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Written by Staff Writer

In-depth look at Obsessive-Compulsive Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.

Obsessive-compulsive personality disorder (OCPD) is not the same as obsessive-compulsive disorder, an anxiety disorder that shares some symptoms but is more extreme and disabling. OCD is an anxiety disorder characterized by the presence of intrusive or disturbing thoughts, impulses, images or ideas (obsessions), accompanied by repeated attempts to suppress these thoughts through the performance of irrational and ritualistic behaviors or mental acts (compulsions). It is unusual but possible, however, for a patient to suffer from both disorders, especially in extreme cases of hoarding behavior. In some reported cases of animal hoarding, the people involved appear to have symptoms of both OCD and OCPD.

A person with obsessive-compulsive personality disorder tends to be very rigid, controlled, constricted, preoccupied with regulation, orderliness, perfection, things of that type. There is a wish for predictability. There is a resistance to any kind of change. If this person is a boss, they are likely to be a micromanager and have difficulty in delegating things over to other people. But they may be very hard workers. Even workaholics display obsessive-compulsive features.

A person with an obsessive-compulsive personality disorder will have a striking inability to adapt to new routines and have such an eye for detail and perfectionism that they will rarely complete any task on time, if at all.

 This means that qualities usually highly regarded - the ability to work reliably and to a high standard - become paralysing. It's easy for such a person to reflect any criticism outwards, saying that they're not understood and nobody appreciates the importance of getting a job done, not only properly, but in the proper way.

What are the signs and symptoms of Obsessive-Compulsive Personality Disorder?

Obsessive-Compulsives are constantly drawing up and dreaming up lists, rules, orders, rituals, and organizational schemes.

In-depth look at Obsessive-Compulsive Personality Disorder - signs and symptoms, diagnosis, causes, and treatment.Obsessions and compulsions are about control of self (mental) and others (interpersonal). People with the Obsessive-Compulsive Personality Disorder (OCPD) are concerned (worried and anxious) about maintaining control and about being seen to be maintaining it. In other words, they are also preoccupied with the symbolic aspects and representations (with the symbols) of control.

Inevitably, OCPDs are perfectionists and rigidly orderly or organized. They lack flexibility, openness and efficiency. They tend to see the world and others as at best whimsical and arbitrary and at worst menacing and hostile. They are constantly worried that something is or may go wrong. In this respect, they share some traits with the paranoid and the schizotypal.

It is easy to spot an Obsessive-Compulsive. They are constantly drawing up and dreaming up lists, rules, orders, rituals, and organizational schemes. They demand from themselves and from others perfection and an inordinate attention to minutia. Actually, they place greater value on compiling and following rigid schedules and checklists than on the activity itself or its goals. Simply put, Obsessive-Compulsives are unable to see the forest for the trees.

This insistence on in-depth scrutiny of every detail frequently results in paralysis.

OCPDs are workaholics, but not because they like to work. Ostensibly, they sacrifice family life, leisure, and friendships on the altar of productivity and output. Really, they are convinced that only they can get the job done in the right manner. Yet, they are not very efficacious or productive.

Socially, OCPDs are sometimes resented and rejected. This is because some OCPDs are self-righteous to the point of bigotry.

At Open Site Encyclopedia, author Sam Vaknin writes:

"They are so excessively conscientious and scrupulous and so unempathically and inflexibly tyrannical that it is difficult to maintain a long-term relationship with them. They regard their impossibly high moral, work, and ethical standards as universal and binding. Hence their inability to delegate tasks to others, unless they can micromanage the situation and control it minutely to fit their expectations. Consequently, they trust no one and are difficult to deal with and stubborn.

OCPDs are so terrified of change that they rarely discard acquired but now useless objects, change the outlay of furniture at home, relocate, deviate from the familiar route to work, tweak an itinerary, or embark on anything spontaneous. They also find it difficult to spend money even on essentials. This tallies with their view of the world as hostile, unpredictable, and "bad".

List of Signs and Symptoms of Obsessive-Compulsive Personality Disorder

•Excessive concern with order, rules, schedules and lists

•Perfectionism, often so pronounced that you can't complete tasks because your standards are impossible to meet

•Inability to throw out even broken, worthless objects

•Inability to share responsibility with others

•Inflexibility about the "right" ethics, ideas and methods

•Compulsive devotion to work at the expense of recreation and relationships

•Financial stinginess

•Discomfort with emotions and aspects of personal relationships that you can't control

DSM IV Criteria for Obsessive-Compulsive Personality 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)

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•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

What causes someone to develop Obsessive-Compulsive Personality Disorder?

No single specific cause of OCPD has been identified. Since the early days of Freudian psychoanalysis, however, faulty parenting has been viewed as a major factor in the development of personality disorders. Current studies have tended to support the importance of early life experiences, finding that healthy emotional development largely depends on two important variables: parental warmth and appropriate responsiveness to the child's needs. When these qualities are present, the child feels secure and appropriately valued. By contrast, many people with personality disorders did not have parents who were emotionally warm toward them. Patients with OCPD often recall their parents as being emotionally withholding and either overprotective or overcontrolling. One researcher has noted that people with OCPD appear to have been punished by their parents for every transgression of a rule, no matter how minor, and rewarded for almost nothing. As a result, the child is unable to safely develop or express a sense of joy, spontaneity, or independent thought, and begins to develop the symptoms of OCPD as a strategy for avoiding punishment. Children with this type of upbringing are also likely to choke down the anger they feel toward their parents; they may be outwardly obedient and polite to authority figures, but at the same time treat younger children or those they regard as their inferiors harshly.

