Summary
A husband describes his wife’s near-constant counting, accompanied by headaches and depressed mood. He asks what might explain behavior that is increasingly affecting her daily life.
The response raises anxiety, Obsessive-compulsive disorder (OCD), and neurological causes as possibilities but states that an interview, history, and examination are needed.
It recommends medical or psychiatric evaluation, particularly because of the headaches, and describes therapy and medication as options if OCD is subsequently diagnosed.
Question
Reader · Identity withheldMy wife is constantly counting, all day, every day.
She looks at me and counts the features on my face, she counts every letter she sees in every word, whether she is reading, watching TV, or driving, she is always counting. No matter what she is doing she is counting. I can see that it is starting to affect her daily life. She is getting bad headaches and feeling depressed.
Why is this happening? Any help would be greatly appreciated.
Thank you.
Answer
Mark Vigil Dombeck, Ph.D.This counting behavior may be nothing to speak of (clinical-wise), or possibly it could be an outward manifestation of an anxiety disorder, such as Obsessive-Compulsive Disorder (OCD), or possibly a neurological problem. There is no way to tell without a face to face interview, detailed history and a physical/neurological exam. OCD is characterized by obsessions which are repetative thoughts and worries, repetitively themed in nature, and typically concerned with what seem like dangerous situations to the person having them.
Examples of common obsessions are "did I leave the door unlocked?", "am I contaminated with germs?", "are my hands dirty?", etc. Counting things is a common behavioral theme, a sort of compulsion for some with OCD. A compulsion is a behavior that is acted out in an attempt to quiet down the obessive thoughts. As such, it is typically an anxiety reducing behavior and that is why it is repeated so frequently. I’m not sure what obsession a counting compulsion might be compensating for – it may not be linked to a particular thought – but the general pattern is that by acting out the behavior, people feel safer/better.
Given that there are compulsive behaviors present, and, particularly because there are headaches present, it would be wise to recommend to your wife that she be examined by a psychiatrist (or at least a regular medical doctor who can screen for organic brain/neurological damage). Some headaches are signs of larger problems that require treatment, and the impact of benign headaches can be lessened by medical treatment in many cases.
If OCD is diagnosed (by a psychiatrist), there are medications that can help the condition, but you should also know that behavioral and cognitive-behavioral psychotherapy can be of assistance as well.
