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Obsessive-Compulsive Disorder amongst Attorneys

published September 10, 2007

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Imagine, then, having a sudden rush of panic attack you. Your mind is now flooded with thoughts of what that bump in the road could have been. Did you run something or, even worse, someone over? You turn around to go back to where you hit the bump, but, of course, you see nothing. You then continue to drive around for hours on end just to ensure that the person you might have hit has not crawled off to the side of the road.
Obsessive-Compulsive Disorder Amongst Attorneys

For most of us, thoughts like this rarely, if ever, cross our minds. But for Paul Jackson*, and countless others in the legal profession, these thoughts are everyday occurrences.

Jackson, along with approximately 5 million to 6 million people in the United States, is affected by what is known as Obsessive-Compulsive Disorder, or OCD. Those affected by OCD are plagued by obsessive or recurrent thoughts, impulses, or images that are seen as intrusive and inappropriate, according to the Diagnostic and Statistical Manual of Mental Disorders IV-TR (DSM-IV), the most recent edition of the book used by mental health professionals to diagnose possible mental disorders. OCD sufferers will then act out compulsions (repetitive behaviors) in order to reduce or prevent anxiety or stress brought about by those thoughts. While many people who are affected by OCD realize that their thoughts and compulsions are irrational, they are almost powerless to stop them.

Jackson was first diagnosed with OCD in 1992. His OCD manifests itself in the forms of excessive hand washing, organizing, and repetition. As with many OCD sufferers, Jackson's obsessions stem from persistent thoughts associated with guilt, such as the possibility of running someone over or contaminating his family with germs he has picked up from taking out the trash.

"If I don't do things a certain way, [I think] that something bad will happen," Jackson said.

For many sufferers, OCD prompts a series of daily, time-consuming manifestations, including continuous fearful or anxious thoughts, and compulsive behaviors that often involve prolonged repetitious or complicated rituals. The disorder is extremely intrusive, frequently causing severe emotional distress and sometimes physical pain for its sufferers. OCD has even disrupted some professionals' legal careers before they've barely begun.

In the fall of 1983, Susan Richman's legal career was off to a bright start. The 28-year-old graduate of Hastings College of the Law was working as an associate at a full-service law firm in San Francisco formerly known as Heller, Ehrman, White & McAuliffe. In addition to being a dedicated new attorney, Richman was engaged to be married. She described this time in her life as "wonderful but stressful."

Yet Richman's life took an abrupt detour one evening following the discovery of a mouse in her apartment. By the time she caught the rodent, it was already dead. This caused Richman to become extremely anxious about potential contaminants in her home.

"Somehow this got me thinking about contamination, like it must have been ill, because why would it have died since I didn't kill it?" Richman said.

Her worries expanded until she was concerned that everything the mouse had touched was contaminated and had to be cleaned. She scoured her floors with Lysol and isopropyl alcohol and then cleaned other areas of the apartment, including her work papers.

Richman also kept track of the things she didn't clean because they could be damaged in the process. She considered these things contaminated and would have to clean anything she touched if she had previously come into contact with one of the items.

Richman's obsessions about contamination soon began extending beyond the boundaries of her home.

"I started worrying about germs on the sidewalk, or if somebody walked past me and coughed, I felt like I was contaminated and all my clothes were contaminated. It went on like this," she said.

Richman described her circumstances as a new attorney who was attempting to balance the demands of an emerging legal career with a then-undiagnosed case of Obsessive-Compulsive Disorder as "horrible."

"I was actually doing pretty good work, but it was costing me so much energy to be doing the work at the firm and also be keeping track of everything that was ostensibly contaminated," she said.

After completing an intense workday, during which she had a self-described "soundtrack" of OCD-related thoughts playing in her mind, Richman would get home around 8:00 or 9:00 p.m. and spend the next six or seven hours cleaning her apartment.

Attorney Brandon Matthews* can also relate to sleepless nights. With his OCD manifesting in organization, counting, and cleaning, he gets about three hours of sleep per night if he is lucky. And although he is physically tired, Matthews cannot get his mind to shut down long enough to get a good night's sleep. He then puts in a 12-hour workday as a lawyer for a nonprofit organization. He said that by comparison, many people in the nonprofit sector work seven hours per day.

