Obsessive-compulsive personality disorder
Encyclopedia
Obsessive–compulsive personality disorder (OCPD) is a personality disorder
characterized by a pervasive pattern of preoccupation with orderliness, perfectionism
, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.
Most patients spend their early life avoiding symptoms and developing techniques to avoid dealing with these strenuous issues.
, attention effectively to clean the home may be hindered by the amount of clutter that the hoarder resolves later to organize.
While there are superficial similarities between the list-making and obsessive aspects of Asperger's syndrome and OCPD, the former is different from OCPD especially regarding affective
behaviors, including (but not limited to) empathy
, social coping, and general social skills.
Perception of own and others' actions and beliefs tend to be polarised (i.e., "right" or "wrong", with little or no margin between the two) for people with this disorder. As might be expected, such rigidity places strain on interpersonal relationship
s, with frustration sometimes turning into anger and even violence. This is known as disinhibition
. People with OCPD often tend to general pessimism
and/or underlying form(s) of depression
. This can at times become so serious that suicide is a risk. Indeed, one study suggests that personality disorders are a significant substrate to psychiatric morbidity. They may cause more problems in functioning than a major depressive episode.
are highly likely to develop OCPD and depression, particularly if they are male.
Genetic concomitants, however, may lie dormant until triggered by events in the lives of those who are predisposed to OCPD. These events could include trauma faced during childhood, such as physical, emotional or sexual abuse, or other types of psychological trauma.
fourth edition, (DSM IV-TR = 301.4), a widely used manual for diagnosing mental disorders, defines obsessive–compulsive personality disorder (in Axis II Cluster C) as:
Criticism
Since DSM IV-TR was published in 2000, some studies have found fault with its OCPD coverage. A 2004 study challenged the usefulness of all but three of the criteria: perfectionism, rigidity and stubbornness, and miserliness. A study in 2007 found that OCPD is etiologically distinct from avoidant and dependent personality disorders, suggesting it is incorrectly categorized as a Cluster C disorder.
's ICD-10
uses the term .
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
identified five subtypes of compulsive. Any individual compulsive may exhibit some or one of the following:
and self-help
. However, in some cases, there can be an impediment to change in that the patient does not accept that they have OCPD, and/or believes (at least at some level) that their thoughts and/or behaviors are in some sense "correct" and therefore should not be changed. 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 (anti-depressants) can ease frustration, reducing stubbornness and negative rumination
.
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 (frugality), and obstinacy (rigidity
and stubbornness). The concept fits his theory of psychosexual development
.
Since the early 1990s, considerable new research continues to emerge into OCPD and its characteristics, including the tendency for it to run in families along with eating disorders and even to appear in childhood.
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...
characterized by a pervasive pattern of preoccupation with orderliness, perfectionism
Perfectionism (psychology)
Perfectionism, in psychology, is a belief that a state of completeness and flawlessness can and should be attained. In its pathological form, perfectionism is a belief that work or output that is anything less than perfect is unacceptable...
, and mental and interpersonal control at the expense of flexibility, openness, and efficiency.
Signs and symptoms
The primary symptoms of OCPD can include preoccupation with remembering and paying attention to minute details and facts, following rules and regulations, compulsion to make lists and schedules, as well as rigidity/inflexibility of beliefs and/or exhibition of perfectionism that interferes with task-completion. Symptoms may cause extreme distress and interfere with a person's occupational and social functioning. According to the National Institute for Mental Health:- OCPD has some of the same symptoms as obsessive-compulsive disorderObsessive-compulsive disorderObsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...
(OCD). However, people with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct.
Most patients spend their early life avoiding symptoms and developing techniques to avoid dealing with these strenuous issues.
Obsession
Some, but not all, patients with OCPD show an obsessive need for cleanliness. This OCPD trait is not to be confused with domestic efficiency; over-attention to related details may instead make these (and other) activities of daily living difficult to accomplish. Though obsessive behavior is in part a way to control anxiety, tension often remains. In the case of a hoarderCompulsive hoarding
Compulsive hoarding is the acquisition of possessions in excess of socially normative amounts, even if the items are worthless, hazardous, or unsanitary...
