Despite the traumatic events that Howard Hughes experienced, he does not appear to have developed PTSD. However, without a doubt, he suffered from OCD. Although some of his symptoms apparently began in childhood, his OCD symptoms worsened significantly when he was in his 40s. There are several reasons for his progressively impaired functioning at that time. First, he used increasingly larger and more frequent doses of codeine and Valium, which probably led to diminished cognitive functioning and control over his compulsions. Second, he had by then suffered brain damage, which came about from two sources: (1) the 14 occurrences of head trauma Hughes withstood from various plane and car accidents (Fowler, 1986) and (2) the effects of advanced syphilis (Brown & Broeske, 1996). Hughes contracted syphilis when in his 30s, before antibiotics were available (Brown & Broeske, 1996). To treat the disease, he underwent a painful and risky mercury treatment, but the treatment was not a complete success, and the disease appears to have progressed during his 40s. After Hughes’s death, his autopsy indicated that significant brain cell death had occurred, which is a sign of advanced syphilis (a condition previously called general paresis; see Chapter 1). Symptoms can include gradual personality changes and poor judgment, which may take up to 15 years to emerge.