That’s Not OCD, You’re Just a Slacker

Second thoughts:
d:
Their ain’t no fucking way he’s got a girlfriend… must be a psychotic delusion.

(actually the right answer was supposed to be b)

Hmmm…. okay. I’m seeing some shit talked about this so I may as well jump in and say something.

I trained as a psychologist. My emphasis is in teaching, learning and development. I specialised in autistic difficulties in adult life, and went on to specialise further in applied ethnopsychology/psychoanthropology. Part of my training is in clinical psychology, so I may just have something to add here.

For something behavioural to be considered disordered, certain characteristics have to be found in it: deviant from cultural norms; causative of distress; and dysfunctional (to name but three such attributes). In the example, we are given a scenario and asked to diagnose the person described in that scenario.

“A 23-year old medical student makes lists of all the tasks that he must accomplish each day. He spends hours studying and refuses to go out with his colleagues even when there are no tests on the immediate horizon, preferring to spend his time looking at specimens in the laboratory. He keeps meticulous notes during all his classes and prefers to attend every lecture, not trusting his colleagues to take notes for him. He is doing well in school and has a girlfriend who is also a medical student.”

There is no mention of any specific deviance from cultural norms (unless it is culturally normal to be a very non-conscientious student in a medical school!). Nor is there any mention of any distress being caused to anyone (himself or others), and there is no information given that identifies this person’s study behaviour as being dysfunctional in any way. This being the case, the following question is actually very presumptuous:

“Which of the following disorders does this student most likely have?”

Without information confirming those three characteristics I’ve mentioned, we cannot just go ahead and assume that there is a psychopathology behind that behaviour. There are equally valid alternative explanations for this person’s behaviour, some of which have been given already by the owner of this blog.

Now let’s see how – in the absence of evidence of deviance, distress and dysfunction – the offered ‘diagnoses’ actually fare. I’m using the ICD 10 Chapter 5 Diagnostic Manual for Research*, in the absence of a copy of DSM IV (in either of its forms).

* the so-called ‘Green Book’

“A. OCD”

We are given no information that would suggest that he has intrusive thoughts going on that cause him any distress or dysfunction in the way they would in OCD; nor are we given information that would confirm the behaviour as ‘compulsions’ under that diagnosic category. Whatever thoughts the person has, no evidence has been adduced that they are experienced as unpleasant to him or others, and we are not given any concrete evidence that his behaviour is actually unreasonable. We are given no actual evidence that he finds it unpleasant to study. Indeed, what we are given is evidence that he takes his study tasks seriously, which my observations of medical students suggests is quite rare but not exactly ‘deviant’ (yes, I was in med school; no, I was not reading medicine – I was reading biological and molecular anthropology). The guy has a girlfriend … so he obviously has time for her, and she may be (for the time being) the main social need he has whilst he earns his medical degree!

Therefore, a diagnosis of OCD cannot be sustained.

“B. Obsessive-compulsive personality disorder”

We are not given any information that suggests that he’s experiencing feelings of ‘excessive doubt or caution’; although he takes his study tasks very seriously, we are not given any information that suggests that he is preoccupied with ‘details, rules, lists, order, organisation or schedules’. We are told that he is doing well in medical school, so we can deduce that he is not ‘perfectionistic to the point of it interfering with task completion’; and we are told that he has a girlfriend so he is not overly concerned with productivity ‘to the exclusion of pleasure and interpersonal relationships’ … it may be that he prefers to study than hang out with his colleagues. He is not insisting on everyone doing things his way (if he were, we would have been told so), and nor is he being unreasonably reluctant to allow others to do things. These criteria hereby disposed of, only three items remain for which we have no information either way. OCPD requires four of them. A diagnosis of OCPD is also, therefore, not sustainable.

“C. Obsessive-compulsive traits”

This isn’t even a diagnosis! Nor can we justify suggesting that he has them, since we have dealt with this issue in dealing with the diagnosis of OCD above.

“D. Schizoid personality disorder”

We are not given enough information about his social relationships to be confident in suggestiong this diagnosis. Sure, he is restricted in his activities – very solitary work in a laboratory; but – given that he may wish to keep doing well in medical school – this is likely to be something he sees as a necessity at this stage in his career. Yes, he maybe only has time for his girlfriend just now, but again we can explain this in terms of his desire to do well in his career rather than as being down to any possible psychopathology. Moreover, the general criteria for a personality disorder have not been established as having been fulfilled, so we cannot just assume that they are (this also pertains to the suggested diagnosis of OCPD above).

