Obsessive-compulsive personality disorder

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Obsessive-Compulsive Personality Disorder (OCPD) is a personality disorder which involves an obsession with perfection, rules, and organization. A person with OCPD may feel anxious when they perceive that things are not "right." This can lead to routines and "rules" for ways of doing things, whether for themselves or their families.


[edit] Comparision to OCD

Obsessive-Compulsive Personality Disorder is often confused with obsessive-compulsive disorder (OCD). Despite the similar names, they are two distinct disorders, although some OCPD individuals also suffer from OCD, and the two are sometimes found in the same family,[1] sometimes along with eating disorders.[2] People experiencing OCPD do not generally feel the need to repeatedly perform ritualistic actions - a common symptom of OCD.

[edit] Symptoms

There are five primary areas that cause anxiety for OCPD individuals: time, personal and social relationships, cleanliness, tidiness, and money. Time becomes a problem when they dwell for so long on getting something "right" that they stand the chance of not finishing in time. Personal and social relationships are often under serious strain because the OCPD individual insists on being in charge and the only one who knows what is "right". Uncleanliness is, in the eyes of some OCPD individuals, a form of lack of perfection, as is untidiness. They may spend considerable time each day putting everything in precisely the right place in precisely the right manner. Money is of concern because many OCPD sufferers are anxious about the potential for things to go wrong in their lives. They may hoard[3] items for a 'rainy day'. Money, for the same reason, may be hoarded so that as little as possible is spent on daily living. This may look like miserliness or stinginess to other people.

There are few moral 'grey' areas for a person with fully developed OCPD; actions and beliefs are either completely right, or absolutely wrong with the OCPD individual always 'in the right'. As might be expected, interpersonal relationships are difficult because of the excessive demands placed on friends, romantic partners and children. Sometimes frustration with other people not doing what the OCPD individual wants spills over into anger and even violence. This is known as disinhibition.[4] Persons with OCPD often have a negative outlook on life (pessimism) with a low underlying form of depression.[5][6][7] This can at times become so serious that suicide is a real risk.[8] Indeed, one study suggests that personality disorders are a significant substrate to psychiatric morbidity. They cause more problems in functioning than does a major depressive episode.[9]

People with OCPD, when anxious or excited, may twitch or grimace, or make odd noises, as in a mild form of Tourette Syndrome or do impulsive[10] and unpredictable things, including risk taking. They may keep their home perfectly organized, or be anxious about delegating tasks for fear that they won't be completed correctly. They may even insist on taking over a task someone else is doing so that it will be done properly. About one in four OCPD individuals may display rigid and stubborn characteristics, a defining criterion.

[edit] Classification

[edit] DSM IV-TR Criteria

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, defines OCPD as follows. However, the usefulness of all but three of the criteria has been challenged in a research study[11]. Perfectionism, rigidity and stubbornness, and miserliness were the three criteria most likely to predict the presence of OCPD. (A study in 2007[12] found that OCPD is etiologically distinct from Avoidant and Dependent Personality Disorders, suggesting it is incorrectly categorized as a Cluster C Disorder.)

"A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  • Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
  • Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
  • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
  • Is unable to discard worn-out or worthless objects even when they have no sentimental value
  • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
  • Shows rigidity and stubbornness

It is important to note that while a person may exhibit any or all of the characteristics of a personality disorder, it is not diagnosed as a disorder unless the person has trouble leading a normal life due to these issues. The difficulty arises when the OCPD individual, who by definition is likely to be stubborn, refuses to admit anything is wrong with him or her. Added to this, OCPD is often only fully on display in the home context.

[edit] History

In 1908, Sigmund Freud named what is now known as obsessive-compulsive or anankastic personality disorder anal-retentive character. He identified the main strands of the personality type as a preoccupation with orderliness, parsimony (meanness), and obstinacy (rigidity and stubbornness). The concept fitted his theory of psychosexual development.

Since the early 1990s, considerable new research has emerged into OCPD and its characteristics, including into the tendency for it to run in families along with eating disorders[13] and even to appear in childhood.[14] The American Psychiatric Association's Diagnostic and Statistical Manual (DSM) has helped to gather together and publicize the research findings of experts from all over the world.

