessions with sidewalks to devotedly play the part more effectively.
Reality shows can be repulsively annoying or entertaining and amusing to watch. The OCD Project is definitely more of the latter. It raises awareness of OCD to the mainstream and helps destigmatize mental illnesses, of which I’m definitely a proponent. Nevertheless, I can’t help but feel that it does so at the expense of exploiting and tormenting its cast members in its attempt to cure them of their disorders. Although the VH1 network executives are probably concerned primarily about the show’s numbers and lucrativeness, I hope that patient care is the foremost interest for Dr. Tolin.
Psychiatry in the Mainstream 
Dr. C,
I saw you mentioned hoarding as a symptom of OCD. I don’t know if you ever seen the television series Hoarders, but the homes of the individuals they feature on this show are anything but cleanly. How can someone compulsive stand to live in such an unkempt environment?
Great question Concerned Reader.
I have seen Hoarders, and you are right that the homes are anything but clean, and are typically unkempt and in utter disarray.
I should first clarify that although compulsive hoarding is a common symptom of OCD, in some cases, it is actually considered a distinct syndrome different from OCD. Pertusa et al review this in their article in the American Journal of Psychiatry.
The key differences are:
Hoarding as a symptom of OCD is characterized by hoarding of items both common (old clothes, magazines, newspapers) and bizarre (nails, hair, feces). The hoarding behavior is obsessional and related to themes of fear of catastrophic consequence, need for symmetry/order, and checking rituals. Symptoms are distressing and impairment tends to be severe.
Compulsive hoarding as its own syndrome is characterized by hoarding of mainly common items for their intrinsic and sentimental value, ie letters, videotapes, magazines. Obsessions are typically absent. Symptoms aren’t usually distressing to the individual and cause a lesser degree of impairment.
The reason that “compulsive” people are able to live in such a pathologically cluttered environment is that they are more distressed by throwing out items than living in the mess. They are driven by the need to collect and the inability to discard; not by a compulsion to be neat or clean. It’s not that they want to live with the clutter; they just can’t get rid of the clutter.
That OCD Project show sounds kind of ridiculous and borderline unethical, like putting together 3 people who all have delusions that they’re Jesus. A much more realistic take on OCD is the A&E show Obsessed, which shows therapists working one on one with patients, using mostly realistic CBT. And there’s enough drama already with something like OCD that I don’t think you have to go for the additional shock value.
Thank you for this excellent post, Dr. C. i know how terrifying OCD can be…and for some strange reason, it waxes and wanes with my other varies symptoms. i guess depending on levels of stress and anxiety and what is happening in life…?
Thanks again,
tracy
Ummm, make that “various”!
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I have been experiencing some obsessions. I tap light switches 3 times, because i feel i am afraid that if i swtich it at a certain time something bad will happen. I also have an obsession with the way i eat things i have to eat the edges first, if i dont i cant finish the food, and when i type after i type a period i ahve to backspace and then type it again before i think it is right. I also cannot drink out of drinking fountains, or if i do i have to tap it several times to make sure its clean? Im not sure what to do about these things, can you please help me?
Hi Keirsten,
Thanks for your comment. If what you are describing is causing distress, I would advise you to consult with your doctor for professional medical advice. I want to emphasize that information on this web site is provided for informational purposes only and is not a substitute for proper medical care. I hope you understand.
Actually some of the exposure therapy in that show seemed to go a little over the edge even to a person with non ritual issues.
But even more so in the next episode coming up because the Doctor is going to drop them off in a abandoned mental hospital to give them….exposure?
That’s what the summery said my dvr guide.
Now that seems like something out of Fear Factor and Ghost Hunters which that has been an obsession lately in ghost shows.
That mental hospital plan seems a bit carried away and not needed..
I hope the doctor doesn’t become a mad doctor with this exposure therapy because you could cross a line that’s sadistic.
That’s just what i think.