Due to his fastidious nature, Matthews has been compared to Adrian Monk, the protagonist of the hit television show Monk. Like Monk, Matthews does not like things to be out of order, incessantly lines things up, and organizes all of his clothes in his closet from lightest to darkest. When he is stressed, he counts on his fingers and becomes even more "compulsively organized." He is also a self-proclaimed "neat freak" and borderline "germaphobe" who hates touching doorknobs, Lysols his office every morning, and washes his two small dogs every night. He has also been compared to Jack Nicholson's character Melvin Udall in the romantic comedy As Good as It Gets. Every year since its release, Matthews has received a copy of the movie, and like Udall, Matthews is sometimes perceived as rude.

"People seem to think that I lack the ability, or maybe just the desire, to sort of filter things out in terms of having an inner voice and saying things or stopping myself from saying certain things," Matthews said.

While OCD can make even the simplest tasks intensely frustrating and time consuming, some attorneys with the disorder are able to keep it from overtaking their professional lives and have even found some benefits among the frustration and pain. Attorney Marissa Elliot* is one attorney who has been able to find a silver lining in her disorder. While she thinks that OCD can sometimes slow her down, she also believes that it has helped her in her career. She said she has often caught things people have missed due to her extra attention to detail.

"If one learns to control the competing interests to his or her benefit, I think OCD can be somewhat helpful in assisting one's thoroughness," she said.

Elliot also believes that the disorder may affect those in the legal industry a little differently than those in other professions. She thinks lawyers are fairly meticulous by nature but that OCD makes them even more so.

Some behaviors attorneys with OCD might engage in include "double-checking legal citations; over-researching a case; over-analyzing the facts; not viewing the applicable law correctly; being verbose in writing; arguing tangential and/or irrelevant law or legal positions during motion hearings or trials; misreading cases, statutes, regulations, and legal articles; misrepresenting facts and law to other lawyers and family and friends; [and] doing excessive reading on minutiae," Elliot said.

Elliot's OCD manifests as hoarding, a behavior which is often not associated with the disorder. People who hoard are often seen as messy or as "pack rats" but in reality have a very real inability to discard items such as clothes, newspapers, or boxes. According to Elliot, she has more than 75 boxes of clothes stacked in her spare bedroom at home. Her office at work is piled with boxes and papers, leaving only about a square foot of unused space. Her paperwork and files are cluttered about her desk, along with stacks of old catalogues.
Celebrities with OCD
Think you are alone? Think again. OCD is estimated to affect 5 million to 6 million people in the U.S.—approximately 2% to 3% of the population! Among the millions worldwide who have had or who are now affected by Obsessive-Compulsive Disorder are several celebrities and prominent individuals, including:
  • Jessica Alba: actress who appeared in the films Sin City and The Fantastic Four
  • Woody Allen: writer, actor, and filmmaker who starred in and directed such films as Annie Hall, Hannah and Her Sisters, and Mighty Aphrodite
  • David Beckham: British soccer star
  • Charles Darwin: English naturalist who developed the theory of evolution by natural selection
  • Cameron Diaz: actress who starred in the films There’s Something About Mary and Charlie’s Angels
  • Charles Dickens: English novelist who penned such works as Oliver Twist, A Christmas Carol, and A Tale of Two Cities
  • Fred Durst: lead singer of the band Limp Bizkit
  • Harrison Ford: actor who starred in the Star Wars and Indiana Jones films and Blade Runner
  • Stanley Kubrick: writer, producer, and filmmaker who directed such films as A Clockwork Orange, 2001: A Space Odyssey, The Shining, and Spartacus
  • Howie Mandel: comedian, actor, and host of the game show Deal or No Deal
  • Michelle Pfeiffer: actress who has appeared in such films as Dangerous Minds, Batman Returns, and Scarface
  • Howard Stern: radio and television personality and host of The Howard Stern Show
  • Marc Summers: author and host of the children’s game show Double Dare
  • Billy Bob Thornton: writer, actor, and filmmaker who has starred in films including Sling Blade, Bad Santa, and Monster’s Ball

As a diligent law student, Elliot balanced school in the evenings with full-time work as a legal secretary and legal assistant during the day. In addition to her school- and work-related responsibilities, she also struggled with OCD.

