Don’t try this at home

by Marc Wilson / 31 December, 2015
Miraculously, the hit-it-and-hope DIY repair method sometimes cures psychological disorders.
 

Photo/Getty Images
Photo/Getty Images


A head injury can induce obsessive-compulsive disorder (OCD) but, in rare instances, it has been known to cure it. In 2012, a Manhattan jury awarded Christina Grossman more than US$1 million after she developed obsessive-compulsive behaviour following a car accident.

A news report claimed that after the crash, in which Grossman’s car collided with another vehicle that had turned into her path, initial brain scans showed little evidence of trauma. However, not long after, she began to feel an overwhelming need to repeatedly wash her hands, turn power switches on and off and take care stepping over door thresholds.

OCD is characterised by the presence of obsessions and compulsions, reminiscent, perhaps, of the old wise woman in Blackadder. It’s important to add, in case anyone who has binge-watched a TV show or collected bubblegum cards ends up with the diagnosis, that these obsessions and compulsions must significantly affect one’s life.

Clinically significant obsessions occur when someone repeatedly experiences intrusive thoughts or mental images. He or she may recognise these as rational, and often feel really anxious if they’re not acted on. Over time, the actions that go with the thoughts become ritualised and repetitious and briefly reduce the feeling of tension that comes with the thoughts.

What sort of rituals? There are as many as six families of behaviours people engage in, but not necessarily all of them. Common ones are compulsive washing and repeatedly checking things such as whether the oven is turned off or the door is locked. Putting things in order is another ritual: someone might feel compelled to organise their pens by colour, and separate from the pencils.

One of the ways we assess OCD characteristics is to use sets of questions about symptoms that allow us to judge if someone is displaying a greater than usual degree of ­obsessive or compulsive behaviour. One of these is the Obsessive Compulsive Inventory, which asks between 18 and 42 questions – it’s online if you want to confirm what your family already know. I don’t check, wash or order (my office is proof), but I do score above average on another set of behaviours – hoarding. You never know when I might need that thing I’ve not needed for the past six years.

But back to Grossman. Why are her brain scans important? After all, she also became wary about riding in black cars, so might it not just be an anxiety reaction resulting from the crash?

Another bizarrely similar example documented in 2012 in the journal Case Reports in Medicine sheds light on this. We don’t know the woman’s name in this instance, but she was also involved in a car accident that left her in a coma for three months with a haemorrhage in the tem­poro­parietal area of the brain.

When she recovered, unlike Grossman, she didn’t have OCD. This is important, because for more than two decades before the accident she had serious, life-inhibiting checking and washing compulsions.

The woman in this case isn’t alone in head trauma-related OCD recovery, but it would be a small party if all documented cases went out for a few drinks. There are just a handful of similar stories. One involves a self-inflicted gunshot wound to the frontal lobes (not recommended!), with similar reduction in OCD symptoms. In these cases it appears that what may have happened is areas that are important for making decisions about when to do something (such as checking whether the door is locked) and also for deciding when to stop doing that thing, are damaged.

On the one hand, these fascinating and unusual stories help us understand how different parts of the brain relate to behaviour. On the other, I’m not sure health professionals should prescribe a head injury as a solution.

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