Counting Coup

24 July 2006

By Leigh Woosley

Editor's note: This is the second in a series of five articles looking at the complex problem of anxiety disorders, the most prevalent mental health disease in America.

For Kevin Gaylor, sexual and violent obsessions were monsters attacking his brain.

He fought, and sometimes still does, a churning fear that he will hurt someone. He thought about hurting his beloved dog, Bella, or abusing a child.

He hates the obsessions and has spent much of his life trying to stop them.

For a time the 36-year-old Gaylor completely avoided children because they sparked disturbing thoughts. He became anxious when kids walked to and from the elementary school in his midtown Tulsa neighborhood.

He wouldn't use a public restroom when a young boy was there. Changing a baby's diaper once sent him into isolation for months.

He didn't see his father for four years after having a thought about hurting him.

Gaylor is not threatening or strange. He goes to work on time, talks on the phone to his mom in McAlester and mixes a darn good martini for friends.

He looks like anyone else walking down the street. But his mind is different from most. It is riddled with compulsions.

The mind of a person with Obsessive Compulsive Disorder uses compulsions, consciously or not, to distract itself from obsessive thoughts. Some common examples of compulsions include excessive cleaning, hand-washing, arranging things, counting and repeating routine activities.

Sometimes the compulsions directly relate to the obsessions, like washing your hands and a fear of germs. Sometimes they don't.

Gaylor started counting when his obsessions first surfaced at age 7.

He counted steps, at first. Steps from his bedroom to the kitchen. From homeroom to the school restroom. When single-file lines in grade school messed up his counting, he became anxious.

Several years later, he took up the saxophone and started counting musical notes. At age 15, he began counting letters, and he hasn't stopped.

He counts letters in words as quickly as the words are spoken. And while he's counting, he's subtly moving his hands as though he's typing the word on a keyboard.

"Did you notice me doing it?" he asked over a breakfast of toast and eggs at a local cafe.

Gaylor was counting the word "aperitif" on the wallpaper. Nine letters, he said, but he added a space to make it 10. Odd numbers bother him.

Farmer Brothers on a sugar packet. Fourteen letters.

Tabasco. Seven letters, but he made it eight. Eight is the best because he equates the number with order. He likes the number eight.

Numbers game

Counting is Gaylor's second nature. He counted throughout the day without noticing, but even more so with obsessive thoughts.

It took only the sight of a child for Gaylor to begin counting incessantly.

When a young girl in his neighborhood was raped and killed, he counted for days.

He also touches things compulsively, preferably brick walls so he can count every groove that separates brick from brick. Gaylor's compulsion to count escalated as his departure for Florida neared.

He was scheduled for treatment at the University of Florida Obsessive-Compulsive Disorder Program in Gainesville. The program treats OCD with a common approach called exposure-response prevention.

It has patients confront their obsessions and then learn to handle the ensuing anxiety without turning to compulsions.

"It's like watching a scary movie," said Eric Storch, director of cognitive behavioral therapy and research at the Florida OCD program.

"The first time, it scares the heck out of you. The second time it's less scary. The third time it's not scary at all, and the fourth time you fall asleep."

The costs

Gaylor sacrificed a lot to go to treatment, including about $8,000 and vacation time from his job at HOPE Testing Clinic.

The greatest surrender, however, was his comfort level. Gaylor knew he would be greatly tested by the treatment, but he took the proverbial leap of faith that it would pay off.

He left the next morning with his luggage, his obsessions, his compulsions and hoped to return with only the luggage.

"As far as the obsessive thoughts, I thought I was just like a serial killer with a conscience, and that I was holding myself back from acting out my thoughts, and at any time I would be exposed for the fraud I really was," he said.

Gaylor now realizes those obsessive thoughts don't define him. The thoughts are his illness, and he would never act on them. He worries that people won't understand that.

"I want it to be very clear to people that I would never hurt anyone. I would never hurt anyone," he said. "I would never hurt a child."

Still, lurking in his consciousness is the panic that he might. This creates a tormenting anxiety that Gaylor once felt multiple times a day.