Elliot said she was very motivated in law school but admitted that her grades were not exceptional. She suggested this may have been related to her drive to learn about every aspect of a case at the expense of missing "the bigger picture."

"I think with studying that I was very intent on learning every nuance about the case I was reading, and that made me miss the forest for the trees," she said.

After graduating from law school in 1978, Elliot, who also earned a B.A. and M.S., worked a series of jobs in major cities to pay off all her student loans. During her time at a small law firm, she successfully completed projects that required analysis but struggled with those involving detailed research.

In 1979, Elliot moved on to a position at a state agency, a role she enjoyed in part because it did not seem to exacerbate the thoughts and behaviors related to her OCD.

"I think this job did not tax me OCD-wise, and that's partly why I excelled," she said.

Two years later, after being stalked by her ex-boyfriend, Elliot was forced to leave the job and city that she loved. She settled in another major metropolitan area, where she worked as a secretary and later, in 1987, for a two-person law firm.

In the years that followed, Elliot struggled to develop her career as an attorney and even considered other professional fields. Then, in the 1990s, she accepted an offer to work at a New England-area federal office. While she continues to work for the same agency, she has encountered a series of challenges that have increased her hoarding tendencies.

In 1998, she was denied her first promotion. This disappointing experience would occur repeatedly throughout the years despite Elliot's qualifications and years of relevant work experience.

"I think I was passed over for promotion because of both gender and superior knowledge," she said. "I could draw circles around them [the other candidates] with my experience. But I did not play the game, largely because I had more experience than they, and there was little in common with them otherwise," she said.

After she was passed over for this and other promotions, Elliot's hoarding behaviors increased. As a result, she feels that her OCD has affected her ability to analyze files quickly and correctly. She said it has also clouded her confidence in her legal knowledge.

The onset of OCD can be triggered by many events, such as the birth of a child or a divorce. For Lynne Wilkinson*, it was the death of a loved one that caused OCD to manifest itself. Wilkinson, a second-career attorney who has been practicing since 1990, was diagnosed nearly three years ago, shortly after the death of her mother. Her OCD manifests itself in several ways, including hoarding, need for symmetry, fear of contamination, and perfectionism.

"It became sort of overwhelming within about a year of my mother's death," Wilkinson said. "Things got really out of control. I was debilitated by it but didn't understand that that's what was going on. There was also some pretty heavy depression following my mother's death. I now know that that's something that often comes with OCD. The OCD is there, and with depression you end up not caring so much about doing whatever checks you normally do to keep the OCD somewhat limited."

Wilkinson believes that OCD has made some aspects of her life and career more difficult, yet she can also see benefits related to her disorder, especially in her work as an employment attorney.

"It has given me a much better insight about clients," she said. "I can handle a mental disability case, for example, where a lot of attorneys who do disability discrimination won't do a mental disability case because they just don't get it, they don't understand it. I think I do."

While people like Wilkinson have been able to find some positive aspects of their disorder, others, like Brent McCoy*, have found that OCD, especially in terms of the manifestations involving checking and rechecking, has been a significant hindrance in their legal work. McCoy has served as an arbitrator in employment and labor disputes for 25 years. He was first diagnosed with OCD in 1991 by a psychiatrist who was treating his child for the same disorder. His symptoms are perfectionism, inability to throw something out without using it completely (a type of hoarding), and a need for everything to be symmetrical and organized. McCoy now thinks the symptoms have been there for most of his life.

According to McCoy, OCD has made it progressively harder to do his job, since making decisions and articulating the reasons behind those decisions have become much more time consuming.