“E. Paranoid personality disorder”

He is not said to be ‘excessively sensitive to setbacks or rebuffs’, and we have not been told of any persistent tendency to bear grudges. There is no report of him behaving in a manner that suggests ‘suspiciousness and and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous”, and we are not told of any “ combative and tenacious sense of personal rights out of keeping with the actual situation”. There is nothing in the description that is better explained by “recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner”, or “persistent self-referential attitude, associated particularly with excessive self-importance”, or “reoccupation with unsubstantiated ‘conspiratorial’ explanations of events around the subject or in the world at large”. This being the case, the diagnosis of ParPD cannot be sustained.

“[and written in] F. Fuck you, that sounds totally normal. Asshole.”

Whilst I wouldn’t characterise the person’s behaviour as totally ‘normal’ (because, psychometrically, ‘normal’ – i. e., always scoring within -1 < z < 1 – is actually extremely rare when you look at the actual probability of it happening), but I would say that his behaviour is more likely to be that of someone who takes his studies seriously, and acknowledges the responsibility involved in being a medical practitioner and is prepared to put in the effort needed to be good at being one. He may not really like his colleagues all that much, compared to liking the rewards of his hard work as they show up in his grades at medical school. The research evidence in educational circles is pretty clear on the fact that cramming for exams is probably the worst way to learn anything (which is probably why many medical practitioners fall prey to becoming followers of ‘quackery’; I refer you to Orac’s blog, Respectful Insolence, on scienceblogs.com for an idea of how rife that problem actually is); the research is clear on the fact that learning properly involved a lot of active integration of the material to be learned into a comprehensive framework of knowledge, the elements of which then need to be understood in relation to each other. As for not trusting his colleagues to take notes for him … why the hell should he? Would they be able to prioritise the information in the same way that he would? Could they get the sorts of informative notes that he might be able to get for himself in lectures anf classes? Because, if they couldn’t – and it is doubtful that they could – he’d be a fool to trust them (no disrespect to them intended). I would say that – given his likely desire to do very well in medical school – his behaviour is entirely natural.

There is no evidence given of any florid psychopathology presenting in this young man’s case. The item should not even have been in any sort of assessment of learning (I say this because this is the sort of thing one sees in clinical psychology/psychiatry tests of learning, such as – for example – those used by the Royal College of Psychiatrists in the UK).

PS- I’m probably going to get some flak for having submitted this comment. Let me assure any flak merchants intending to flame me on this of one thing: I don’t give a fucking shit. My ability to deal effectively with details and my dedication to being painstakingly accurate got me a Distinction in my Master’s degree… after that, I dont’ have to care about the opinions of people who are probably to lazy to think properly about any subject to be any good at it.

A couple of things here for Mister Andrews.
Not “to come across as some nit-picking arsehole”:
1. What is the meaning of “suggestiong”? Read your analysis of answer D.
2. “irrevokably” I know it is an acceptable spelling, but please, spare us.
3. You should really do as you say “My ability to deal effectively with details and my dedication to being painstakingly accurate got me a Distinction in my Master’s degree…” especially when it comes to details. As you may find in this phrase from your analysis of E. : “‘suspiciousness and and a pervasive tendency” And and (joke here) I have found other places where you did not pay attention to the details such as “it is very important to be accurate and use as full an information set as possible.”
4. I wonder if you understand that the original photo is a joke?
5. You have once again reminded me of the old maxim “an asshole with an education is no more than an educated asshole!”
6. Question, should the term anal retentive be hyphenated? (another joke)!
7. On the other hand, I will give give you kudos for taking the time to analyze the question and answers to the original question and answers for the rest of us!
8. I hope you give me some acclaim for my analysis of your analysis! (yet another joke)…

(Separately on purpose; wouldn’t want the tone of the previous comment to spoil this one)

Mister Appleby:

“7. On the other hand, I will give give you kudos for taking the time to analyze the question and answers to the original question and answers for the rest of us!”

If you’re being serious, then – thank you.

Hi Ebony!

I thank you :)

*bows courteously*

cool. All yall.

