Obsessive compulsive disorder (OCD) is both familiar and common. This week in the office, I came across a manifestation that I think warrants reporting. I call it the Spam Sign.
Warren has been my patient for nearly a decade. He comes in for his annual preventive visit and for occasional acute visits, mostly related to injuries incurred at the gym in pursuit of body-building perfection. He is single, generally healthy, on no regular prescription medications (though he takes a long list of supplements), a non-smoker, and employed as a sales representative for a local manufacturing firm. More accurately, until recently he was employed.
I saw him this week for ‘trouble sleeping.’ He had lost his job several weeks ago and was having more and more trouble falling asleep. Once asleep, he was fine until morning, but it was now taking him 4-5 hours to get to sleep, despite four hours of exercise daily at the gym, melatonin and a bedtime antihistamine. He clearly dated the onset of his symptoms to the date he became unemployed. In response to my questions, he said he was almost out of his savings and was quite worried about finances, but was not actually looking for a job because he was too busy. Too busy with what, I asked. Checking his spam.
Checking your spam, I asked. For what?
I’m afraid I might miss my golden opportunity, he said. Somewhere in the flood of electronic junk we all encounter, he was convinced was the perfect offer, tailored just for him, and he was desperately afraid he might overlook it. He read every spam message he received, tagging it as read. Then he read it a second and third time before discarding it. He had turned off all the spam filtering available through his ISP to make sure every piece of his spam got through. (I tried this for one day, and was appalled. I didn’t find any golden opportunities, but missed an important message in the deluge. Try it. You will gain a new appreciation for your ISP.) It turned out that his productivity at work had been steadily declining because of the time he spent doing this, and he was ultimately fired when he started trying to access his co-workers’ emails to read their spam. His problem sleeping was a result of anxiety that the crucial, once-in-a-lifetime message he needed to find would be sent to him at his former work email address and he would miss his chance
In his honor, I have termed this delusional and maladpative optimism the Spam Sign: an obsession with the possible existence of something worthwhile, camouflaged and buried in spam, resulting in multiple dysfunctional compulsive behaviors to avoid missing the elusive and often imaginary grain of wheat in the mountain of chaff. To be diagnostic of OCD, it should have persisted at least six months and have impaired at least one sphere of activity (relationships, work, recreation, activities of daily living).