Field Guide to the Obsessive-Compulsive: Famously Fussy

imageJeff Lewis, a real-estate investor who buys and sells residential property in swanky Los Angeles neighborhoods, is preoccupied with order, symmetry, perfection, cleanliness, rules, and lists. If his refrigerator isn't stocked with bottles of Evian water, all with labels facing outwards, "there is hell to pay." But rather than tormenting the 37-year-old Lewis—star of the Bravo reality show Flipping Out—these obsessions have turned him into a multimillionaire. In Lewis's line of work, attention to detail is essential. Before putting a home back on the market, he must supervise months of painstaking renovations, typically at a cost of several hundred thousand dollars. "OK, I have a mental affliction," he says. "But it's an asset. My perfectionism sets my product apart."

Lewis has all the hallmarks of obsessive-compulsive personality disorder (OCPD), the most common personality disorder, affecting nearly 17 million Americans. Because all personality disorders lie on a spectrum from faint to acute, many millions more have a touch of OCPD: not enough of the symptoms to meet the diagnostic criteria, but enough to be considered especially persnickety.

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Like Lewis, these people are often high achievers because of their so-called pathology—not in spite of it. "For accountants, lawyers, and engineers, it's a good fit," says psychologist Steven Phillipson, clinical director of Manhattan's Center for Cognitive-Behavioral Therapy. As Glen Gabbard, psychoanalyst and professor of psychiatry at Baylor University, puts it, "The perfectionism, the thoroughness, the politeness, and the conscientiousness of the person with OCPD are adaptive. No one can get through medical school without OCPD traits!"

In fact for some professions, only those with OCPD need apply: Obsessions and compulsions drove the English language's three most famous lexicographers—Samuel Johnson, Noah Webster, and Peter Roget. Roget, a British doctor who completed his legendary Thesaurus at the age of 73, began compiling copious word lists when he was just 8. Much later, he organized his whole life into a list, dubbing his autobiography List of Principal Events.

The Picture of Pickiness

Lewis has been this way as long as he can remember. In elementary school, he refused to step on the lines on the sidewalk. "If my parents didn't give me separate plates for my chicken, mashed potatoes, and spinach, I would get visibly anxious and wouldn't eat anything," he says. Signs of OCPD often appear in childhood; the cause of the disorder is not known but is thought to develop out of a mix of genetic, environmental, and psychological factors.

Each morning, he issues a to-do list to each of his half-dozen employees. "I don't want anyone to forget anything," he says. Much of the dramatic tension in Flipping Out stems from struggles with his various personal assistants, who keep the business running. Firings (and rehirings) are routine.

Though OCPD has helped Lewis sell nearly 50 homes over the last 10 years, it has exacted a toll on his personal life.

"I realize that I can be hard to be around," he says. "Everyone doesn't think the way I do." Having recently ended a five-year relationship with a partner, Lewis, who is gay, is now motivated to change and has vowed to become less demanding. "In the future, I won't nag my partner to put the shampoo and the conditioner on the proper shelves in the shower. I'll do it myself."

It's estimated that less than 1 percent of those who fit the criteria for OCPD seek mental health treatment to cope with the less appealing parts of their personality. "People with this disorder often deny that they have a problem," says Frederic Busch, a psychoanalyst and professor at Weill Cornell Medical College in New York City.

From Debilitated to Dynamite

OCPD is frequently confused with obsessive-compulsive disorder (OCD), a less common but more disabling condition, with a stronger biological component. "With OCD, people become bombarded by very bothersome and intrusive thoughts. Rather than providing them with pleasure or satisfaction, the obsessions impair their functioning," says Jeffrey Schwartz, a psychiatrist at UCLA and author of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior.

In contrast to those with OCPD, people with OCD tend to be acutely aware that something is wrong. For years, Jeff Bell, now the afternoon news anchor on KCBS Radio in San Francisco, was plagued by a host of irrational fears. When driving his car or boat, he would constantly worry that he had inadvertently hurt someone. The countless hours he wasted ruminating about these alleged accidents nearly cost him his job.

The author of a memoir, Rewind, Repeat, Replay, Bell eventually found a therapist who provided exposure and response prevention (ERP)—a specialized form of cognitive-behavioral therapy that helps people gradually face their overwhelming anxiety. At the beginning of treatment, patients learn that though they are not crazy, their catastrophic worries aren't rooted in reality. Over time, they develop the courage to sit with their worst fears. Bell recalls feeling the urge to spend hours scrubbing his hands in the bathroom before a scheduled speech. He was convinced that if he went on stage, he would inflict a mysterious disease on his audience. "I was scared, but I chose not to give in to my concern about 'reverse contamination,'" Bell says. Research by scientists such as Schwartz shows that such changes in thinking and behavior can actually correct the person's faulty biochemistry. Even patients with severe OCD can often make significant progress after about 15 sessions of therapy.

Bell has been a lifelong perfectionist, but when his OCD flared up he couldn't perform his duties as a field reporter. "I would get so bogged down in minor details that a 60-second spot would take forever. Often it never got on the air," he says. While his endless ruminations are no longer a problem, his thoroughness remains. "My compulsion to do everything right has solidified my reputation as someone who delivers scrupulously fact-checked stories." —Joshua Kendall

How to Obsess Less

Those on the OCPD spectrum can learn to relax a little with these techniques from Steven Phillipson, founder of OCDOnline.com.

  • Listen to Yourself. Your dedication to detail probably reflects an underlying philosophy, such as, "I need everything to be perfect so no one notices I'm an imposter," or, "The whole business will collapse if I don't have complete control." Start keeping a log to record your thoughts as you engage in the tasks that bog you down.
  • Say Something New. Now that you're attuned to your faulty beliefs, answer them with counterarguments such as,"All humans are imperfect," or, "Nothing terrible will happen if I delegate some work."
  • Be Pragmatic. Focus on greater goals, not the nitty-gritty. Students who scrutinize every sentence of their papers should commit to finishing the whole assignment in a few hours; people who relentlessly hone in on their partner's weak spots should step back and remember the value of preserving a good relationship.

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