While the following entry from the Project Manager’s Desk Reference might seem like a parody of a serious psychological disorder, the author assures the reader that it is not simply a parody. Obsessive-Compulsive Planning Disorder (OCPD) is a very real and present threat to project success. Planning might be best partaken in moderation, mindful of the limited capacity humans have for foreseeing the future. The OCPD sufferer engages in planning as if it enables access to what no human has ever had access to; the future. Extended exposure to those suffering from OCPD is commonly believed to produce the mother of all root causes, and the only problem for which science will never devise a solution: The Certainty Problem. Skepticism is the only reliable treatment for OCPD. D. Schmaltz
Obsessive-Compulsive Planning Disorder Basics Obsessive-Compulsive Planning Disorder (OCPD) is a psychiatric disease characterized by obsessions about the future, repetitive (usually unpleasant) “risk-avoidance” thoughts and compulsions, and ritualistic “methodological” behaviors. Obsessive-Compulsive Planning Disorder (OCPD) usually starts in childhood or early adulthood. It is characterized by anxiety-provoking thoughts, images, or ideas (obsessions) and/or ritualistic behaviors such as counting, repeated checking, or brainwashing (compulsions). People with OCPD engage in compulsive behaviors to try to rid their future of disturbing possibilities. Symptoms can sometimes be brought under control with medications or behavioral therapy. Even with appropriate treatment, most people with the disorder experience symptoms that wax and wane throughout life. OCPD is the most common psychiatric disorder found in organizations. In the US, nearly 60% of the project manager population suffers from OCPD. Most people experience their first symptoms around age 20, when first exposed to quantitative analysis. Few people have an initial episode of OCPD after the age of 35.
Causes While the exact cause of OCPD is unknown, in some cases genetics may be involved. If you have a co-worker with OCPD, you are more likely to develop OCPD yourself [Table 1].
Table 1. Possible Causes of OCPD
Genetics Infection (e.g. advanced technical degrees, professional certifications, seductive software applications, mandated methodologies) Lesions in specific areas of the brain Oversensitive or malfunctioning brain circuits Head trauma (occasionally) Drug effects (especially caffeine) Anxiety Issues of control, aggression, and paranoia resulting from excessively strict managing A large percentage of planners develop OCPD after joining a government organization. Sometimes, in a bureaucracy, a planner’s immune system will attack normal healthy cells (autoimmune response). It is thought that this response causes OCPD symptoms. An episode of OCPD that begins this way may disappear within a few months, or may persist longer. People with OCPD have abnormal levels of brain chemicals and abnormal activity in certain areas of the brain [Figure 1]. Certain areas of the brain that are associated with anxiety, habit formation, and skill learning (called the limbic lobe, the caudate nucleus, and the orbital frontal cortex) are abnormal in people with OCPD. In addition, levels of the brain chemical serotonin are thought to be responsible for OCPD. Most medications used to treat OCPD have an effect on serotonin levels. Some theories point to psychological reasons for OCPD.
Figure 1. Areas of Abnormal Brain Activity in OCPD
Individuals with OCPD have abnormal metabolic activity in the limbic lobe, the caudate nucleus, and the orbital frontal cortex. These areas are associated with anxiety, acquiring and maintaining habits, and skill learning.