"I take an inordinately long time to do my work," McCoy said. "That is because I have difficulty focusing on complex intellectual tasks, lack energy, and work so hard trying to do every professional task perfectly and make every interpersonal contact perfect. That renders my work products, no matter how excellent they may be (and they have been touted as such), often too late to be of much use, and it leaves me too exhausted to undertake much social contact with others [since] it takes so much effort. Nothing is easy; I never have a carefree moment. Life is full of worry and doubt and guilt and fatigue. It is impossible to say what part OCD, by itself, would play in this."

Rather than finding this great attention to detail helpful in some respects, McCoy feels that his job as an arbitrator may be one of the worst for an OCD sufferer to get into, since arbitrators must make neutral decisions.

"As you probably know, the French call OCD 'the doubter's disease' because it makes people who have it doubt everything," McCoy said. "This is particularly difficult, I think, for attorneys, who already practice in a world of great uncertainty. While OCD may help an attorney find loopholes—reason to doubt every possible conclusion—and thus help them argue against virtually every point, it can paralyze an attorney who, like me, must eventually make decisions in [his or] her work."

<<OCD in the Workplace

As a group, attorneys seem to possess certain qualities: thoroughness, attention to detail, and a strong sense of determination. Those with OCD tend to feel the strain even more. When you are constantly burdened with thoughts of attaining perfection, it is difficult to concentrate on anything else. Attorneys with OCD constantly check and recheck documents and spend a lot of time analyzing things that other attorneys would not have looked at twice.

In spite of being diagnosed with OCD, Paul Jackson graduated from law school in 1999 and has even established his own firm. He feels that it would be difficult for him to work at a major law firm due to his OCD.

"I don't think I could work at a firm because I spend way too much time at the office," he said. "The hours that I am actually billing versus the hours I am at the office is very inefficient. I spend a lot of time doing OCD things that I don't bill clients for."

Jackson said that while OCD may have affected his work at the office, it has never affected a case or his ability to serve his clients as an attorney. In some respects, OCD has helped him as a lawyer. As a byproduct of his OCD, he said, he pays great attention to detail, even more so than most lawyers. However, he still feels that the burdens outweigh the benefits.

"Every lawyer's life is stressful; I don't doubt that," Jackson said. "I do think the OCD adds an extra stress to my life [in] that I have a hard time getting away from the office, I have a hard time not obsessing over cases and deadlines and 'Did I do this case right? Did I do that case right?' There is a constant fear in me, and I think every lawyer has that fear, but I do think with OCD it is definitely amplified."

Some attorneys with OCD, like Thomas Barrington*, also question the legal profession's reinforcement of certain characteristics that may be prevalent among lawyers with the disorder, like excessive attention to detail and over-analysis of facts and figures.

"The sad part is some of the OCD-type behaviors are rewarded by the profession. And that is what I think is upsetting—this ability to work hard and work late and bill hours—I think some of that is OCD, and I think OCD people are attracted to that," he said.

Like Jackson, Barrington does not work in a law firm. He found his time working at one to be a frustrating and overwhelming experience, which exacerbated his obsessive thoughts and compulsive behaviors.

Barrington practiced corporate law at a large New York firm in the early 1990s. It was then that his undiagnosed OCD began to take a dramatic toll. He said that taking the job was probably the worst thing for him since corporate associates work so hard already and, because of his OCD, he was compelled to work even harder.

"I wish I would have known that I had it [OCD]," Barrington said. "I probably never would have gone into corporate law at a big New York law firm," he said.

Barrington was diagnosed with OCD two years ago, following the diagnosis of his oldest daughter. This caused him to reflect on his own childhood, which included thoughts and behaviors he now attributes to the disorder.

"I always knew there was something different about me, and I didn't know what it was. When I was a little kid, for example, and into adulthood, I would twirl things. I would touch wood a lot," said Barrington, who is general counsel for a biotechnology company. "I would tend to be someone who could focus on something, but if I had more than one thing to do, it was always tough to portion my time effectively. I normally spent longer on things than other people did," he said.

After graduating from an Ivy League law school in 1990, Barrington bounced between jobs at law firms across the country for years. He said that while he was acknowledged as a hard worker, he would often take too long on a given project and subsequently be fired.