Sara and CA, I humbly thank you both for your comments.

and there is also a saying, don’t argue with an idiot… etc :D
I haven’t educated myself in these things so my opinion is only based on life experiences :3

David N. Andrews M. Ed., C. P. S. E.
haha! read your comments… it was a bit .tedious. :) … like you said… too much detail and the need for accuracy, and not enough of effort to fuse the information with people who might read it. I mean… there was clearly effort to do that.. but within your own bounds and set of rules… and a bit arrogant just to be honest…

anyway.. what I’m saying is that instead of giving us that heap of information up there that I could have looked up in a psych book or googled,… a more not so in your face comment giving better and understandable analysis would have been much better..

It might appeal more to people that have learned something about this… but I somehow doubt that…
and the fact that you said ” I don’t give a fucking shit” made me wonder if it was completely pointless reading or commenting on what you wrote…

I don’t know… If I was studying, teaching others or developing something around psychology, I would really like to get and study opinions and thoughts on things from other people,
even if they are “people who are probably to lazy to think properly about any subject to be any good at it”

but like you said that you understood that you were probably going to get some flak for it so…
it is clear though that you do realize that you may come across a bit arrogant…
or you think that people will VIEW you as arrogant :)

so keep working on yourself… I found the whole thing a bit annoying and decided to comment on it… and while I think about it now… I shouldn’t have started writing…. -_-”
but I’m not wasting it… posting this and then forever goodbye :)

Kudos for the time, effort and thought put into it, :)
and keep working on the mind thing……….

oh and good luck in studying in Africa :)

(from what your’e learning and doing it should SOMEHOW connect to writing better stuff)

OH the picture is btw awesome ! XD lol

Linda: “it is clear though that you do realize that you may come across a bit arrogant… or you think that people will VIEW you as arrogant :)”

Hmmm… where did you get that from? It had nothing to do with arrogance or thinking that people will think I’m arrogant. But you did manage to exemplify exactly why getting a lot more information about something is important. So, even if you were wide of the mark, you did something useful.

“so keep working on yourself… I found the whole thing a bit annoying and decided to comment on it… and while I think about it now… I shouldn’t have started writing…. -_-
but I’m not wasting it… posting this and then forever goodbye :)”

You might want to do the same on yourself, eh? And, yes, maybe you shouldn’t have started writing. You see, during the considerable amount of work that I have done on myself (which you were not there for!) I learned to not get into anything deep about which I had no clue.

“anyway.. what I’m saying is that instead of giving us that heap of information up there that I could have looked up in a psych book or googled,… a more not so in your face comment giving better and understandable analysis would have been much better..”

You say that as if I was writing the comment for you (or people like you)! I wasn’t. I was writing that comment for anyone who was interested enough to want that information without having to go and look for a psychology text book. You (and people like you) were not even a thought in my head. I write for people who are interested enough to read the details properly, not for the uninterested.

Oddly enough, I have – on other blogs (where comments usually are as long and involved as my first comment here, and where my long comments wouldn’t attract sniping such your comment) – seen people who leave one comment and then bugger off into the dark. We call them ‘hit-and-run’ commenters… basically a form of troll. Not something to aspire to being, really. But then … if you ‘keep working on yourself’, you might just get past that and respond with comments that have something useful to say. If, indeed, you are actually ‘working on yourself’.

“oh and good luck in studying in Africa :)”

What? Where did Africa come from? Another one of your self-generated inferences that had no basis in anything that was actually said?

Interesting … you really do exemplify exactly what I was railing against! Ever thought about earning some pocket-money as a participant in experimental studies into the Dunning-Kruger effect?

hey dave, you’re a very serious fellow aren’t you? I think Dan’s comments hit the bull’s eye. As for yours, well, you are obviously very talented at doing exams and stating the bleeding obvious too. I think we should apply the multiple choice question to your analysis, and, sorry, but the answer isn’t F:!
sorry cobber, but you really need to grin sometimes!

While this is all very interesting to read, it seems like a pissing contest. David (obnoxiously long name) knows what he’s talking about (or doesn’t, as I hardly give a damn), and you (David Appleby) should just leave it at that. And, to David (obnoxiously long name), you come off as pretentious, but then again so do I. As far as that goes, yes you know your shit, but should you tool on everyone? I don’t personally think so, it’s more along the lines of letting the person in question learn for themselves, if they choose not to, then it shouldn’t matter either way. No harm no foul. And as far as this kids answer goes, joke or not, I’d probably write something similar because I in-fact am fairly OCD, and to me, it does sound “normal”. With that being said, I bid you all adieu, and I hope you all have brilliant days/evenings (whatever your clock specifically says). :)

One Love.

Too read; didn’t long

Uhm, like, no comment.