, attention effectively to clean the home may be hindered by the amount of clutter that the hoarder resolves later to organize.
While there are superficial similarities between the list-making and obsessive aspects of Asperger's syndrome and OCPD, the former is different from OCPD especially regarding affective
Affect (psychology)
Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...
behaviors, including (but not limited to) empathy
Empathy
Empathy is the capacity to recognize and, to some extent, share feelings that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion. The English word was coined in 1909 by E.B...
, social coping, and general social skills.
Perception of own and others' actions and beliefs tend to be polarised (i.e., "right" or "wrong", with little or no margin between the two) for people with this disorder. As might be expected, such rigidity places strain on interpersonal relationship
Interpersonal relationship
An interpersonal relationship is an association between two or more people that may range from fleeting to enduring. This association may be based on limerence, love, solidarity, regular business interactions, or some other type of social commitment. Interpersonal relationships are formed in the...
s, with frustration sometimes turning into anger and even violence. This is known as disinhibition
Disinhibition
Disinhibition is a term in psychology used to describe a lack of restraint manifested in several ways, including disregard for social conventions, impulsivity, and poor risk assessment. Disinhibition affects motor, instinctual, emotional, cognitive and perceptual aspects with signs and symptoms...
. People with OCPD often tend to general pessimism
Pessimism
Pessimism, from the Latin word pessimus , is a state of mind in which one perceives life negatively. Value judgments may vary dramatically between individuals, even when judgments of fact are undisputed. The most common example of this phenomenon is the "Is the glass half empty or half full?"...
and/or underlying form(s) of depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
. This can at times become so serious that suicide is a risk. Indeed, one study suggests that personality disorders are a significant substrate to psychiatric morbidity. They may cause more problems in functioning than a major depressive episode.
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 geneDopamine receptor D3
D dopamine receptor is a protein that in humans is encoded by the DRD3 gene.This gene encodes the D3 subtype of the dopamine receptor. The D3 subtype inhibits adenylyl cyclase through inhibitory G-proteins. This receptor is expressed in phylogenetically older regions of the brain, suggesting that...
are highly likely to develop OCPD and depression, particularly if they are male.
Genetic concomitants, however, may lie dormant until triggered by events in the lives of those who are predisposed to OCPD. These events could include trauma faced during childhood, such as physical, emotional or sexual abuse, or other types of psychological trauma.
DSM
The Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
fourth edition, (DSM IV-TR = 301.4), a widely used manual for diagnosing mental disorders, defines obsessive–compulsive personality disorder (in Axis II Cluster C) as:
- 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. It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
Criticism
Since DSM IV-TR was published in 2000, some studies have found fault with its OCPD coverage. A 2004 study challenged the usefulness of all but three of the criteria: perfectionism, rigidity and stubbornness, and miserliness. A study in 2007 found that OCPD is etiologically distinct from avoidant and dependent personality disorders, suggesting it is incorrectly categorized as a Cluster C disorder.
WHO
The World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
's ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
uses the term .
- It is characterized by at least three of the following:
-
- feelings of excessive doubt and caution;
- preoccupation with details, rules, lists, order, organization or schedule;
- perfectionism that interferes with task completion;
- excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
- excessive pedantry and adherence to social conventions;
- rigidity and stubbornness;
- unreasonable insistence by the individual that others submit exactly to his or her way of doing things, or unreasonable reluctance to allow others to do things;
- intrusion of insistent and unwelcome thoughts or impulses.
