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July 19, 2011

Are you Taking Enough Risks?

With her health and marriage on the line, a lifelong perfectionist learns to chill out.

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I've always been the anxious type. In kindergarten, I burst into tears when Cookie Monster shook my hand at a parade. I was so wired the week before my wedding, my sister started slipping me Benadryl at night. And when my husband was visiting India and terrorists attacked a city hundreds of miles away, I instantly had a State Department rep on the phone starting a case file. A born-and-bred New Englander, I have not a ray of West Coast sunshine in my genes or outlook.

Even low-stakes events, like throwing a friend's baby shower, send me into a manic tailspin of insomnia-fueled to-do lists. I thrive on the adrenaline, but my high-strung tendencies long ago went from cute to cuckoo in my husband's eyes. After seeing me sweating over a crustless-sandwich shower spreadsheet, he put his foot down: My fretting was out of hand. And something clicked. I realized it would be nice to relax for once. Stress was leaving me tired and edgy — distracted at work, irritable at home. So when I read about a psychological trait, high harm avoidance (HHA), describing people who worry a lot, expect the worst, and are painfully shy, I had to learn more.

I called up Dr. C. Robert Cloninger, whose groundbreaking research on genetics and personality revolutionized the field of psychiatry in the '80s and '90s. In 1993, he created the Temperament and Character Inventory (TCI), a landmark test used to diagnose mental illness. But I was most intrigued by his founding roles at the Center for Well-Being at Washington University in St. Louis and the Anthropedia Foundation, a nonprofit whose motto includes the phrase "the science of happiness." If Cloninger couldn't get me to chill out, who could?

On the phone, Cloninger spoke in the gentle tones of a therapist. Harm avoidance, he clarified, measures a person's anxiety-proneness. Anxiety is good in small doses — it played a key role in human evolution — but when people are too anxious, it can result in a host of problems. "Anxiety is the most common feature of psychopathology," Cloninger said; stress blocks positive emotions and negatively impacts the hormonal and immune systems. More than half of all people with above-average harm-avoidance scores will have a diagnosable mental disorder, and the list of diseases linked to HHA includes OCD, eating disorders, bipolar disorder, schizophrenia, and depression, plus a slew of others. We hung up, and I pored over reams of research confirming his claims. I knew I was high-strung ... now, was I actually on my way to a serious mental illness?

I had a psychiatrist friend e-mail me the TCI, a series of statements I had to grade according to how strongly I agreed with them. Having read up beforehand, I tried to guess what the questions tested (the TCI also gauges novelty seeking, persistence, and reward dependence). Number 64, "I stay relaxed and carefree when everyone else is fearful," seemed to measure harm avoidance. False. Next up: "I prefer to do something risky rather than stay inactive." Nope. But I disagreed with the prompt, "Things often go wrong unless I'm careful." I do plan obsessively, but in the end, I reflected, things usually work out. I faxed back the test.

When my results arrived by e-mail, I was shocked. I scored in the 25th percentile on harm avoidance — "low," according to the analysis, which said I was "relaxed and outgoing." Further parsing revealed that harm avoidance has four subcategories: anticipatory worry, fear of uncertainty, shyness, and fatigability. I scored high in fear of uncertainty and shyness, but very low in anticipatory worry and fatigability. So, I met two of the criteria for HHA?

"You are harm avoidant, but only sometimes — with strangers, and in situations you don't control," Cloninger said when I enlisted his help. "You compensate with high energy levels. Since you don't tolerate uncertainty, you control, plan, and avoid risk that way. You probably engage in a lot of type A behaviors." I felt like he'd peered down the phone line and seen into my soul.

Scanning further, my eye went to the highest number on the page — I was in the 97th percentile for persistence, scoring out of the ballpark on every subcategory: perfectionism, ambitiousness, eagerness, and determination. Could that explain my sleeplessness, the constant jittery energy of a project never quite done?

"Perfectionism is interesting," Cloninger said. "It leads to insecurity, anxiety, and shame. It's useful to work hard, but you have to be flexible. Perfectionists can be overly committed to a certain outcome when it's time to reassess." Guilty as charged. Cloninger went on to explain that persistence and harm avoidance actually operate on separate but overlapping brain circuits. In the anxiety-prone, the amygdala — part of the primitive brain that alerts us to danger — goes into overdrive and shuts off rational thought. In perfectionists, the brain's reward center interprets neutral stimuli like a positive outcome — a promise they'll win next time. Both responses sounded slightly insane. Overwhelmed, I wasn't sure where any of that left a half-harm-avoidant perfectionist planner like me.

Cloninger's advice? Put Google Calendar, my sole ally against the demands of my overscheduled life, on hiatus. "Planning has become a ritual with an obsessive aspect," he said. So on my husband's and my next joint activity, we'd do it his way. He is a last-minute kind of guy, which normally drives me crazy. But now I vowed that if he was comfortable with our preparedness level ahead of an event, I'd go with it.

A few weeks later, a milestone birthday for my husband would fall on a long weekend. I itched to dive in and research the perfect bed and breakfast for a short trip, but he wanted to wing it. So we compromised: I made a dinner reservation at a restaurant I'd been dying to try, and he would find a hotel. The week of the trip, he hadn't booked anything, and I fought the urge to surf TripAdvisor. Then, the day before we left, he found a rustic inn where, thanks to a last-minute cancellation, we got upgraded to a suite. The weekend was wonderful, and it made me realize: Maybe letting him do the work — and the worrying — wasn't so bad, after all.


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