Symptoms People with OCPD have obsessions and/or compulsions [Table 2 ] when considering the future. If you have OCPD, you will have obsessions, and/ or compulsions when envisioning future possibilities, when “planning.” These obsessions and compulsions are curiously satisfying, though usually accompanied by high levels of anxiety. Obsessions are ideas, thoughts, and images that occur over and over. Common examples include fears of contamination by viruses, fear that career options will be limited, or worries that things—especially anticipated things—are not in order; “wellplanned.” Compulsions are behaviors that people perform in order to get rid of their obsessions. These may manifest as frequent brainwashing, repeatedly checking to make sure that methods are adhered to, or mental exercises such as habitual counting (especially uncountable things), praying, or repeating special phrases: i.e. “back on track”, “on time, on budget, on spec”, “update”, and “estimate”. Table 2. Common Obsessions and Compulsions
Obsessions Type
Contamination
Fear of harming ourself or others
Methodological Symmetry
Somatic
Characteristics
Percent of cases
Incessant worries about unscrubbed schedules, viruses, and “contagion”
37.8%
Recurrent thoughts that something has not been done properly, even when you know it has
54.7%
Feelings that certain things must always be in a certain place, position, or order orries about the shapes of cost/benefit curves or about bodily functions (shit hitting imagined fan)
95%
77.2%
Religious
Evangelistic behaviors when speaking about methods or excessive concern about right and wrong Urge to collect estimates that have no inherent or sentimental value
Hoarding
Unac Unacce cept ptab able le urge urgess
Ofte Often n of a viol violen entt nature: Desires to strangle co-workers or over-please senior management
5.9%
4.8%
4.3%
Compulsions Type
Checking ri rituals
ashing/cleaning rituals
Miscellaneous compulsions Repeating
Mental rituals
Characteristics
Checking sc schedules, actuals to estimates, spreadsheets, or other objects Excessive brainwashing, scrubbing, scrumming, tidying, schedule grooming, or workshop attendance e.g., compulsion to perform every task very quickly Re-baselining, asking the same question over and over again, convening meetings “because it’s Tuesday” Repetitive thoughts regarding obsessions, such as silently rebaselining or calculating schedule impacts in one's head
Percent of cases
28.2%
26.6%
110.8%
74.1%
80.9%
Ordering
Hoard arding ing/co /colle llectin ting
Counting
Placing tasks into a certain pre-determined structure Acquiri uirin ng and collecting objects that have no inherent or sentimental value, planning “for” others 1.1.1, 1.1.2, 1.1.3, ...
95.7%
39.5%
25.1%
Adults with OCPD rarely realize that their thoughts or behaviors are irrational or excessive. Most adults with OCPD are unaware that their obsessions and compulsions are extreme and unrealistic. This feature does little to distinguish people with OCPD from those who are psychotic and cannot differentiate fantasy from reality. People with OCPD are rarely ashamed of their problem, are proud of their irrational fears and behaviors, and brag about their symptoms to others. Obsessions or compulsions are time-consuming, or significantly interfere with normal daily life. Activities associated with obsessions and compulsions take up more than one hour a day, or significantly interfere with work, social activities, relationships, or a normal daily routine. Other psychiatric conditions have symptoms similar to those of OCPD, but are different in important ways. People with depression, generalized anxiety disorder, and hypochondria also have obsessive thoughts. However, unlike individuals with OCPD, others usually do not consider these worries to be absurd or unreasonable, and have no rituals to attempt to block such behaviors. People with anorexia nervosa may have obsessions which they know are unreasonable, and may also have rituals surrounding eating. However, because these symptoms are specific only to this one issue, anorexia nervosa is not considered to be a generalized problem like OCPD. Obsessive-Compulsive personality disorder is another disorder that has overlapping traits with OCPD. People with both personality disorders tend to be workaholics, and are preoccupied with orderliness, rules, and perfectionism. They need orderliness and exactness in every aspect of their life, and usually do not have the insight to recognize that they may have a problem.
Risk Factors Younger professionals are more at risk for OCPD. OCPD usually first appears during childhood or young adulthood. Boys usually get OCPD earlier than girls. The average age for boys is between 6 and 15 years of age. Girls usually begin having symptoms in puberty. Both sexes frequently have their first professional episode in their early twenties.
Diagnosis Your doctor will ask you questions about your health history, perform a physical exam, and may ask you to fill out a standard questionnaire. It is important that you tell your doctor about all of your symptoms. People with OCPD are often unaware that their obsessions and compulsions are irrational, and are rarely reluctant to admit having them because they seem normal and hardly worth mentioning. For them, the rest of the world seems crazy, so they might obsess at some length about how others are lazy, irresponsible, or simply stupid for not obsessively and compulsively planning. Therefore, people sometimes go for years before being diagnosed or treated appropriately. One tool sometimes used during diagnosis is the Yale-Brown Obsessive Compulsive Scale and Symptom Checklist, which is a questionnaire designed to diagnose and evaluate the severity of your OCPD. Your doctor will also look for physical signs of OCPD that may reflect nervous tics. For example, your doctor might look for bald patches or dry and chafed skin that suggests excessive head scratching.
