Question:
Dear Sir,
My intention to write to you, is my older son who has been suffering from OCPD. He is 27 years old now and I want to say how amazed I was while reading the article, The Right Stuff of Steven Phillipson, with all the points matching my son's situation.
We noticed his problems when he was 17 and consulted to several psychiatrists, some of them are my friends. All agreed that this problem is chronic and could not be cured totally. I don't think that my son has a physical defect but all the problems seems to be caused by his concentrating on his way of thinking and negative attitudes.
Please find some detail below to explain his situation;
Complaints:
1- Afraid of his future, if we (parents) don't support him he will be taken into mental hospital. Dependent personality characteristics.
2- No self confidence. Afraid of being alone. Contrary, irritated and extremely frustrated if he is in a crowded or foreign place.
3- Thinking that, everybody is laughing at him or looking at him.
4- Social disfunctioning. Does not want to work and doesn't have any goal in his life.
5- Sleeping disorder.
6- Extremely jealous and stingy. Doesn't like sharing anything.
7- Frustration and in deep anxiety. Repeated movements such as washing hands again and again.
8- Thoughts concentrated on; people will make harm to him or his belongings, to his car for example.
Medical Treatment: visits a psychiatrist in every month or 20 days and take following medicines: Fluvoxamine maleate 100 mg/day Risperidone 2 - 3 mg/day Biperdine Hcl 1 - 2 mg/day
This treatment has not solved his problems and not lead him to live a normal life.
Background: 1- He was born in October 1974, my wife was pregnant to him when the war took place in Cyprus. My wife spent the 7-8th months of pregnancy in a shelter, under bomb attacks from Greek side. I was in the commanding headquarter and we did not see each other for 2 months.
2- He suffered sore throat when he was 6 months old and kept in steam tent in the hospital for one week. No other serious illness or suffering.
3- As my wife was working during day times his aunt looked after him until he was 4 years old. He had repeated body movements sometimes when he was a baby says his aunt. His aunt has a son, a few years older. He dislikes his cousins. He has personal conflict with him from his side.(without any reliable cause)
4- He was very successful in elementary, secondary schools and during the first two years of the university until his severe complaints started. However had some habits meanwhile which were considered as a play such as touching the places he passes. And he was a stubborn child.
5- We extended his university education period and I started to help him daily in his courses and homework. By this way and by the help of his teachers he managed to get B.A. in Business Administration. He speaks and writes English. Vocabulary rememberence is very good. But never had a socially active life in university.
6- He started to work in my company but very often kept quarreling with staff and secretaries and stopped working. He accuses people treating him sarcastic even if it is not the situation.
7- He is a very good car driver and his memory is very deep. Remembers almost all the car plate numbers, telephone numbers etc.
8- Exempted from military service due to a diagnosis of chronic neurotic adaptation disorder.
9- Engaged with a girl but divorced in 4 months last year.
Present Situation: Sleeps until noon or evening, visits a few friends, of whom he trusts and are in lower status than him in society, grand mother or only the relatives he likes. Spends time sitting in a pub (if not crowded) and watches all football games on TV but without any criticism or comments only showing emotional happiness or sadness as he does in all events. He just cares one's behavior and tics without paying attention the topic of what the conversation is about. He always has complaint of not being able to concentrate on a thing completely to get to understand it fully as he always has obsessed negative thoughts in his mind which are always preventing him of taking pleasure of life. It is an agony for him to do shopping (as he cannot decide which to buy) and paying to the cash desk (as he cannot be sure of the calculation).
He goes to bed at 2-3 pm after taking night time medicines. He doesn't spend or spoil much money on anything, I provide his pocket money. He mostly shows mood swings and is very sensitive to everything especially to the changes in his environment as he can not judge or decide and be flexible.
Family: I am 56, graduated in engineering, very successful in school life, awarded scholarship. I am perfectionist and very honest, I pay attention on virtue and promises, not on money. I had hundreds business meetings all over the world, but never late or early, keen on punctuality in my appointments. My business counter parts completely trust me. A Bank manager makes this joke: "Mr. D should keep the key of the bank safe". No compulsions. My wife is housewife, high school graduated very modest and obedient, devotes herself to our family. My younger son is very clever, has B.Sc., passed several Microsoft exams and is working in a GSM Company for two years. He has hobbies, girlfriends and is happy.
Dear Sir,
I know that I took some of your valuable time, but I hope that our story will provide you some hints in your evaluations and your kind guidance will lead us to live better life with our beloved, problem creator son,
With all my family's sincere regards,
Results from screening test:• longstanding Hx of not being able to stay on task
• easily distractable
• moody
• empty/bored
• paranoid under stress
• oversensitive to rejection and criticism
• dysthymic
• difficulty with enjoying life
• perfectionism interfering with task completion
• trouble trusting others fearing they’ll mess it up
• OCD with rituals
• nervous more than not
• always feels scared
• mind never shuts off and never has
• panic
Dr. Heller's Answer:
First of all, he has many diagnoses other than the OCPD. He almost certainly has the OCD and generalized anxiety disorder. This means the fluvoxamine (Luvox) is making his anxiety worse. BuSpar is needed here. He may have PTSD and need Remeron as well. Based on what was answered in the screening test you’ll likely see a dramatic change on Prozac compared to fluvoxamine. He needs high doses of Prozac (usually 80mg daily) once he’s tolerating BuSpar.
I’m suspicious of the BPD, panic and ADHD as well. The combination of ADHD and OCPD is a "disorganized perfectionist." If he has the BPD, the addition of Tegretol to Prozac would have a profound effect, enabling him to stop his Risperdal.
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