- Includes:
- compulsive and obsessional personality (disorder)
- obsessive-compulsive personality disorder
- Excludes:
- obsessive-compulsive disorder
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
Millon's subtypes
Theodore MillonTheodore Millon
Theodore Millon is an American psychologist known for his work on personality disorders.-Biography:Millon was born in 1928, the only child of immigrant Jewish parents from Lithuania and Poland. His 19th-century ancestors came from the town of Valozhyn, then a part of the Russian Empire...
identified five subtypes of compulsive. Any individual compulsive may exhibit some or one of the following:
- conscientious compulsive—including dependentDependent personality disorderDependent personality disorder , formerly known as asthenic personality disorder, is a personality disorder that is characterized by a pervasive psychological dependence on other people...
features - puritanical compulsive—including paranoidParanoid personality disorderParanoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others....
features. - bureaucratic compulsive—including narcissisticNarcissistic personality disorderNarcissistic personality disorder is a personality disorder in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity...
features - parsimonious compulsive—including schizoidSchizoid personality disorderSchizoid personality disorder is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and sometimes apathy, with a simultaneous rich, elaborate, and exclusively internal fantasy world...
features. Resembles Fromm'sErich FrommErich Seligmann Fromm was a Jewish German-American social psychologist, psychoanalyst, sociologist, humanistic philosopher, and democratic socialist. He was associated with what became known as the Frankfurt School of critical theory.-Life:Erich Fromm was born on March 23, 1900, at Frankfurt am...
hoarding orientation - bedeviled compulsive—including negativistic (passive-aggressive) features
Differential diagnosis
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, sometimes along with eating disorders. People experiencing OCPD do not generally feel the need to repeatedly perform ritualistic actions—a common symptom of OCD—and usually find pleasure in perfecting a task, whereas OCD patients are often more distressed after their actions.Treatment
Treatment for OCPD normally involves psychotherapyPsychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
and self-help
Self-help
Self-help, or self-improvement, is a self-guided improvement—economically, intellectually, or emotionally—often with a substantial psychological basis. There are many different self-help movements and each has its own focus, techniques, associated beliefs, proponents and in some cases, leaders...
. However, in some cases, there can be an impediment to change in that the patient does not accept that they have OCPD, and/or believes (at least at some level) that their thoughts and/or behaviors are in some sense "correct" and therefore should not be changed. Medication in isolation is generally not indicated for this personality disorder, but fluoxetine
Fluoxetine
Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
has been prescribed with success. Anti-anxiety medication may reduce feelings of fear while SSRIs (anti-depressants) can ease frustration, reducing stubbornness and negative rumination
Rumination (psychology)
Rumination is a way of responding to distress that involves repetitively focusing on the symptoms of distress, and on its possible causes and consequences. Rumination is more common in people who are pessimistic, neurotic, and who have negative attributional styles. The tendency to ruminate is a...
.
Psychotherapy
- Cognitive behavioral therapy
- Behavior therapy: Discussing with a psychotherapist ways of changing compulsions into healthier, productive behaviors. An effective form of this therapy has been found to be cognitive analytic therapyCognitive analytic therapyCognitive Analytic Therapy is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. This time-limited therapy was developed in the context of the UK's National Health Service with the aim of providing effective and affordable psychological treatment which could...
. - PsychotherapyPsychotherapyPsychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
: Discussion with a trained counselor or psychotherapist who understands the condition. - PsychopharmacologyPsychopharmacologyPsychopharmacology is the scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior...
: A psychiatristPsychiatristA psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
may be able to prescribe medication to facilitate self-management and also enable more productive participation in other therapies.
Epidemiology
Obsessive–compulsive personality disorder occurs in about 1 percent of the general population. It is seen in 3–10 percent of psychiatric outpatients. It is twice as common in males as females.History
In 1908, Sigmund FreudSigmund Freud
Sigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...
named what is now known as obsessive–compulsive or anankastic personality disorder "anal retentive
Anal retentive
The term anal-retentive , commonly abbreviated to anal, is used conversationally to describe a person who pays such attention to detail that the obsession becomes an annoyance to others, and can be carried out to the detriment of the anal-retentive person. The term derives from Freudian...
