Making the media rounds before the premiere of the film Takedown: The DNA of GSP, Georges St. Pierre told the Canadian Broadcasting Corporation that obsessive-compulsive disorder (OCD) helped him and hindered him during his tenure as UFC welterweight champion. It motivated him to become a better martial artist, he said, but it was a detriment to his sleep habits and his personal life, and its effects played a part in his sabbatical from the sport.
St. Pierre has touched on the subject of OCD before. So far, there’s no confirmation of a clinical diagnosis, and plenty of fastidious homebodies with spotless countertops and neat sock drawers make jokes about being possessed by what’s actually a potentially debilitating condition. We spoke with Dr. Gerald Nestadt, a psychiatrist and director of the Obsessive-Compulsive Disorder Program at Johns Hopkins Hospital, about the roots of OCD, the symptoms, the treatment, and an alternative mental health condition that might have contributed to St. Pierre’s pursuit of martial arts perfection.
Dr. Gerald Nestadt: Only about two percent of the population has OCD. It’s really a pretty simple diagnosis: You have to have an obsession and/or a compulsion. An obsession is a thought, an idea, a picture that sort of pops into your mind that you don’t want, that you think is irrational. You try to get rid of rid of it, but you can’t. If you try and stop thinking about it, you get really anxious. That often leads to compulsions, and the compulsions are usually things that try and get rid of those obsessional thoughts.
A typical example would be someone with a cleanliness obsession, who looks down and sees the dirty spot on his desk and thinks it may be feces. And, you know, it’s not. But he can’t get rid of that thought, and he knows inside his head that it isn’t feces, but it makes him terribly anxious—he tries not to think about it, but he can’t. In that example, even if he hasn’t even touched it, he’ll go wash his hands excessively.
The diagnosis is the presence of an obsession—not just the desire to do something a lot, it’s something that is painful and unwanted—and a compulsion, which is something you’re only doing because you think it will prevent some particular thought that you have or some worry that you have, even though it doesn’t make any sense. The second part [of the diagnosis] is pretty straightforward: The obsession has to disturb or disable you in some way. It can either take time out of your day—typically more than one hour—or it’s incredibly distressing to you, or you can’t function.
It goes all the way from people who can’t leave their house because maybe somebody sprayed some insecticide a block away and they’re worried that the insecticide will affect them, to smaller things, like worrying that even though you know you locked your car, you can't help worrying or doubting yourself, and you have to go back a few times to relock your car. It involves lots of different things, all the way from religious thoughts to sexual thoughts to aggressive thoughts. Other times, people think that everything has to be symmetrical and ordered, otherwise they feel uncomfortable or distressed.
Everyone in the field believes that there’s probably a genetic contribution, but there’s also an environmental contribution. Typically it runs in families, so if one family member has it there’s a higher probability that another family will have it. We think that there’s a pathway in the brain, from the cortex through the basal ganglia through the thalamus, that is functioning inadequately. In fact, it’s probably overactive. So we think that that type of pathway is causing this and influencing the way people are able to put aside thoughts and are satisfied with whether they’ve remembered something correctly or accurately.
[Treatment for OCD] is very straightforward. Medications are very helpful—they’re what’s called the selective serotonin reuptake inhibitors: Prozac, Zoloft, Lexapro. The other thing is behavioral therapy. It’s called Exposure and Response Prevention, where you have a worry or a thought that’s bothering you, and you actually expose yourself to that thought. You make yourself think it or see it, but you stop yourself from doing what you usually do to reduce the anxiety. If you’re worried about germs, you expose yourself to something dirty. When you get anxious, you don’t let yourself go and wash your hands: You sit through the anxiety until it goes away. Much like someone who’s afraid of climbing mountains goes and climbs mountains until they’ve overcome the fear.
There’s no question stress in whatever domain—and high-performing professional athletes could be one of them—can provoke the symptoms. I don’t think they necessarily cause them, but they certainly can provoke them and aggravate symptoms in someone who’s vulnerable to them. David Beckham, the soccer player, described having OCD. There’s no doubt that there are other athletes that have that problem.
The truth is unless St-Pierre has actually discussed or divulged what his symptoms are they could be anything. There’s no way of even guessing. It could be that whenever he made a move, he’d have to move his left foot first before his right foot. Or that in preparation for a bout, he’d have to go through some ritual that took an excessive amount of time away from him. But unless we know, a guess would be unacceptable.
The question, to me, is does he actually have OCD, or is he talking about being obsessed but doesn’t have true obsessions or compulsions? I don’t know.
From an obsession and a compulsion in true OCD, there are no benefits that I know of. Now, related to OCD, there’s something called obsessive-compulsive personality.That really involves being a perfectionist and being meticulous about the way one does things or needing to do things in exactly the right way, which is different than OCD even though it shares part of the name.
It’s not a disease or an illness—it’s more of a personality style. If you took one trait like perfectionism, we’ve all got some of it. But some people have it so extreme that it really starts interfering with their lives and interfering with the lives of others. St-Pierre could well be talking about this aspect, where he’s so perfectionistic that if he’s going to work out he has to work out in an absolutely perfect manner, do exactly the right thing. And when he thinks about nutrition, he has to eat exactly the right things. That can be burdensome and disabling to some degree because you’re pressuring yourself. On the other hand, it has an advantage: The advantage is that people who are perfectionists and worry a lot about their performance tend to do exceedingly well.
We’ve even done studies in the population that show these kinds of people are the ones that get the better jobs, that these are the kind of people that succeed. And I’m sure that these are the kind of people that become the top athletes.
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