Palo Alto Weekly

- May 7, 2008

Compulsions out of control

Stanford psychiatrist writes about people with OCD "Compulsive Acts: A Psychiatrist's Tales of Ritual and Obsession" by Elias Aboujaoude; University of California Press; 175 pp.; $24.95

by Don Kazak

Alex, patient of Stanford psychiatrist Elias Aboujaoude, described himself succinctly to the therapist.

"I don't consider myself to have an addictive personality. I don't drink or do drugs. I don't get addicted to the kind of habits that bring people to this clinic, either: I don't check or clean excessively; I've never gambled; and I don't pick my skin or pull my hair or bite my nails compulsively. But I'm an addict nonetheless. A modern-day addict."

Alex was visiting Aboujaoude at Stanford's clinic for patients diagnosed with obsessive-compulsive disorder (OCD), an often very debilitating condition that leads to ritual behavior and can disrupt lives and destroy families.

But Alex didn't have the any of the usual OCD behaviors.

An extremely shy man who worked as a research physicist, Alex was celibate until he was 29 years old.

Going to a different therapist for help, he was told that online dating might prove useful.

He ended up finding a girlfriend, even getting engaged. But he became a compulsive Internet user, broke up with his girlfriend for an online character he had created, and even became part of group of people that shuns the real world to live online.

Aboujaoude relates Alex's story in his book, "Compulsive Acts," which tells the stories of patients he has treated at Stanford's OCD clinic.

Ritual, obsessive and compulsive behavior can sometimes be treated with a combination of medication and therapy.

Like excessive drug or alcohol use, some addictive behaviors change the way the brain functions.

But as extreme as Alex's situation was, Aboujaoude cautions the media against using the term "Internet addiction" because not enough research has been done to classify excessive Internet use as an addiction. But there certainly is what he calls "problem Internet use" and it is not limited to Silicon Valley.

The definition of a problem user, Aboujaoude writes, is someone who spends about 30 hours a week on the Internet for things not related to work or well-being, causing "significant stress and disability." Earlier studies have shown this group to be largely made up of single, college-educated men in their 30s.

Stanford even did a national survey in 2004 to determine the extent of people reporting obsessive Internet use. Many respondents reported various degrees of problems, including 9 percent who hid their Internet use from people around them.

The story of Alex did not have a happy ending. Besides dumping his real girlfriend for one he created online, he stopped his face-to-face therapy and would only have computer chats with Aboujaoude.

But many of the stories Aboujaoude tells in "Compulsive Acts" don't turn out well. At least one has a tragic ending.

Pathological gambling is an impulse-control disorder that destroys lives.

A husband and wife came to seek Aboujaoude to get help for the husband's gambling addiction. His wife did all the talking.

They had met as college students in Hong Kong and immigrated to the United States when he received a job offer in Las Vegas. He had been working on a doctorate degree in statistics.

As part of coming to America, they made a point of visiting all 50 casinos in Las Vegas and the husband became a compulsive gambler.

The young couple was losing money because of the husband's gambling. So his wife got a job in a casino, eventually becoming a casino hostess escorting high rollers.

"Well, you know what 'escort' means," the wife said. "I told my husband —I couldn't do such a thing behind his back."

The husband didn't object.

The couple eventually moved from Las Vegas to San Francisco and opened a successful restaurant. But several years later, a casino was built 90 miles from San Francisco and the husband, who hadn't gambled for years, fell back into his addiction. He later shot and killed himself.

Aboujaoude notes that Americans lose $80 billion on gambling a year, "a figure that has grown every year for the last two decades, now surpassing combined entertainment and leisure returns from venues such as movie box office, spectator sports, recorded music and cruise ships."

He also notes that the rates of suicide are four times higher in cities with casinos than those without them.

Casinos hire behavioral scientists to make the gambling environment conducive to people staying at the gaming tables or slot machines a long time to lose a lot of money.

Obsessive-compulsive disorder affects 1-2 percent of the population and men and women are equally prone to fall victim, although kleptomaniacs, another OCD category, are predominately women.

Treating the disorder can be complicated. For instance, many compulsive gamblers are also drug users, making it difficult to isolate one addiction from the other.

Addictive behaviors seem to release dopamine to the pleasure center of the brain. Dopamine is also released by alcohol and drug addictions, giving pleasure.

There are drugs that can also increase the dopamine levels in the brain without resorting to addictive behavior or destructive alcohol or illicit drug use. Those hold promise for treatment, according to the authors.

But as Aboujaoude relates in his well-told but sometimes harrowing sets of stories from treatment of OCD patients, the disorder can be resistant to therapy and other treatment.

OCD patients, he writes, are often very self-aware of their behavior, often feel ashamed or embarrassed, but find it very difficult to break free of the obsessions that are in their heads.

Aboujaoude will appear at Kepler's Books in Menlo Park at 7:30 p.m. May 27.

Senior Staff Writer Don Kazak can be e-mailed at dkazak@paweekly.com.

Comments

Posted by Bassam Kassab, a resident of another community
on May 18, 2008 at 5:01 pm

The new book of Dr. Elias Aboujaoude, "Compulsive Acts: A Psychiatrist's Tales of Ritual and Obsession," was so enjoyable to read. Well, it is not accurate to say that I "enjoyed" reading about other humans' problems and miseries. The truth is I enjoyed the style in which the novellas were presented by a psychiatrist who has a talent to tell a story and make it intriguing. I can clearly see that someone could take this book and write a movie script based on various characters--the OCD patients and the psychiatrist as the main protagonist.



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