Barrington finds his current job as general counsel much more conducive to dealing with his OCD than working as a corporate attorney. He's also found that "being the boss" and having assistants is very helpful.

"OCD and corporate law and law firms don't seem to go well, with me at least, so that's why I went in-house," he said.

While some attorneys with OCD, like Barrington and Jackson, have found success working outside of large law firms, others who look for alternatives to the traditional legal career path still encounter workplace challenges when it comes to dealing with their OCD.

In the aftermath of Hurricane Katrina, Brandon Matthews left law firm life and began working at a nonprofit organization. While he enjoys the fact that his work benefits other people, Matthews acknowledges that working in the nonprofit sector is also frustrating for someone with OCD.

Matthews graduated with a J.D./M.B.A. from Mississippi College School of Law in 2001. He worked in a law firm for several years but soon became disenchanted with the legal profession and began to question some of the practices used by lawyers, especially in terms of billing.

"I was one of those people that really did go to law school with an altruistic sense, really wanting to help people," Matthews said.

"It's very frustrating being an obsessive-compulsive in this type of environment because the nonprofit world, from what I've seen, is the exact antithesis of the private world," Matthews said. "In the private sector, as an attorney, when you need something, it gets done. There are always a lot of resources and money, but [there is] never enough time to do everything. But with the nonprofit world, it is the exact opposite: there are no resources and no money, but there is a lot of time. Whereas in a private firm, if my computer went down, somebody was up there to take a look at it immediately, in the nonprofit world, you can wait three days for someone to come by, and if you're like me, just very impatient—I am very bottom-line oriented, overly candid about things—it's a frustrating experience."

Marissa Elliot encourages attorneys with OCD to acknowledge that they may overanalyze things and spend too much time on tasks. She said she also strongly suggests using one's peers "to double-check work and ideas, as a reality point that would otherwise be lost to the OCD thinking, and [attending] bar association meetings and subcommittees if they are specializing, as another check on over-lawyering."

In some cases, OCD may directly lead to problems in the workplace, especially with respect to deadlines. Lynne Wilkinson believes that her extreme attention to detail has caused her to almost miss deadlines on a consistent basis.

"It has me get things done very last minute, literally at the last minute, so that I file things when there's just no more time," Wilkinson said. "So if I'm on my way to the court to file something and there has been a car accident somewhere along the way and I was delayed, I would miss a deadline."

While she has yet to actually miss a deadline, Wilkinson knows at least one attorney who was disbarred for failing to meet deadlines.

"I can see it; I can see how that would happen, because there are times when I have come very, very close in filing something—it's been at the very last minute. It is certainly possible that I would have missed one of those deadlines and screwed up somebody's life and committed malpractice. I can see it very easily happening, unfortunately," she said.

McCoy also has concerns regarding the effects of OCD on his job performance. Because of the difficulties of the disorder, McCoy fell behind on his work, and a large number of cases have been left unresolved. For the time being, he has put all new casework on hold in order to catch up on the backlog he has accumulated.

"I will return to it only when I have reason to believe that I can represent to parties, in good faith, that I will complete my work for them in a timely manner," McCoy said.

<<Effects Outside of the Workplace

For all OCD sufferers, the disorder can dramatically affect their personal lives as well as their professional lives. Jackson feels that while he is extremely successful as an attorney, his success is due in large part to the fact that he spends so much time at the office, which often cuts into his time at home with his family.

"I think what it affects is your personal life, because if you obsess about your job, you are obviously going to be very good at what you do, but the rest of your life is going to suffer," he said. "That's the part that is really difficult with OCD. OCD is very difficult when it comes to personal relationships and that sort of thing."

OCD has also caused some major issues in Wilkinson's life. Her hoarding behavior has resulted in her accumulating "scads" of old journal and newspaper articles. The piles of old papers and other unnecessary items that have invaded her house and office have made it difficult to find important files and other documents she needs for current cases. She is extremely thankful for her paralegal, who has initiated a much more organized system at Wilkinson's independent practice.