There’s only a line the OCd project could cross if the doctor gets carried away with this exposure and scare tactics.
He could cross into the mad doctor thing if he trys to keep getting more extreme which goes into torture.
I just hope he doesn’t become as sadistic as the Fear Factor and Solitary doctors who are already mad.
In the shows recent episode summary on my dvr said they were giving the OCD patients a fieldtrip to an abandoned mental hospital?
That sounds from what I get from previews a ghost hunter show thing.
I think the OCD doctor is starting to go a bit over the edge if he continues like this and if he does it’s not nice if he’s close to exploiting abuseing peoples minds.
Awareness is good but useing treatment as an exhibitution or dare is not good.
I’m no doctor but I care about people.
Hi Lynn,
You raise some very interesting and valid points. Thanks for your comments!
Dr. C,
Do you ever see patients whose obsessions are worse than their compulsions? What then would be the treatment of choice for that situation?
Thank you again for a wonderful and very educational blog,
tracy
Great questions Tracy.
Although I don’t want to comment specifically on my patients, I will say that people with OCD can experience obsessions that are more severe and cause greater impairment than compulsions, and vice versa. Some may even experience obsessions without compulsions – “Pure O” – although some OCD experts may argue that compulsions are naturally inherent in OCD as they are performed to alleviate the anxiety from the obsessions, perpetuating the OCD cycle (obsessions -> anxiety -> compulsions -> temporary relief -> obsessions –>). These compulsions tend to be subtle like avoidant and reassurance-seeking behaviors.
The treatment for “Pure Obsessional” OCD, like most other psychiatric disorders, includes both psychotherapy and medication management. Cognitive Behavioral Therapy (CBT) with emphasis on exposure and response prevention (ERP) and cognitive restructuring are well established therapies for obsessional OCD. That’s basically what the cast members on The OCD Project are undergoing. Since compulsions aren’t as prominent, treatment is aimed more at the cognitive than the behavioral level. Antidepressants, particularly the ones that act on serotonin (SSRIs), are the first-line medications used to treat OCD. Treatment of moderate to severe cases of OCD typically requires both CBT and medication together.
Thank you Dr. C for your comments. I find that I am with you (in the minority, sadly) that think that this show is a bit over the top in terms of sensationalism.
My concerns are that while the show may raise awareness of OCD, it also is putting the blame on patients who are afraid to get treatment using these extreme methods of ERP and CBT that Dr. Tolin is advocating for. He tells these people “do it my way or go home” and “either fight this now or its over… fire me then” and says that these statements are for motivation, when I feel that they pin the blame on those that are suffering. If one does not submit to this methodology, then it is one’s own fault for not obtaining a cure. That seems to be a rocky road to tread on, ethically, given that their might be better ways of accommodating someone who can’t handle these extreme methods. I was wondering if you had any thoughts.
Hi FF,
I appreciate your keen insight. First off, I want to say that you’re not in the minority (at least not amongst the professional mental health care providers). It is true that Dr. Tolin has his own way of treating patients with severe OCD and other anxiety disorders. You have to keep in mind that he is an expert, and that his manner of treatment, albeit extreme, works for some. It may not work for everyone, to which you alluded, but for the ones that it does help, it makes a world of a difference for them. I agree with you hands down that you shouldn’t coerce someone to do something they’re not comfortable with, but there are people who need a little (or forceful) push. If it takes 1 person to succeed in treatment for every 9 others that fail, isn’t it worth it to have helped that one individual?
Thanks for your insightful question.
OCD is a product of high anxiety. I had OCD for very long but once I understand the underlying problems, I am cured from OCD.
Many doctors tend to misdiagnozed their patient as mentally ill. This is wrong.
OCD is NOT an illness, not physically and not mentally.It is not a stand alone symptom for without high anxiety, OCD and other phobias simply cannot exist.
So to be cured from OCD is simply to “switched off” your high anxiety which is inherent in every human and all the symptoms will go away. Guarantee!
haqmani