The Obsessive-Compulsive Patient - A Case Study

Notes of therapy session with Magda, female, 58, diagnosed with Obsessive-Compulsive Personality Disorder (OCPD)

Magda is distressed when I reschedule our appointment. "But we always meet on Wednesdays!" - she pleads, ignoring my detailed explanations and my apologies. She is evidently anxious and her voice trembles. In small, precise movements she rearranges the objects on my desk, stacking stray papers and replacing pens and pencils in their designated canisters.

Anxiety breeds frustration and is followed by rage. The outburst lasts but a second and Magda reasserts control over her emotions by counting aloud (only odd numbers). "So, when and where are we going to meet?" - she finally blurts out.

"On Thursday, same hour, same place" - I reiterate for the third time in as many minutes. "I must make a note of this" - Magda sounds lost and desperate - "I have so many things to do on Thursday!" If Thursday is not convenient, we can make it the next Monday, I suggest. But this prospect of yet another shift in her rigidly ordered universe alarms her even more: "No, Thursday is fine, fine!" - she assures me unconvincingly.

A moment of uneasy silence ensues and then: "Can you give it to me in writing?" Give what in writing? "The appointment." Why does she need it? "In case something goes wrong." What could go wrong? "Oh, you won't believe how many things often go wrong!" - she laughs bitterly and then visibly hyperventilates. What for instance? She'd rather not think about it. "One, three, five..." - she is counting again, trying to allay her inner turmoil.

Why is she counting odd numbers? These are not odd numbers, but prime numbers, divisible only by themselves and by 1. I rephrase my question: Why is she counting prime numbers? But her mind is clearly elsewhere: am I certain that the office isn't reserved by another therapist for Thursday? Yes, I am certain, I checked with the clinic's receptionist before I rescheduled. How reliable is she, or is it a he?

I try a different tack: is she here to discuss logistics or to attend therapy? The latter. Then why don't we start. "Good idea" - she says. Her problem is that she is overloaded with assignments and can't get anything done despite putting in 80 hour weeks. Why doesn't she get help or delegate some of her workload? She can't trust anyone to do the job properly. Everyone nowadays is so indolent and morally lax.

Has she actually tried to collaborate with someone? Yes, she did but her co-worker was impossible: rude, promiscuous, and "a thief". You mean, she embezzled company funds? "In a way". In what way? She spent the whole day making private phone calls, surfing the Net, and eating. She was also slovenly and fat. Surely, you can't hold her obesity against her? Had she eaten less and exercised more, she wouldn't have looked like a blob - demurs Magda.

These shortcomings aside, was she an efficient worker? Magda glowers at me: "I just told you, I had to do everything by myself. She made so many mistakes that often I had to retype the documents." What word processing software does she use? She is accustomed to the IBM Selectric typewriter. She hates computers, they are so unreliable and user-hostile. When "these mindless monsters" were first introduced into the workplace, the chaos was incredible: furniture had to be moved, wires laid, desks cleared. She hates such disruptions. "Routine guarantees productivity" - she declares smugly and counts prime numbers under her breath.