OBSESSIVE POSTING DISORDER

This is a serious mental health problem that has recently been identified and studied by mental health professionals and other interested parties. This leaflet is intended to give you a basic grounding in understanding the condition in order that you can identify it in your family and friends and thereby empower yourself to offer them support. As always with any serious medical problem it is best to consult a doctor in order to get the best medical advice.

What is obsessive posting Disorder (OPD)?

Obsessive Posting Disorder is very common, although it is only recently that the extent of its occurrence has been recognised and individuals successfully diagnosed. OPD is a condition that effects many middle class professionals, but it has been recognised amongst all social classes and groups. Young and middle aged persons are particularly affected. It seems to be particularly prevalent amongst activists and other persons who have passionate belief systems. The major characteristic of OPD is an excessive desire to communicate your thoughts, feelings and acts to relative strangers despite major contra–indications to the appropriateness of such communications. However there is still great controversy about what OPD is, what causes it, and how it can be treated.

What are the signs of OPD?

Every person with OPD is unique, however it is useful to know what common symptoms to look for which may indicate the presence of OPD.

A.                Characteristic symptoms: Three or more of the following, each present for a significant portion of time during a one month period.

1 Bizarre communication: Such as with people they have no known relationship with, about issues of an idiosyncratic or personal nature which would not normally be suitable for public disclosure. Communication will be incessant and obsessive, and the sufferer will engage in it throughout the day and night.

2 Inappropriate communication: Insisting on carrying on communicating despite clear evidence of disinterest by the recipients of such information. In particular the fundamental ground of human discourse, the acknowledgement of the other is frequently lacking. This often manifests itself in lack of common courtesy and impaired understanding of the other communications.

3 Disordered cognition and Intellectual rigidity:  Suffers often display bizarre thought patterns.  This can manifest in rigidly held beliefs (which are held to be facts). Holding on to the validity of such ideas when presented with clear evidence to the contrary, from the real world.

4 Delusions of grandeur: Suffers sometimes see themselves as important, gifted and perceptive.  Sufferers believe that their facebook ’friends’ are people they have a close personal relationship with, despite never having met. A frequent delusion is that suffers deserve to be trusted and believed by others, prior to expressing any insight which would make such trust appropriate. This can frequently lead to pointless arguments and having your account deleted.

5 Grossly disorganised behaviour: As the desire to communicate comes to dominate the sufferers’ everyday duties, patterns of behaviour and structure come to suffer.

6 Formal sleep disorder: The sufferer may lose sleep staying up late or rising early in order to keep up with the latest post.

7 Dependency: An excessive need to be confirmed in their sense of self regard by the other.

8 Negative transference and projection: A common feature is that the sufferer is unable to distinguish their own beliefs from those of the people they are attempting to relate to. This is assumed to be the reason why they sometimes ‘act out’ this confusion by behaving in ways which provoke anger in other people and then punitively label this anger as a sign of pathology in that other.

                    B.                 Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset.
                   C.                Duration: continuous signs of the disturbance for at least six months. This six-month period must include at least one month of symptoms that meet criterion A.
                   D.                Mood disorder exclusion: A differential diagnosis has ruled out mood disorder because no depressive or manic or mixed episodes have occurred with active phase symptoms or their duration has been brief.
                   E.                 Substance/general medical condition exclusion:  The disturbance is not due to the direct physiological effects of a substance or a general medical condition.
                   F.                 Relationship or a pervasive development disorder: If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of obsessive posting disorder is made only if prominent delusions of grandeur or grossly disorganised behaviour are also present for a least a month.

What causes OPD?

This is a question which is causing debate, especially amongst mental health service users and survivors who were the first to notice this condition. They as usual struggled to be heard amidst the usual stigma and discrimination they suffer, but lately mental health professionals have listened and are now taking the condition seriously. Undoubtedly much of its symptomatology becomes deeply ingrained in sufferers’ behaviour patterns as a result of negative socialisation.  Sufferers tend to isolate themselves from regular human relations thus leading to an increased tendency to show signs of the disorder.

Others however believe that these environmental factors merely mask a severe underlying disorder which is almost certainly genetically determined (although the precise mechanism of this organic fault has not yet been fully determined). Most researchers today would work from a stress/vulnerability model recognising environmental triggers but concentrating on how to treat the underlying disorder.

Notable sufferers.

Today it’s most prominent manifestation is thru internet forums but this should not confuse us, this is just the post-modern manifestation of the disorder. In previous era it has, and to some extent still does take the form of serial letter writing, graffiti, pamphleteering and postering to name just some.