Social situations in which she must shake someone's hand are extremely difficult for Wilkinson because of her contamination fears. She will often make up excuses to avoid touching people at all. When she does shake someone's hand, she said, her hand feels like it is coated in "scum," and she immediately washes her hands or uses instant hand sanitizer, which makes things awkward if the person sees her doing that.

With his incessant work habits and lack of sleep, Barrington developed testicular cancer. He underwent treatment for the disease and was in remission for four years. Eventually he returned to his old habits of working too hard and pulling all-nighters, and the cancer resurfaced.

"I probably shot my immune system," he said.

Now cancer-free, Barrington encourages others, including those who may suffer from OCD, to attempt to gain a better understanding of the disorder.

"I think people, first of all, need to take a good look at themselves to really understand what is OCD, what is an OCD behavior, and what is not," he said.

Treatments and Advice

When he was first diagnosed in 1992, Jackson was placed on medication to help alleviate the symptoms of his OCD, but he quickly stopped taking it due in part to the stigma surrounding the disorder and the methods for treating it.

"I didn't want to take any pills because of the stigma...[of] taking SSRIs [selective serotonin reuptake inhibitors] or medication," Jackson said. "So the symptoms pretty much stayed the same—a lot of excessive hand washing, a lot of excessive organization, things had to be done in a certain way—and a lot of those associated with bad and blasphemous thoughts that I had in my mind."

Since that time, Jackson has changed his mind regarding medication and encourages those who have OCD to take the medications prescribed to them. He also encourages people to consider going to therapy to help alleviate some of the manifestations and symptoms of the disorder.

Not long after she began experiencing severe obsessions and compulsions related to contamination, Richman, who was a new attorney at the time and whose grandfather and great-grandfather were psychoanalysts, recognized she needed professional help. By November of 1983, she had sought treatment from a psychoanalyst. Yet this eventually proved useless in her struggle to understand and gain control of the then-unrecognized disorder.

"By the time I realized that this psychoanalyst wasn't going to work, months had progressed, and I couldn't continue like that," said Richman. "I was falling dead from exhaustion, and I couldn't really get anywhere for help."

The rigors of balancing a new legal career with the grueling manifestations of her OCD and the ineffective psychoanalysis continued to take their toll. In July of 1984, Richman's concerned family traveled to San Francisco to take her home to Chicago.

Over the next few years, Richman struggled with unsuccessful treatments for what she and her family thought might be a germ phobia. Although she tried everything from a prescription for powerful antidepressants to art therapy, nothing seemed to help the formerly high-performing attorney and student, until her sister was unexpectedly referred to a contact at the National Institute of Mental Health. The individual recommended a behavior-therapy program in Pennsylvania led by Edna Foa, professor of clinical psychology in psychiatry at the University of Pennsylvania and director of the Center for the Treatment and Study of Anxiety.

In 1986, as a participant in Foa's program, Richman finally learned she was suffering from OCD and that it was a treatable disorder. She underwent three weeks of intense exposure and response prevention (ERP) behavior therapy. ERP behavior therapy involves a person being repeatedly exposed to the source of his or her anxiety in a supervised environment until he or she develops a tolerance, which reduces his or her need to perform compulsive behaviors.

After she completed the program, Richman's anxiety surrounding contamination and her need to compulsively clean were under control. She was able to reunite with her family and take steps toward leading a productive life.

"At the end of three weeks, I was normal again, and this was after three years of becoming more and more dysfunctional," she said.

Through Dr. Foa's program, Richman learned to effectively manage her OCD and regain control of her life. Even when the disorder resurfaced following her successful completion of the Illinois bar exam in 1988, she had the confidence and motivation to seek follow-up treatment in Chicago. Even now, Richman uses the skills she developed in treatment to deal with her anxiety proactively on her own.

"Now I go out and do exposure therapy on my own if I need it," said Richman, who is vigilant about keeping the disorder in check.

