Mark Goulston M.D., F.A.P.A.

Just Listen

OCD

OCB: Do You Have Achiever's Disease?

Obsessive Compulsive Bipolar - don't confuse with Obsessive Compulsive Disorder

Posted Nov 17, 2014

Although previously published as a “Question Mark” column in Emmy Magazine, 2002, I’m republishing it now because the combination of OCD and Bipolar disorder is still prevalent in many entrepreneurs.

Editor’s Note:

When one of our regular columnists, Dr. Mark, responded to this month’s question, it occurred to us that he is not the only one who sees people with the condition he has named Obsessive Compulsive Bipolar.

We all know of people who are as difficult and exasperating as they are talented and successful. We also realized that many of us aspire to be like them. And it’s not only because they seem so powerful and important as that they seem to be personally immune to such adversity as the Writer’s Strike. They also seem to be protected from a cultural malady that torments most of us, namely feeling powerless and insignificant.

Although Dr. Mark has written in his characteristic Q & A format, check out his checklist and answer the question: “Do you know anyone who has OCB?” Most of us at EMMY magazine do.

OCB: The Condition of the Millennium is Born (This was published in 2002)

Dear Dr. Mark,

I’m a writer/producer, and I’m not using my name because everyone knows it. I’m talented, I’ve worked hard, and I deserve my reputation as a power player in television because I’m willing to take risks that others won’t. I’m one of the few “Oh yeah? Just watch me!” people in TV who routinely do the impossible. I’m at my best when conventional wisdom and conventional rules just don’t cut it.

My problem is that the risks I take professionally earn admiration, but those that I take privately — like gambling, getting high, having affairs — are causing embarrassment and humiliation. And it’s getting worse.

I know I’m a basically good guy, but I have to admit that I have hurt more than a few people along the way. To be honest, I’ve even betrayed some of the people who have trusted and cared about me most, and I’ve lied to cover it up.

In my heart, I never meant to hurt anyone. It’s just that I’ve always done things my way, and my way works so incredibly well — at least professionally. The worst part is how much I’ve hurt my family and friends.

I’m afraid that if I let some shrink start playing around with my personality, I’ll lose that creative edge that made me successful in the first place. But I’ve got to do something.

What?

EXCEPTION TO THE RULES in Malibu

Dear Exception,

Here’s your choice. You’re either immoral or you’re sick. Pick your poison. But if you’re really a bad person, I doubt you would have written.

Over the past ten years, I’ve treated many people from the television, movie and dot-com worlds with problems painfully similar to yours. All those people were powerful, driven and successful. They also hurt people without really meaning to. There have been so many of them lately that I came up with a name for the condition: OCB. You may have heard of OCD, which stands for Obsessive Compulsive Disorder. OCB stands for Obsessive Compulsive Bipolar. It’s more of a condition than a disorder because OCBs often function quite highly, even though their personal lives are usually a mess.

They differ from pure bipolar (or manic-depressive) people. When bipolar people become manic they go off the deep end into psychosis, occasionally breaking the law and frequently ending up in a hospital. Even so they do it with a smile, because they feel invincible and free when they are manic.

OCBs don’t go to those extremes. Their obsessive-compulsive traits work like emergency brakes, pulling them back just before they go over either edge. People with OCB don’t lose touch with reality, just with common sense.  Generally regarded as exceptional because of their formidable abilities, they come to believe they’re exceptions to the rules that apply to everyone else. They tend to disregard the possible consequences of their behavior. Sometimes they’re even surprised when those consequences are disastrous. Compelled to seek the exhilaration of “controlled” mania, their life becomes like a roller coaster. They don’t get real joy or contentment on the ride, but it is exciting, and they’re not necessarily unhappy.

It’s their friends, partners (usually female, because OCB men outnumber women 4 to 1) and children who are miserable. It’s they who must live with the OCB’s unpredictability, his inability to give them undivided attention, his lack of emotional understanding and his failure to make good on promises to reform. One woman compared life with her OCB boyfriend to riding with him in a Porsche, blasting along curvy Mulholland Drive at 60 mph. “He tells me to just cool it, he’s in complete control as he downshifts and the tires screech,” she said. “He probably does feel more in control, feeling the wheels touching the road while he shifts and accelerates. On the other hand, I don’t feel anything other than scared silly and totally at his mercy. Sometimes I dig my fingernails into the dashboard, and it irritates the hell out of him.” People with OCB are addicted to excitement and power.

