OCD in Monica Geller-Binger

Obsessive-Compulsive Personality Disorder in Monica Geller-Bing From F.r.i.e.n.d.s Examiner: Crystal Graham Date of report: 10/25/2002 REASON FOR REFERRAL Monica Geller-Bing is a 33 year old, caucasian, female, chef, and wife who was referred by her husband, Chandler Bing, for a diagnostic intake interview due to concerns regarding her excessive fixation on doing things the “right way” as well as her rigidity. She is overly particular about where items in her home should be placed and how they should be placed, according to her husband. Chandler explained how his wife spends most of her time cleaning, organizing, and making sure everything is “perfect”. He explains how once she attempted to leave her shoes in the living room to prove to everyone that she did not have a burning need to be organized and orderly. She was wide awake all night thinking about the shoes in the living room. She went back and forth about it in her head, he explained that she was “obsessing” over it. He further explained how Monica has a difficult time with spontaneity, she loves order, schedules, and lists. Monica explained how she finds it hard to delegate tasks to others because she feels like others will do them incorrectly, so she feels like she has do them herself. Monica is described as being work oriented and is very rigid about what she does outside of that. Monica is also described as being “emotionally shallow”, not feeling or understanding things deeply. She struggles understanding the feelings of others. Monica did not appear to have any obsessions or compulsions. Based on the information given, Monica seems to display characteristics of Obsessive-Compulsive Personality Disorder. An Assessment technique that would be helpful for Monica is behavioral observation, which would assess the defining features in Obsessive-Compulsive Personality Disorder as described by her and her husband. Behavioral observation can be used to observe, describe, explain, predict, and even correct Monica’s behaviors that prohibit her from living a normal life. Further, the Five-Factor Obsessive-Compulsive Inventory (FFOCI) was designed to assess ObsessiveCompulsive Personality Disorder that is based on the five-factor model (FFM) of personality. The FFOCI contains 12 subscales that assess the aspects of the fivefactor model that pertain to OCPD. The FFOCI can be used to assess OCPD in Monica Geller-Bing. BACKGROUND INFORMATION Prior Mental Health History Monica has no prior known mental health issues or diagnosis. Family History Monica explained how she grew up with her two parents, Jack and Judy Geller, as well as her older brother Ross Geller. Ross was the first born and is seen as the “miracle child” due to their mother’s fertility complications. Monica explained how there is no history of mental disorders in her family, no one in her family has ever been diagnosed. Monica was upset when explaining how her mother constantly puts Ross on a pedestal and believes he could do not wrong. She continues by explaining how her mother expects her to fail. She tells a story of when her mother asked her to cater a party at their parents house, Monica was surprised her mother would allow her to take on that task and she knew she could not mess it up. However, Monica wore fake nails that day because she tends to bite her nails when she is nervous and in order not to do that she wore press on nails. Monica discovered that she had a nail missing and knew she had to tell her mother. Her mother said it was okay because she bought frozen lasagnas incase she “pulled a Monica”. Her mother criticizes most of what she does, says, wears, etc. Social History Monica has a tight knit group of friends which include Rachel Green who she was best friends with in high school and whom she did not reconnect with until their early to mid twenties. Chandler Bing is in this friends group, he attended college with Ross and were roommates as well as best friends. Monica and Chandler had a fling one night, but then began to grow to love one another and at this current point in time, they are married. She has a friend named Phoebe Buffay, but Monica could not recall how she met her. Joey Tribbiani became Chandler’s roommate through an ad in the paper. Monica’s brother is also included in this friend group. Monica explained how she used to have an eating disorder when she was younger, she was extremely overweight. She explains how she decided to lose weight when Chandler called her “fat” one Thanksgiving when Ross brought him over for dinner. She decided to lose weight, in order to get him back when he would see her the following Thanksgiving. Although these individuals seem important to Monica, she and her friends seem to have unhealthy habits at times. They lie to each other, do things without asking, make sexual passes at one another, etc. Work History Monica has always aspired to be a chef, she has worked at plenty of miscellaneous restaurants and even attempted to have a catering business. However, her real dream was to be a head chef of a restaurant, which she currently is, at Alessandro's. In this work position, she gets to call the shots and she is able to make sure everything is done “the right way” and ultimately, Monica’s way. Daily Activities Monica’s fixations have resulted in sleep deprivation most nights, meaning she is receiving an insufficient amount of sleep, less than 7 hours of sleep per night. Monica eats at specific times of the day and does not stray away from those times. She eats breakfast every morning at 7:10-7:30 a.m. before she leaves for work at 7:45 a.m. after washing her dishes and making sure her apartment is “perfect” before she leaves. She eats lunch at 12:30-1:00 p.m. Lastly, she eats dinner from 5:00-5:30 p.m. Monica also has the same patterns pertaining to exercising, she goes for a jog every morning on the exact same path from 6:00-6:30 a.m. Monica does not use any substances of any kind at this point in time and she does not have any medical conditions that might impact her mental health up to this point. OBSERVATIONS Monica arrived promptly, she was exactly on time, she was not a minute early nor a minute late. She appeared to be well kept but she also appeared to be tired. Monica brought a list she made of the activities she engages in that appears to be a problem in her life, she numbered them and wanted to discuss them in the same order she had written them. Monica took a few moments to talk after being talked to, she appeared to be gathering her thoughts in a particular manner. She spoke for the majority of the assessment, making sure to stick to her list and being careful not to stray away from it. She failed to answer majority of the questions because her focus was on her list. She shows little to no affection but instead focuses diligently at the task at hand, e.g. going through her list. Throughout the assessment, Monica did not appear to have any obsessions or compulsions. RELEVANT DSM-V CRITERIA Obsessive-Compulsive Personality Disorder is categorized as a type of Personality Disorder, under Cluster C, along with Avoidant Personality Disorder and Dependent Personality Disorder. The diagnostic criteria includes: 1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. 