After resuming her legal career for several years at a well-known firm in Chicago, Richman became inspired to help others with OCD avoid the pain she experienced before learning how to manage the disorder. In 1994, she co-founded the OCD Foundation of Metropolitan Chicago. As the honorary chair of the foundation, Richman now works full time to further its mission to raise awareness of the disorder among the public and professionals; to provide information and support to OCD sufferers, particularly children and their families; and to promote research into finding new treatments and, hopefully, a cure.

"It's so rewarding because it's so easy to help people with this disorder. All you have to do is get them the right treatment," said Richman.

She encourages attorneys and others outside the legal profession with OCD to seek treatment.

"Help is out there, and this is very treatable," she said. "They're not alone, so they should seek help through exposure therapy or medication, if necessary."

Matthews hopes that those who have OCD are able to confide in other people and said that it is not something one has to go through alone.

"Were I to go back through that experience again, I would be more apt to share with others that I am obsessive-compulsive, and I would seek out other obsessive-compulsives," he said.

Although OCD is a progressive disorder, it is also easily treatable with cognitive therapy and/or medication. Wilkinson utilizes both; she takes Celexa and Wellbutrin in order to treat the anxiety and depression that accompany her OCD, and she also participates in two cognitive behavioral therapy groups. She advises those who suffer from OCD to acknowledge that they have the disorder.

"It's something that is increasingly acknowledged as a disability. There's still a stigma to any sort of mental health issue, especially for attorneys because we are supposed to be so together. It's something you don't really have to talk about; it's not something you have to report to the bar, at least not in California. It's something that is so treatable with consistency. You can't expect it to go away instantly, but the really good thing is that it's treatable," Wilkinson said.

For some seeking treatment, finding the right medication can involve trying a dizzying series of prescriptions for both OCD and related disorders, sometimes with mixed results.
OCD and OCPD: Understanding the Difference
“I think people, first of all, need to take a good look at themselves to really understand what is OCD, what is an OCD behavior, and what is not,” said attorney Thomas Barrington.

One of the biggest challenges to overcoming the misconceptions and misunderstandings surrounding OCD is recognizing the difference between it and a similar sounding but vastly different disorder called Obsessive-Compulsive Personality Disorder.

Unlike people with OCD, those with OCPD do not engage in ritualistic behaviors. The degree of their disorder is less severe and disruptive. Often preoccupied with perfectionism and maintaining strict control over their behavior, people with OCPD see their way of life as correct and perfect. They often do not feel that they have a problem and, in fact, view their behaviors as desirable, unlike OCD sufferers, who recognize their disorder as something unpleasant that they would like to change.

Soon after he was diagnosed, McCoy started taking Prozac, which he found took "the sharp edge off" of the symptoms. Recently, he consulted with a psychopharmacologist to talk about his progress with OCD and discuss the depression he believed he was suffering from. The Prozac has now been replaced with Cymbalta, which is meant to treat his OCD and his recently diagnosed ADD. In addition, McCoy began taking Concerta to treat the ADD. The psychologist also suggested that he be tested for a sleeping disorder, which can often be mistaken for depression. While the drugs have helped alleviate some of his symptoms, McCoy still feels the need to do everything perfectly and to make everything organized and symmetrical.

McCoy also urges those who have OCD to get treatment from someone who has a great deal of experience with the disorder. For the majority of people, a combination of medication and therapy has been found to be most effective in treating OCD. He encourages people to learn all they can about the various types of treatment and to find the ones that work best for them. The key is being patient, he said, since it will take time. He also emphasized the need to stay on the medication. The symptoms of OCD are in a constant state of flux, decreasing one day and coming back even stronger the next; OCD does not go away on its own.

"Don't give up; your challenges can make you a better person and attorney," McCoy said.

For Paul Jackson, who braved the excruciating fear of striking people with his car, along with manifestations involving repeated washing and organizing, taking prescribed medication has also been an important step toward managing the disorder. He encourages attorneys and others with OCD to take the medication prescribed to them. He also recommends therapy to help alleviate some of the manifestations and symptoms of the disorder.

"My advice would be to get the therapy, talk to somebody, don't be ashamed of it, and realize that there are some aspects of it that may be helpful to you," he said.

*Some names have been changed to protect identities.

published September 10, 2007

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