After a Sexual Encounter at Work, Now I Have Obsessive Compulsive Disorder

Reader’s Question

I really need to go back to my normal life. I am 35 years old, married, and have five kids; I have a master’s degree in MPA, and I am a registered nurse.

This is my story. I was working in a place which sells products that are against my beliefs and religion (items that I should not sell, as my religion requests). I worked there for three and a half years, and in the last months I had a lot of stress due to the religion conflict and due to other work environment problems. I was doing OK at the beginning, but on one black day I was there and a customer whom I know came to the store and after talking for a while, she wanted to perform sexual acts with me. After 1-2 minutes I stopped her. I don’t know why I cheated on my wife in this way — it is against my beliefs, I am married, and my wife and kids are all my life. Then the customer went away, and after that I suffered from acute depression. I solved that by prayers and asking God for forgiveness. One week later I was reading the newspaper and there were an article about AIDS. That’s was the beginning of my disaster. I rushed to my doctor and explained the situation and he said there is nothing I have to worry about, but I tested at least 7 times from over 2 years. All results were negative. I called the AIDS hotline at least 100 times about everything and searched related websites on a daily basis until I stopped. But another problem came, which is Obsessive Compulsive Disorder. I say that because I am a nurse, and a doctor told me that too, but he did not put me on any medication that time three years ago. Now I am still checking the door, do not touch any door knobs, wash my hands 15 times at least, and carry hand sanitizer all the time. I even change my pajamas twice a day and eat a meal at home only after I wash my hands for at least 10 minutes. I am worn out. What is my problem, and what do I have to do now after three years of suffering? Prayers are not enough.

Our Clinical Psychologist’s Reply

Your situation is a good description of how stress can produce obsessive-compulsive symptoms. It’s a process that involves several steps.

First, we experience a high level of stress over many months — in your case, working a job that is contrary to your faith. This prolonged high level of stress gradually lowers the brain’s Serotonin level, a neurotransmitter that is associated with body regulation, sleep, temperature, and mood. While we recognize that we are stressed, we are really very close to a clinical depression and have problems with sleep, appetite, energy, motivation, etc.

Second, a significant event occurs that adds to our stress. The event is typically emotionally traumatic and stressful enough to move us into a clinical depression. The significant event can be unrelated to our original stressful life events. In my clinical practice, examples of these events have included:

• being bitten by a pet pig,
• a blood splash for a nurse,
• a feeling that one has been exposed to a medical danger,
• a panic attack, and
• a social humiliation.

Your sexual experience created a crisis in faith and your marriage. Your guilt was followed by reading the article about AIDS which then produced the obsession about contamination and disease.

Lastly, the added stress further lowered your Serotonin level. Low Serotonin is associated with the presence of obsessive-compulsive symptoms/disorder. You then connected the sexual experience with obsessive thoughts about disease and contamination, producing your current obsessive and compulsive behaviors. Low Serotonin can produce OCD symptoms in individuals with no prior history of OCD but in your case, with a prior history of OCD symptoms, your OCD symptoms were greatly exaggerated by the situation.

Regarding treatment, you may respond well to the use of a Serotonin-increasing antidepressant, many of which are also effective in the treatment of OCD. While your obsessive thoughts and compulsive behaviors involve a topic of medical/disease contamination, the clinical pattern is clearly OCD. You will find additional help by seeking counseling in your community. Your situation is a good example of how a high level of stress and a traumatic event can combine to trigger Depression and Obsessive-Compulsive Disorder.