Power is the toughest mistress to compete against. In fact the seductive attraction to mistresses is that they make an OCB man feel powerful and even heroic in ways that his wife or girlfriend no longer does.  When power and excitement are present, OCB people are sharp, goal-directed, amazingly effective and productive.  When these feelings are missing, they become unfocused, listless and irritable. It’s the moodiness and their tendency to over-control that prompts psychiatrists to treat them with antidepressants like Prozac, Paxil, Lexipro or Luvox (these drugs, called SSRIs, are used to treat depression and OCD, to help people “lighten up”).

Frequently this is insufficient, because treating OCB people with only SSRIs is like trying to control boiling water by putting a lid on the pot. The lid won’t help unless you take the pot off the fire. In fact, putting a lid on boiling water only adds to the pressure. Similarly, giving only an anti-depressant to someone who has a concurrent bipolar component can make matters worse by causing him to become more manic.

What does seem to help is a combination of an SSRI and a mood stabilizer such as lithium, Tegretol, Depakote or Lamictal . These medications for bipolar disorders help turn down the flame. Psychiatrists have been using the combinations for many years for what’s referred to as “treatment resistant depression.”

As intensity of the OCB lessens, patients find calm and often a new kind of non-frenetic energy. One patient was so relieved he called me in tears: “I’m normal!” he said. “All my life, I thought normal was for everyone else. You know? Success doesn’t make up for feeling like a mental misfit!”

After medications have effectively stopped the Porsche by removing the keys, individual and couples therapy can help a patient and partner develop a healthier relationship — now that they have slowed down enough to put some emotion into it. Insight therapy might also help, since there’s usually some childhood abuse, neglect or dysfunction that contributes to (but alone doesn’t cause) OCB.  Pretty soon OCB people listen better, are more “present” and see the quality of all their relationships improve. One treated dad started to cry as he told me about reading his five-year-old year old a bedtime story. For the first time, he was emotionally “there,” not just mouthing the words with his mind miles away.

There are a couple final reasons to get your OCB taken care of sooner rather than later — peace of mind and increasing your chances of getting into Heaven. Years ago I made house calls to an entertainment industry giant dying of cancer. He also had OCB, having thought he was above the consequences of alcohol and cigarettes. A few weeks before he died, he talked about something that had been tormenting him. “I don’t think I’ve ever done anything important in life,” he said.

I tried to reassure him that he had brought pleasure to millions of people, created hundreds if not thousands of jobs and had a lot to be proud of. He thought I was trying to manipulate him into a solace he didn’t deserve. “Yeah sure,” he said, “but what about the two wives I ruined and my three loser kids on drugs who’ll never amount to anything?”

Because he was like other people with OCB and never meant to hurt anyone, I’m sure he made it into Heaven. But it probably wasn’t a slam-dunk.

Do you know anyone who has OCB?

  1. Powerful, charismatic, larger-than-life AND taking professional and creative risks resulting in a much better than chance record of success (because their exceptional instincts and abilities override professional shortcomings)
  2. Fiercely competitive but a terrible and often vindictive loser
  3. Superficially compassionate and empathic in public when it will increase people’s admiration/adoration/compliance, but mercurial and evasive regarding deeper emotional closeness
  4. Emotionally distant and cold towards spouse who sees through his self-serving veneer and often views him contemptuously as a opportunistic bullshitter. Non-distant, but mentally preoccupied when with his children (= cell phone dads).
  5. Often married to strong women who keep them grounded early in the relationship, but whom they later resent later for trying to control them.
  6. Surrounds self with sycophants and if they have affairs it is usually with emotionally dependent and needy women who make them feel like a hero (although the women may turn out to have ulterior motives)
  7. Do not feel they are doing anything wrong if they are not consciously doing anything to hurt anyone
  8. Long standing pattern— usually dating back to college— of driven, controlled and controlling behavior, periodically interrupted by impulsive and reckless behavior
  9. Many year history of seeking out exciting and risky situations that provide an adrenaline rush
  10. Grandiosity usually manifested as reckless behavior with a disregard for consequences and even surprise when negative ones occur
  11. Depression usually expressed as moodiness, impatience, annoyance, irritability and emotional withdrawal.
  12. Dabbles with cocaine or speed (rarely reaching the need for rehab), which help them to feel powerful and effective (which causes them to be confused with people who have Attention Deficit Disorder).

(If 6 or more of the above are present over a period of many years, there is a high likelihood of OCB being present).