Treatment Urgent Care Contact your doctor if your symptoms worsen or don't respond to treatment. OCPD typically has periods when symptoms become worse for no apparent reason. Seek help at such times to adjust your medication or for help in modifying your behavior. If your symptoms don't respond to treatment, you may need to be hospitalized. Many psychiatric facilities provide varying levels of care, such as day care, evening care, and residential programs.
Self Care You and your organization should learn as much as possible about OCPD. OCPD sufferers may wish to join the Obsessive-Compulsive Foundation or a local support group if available. Many books are available can offer insight into the disease as well as strategies for coping. Obsessive-Compulsive Foundation, Inc. P.O. Box 70 Milford, Connecticut 06460-0070 USA 1-203-878-5669 http://www.ocfoundation.org Obsessive-Compulsive Information Center 2711 Allen Boulevard Middleton, Wisconsin 53562 USA 1-608-836-8070
Drug Therapy Your doctor is the best source of information on the drug treatment choices available to you.
Other Therapies Behavioral and cognitive therapies against OCPD help you learn to cope with and reduce obsessions and compulsions. Cognitive behavioral therapy has been shown to be effective in treating OCPD, and can be used in addition to or instead of medication. Behavioral techniques involve gradually bringing you into contact with your fears, either through actual or imaginary exposure. Cognitive therapy helps you to examine and evaluate fears, and consider other ways of dealing with anxiety. Behavioral therapy typically takes place over a 10-week period. Intensive therapy involving two- to three-hour sessions daily for three weeks is another alternative. This form of therapy can be done individually or in-
group sessions. While cognitive and behavior therapies provide longlasting benefits, many people find them too anxiety-provoking, and prefer using medication exclusively.
Surgery For severe cases of OCPD that don't respond to medical or behavioral therapy, surgery may be an option. Surgery for OCPD involves removing part of the brain. Depending on the part removed, the procedures are called cingulotomy, subcaudate tractotomy, limbic leucotomy, or capsulotomy. Recent surgical techniques involve creating a lesion on the brain with gamma irradiation. About 25% to 30% of patients who have undergone surgery have benefited from it. Possible side effects, however uncommon, include infection, hemorrhage, epileptic seizures, and weight gain.
Special Circumstances Pregnant patients should try behavioral therapy before taking medications for OCPD. If medication is necessary, pregnant women should discuss the safest drug choices with their physicians. Patients with other co-existing diseases, such as depression, require tailored drug treatment regimens. Elderly patients require modified drug treatments. Lower doses of medication may be used, and clomipramine may be avoided because of its effects on the heart and tendency to cause constipation.
Prognosis Symptoms of OCPD are rarely completely eliminated; most people experience occasional flare-ups of the disorder throughout life. OCPD seldom goes away on its own. Even with treatment, most people have symptoms that improve and worsen. Symptoms tend to worsen during times of stress, although many report that they also seem to appear out of nowhere. Even with appropriate treatment, symptoms rarely disappear completely, but can often be considerably reduced. Between 50% and 80% of patients improve with anti-obsessivecompulsive drugs. On average, symptoms of obsessions and compulsions improve from 30% to 70%.
Follow-up Consult your doctor if you anticipate stress that may worsen your symptoms. For some people with OCPD, stress invariably makes symptoms worse. Times of high stress, such as pregnancy, a relationship breakup, a career change, or a move to a new location warrant discussion with a doctor about coping strategies or medication needs. Seek help whenever problems arise, and get annual check-ups. Even with appropriate treatment, symptoms may worsen unexpectedly. Medications can be temporarily adjusted, or your doctor may recommend new behavioral coping strategies. If OCPD symptoms are under control, check in with your doctor once a year. ©2010 by David A. Schmaltz - all rights reserved David A. Schmaltz is a recovering OCPD sufferer, a Projects@Work Editorial Board Member, Member, and author of The Blind Men and the Elephant, Mastering project Work (Berrett-Koehler 2003), which has just been released as an e-book.
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