The facts presented in the multiple choice question show the few undeniable facts gleaned from a professional examination. In a real situation a researcher would have more inferential facts leading to a more inspired diagnosis, but judging by the facts alone one could assume a direction to move towards.

Don’t be afraid to be wrong, it will make you all better doctors :)

I think that the article may have been written about David N. Andrews M. Ed., C. P. S. E.

“The person in the scenario is a hard working person, and a good student. Why does there have to be a disorder or an “abnormal” behavior? Not, saying that people dont have them, but it seems that people read into peoples actions too much. I would answer F too.”

Well said, John. This is what I was trying to get at.

Cody: “Mr. Andrews,
Excellent analysis and commentary. You discussed why this was a poorly written question and gave factual reasoning and good sources to back up your claim. Hat’s off to you.”

I thank you. I did my best to justify what I was saying, so I’m pleased that you see it for what it is. I get the feeling that – had I not done so – the people who have commented negatively about me (rather than what I said) would have had a go at me for not backing up what I was saying, and just said that I talk bollocks.

Interesting to note, though, is that the negative commenters have done exactly the thing I was writing about: making judgements based on very little – if any – knowledge about me. Very interesting little social psychological experiment into the Dunning-Kruger effect and its influence on untrained commenters on blogs. Incidentally, I comment on a number of blogs, usually scientific, where the sort of comment I did here actually goes down well. There seems to be something of an ‘arrogance of ignorance‘ in what those commenters have said (hell, if they want to call me ‘arrogant’, then they shouldn’t complain if I call them it!).

Fact is, I saw something that a friend had shown me the link to, and asked me what I’d thought of it. So, I was motivated to answer the question I was asked by this friend: what did I thnk of the question?

People who know me know what sort of answer they’ll get: factual, based on evidence, and probably not short. But it will be fairly comprehensive. And, if I answer it well, it will be clear to most people reading it what I’m talking about.

And the fact is that some people did find what I had to say interesting and possibly useful. That pleases me. Its nice to be able to do that. It’s those people that I do it for. The rest are really of no consequence, but they’ll make their mark in the form of hostile comments. Says more about them than it does about me, to be honest. Especially when they make ‘psychologistic’ comments as some have done, without having a clue what they’re really talking about and without knowing me. Point here is: the negative comments that were made don’t detract from the fact that I was right in what I said in my original comment. Ad hominem attacks are the last resort of those who can find no fault in the message so they have to have a go at the messenger.

I’d thought I might write an article on this experience. Not sure if I really want to, in light of the other work I have going on just now. But it’s certainly piqued my interest in this aspect fo blogging.

To those who commented positively, a huge hearty ‘thank you’ for your collective appreciation. It was worth the effort it took to write the comment, because of your comments regarding mine.

SO, gentlemen, thanks for allowing me to, for once in my life, read a written pissing contest, and just for the record, I got the joke, but the educated asshole still had a point!

Wow. I StumbledUpon this page and had a blast reading everything. I know very little about psychology, but I can see why Dr. David would see the opportunity to write an article about the material here. Fascinating responses all around. Some silly, some scholarly, some strange, but wonderfully entertaining!

dr david need to get laid and not spend days replying to strangers just to prove a point ^_^

resond -> response

typo. AR-Appleby notwithstanding.

heh.

time for bed.

Those of you who got that – major props to yez!

I didn’t misunderstand because I disagreed with the conclusion that an answer should have been picked as opposed to challenging the question and the underlying assumptions that it makes. That is a fundamental error to force an answer from a question as flawed as it obviously is. Even the professors that you spoke with admitted that the question is bad. The whole point of my reply is that we should be fighting mediocrity in education and that includes questions on exam or study guide.
I can appreciate their years of study and your education level. It takes dedication to persevere to achieve a degree of those levels. Please, do not assume that I am uneducated because the wording of my post was disjointed.
Many great things in Psychology have come from disagreement. If I had been given that question on exam I would have challenged it because it doesn’t meet the standards that I believe universities should hold.
So, pretty much what I’m saying is that it is a mark of a great scientist/psychologist/anything along those lines if they challenge mediocrity for themselves and everyone else.

I apologize if anything I said came off as an offense to you.

Actually, I am a psychology major, and the answer is obsessive compulsive traits. what this means is that he does not have a clinical level disorder, but simply has TRAITS indicative of developing ocd under clinical levels of stress. They phrased the question wrong by saying disorders, thats all