Obsessive Secrets

One in 40 adults secretly suffers from obsessive- compulsive disorder, a mental illness that can affect job performance, yet few employers know of its potential impact on the workplace.

Friday, May 16, 2008
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After graduating from college with a bachelor's degree in electrical engineering, Tom (not his real name) landed a job with a large consumer electronics company. He tackled projects that were intimidating to some of his peers, and quickly became one of the organization's most promising stars.

But Tom was worried. For years, negative thoughts had invaded his mind. As hard as he tried, he couldn't get rid of them. Sometimes, he would read the same line in a book over and over, unable to stop. To make matters worse, he also suffered from anxiety and depression, which usually exacerbated his symptoms.

No one at Tom's workplace knew he was in trouble. Tom hid his illness from those around him, believing he would be fired if his secret came out. Even after working with a clinical psychologist on other personal issues, he says, these problems still remained. His only saving grace was they weren't consistent -- they would come and go.

As Tom started to climb the corporate ladder, he grew increasingly certain that his problems would eventually surface. "The higher up you go, [the more] you have to be 100 percent all the time," says Tom, now 60 years old and semi-retired. "I knew it might be disastrous with the pressures."

To avoid being exposed, Tom listened to his entrepreneurial spirit. He quit his job at 27 to start his own retail business. By doing so, he says, he was able to "coast" through rough times. When he was in his late 40s, Tom learned from a psychologist what his illness was called.

He suffered from obsessive-compulsive disorder, a mental illness that affects people in different ways. Many like Tom think uncomfortable, scary, violent or negative thoughts, but seldom act on them.

Others engage in compulsive behaviors such as excessive bathing, hand washing or cleaning, hoarding useless objects or repeatedly counting or arranging things. For most, it leads to hour after hour of uncontrollable, repetitive or compulsive behavior, limiting their ability to function normally at home or in the workplace.

People suffering from OCD can, however, be successful in their jobs with help from medication, psychotherapy and simple employer accommodations. To find out how companies are helping them stay employed and productive, more than a dozen large employers were contacted to contribute to this story.

Likewise, an e-mail blast was sent to approximately 2,500 members of a listserve that supports people with OCD, inviting them to share their work experiences. Only two employees agreed to be interviewed, which highlights an overriding concern: Employees with OCD rarely come forward, fearing they'll lose their jobs. But considering the high cost of employee turnover and low productivity when hidden problems such as these are not addressed, employers become potential losers as well if they fail to recognize the problem and offer effective accommodations.

Under the Radar

OCD ranks as the fourth most common psychiatric illness in the United States, affecting one in 40 adults and one in 200 children, according to the Obsessive Compulsive Foundation. It strikes men and women in equal numbers, usually in their childhood, adolescence or early adulthood.

Considering the high number of Americans with OCD, every large U.S.-based company probably employs at least several people with the disorder, according to the OCF. Typically, many only reveal they have the illness if they're placed on probation, suspended, counseled or terminated. But by then, enough damage has been done that employees aren't very receptive to an employer's help.

While HR is not expected to play psychiatrist, employees with OCD often leave obvious clues, says Dr. Terry Eagan, a psychiatrist and medical director at Moonview Sanctuary, a holistic treatment center in Santa Monica, Calif., for people with OCD and other psychological disorders.

Although the disorder manifests itself in different ways and experts caution employers not to jump to conclusions about an OCD diagnosis, Eagan points to some behaviors that could trigger OCD concerns:

* Time management -- Employees come chronically late to work, take too long to complete projects or individual tasks, or work several hours more each day than others in their department who perform the same or similar tasks.

* Resistance to change -- Workers have serious difficulty adapting to changes in the workplace that may involve work schedules, assignments or department policies or procedures.

* Constant state of anxiety -- Employees repeatedly engage in nervous behaviors such as nail biting or foot tapping. Some may be excessively preoccupied with orderliness and will repeatedly rearrange items on their desk or in their office.

* Contamination fears -- Employees are abnormally concerned about cleanliness. They may spend a lot of time scrubbing their desk or resist shaking people's hands. Some repeatedly wash their hands to the point where they are dry, cracked and bleeding.