"It's that anxiety, a heart-clinching fear that I've done something wrong," he said. "The fear that I'm inappropriate. My face gets red. My heart starts beating really fast. I'm bad. Only a bad person would think this. It is the most horrible feeling you can imagine."

'Thank God. Thank you, God'

The symptoms of OCD that Gaylor experiences aren't reported as frequently as the obsession with germs and neatness, but they're just as common, said Eda Gorbis, a psychologist who specializes in OCD and is an assistant clinical professor at the University of California, Los Angeles, School of Medicine.

"They are very typical," she said on the phone from her office. "But (people with OCD) don't ever hurt children. If this is OCD, they are not capable of doing any harm. They are petrified of doing any harm. And they are afflicted with extreme guilt for having these thoughts."

Gaylor guarded his thoughts with mental armor, ashamed and terrified that others would discover his thoughts, that they would condemn him as evil or a potential pedophile.

Alone with his obsessions, Gaylor remained tormented by them. He never considered his thoughts as symptoms of a disease. The diagnosis was a relief.

"Thank God. Thank you, God," Gaylor said. "Yes, I may have a mental disorder, but I'm not all those things I thought. I'm not a serial killer. I'm not going to do all of those things."

Gaylor also saw a psychiatrist and found relief in the drug Prozac - one of a family of medication commonly used for anxiety disorders.

No medicine, however, could stem the terror Gaylor experienced during treatment in Florida, where he faced what he feared most.

The treatment team there ranked situations that sparked Gaylor's anxiety from least to most intense. They began exposing him, first to the mildly disturbing ones. Over 30 days, they increasingly exposed him to more and more intensely disturbing situations.

Early on in the treatment, he changed a baby doll's diaper. Weeks later he was eating lunch at the McDonald's playground surrounded by children, the greatest trigger of his anxiety.

In an e-mail written during his treatment, Gaylor said all of his expectations were being met. He was facing all of his fears.

"It's retraining my brain," he wrote. "It's pretty brutal for me, though. And it's going to get worse."

A building process

For days Gaylor visited a play area at a Florida mall where children ran rampant through plastic trees, alligators and turtles. He started by sitting at a table on the perimeter of the indoor playground.

"I would tell them (the therapists) 'I am not going to do this. This is what a child molester would do,' " he said. "They knew it was my OCD, and they wanted me to realize I wasn't a child molester, that I didn't have those kinds of thoughts."

Each day he got closer to the play area until he was sitting in the middle of it with little kids brushing against him as they ran by. Gaylor's anxiety level immediately shot up into a full-blown panic attack.

Lack of breath, racing heart, watering eyes. A fear that the attack would never end.

But he stayed in the playground. The anxiety eventually abated, and the next day the playground was less daunting. It lost its power.

"It was having that anxiety and having it go down and doing the same the next day," Gaylor said, making homemade spaghetti sauce on a Sunday afternoon at home. "It was a building process. It was behavior modification, and it worked. It really worked."

An assessment done at the treatment center just before Gaylor left showed his OCD had improved by 50 percent. Gaylor guesses 80 percent.

"Compared to where I used to be, it's a huge difference," he said. "Just in terms of being able to be out in society and be OK. I wanted to be able to be around kids and not be a freak. And that's what I got out of it."

He still counts. He still touches brick walls. But he can be around children without incessant, intrusive thoughts that he will hurt them. He can smile at a child in the grocery store or wave to a neighborhood kid and not feel inappropriate.

He still struggles at times. The work is not over, but he wonders if anyone's work ever is.

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OBSESSIVE COMPULSIVE DISORDER

People affected: 2.2 million adults, 1 percent of the American population.

Median age of onset: 19, but first symptoms show during childhood and adolescence.

Symptoms: Persistent, upsetting thoughts (obsessions) and rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals - handwashing, checking, counting - end up controlling them.

Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home.

Qualities: OCD strikes men and women in roughly equal numbers and usually appears in childhood, adolescence or early adulthood. One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them.

Copyright 2006. Used with permission from Leigh Woosley and Tulsa World.