It has been noted that many venerable persons from history have shown signs of the disorder and are believed to have been sufferers.  This should be a great solace to sufferers, as, if medical science can identify protective factors there is no need to think that sufferers cannot go on to live productive lives.

Some noted sufferers where Henry James, the novelist, Ronald Reagan, former US president, Jane Austen, Napoleon Bonaparte, Jackie Kennedy Onassis, JFKs wife and Albert Einstein the noted physicist. All these manifested the disorder thru writing large amounts of correspondence. Jean Michel Basquiat, the artist is also thought to have been a sufferer manifesting thru graffiti, he was famous in the 1980’s for his ‘graffiti art’.

It is not known as yet if Ronald Reagans OPD influenced his politics but it alerts us to the fact that some sufferers may rise to positions of public prominence or power. This should alert us to the need for a vigorous public information campaign in order that the public are fully informed.

How can OPD be treated?

There are several barriers to treatment identified.

  • Most suffers do not, or are unable to recognise that they have a problem. This lack of insight is a major stumbling block to treatment.
  • Much of the sufferer’s disturbed behaviour is positively reinforced by the surroundings they develop for themselves. They tend eventually to come to restrict their relations to other suffers.
  • The main harm caused by OPD is not experienced by the actual sufferer but by those around them. This limits the motivation to change.

In spite of the above, treatment is being tried. At present the core of therapy is seeking to find the right balance between support and challenge to try to bring the above problems to the sufferer’s consciousness.

Results to date are mixed. There have been some successes; however, the people administering the therapy (largely other posters) are becoming frustrated at the painfully slow rate of progress achieved thru this approach.

Unfortunately the prevalence of the disorder is also reinforcing it. As more and more individuals develop the full blown disorder and don’t answer their phones or socialise in regular ways others become vulnerable. This isolation leads them to depend on communication thru irregular means thus making them vulnerable to develop positive symptomology.

Ultimately it may be that OPD only responds to a limited degree on individual therapy and that an approach based on structural change will need to be tried. It may be tempting to just ask them out for a pint but while this may distract them for a while, because of the widespread use of smartphones it won’t dissuade them, and in fact the disinhibitory effects of alcohol may provoke a crisis of all night posting.

Classification:

Although only recently identified it is in testament to the vigorous intellect discourse within the psychiatric community that dispute has arisen about how to classify OPD. Most psychiatrists would readily place the disorder within the anxiety spectrum. However a growing number of mental health professionals think that not enough alarm is being raised about this serious condition. They feel that it is most likely one manifestation of psychosis, most likely bi-polar depression. They point to the decline in social functioning, the loss of sleep and sleep hygiene, as well as the notable irritability of sufferers. The presence of delusions in many cases also indicates psychosis as a more appropriate diagnostic category. In addition a number of practising psychiatrists argue it should be included amongst the personality disorders. They point to the poor prognosis and the poor results from current treatment modalities. And recently it has been postulated recently that excessive internet use may in fact be an addiction.

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This at first glance may look like a pretty reasonable depiction for public education about a ‘mental illness’ which may concern people. However it has been entirely concocted (by me informed by some of the sources below). This may seem a rather trite if somewhat ironic take upon the literature ‘advertising’ and ‘marketing’ ‘mental health’ awareness. However it may actually be handy to distinguish the literary rhetoric for an understanding of more ‘real’ experiences. That this claims to educate us about an imagined ‘mental disorder’ should alert us of the need to be more circumspect when informing ourselves about the troubles which afflict a loved one. They no doubt are enormously distressed which is distressing to us and this document (constructed to ‘amuse’ the service users who have learnt not to take their diagnosis so seriously but rather to concentrate upon their lives) can be taken as a call not to take our labels so seriously, either in identifying with them (it can seem very helpful to have a name to understand our problems) or in totally rejecting the label as totally pointless or meaningless. It might be viewed as yet another ‘metaphorical illness’ to be treated with ‘metaphorical medicine’s by ‘metaphorical therapists’?

Bibliography, sources and resources.

American Psychiatric Association;  Diagnostic and Statistical Manual of Mental Disorders      DSM-III (1980); DSM-III-R (1987); DSM-IV (1994); DSM-IV-TR (2000)

Bentall, Richard; Doctoring the mind

Boyle, Mary; Schizophrenia: A scientific delusion

Kutchins, Herb and Kirk, Stuart A.; Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders

Lowson, Dave; Professional thought disorder

On being sane in insane places

Rowe, Dorothy; Beyond Fear

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