Category Archives: Television

Obsessive Compulsive Disorder

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.

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Filed under Celebrities, Diagnosis, Television

Antisocial Personality

Criminal Minds (2005-2010)

Hands-down the most disturbing of personality disorders is Antisocial Personality Disorder (ASPD). Many mainstream TV dramas base the content of their shows on people with ASPD – Criminal Minds, Bones, Law and Order, The CSI Series, and the list goes on….

In psychiatry, the meaning of antisocial is not the same as the layman’s term used often to describe the shy and sort of awkwardly charming introvert who embarrasses easily. Think Micheal Cera in Superbad or Juno, or any of his other roles. Instead, antisocial refers to people who are sociopaths or psychopaths. They lack a moral compass and have utter disregard for social norms. These people are entitled, deceitful, and remorseless of any type of wrongdoing. They lie, con, and cheat – not the type of person you’d want to meet on Match.com! Their inability, or refusal, to abide by rules and laws may give rise to criminal behavior and consequently overcrowded prisons – more than 80% of inmates are ASPDs. Unlawful acts can vary widely from vandalism, petty theft, and identity fraud to arson, rape, and killing sprees. They can be an acquaintance, co-worker, or even a friend or relative. Not all ASPDs are violent criminals, but Ted Bundy, Jeffrey Dahmer, and Charles Manson  have been described as some of  the most notorious and infamous ones.

Currently in psychiatry, per our bible the DSM-IV, there isn’t a distinction between a sociopath and a psychopath (pending revision). Although they’re both diagnosed as ASPD, and occasionally used interchangeably,  some experts believe they are separate entities.  A key difference between a sociopath versus a psychopath seems to be related to the underlying cause of their behavior, which summons the nature versus nurture argument.  Sociopaths are thought to have been shaped by an invalidating and traumatic upbringing, whereas psychopaths are born emotionally and morally deficient. The latter is hard-wired differently from the get-go. Thus, fearlessness and stimulation-seeking are seen at an early age. Imaging studies have shown brain abnormalities implicated in emotional detachment and physiologic responses characteristic of psychopathic behavior.

ASPDs tend to possess superficial charm and allure, which serves them well in manipulating others for personal gain. Their bodies may be covered with ostentatious tattoos. This is, of course,  not an absolute sign of an ASPD; otherwise, I can’t imagine what it’d be like to be NBA Commish David Stern, given the growing prevalence of tattooed bodies in the league. Also of note, a juvenile history consisting of the triad of bedwetting, fire-setting, and animal cruelty seems to be a harbinger of violent criminal behavior.

Clinically, ASPDs don’t seek treatment for their symptoms per se as they don’t see anything wrong with their antisocial behavior. They typically present for psychiatric treatment in the context of prescription drug-seeking, substance abuse problems, malingering – feigning an illness to get something they want – and violent behavior. Unfortunately, there is no demonstrated effective mental health intervention for treating ASPD itself. Thus, the criminal justice system becomes their de facto treatment system. Somewhat reassuringly, it has been observed that antisocial behavior in ASPDs attenuates over time, particularly beginning in their late 30s.

Many TV watchers become enthralled by crime drama shows like an unsuspecting victim is drawn to an antisocial’s charm and deceit. Entertaining and seemingly preposterous as the shows may be, the reality is that people with antisocial personality disorder do exist and live amongst us. The next time you feel captivated by someone’s charisma, yet feel like you’re being manipulated, follow your gut instinct and change the channel.

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Filed under Personality Disorder, Television