[edit] Possible causes

Research into the familial tendency of OCPD may be illuminated by DNA studies. Two studies suggest that people with a particular form of the DRD3 gene are highly likely to develop OCPD and depression, particularly if they are male.[15][16]

[edit] Treatment

Treatment for OCPD normally involves psychotherapy and self-help. Medication in isolation is generally not indicated for this personality disorder, but fluoxetine has been prescribed with success. Anti-anxiety medication may reduce feelings of fear while SSRIs can ease frustration, reducing stubbornness and negative rumination. A mild tranquilizer can reduce alcohol dependence, if present. ADD medication can improve task completion by improving mental focus, which will provide visible success and improve outlook for recovery. Caffeine sensitivity may be an exacerbating factor.

[edit] Psychotherapy

[edit] Self-help

Since most of the cognitive processes that drive an OCPD individual's behaviour may not be openly expressed or discussed with other people, self-help is almost the only way to conquer the disadvantages of this disorder. Self-help is an integral component of Cognitive Analytic Therapy, a form of Behavior Therapy. Those who wish to check whether they may have OCPD can use a self-administered questionnaire designed by Leonard Cammer (see book list).

Recommended self-help techniques might include the following:

  • Educating family and friends about the condition will help them to manage behavioral problems more sympathetically, and to watch out for the warning signs.
  • Support groups may also be helpful in accepting and changing obsessive-compulsive behaviors.
  • Relaxation, meditation, exercise, regular sleep, and a balanced diet are all important factors in maintaining this focus.
  • Keeping a diary may help the individual to identify those stressful situations that help to trigger compulsive reactions, enabling them to focus on more constructive activities.
  • Releasing of hoarded items, simultaneously reducing the shame associated with hoarding. Having an assistant to cull hoarded, collected, and stored items will facilitate the process.

[edit] See also

[edit] Further reading

  • Alarcon, Renato D et al. (1980). Personality Disorders and Culture. New York: John Wiley and Sons, 1998.
  • Baer, Lee. (1998). "Personality Disorders in Obsessive-Compulsive Disorder." In Obsessive-Compulsive Disorders: Practical Management. Third edition. Jenike, Michael et al. (eds.). St. Louis: Mosby.
  • Beck, Aaron T. and Freeman, Arthur M. and Associates. (1990). Cognitive Therapy of Personality Disorders. New York: Guilford Press.
  • Benford, Timothy B & Johnson, James P. (1991). Righteous Carnage. The List Murders. New York: Charles Scribner's Sons. ISBN: 9780971056046. Now available as an e-book (see links below).
  • Cammer, Leonard, MD. (1983). Freedom From Compulsion. How To Liberate Yourself From Uptight, Obsessive Patterns of Living That Rob You of Peace of Mind. New York: Simon & Schuster. ISBN-13: 9780671501884
  • Daniel, Gwyneth, PhD. (2008). Tightrope Walking. Everything You Need To Know About OCPD and Perfectionism. Christchurch: Willows Books Publishing. ISBN 978-1-901375-11-4. Out of print. Available online through Google Books.
  • Freud, S. (1959, original work published 1908).Character and Anal Eroticism, in The Standard Edition of the Complete Psychological Works of Sigmund Freud, 9, 170-171. James Strachey, ed. London: Hogarth. ISBN-13: 9780701200671 ISBN: 0701200677
  • Jenike, Michael. (1998). "Psychotherapy of Obsessive-Compulsive Personality." In Obsessive-Compulsive Disorders: Practical Management. Third edition. Jenike, Michael et al. (eds.). St. Louis: Mosby.
  • Kay, Jerald et al. (2000). "Obsessive-Compulsive Disorder." In Psychiatry: Behavioral Science and Clinical Essentials. Jenike, Michael et al. Philadelphia: W. B. Saunders.
  • Mallinger, Allan E & Dewyze, Jeannette (1992). Too Perfect: When Being in Control Gets Out of Control. New York: Clarkson Potter. ISBN-13: 9780449908006 ISBN: 0449908003
  • MacFarlane, Malcolm M. (ed.) (2004). Family Treatment of Personality Disorders. Advances in Clinical Practice. Binghamton, NY: The Haworth Press.
  • Ryle, A. & Kerr, I. B. (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & Sons. ISBN: 9780470853047.
  • Salzman, Leon. (1995).Treatment of Obsessive and Compulsive Behaviors, Jason Aronson Publishers. ISBN 1-56821-422-7
  • Shapiro, David. (1984). Autonomy and Rigid Character, Basic Books. ISBN 0-465-00568-3
  • Shapiro, David. (1965). Neurotic Styles, Basic Books, 1965. ISBN 0-465-09502-X
  • Penzel, Fred. (2000). Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well. Oxford University Press, USA. MPN 0195140923
  • World Health Organization (WHO). (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO.