2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met). 3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity). 4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification). 5. Is unable to discard worn-out or worthless objects even when they have no sentimental value. 6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things. 7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. 8. Shows rigidity and stubbornness. In order to be diagnosed with Obsessive-Compulsive Personality Disorder, patients must have a persistent as well as an excessive pattern of fixation with order, perfectionism, control of self, others, and situations. Monica shows clear signs of her need for orderliness; everything in her home, kitchen at work, car, etc. has a specific place and Monica spends a lot of her time ensuring that. She evidently strives for perfection, making her inefficient majority of the time. She makes sure she is exactly on time everywhere she goes. In order for Monica to have control over situations, she often delegates herself as leader. Monica is unwilling to delegate tasks because to others because she fears they will do them wrong, as individuals with OCPD do. Monica is the head chef at a restaurant and this allows her to have immense control. OCPD individuals are emotionally shallow, making it hard for the individual to have deep emotions and lacking empathy. Monica has a difficult time understanding the point of view of others and struggles to understand emotions that are more complex. She appears to have restricted emotional expression. OCPD individuals have difficulty with spontaneity. Monica expressed how she can’t do anything spontaneously, she explained how she must write out a list of her day every morning between her morning jog and breakfast. OCPD individuals often have interpersonal problems as Monica does amongst her friends. Due to these characteristics within Monica, her friends have learned what are appropriate and inappropriate actions around her. They have learned to not move around the furniture, put everything back in it’s exact place, and volunteer themselves as leader of any task. Further, individuals who are diagnosed with OCPD rarely have obsessions and compulsions. Monica does not have repeated thoughts, urges, or mental images that cause anxiety. She also does not repeat behaviors in response to repeated thoughts, urges or mental images.These individuals lack flexibility, openness, and efficacy. Although Monica is strict on herself with lists and schedules, she is not very efficient throughout the day due to the lack of flexibility within her daily tasks. She must stick to her schedule exactly, this restricts her from being open and flexible. Also, due to her strictness her schedule lacks room to do other activities. So, Monica ends up doing the same thing day after day, affecting her efficacy. INTEGRATION There appears to be a moderate genetic contribution to Obsessive-Compulsive Personality Disorder. Although some people may be predisposed to favor a certain amount of structure in their lives, Monica experienced unintentional parental reinforcement pertaining to the constant need to be perfect. Monica’s mother constantly made her feel anything except perfect and Monica has fixated on that, she says she often feels inadequate. Jack and Judy Geller constantly glorified her older Ross and were constantly demeaning Monica. Monica is persistent and dedicated to her work, but her preoccupation with details prevents her from completing much of anything. This may be due to her mother constantly pointing out the smallest details about her appearance and actions. The exact cause of OCPD is unknown, but it is known that OCPD has a certain genetic component and can be due to childhood experiences to some extent, like the ones Monica experienced. It would be helpful to diagnose Monica Geller-Bing with ObsessiveCompulsive Personality Disorder because she has the identifying features of OCPD and with this understanding she can get the appropriate treatments to improve the current state of her disorder. TREATMENT PLAN/RECOMMENDATIONS Although there is little data on treatment, there are treatments used for Obsessive-Compulsive Personality Disorder. Recommended treatment for Monica is Cognitive-Behavioral Therapy (CBT) for OCPD that addresses fears related to the need for orderliness, it targets rumination, procrastination, and feelings of inadequacy. Cognitive-Behavioral Therapy will examine Monica’s thought processes and how those thoughts out affecting them. This will allow Monica to become more aware of her own thought patterns. Further, cognitive reappraisal techniques will help the individual to refrain from having fixated thoughts. Cognitive reappraisal includes addressing the negative pattern of thinking that the patient has fallen into and attempting to change that pattern into a more positive one. OCD iDifferent ways of thinking elicit different emotional responses. So, in Monica’s case, cognitive reappraisal will attempt to make her thoughts less fixated. Another therapeutic technique used for individuals with OCPD is Psychodynamic Therapy that is based around insight, helping the individual with OCPD identify their perceptions of particular situations and assess why lack of control causes problems for the individual. Psychodynamic Therapy will help Monica become more self-aware and strive to correct her fixated thoughts.