Eagan says supervisors who observe employees engaging in any of these behaviors should initiate conversations with them. Typically, he says, people with OCD are highly sensitive to criticism, so managers should start the talk by offering positive feedback about their job performance or contribution to the organization.

This approach may prevent them from feeling negative emotions ranging from shame and guilt to anger, depression or embarrassment.

Then, supervisors should ask a series of questions. How can we help you become more effective in your job? Is there anything preventing you from performing your job? Is this job too stressful for you? If so, how can we reduce the stress?

"The boss needs to take ownership [of the situation]," Eagan says, adding that when asked these questions, 60 percent to 70 percent of employees with OCD will disclose their disorder. "The other 30 percent to 40 percent [won't admit to it and will later be] fired or quit. They're too afraid of being found out or can't handle the strain [of the job]."

Sabrina (not her real name), who works for a large home mortgage company, was one of those who chose to disclose. Her OCD was centered on contamination issues: She was fearful of getting physically close to people and touching objects.

For example, she avoided shaking people's hands and would use her name badge instead of her finger to press the elevator button. After 10 months on the job, the mental strain became overwhelming. She told her boss about her disorder and offered to resign.

To her surprise, her boss was very sympathetic. She suggested that Sabrina apply for medical leave. She could receive 65 percent of her pay for 26 weeks. Sabrina ended up taking 16 weeks off of work, effectively using the time to receive therapy and drug treatment.

"When I left, I never thought I would be able to come back to the same workplace because it was too contaminated," says Sabrina, 37.

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That occurred in 2006. Although she still struggles daily with the disorder, Sabrina has worked full time for more than a year in the same position. During a recent performance review, she says, her supervisor commended her for doing a great job.

"Having a job to come back to forced me to come back [to work]," Sabrina says. "I do have a great sense of loyalty and am very grateful to my immediate boss and employer. I really want to do well because they put their trust in me."

Helping Hand

From a legal standpoint, employees who suffer from OCD need to be treated like any other workers. Supervisors must focus on their job performance or behavioral issues that may surface, says Myra Creighton, an Atlanta attorney at Fisher & Phillips who specializes in the Americans with Disabilities Act and mental disabilities in the workplace.

HR must also avoid making assumptions about underlying medical conditions. "Don't try to diagnose," she adds. However, if employees do come forward, revealing they've been diagnosed with OCD, it doesn't always mean they're legally disabled or protected under the ADA, she says.

Creighton tells of a manager with OCD who came late to work every day, violating his company's tardiness policy. Although his employer knew he had OCD, he was ultimately terminated because being on time was an essential function of his job.

"Employers are under no obligation to eliminate a central function of someone's job," Creighton says. However, if employers can make a reasonable accommodation that helps the employee perform those functions, then they're legally obligated to make that accommodation.

But what's reasonable for one employer may not be for another. What's more, if a company provides an accommodation that works, the employee with OCD has no right to demand a different accommodation, says Edward Matisik, a Washington-based attorney and author of The Americans with Disabilities Act and the Rehabilitation Act of 1973: Reasonable Accommodation for Employees with OCD.

While ADA's goal is to protect the rights of people with disabilities in the workplace, he says, it doesn't allow employers to use workers' disabilities as excuses for poor performance, especially if the employees lack the required skills and experience to do their jobs.

Despite the challenges that OCD presents, companies have found some simple, inexpensive ways to accommodate employees with the illness. Matisik offers these examples:

* A file clerk, who had trouble concentrating, would lose focus when interrupted by co-workers. She rarely completed her filing on time. So her supervisor set aside one hour each day for her filing and told co-workers not to disturb her.

* An employee became a nervous wreck over what would happen at upcoming meetings, believing he would be fired. His job performance would greatly deteriorate several days before each meeting. So his boss gave him an agenda for every meeting that was strictly followed.

* A head nurse came too late to work every day to receive instructions from the head nurse of the previous shift. So the hospital transferred her to its walk-in clinic. Her hours were flexible and her salary and seniority stayed the same.

When comparing the costs between making simple accommodations and recruiting and training new staff, it doesn't take long to do the math; the former is better, says Matisik.

"The key to working with people with OCD is making them understand you're not looking to fire them," he says. "Let them know you want to come up with something to make the situation better for both of you."

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