character". He identified the main strands of the personality type as a preoccupation with orderliness, parsimony (frugality), and obstinacy (rigidity
Rigidity
Rigid or rigidity may refer to:*Stiffness, the property of a solid body to resist deformation, which is sometimes referred to as rigidity*Structural rigidity, a mathematical theory of the stiffness of ensembles of rigid objects connected by hinges...
and stubbornness). The concept fits his theory of psychosexual development
Psychosexual development
In Freudian psychology, psychosexual development is a central element of the psychoanalytic sexual drive theory, that human beings, from birth, possess an instinctual libido that develops in five stages. Each stage — the oral, the anal, the phallic, the latent, and the genital — is characterized...
.
Since the early 1990s, considerable new research continues to emerge into OCPD and its characteristics, including the tendency for it to run in families along with eating disorders and even to appear in childhood.
Further reading
- Baer, Lee. (1998). "Personality Disorders in Obsessive–Compulsive Disorder". In Obsessive–Compulsive Disorders: Practical Management. Third edition. Jenike, Michael et al. (eds.). St. Louis: MosbyMosbyMosby may refer to:Places:* Mosby, Missouri* Mosby, Montana* Mosby, Norway* Mosby Tavern, a 1740 historical building in Powhatan County, Virginia, also known as "Littleberry Mosby House" or "Old Cumberland Courthouse"People :* John S...
. - Freud, S. (1959, original work published 1908).Character and Anal Eroticism, in The Standard Edition of the Complete Psychological Works of Sigmund Freud, 9, 170–1. James Strachey, ed. London: HogarthHogarth-People:* Burne Hogarth, American cartoonist, illustrator, educator and author* David George Hogarth, English archaeologist* Donald Hogarth, Canadian politician and mining financier* Paul Hogarth, English painter and illustrator...
. ISBN 978-0-7012-0067-1 ISBN 0-7012-0067-7 - Jenike, Michael. (1998). "Psychotherapy of Obsessive–compulsive Personality". In Obsessive–Compulsive Disorders: Practical Management. Third edition. Jenike, Michael et al. (eds.). St. Louis: MosbyMosbyMosby may refer to:Places:* Mosby, Missouri* Mosby, Montana* Mosby, Norway* Mosby Tavern, a 1740 historical building in Powhatan County, Virginia, also known as "Littleberry Mosby House" or "Old Cumberland Courthouse"People :* John S...
. - Kay, Jerald et al. (2000). "Obsessive–Compulsive Disorder". In Psychiatry: Behavioral Science and Clinical Essentials. Jenike, Michael et al. Philadelphia: W. B. Saunders.
- MacFarlane, Malcolm M. (ed.) (2004). Family Treatment of Personality Disorders. Advances in Clinical Practice. Binghamton, NY: The Haworth Press.
- Penzel, Fred. (2000). Obsessive–Compulsive Disorders: A Complete Guide to Getting Well and Staying Well. Oxford University PressOxford University PressOxford University Press is the largest university press in the world. It is a department of the University of Oxford and is governed by a group of 15 academics appointed by the Vice-Chancellor known as the Delegates of the Press. They are headed by the Secretary to the Delegates, who serves as...
, USA. MPN 0195140923 - Ryle, A. & Kerr, I. B. (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & SonsJohn Wiley & SonsJohn Wiley & Sons, Inc., also referred to as Wiley, is a global publishing company that specializes in academic publishing and markets its products to professionals and consumers, students and instructors in higher education, and researchers and practitioners in scientific, technical, medical, and...
. ISBN 978-0-470-85304-7. - Salzman, Leon. (1995).Treatment of Obsessive and Compulsive Behaviors, Jason AronsonJason AronsonJason Aronson is an American publisher of books in the field of psychotherapy. Topics dealt with in these books include child therapy, family therapy, couple therapy, object relations therapy, play therapy, depression, eating disorders, personality disorders, substance abuse, sexual abuse, stress,...
Publishers. ISBN 1-56821-422-7