[edit] References

  1. ^ Samuels J et al. (2000). Personality disorders and normal personality dimensions in obsessive-compulsive disorder. Br J Psychiatry. Nov. 177: 457-462.
  2. ^ Mancebo MC et al. (2005). The relation among perfectionism, obsessive-compulsive personality disorder and obsessive-compulsive disorder in individuals with eating disorders. Int J Eat Disord. Dec; 38(4).
  3. ^ Jefferys D, Moore KA. (2008). Pathological hoarding. Aust Fam Physician. Apr; 37(4): 237-241.
  4. ^ Villemarette-Pittman NR et al. (2004). Obsessive-compulsive personality disorder and behavioral disinhibition. Psychol. Jan: 138(1):5-22.
  5. ^ Pilkonis PA, Frank E. (1988). Personality pathology in recurrent depression: nature, prevalence, and relationship to treatment response. Am J Psychiatry. 145: 435-441
  6. ^ Rossi A et al. (2000). Pattern of comorbidity among anxious and odd personality disorders: the case of obsessive-compulsive personality disorder. CNS Spectr. Sep; 5(9): 23-6.
  7. ^ Shea MT et al. (1992). Comorbidity of personality disorders and depression; implications for treatment. J Consult Clin Psychol. 60: 857-868.
  8. ^ Raja M, Azzoni A. (2007). The impact of obsessive-compulsive personality disorder on the suicidal risk of patients with mood disorders. Psychopathology. 40(3): 184-190
  9. ^ Skodol AE et al. (2002). Functional Impairment in Patients With Schizotypal, Borderline, Avoidant, or Obsessive-Compulsive Personality Disorder. Am J Psychiatry 159:276-283. February.
  10. ^ Stein DJ et al. (1996). Impulsivity and serotonergic function in compulsive personality disorder. J Neuropsychiatry Clin Neurosci. 8: 393-398.
  11. ^ Grilo CM. (2004). Diagnostic efficiency of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder. Behaviour Research and Therapy 42(1) January,57-65.
  12. ^ Reichborn-Kjennerud T et al. (2007). Genetic and environmental influences on dimensional representations of DSM-IV cluster C personality disorders: a population-based multivariate twin study. Psychol Med. May; 37(5): 645-653
  13. ^ Lilenfeld et al. (1998). A Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa. Arch Gen Psychiatry. 55:603-610.
  14. ^ Anderluh MB et al. (2003) Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. Am J Psychiatry. Feb. 160: 242-247.
  15. ^ Joyce et al. (2003). Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders. Psychiatry Research. 119(2):1-10.
  16. ^ Light et al. (2006). Preliminary evidence for an association between a dopamine D3 receptor gene variant and obsessive-compulsive personality disorder in patients with major depression.
  17. ^ Protogerou et al. (2008). Evaluation of Cognitive-Analytic Therapy (CAT) outcome in patients with Obsessive-Compulsive Personality Disorder Annals of General Psychiatry 2008, 7(Suppl 1):S109
  18. ^ Ryle, A. & Kerr, I. B. (2002) Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & Sons.

[edit] External links

  • [1] BBC website, online questionnaire from The Multidimensional Perfectionism Scale scale for self-evaluation of tendencies to perfectionism.
  • [2] Web page showing DSM IV-TR year 2000 criteria for OCPD.
  • [3] Obsessive-compulsive personality disorder: A Defect of Philosophy, not Anxiety Article about the characteristics of OCPD by Steven Phillipson
  • [4] Obsessive-compulsive personality disorder. Article on MedlinePlus.gov's Medical Encyclopedia
  • [5]. Webpage on Psychodynamic Development, early years, includes a section on "Anal-retentive and Anal-expulsive personalities".
  • [6] E-book: Righteous Carnage: The List Murders.
  • [7] A comprehensive treatment of OCPD from a website on mind disorders.
  • [8] A webpage on 'anankasia', a 'Surfeit of Truth'.
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