Do You Have Achiever's Disease?

By: Mark GoulstonTue Jul 8, 2008 at 5:45 PM

Frequently this is insufficient, because treating OCB people with only SSRI's is like trying to control boiling water by putting a lid on the pot. The lid won't help unless you take the pot off the fire. In fact, putting a lid on boiling water only adds to the pressure. Similarly, giving only an anti-depressant to someone who has a concurrent bipolar component can make matters worse by causing him to become more manic.

What does seem to help is a combination of an SSRI and a mood stabilizer such as lithium, Tegretol, Depakote, or Lamictal. And if you're in the midst of a skid and need brake pads to keep from going out of control, medications like Zyprexa, Geodon, or Abilify can keep you on the road. These medications for bipolar disorders help turn down the flame or from going off a cliff.

Psychiatrists are increasingly using combinations of these medications as the complexity of these conditions has increased. As the intensity of the OCB lessens, patients find calm and often a new kind of non-frenetic energy. One patient was so relieved, he called me in tears. "I'm normal!" he said. "All my life, I thought normal was for everyone else. You know? Success doesn't make up for feeling like a mental misfit!"

After medications have effectively stopped the Porsche by removing the keys, individual and couples therapy can help a patient and partner develop a healthier relationship -- now that they have slowed down enough to put some emotion into it. Insight therapy might also help, since there's usually some childhood abuse, neglect or dysfunction that contributes to (but alone doesn't cause) OCB.

Pretty soon OCB people listen better, are more "present" and see the quality of all their relationships improve. One treated dad started to cry as he told me about reading his 5-year-old a bedtime story. For the first time, he was emotionally "there," not just mouthing the words with his mind miles away.

There are a couple final reasons to get your OCB taken care of sooner rather than later -- peace of mind and increasing your chances of getting into heaven. Years ago I made house calls to a corporate giant dying of cancer. He also had OCB, having thought he was above the consequences of alcohol and cigarettes. A few weeks before he died, he talked about something that had been tormenting him. "I don't think I've ever done anything important in life," he said. I tried to reassure him that he had started an industry, created hundreds if not thousands of jobs, and had a lot to be proud of. He thought I was trying to manipulate him into a solace he didn't deserve. "Yeah sure," he said, "but what about the two wives I ruined and my three loser kids on drugs who'll never amount to anything?"

Because he was like other people with OCB and never meant to hurt anyone, I'm sure he made it into heaven. But it probably wasn't a slam dunk.

OCB's Dirty Dozen
Sound like anyone you know?

Powerful, charismatic, larger-than-life; takes professional and creative risks and often succeeds because his exceptional instincts and abilities override professional shortcomings.
Fiercely competitive; a terrible and often vindictive loser.
Superficially compassionate and empathic in public, but mercurial and evasive when it comes to deep emotional closeness.
Emotionally distant and cold towards spouse, who sees through his self-serving veneer and often views him contemptuously as an opportunistic liar; not obviously distant, but usually mentally preoccupied when with his children (cell-phone dad).
Often married to a strong woman who keeps him grounded early in the relationship; later resentment develops as he feels spouse try to control him.
Surrounds self with sycophants; if he has affairs, they're usually with emotionally dependent, needy women who make him feel like a hero (although the women may turn out to have ulterior motives).
Does not feel he is doing anything wrong if he is not consciously doing anything to hurt anyone.
Longstanding pattern, usually dating back to college, of driven, controlled and controlling behavior, periodically interrupted by impulsive and reckless behavior.
Long history of seeking out exciting and risky situations that provide an adrenaline rush.
Grandiosity, usually manifested as reckless behavior with a disregard for consequences and even surprise when negative ones occur.
Depression usually expressed as moodiness, impatience, annoyance, irritability and emotional withdrawal.
Dabbles with cocaine or speed (rarely reaching the need for rehab), which helps him to feel powerful and effective; causes him to be confused with people who have Attention Deficit Disorder. If you've observed six or more of the above traits over a period of many years, there is a high likelihood of OCB.