The perils of obsessions in autism (not like Jack Nicholson in 'As Good As It Gets')

AP photo/ Mark J. Terrill

Jack Nicholson's character in As Good As It Gets ultimately triumphs over his OCD.......and.....he even gets the girl! It is a super comedy, invading the space of obsessive compulsive disorder. Whether or not Jack steps on the cracks in the sidewalk could devastate his day. Eureka! Medication works for OCD!

It is a stunning realization to recognize the burden of raising an autistic child. Then comes the one two punch. There are segues and addendums to the disorder. It seems that the merry-go-round will never end. It is not in my nature to say “die”, or in this case give up. My innate desire to delve and analyze is a constant.

Consequently, when our son was diagnosed, I gave the A word the cold shoulder, determined to hit the symptoms head on. The single most tenacious symptom that grabbed our son was his obsessive and often compulsive behavior. He was not loud about it in fact most of the obsessions were in his head. I called it the “movie in his mind”. His memory has always been very keen, better than mine, and he harbored infinite information on many subjects. The problem was that it interfered with life.

I was once asked, “Does the obsessive behavior interfere with his  every day life?” We were advised if so, we could try medication. Finally, after much delay and procrastination, (after all, give a 12 year old antidepressants?) we said “Yes, it does impede his life, our lives, yes!” Following a 3 year dalliance with a plethora of anti-anxiety, antidepressant, anti-obsessive medications we failed miserably.

One psychiatrist advised us that in his opinion, that there was effective medication for true OCD. However, with perseverative behavior in autism, medication is a gamble at best. He explained that when patients suffer from obsessive compulsive disorder, they experience a “risk avoidance sensation”. They might do ritual behavior, as washing hands etc. to avoid being dirty. Those patients on the autistic spectrum do habitual behaviors for pleasure seeking purpose, as lining up cars etc. It made sense to me.

Approximately seven years have passed since our meeting with this thoughtful psychiatrist. I have thought a lot about the notion of risk-avoidance vs. pleasure seeking behaviors. What strikes me is that the motivating factor seems to be about control. The person who wants the ultimate power over the direction of their life, and lacks rational thought succumbs to OCD. How is this reaction different from a person devastated by autism? The question begs further consideration.