Genetic contributions to OCPD have not been well documented. Cultural influences may, however, play a part in the development of OCPD. That is, cultures that are highly authoritarian and rule-bound may encourage child-rearing practices that contribute to the development of OCPD. On the other hand, simply because a culture is comparatively strict or has a strong work ethic does not mean it is necessarily unhealthful. In Japanese societies, for example, excessive devotion to work, restricted emotional expression, and moral scrupulosity are highly valued characteristics that are rewarded within that culture. Similarly, certain religions and professions require exactness and careful attention to rules in their members; the military is one example. OCPD is not diagnosed in persons who are simply behaving in accordance with such outside expectations as military regulations or the rule of a religious order. Appropriate evaluation of persons from other cultures requires close examination in order to differentiate people who are merely following culturally prescribed patterns from people whose behaviors are excessive even by the standards of their own culture.

What are the risk factors linked to Obsessive-Compulsive Personality Disorder?

Most theories attribute the development of OCPD to early life experiences, including a lack of parental warmth; parental over-control and rigidity, and few rewards for spontaneous emotional expression.

How is Obsessive-Compulsive Personality Disorder diagnosed?

Obsessive-compulsive personality disorder is estimated to occur in about 1% of the population, although rates of 3%-10% are reported among psychiatric outpatients. The disorder is usually diagnosed in late adolescence or young adulthood.

It is relatively unusual for OCPD to be diagnosed as the patient's primary reason for making an appointment with their doctor. In many cases the person with OCPD is unaware of the discomfort that his or her stubbornness and rigidity cause other people, precisely because these traits usually enable them to get their way with others. They are more likely to enter therapy because of such other issues as anxiety disorders, serious relationship difficulties, or stress-related medical problems. Diagnosis of OCPD depends on careful observation and appropriate assessment of the individual's behavior; the person must not only give evidence of the attitudes and behaviors associated with OCPD, but these must be severe enough to interfere with their occupational and interpersonal functioning.

The differential diagnosis will include distinguishing between obsessive-compulsive disorder (OCD) and OCPD. A person who has obsessions and compulsions that they experience as alien and irrational is more likely to be suffering from OCD, whereas the person who feels perfectly comfortable with self-imposed systems of extensive rules and procedures for mopping the kitchen floor probably has OCPD. In addition, the thoughts and behaviors that are found in OCD are seldom relevant to real-life problems; by contrast, people with OCPD are preoccupied primarily with managing (however inefficiently) the various tasks they encounter in their daily lives.

Some features of OCPD may occur in other personality disorders. For example, a person with a narcissistic personality disorder may be preoccupied with perfection and be critical and stingy toward others; narcissists are usually generous with themselves, however, while people with OCPD are self-critical and reluctant to spend money even on themselves. Likewise, a person with schizoid personality disorder, who lacks a fundamental capacity for intimacy, may resemble someone with OCPD in being formal and detached in dealing with others. The difference here is that a person with OCPD, while awkward in emotional situations, is able to experience caring and may long for close relationships. Certain medical conditions may also mimic OCPD, but are distinct in that the onset of the symptoms is directly related to the illness. Certain behaviors related to substance abuse may also be mistaken for symptoms of OCPD, especially if the substance problem is unrecognized

As described earlier, diagnosis may also be complicated by the fact that behaviors similar to OCPD may be normal variants within a given culture, occupation, or religion; however, in order to fulfill criteria for the personality disorder, the behaviors must be sufficiently severe as to impair the patient's functioning.

How is Obsessive-Compulsive Personality Disorder treated?

Psychotherapeutic approaches to the treatment of OCPD have found insight-oriented psychodynamic techniques and cognitive behavioral therapy to be helpful for many patients. This choice of effective approaches stands in contrast to the limitations of traditional forms of psychotherapy with most patients diagnosed with OCD. Learning to find satisfaction in life through close relationships and recreational outlets, instead of only through work-related activities, can greatly enrich the OCPD patient's quality of life. Specific training in relaxation techniques may help patients diagnosed with OCPD who have the so-called "Type A" characteristics of competitiveness and time urgency as well as preoccupation with work.

It is difficult, however, for a psychotherapist to develop a therapeutic alliance with a person with OCPD. The patient comes into therapy with a powerful need to control the situation and the therapist; a reluctance to trust others; and a tendency to doubt or question almost everything about the therapy situation. The therapist must be alert to the patient's defenses against genuine change and work to gain a level of commitment to the therapeutic process. Without this commitment, the therapist may be fooled into thinking that therapy has been successful when, in fact, the patient is simply being superficially compliant.

For many years, medications for OCPD and other personality disorders were thought to be ineffective since they did not affect the underlying causes of the disorder. More recent studies, however, indicate that treatment with specific drugs may be a useful adjunct (help) to psychotherapy. In particular, the medications known as selective serotonin reuptake inhibitors (SSRIs) appear to help the OCPD patient with his or her rigidity and compulsiveness, even when the patient did not show signs of pre-existing depression. Medication can also help the patient to think more clearly and make decisions better and faster without being so distracted by minor details. While symptom control may not "cure" the underlying personality disorder, medication does enable some OCPD patients to function with less distress.

Individuals with OCPD often experience a moderate level of professional success, but relationships with a spouse or children may be strained due to their combination of emotional detachment and controlling behaviors. In addition, people with OCPD often do not attain the level of professional achievement that might be predicted for their talents and abilities because their rigidity and stubbornness make them poor "team players" or supervisors. Although there are few large-scale outcome studies of treatments for OCPD, existing reports suggest that these patients do benefit from psychotherapy to help them understand the emotional issues underlying their controlling behaviors and to teach them how to relax. Since OCPD sufferers, unlike people with OCD, usually view their compulsive behaviors as voluntary, they are better able to consider change, especially as they come to fully recognize the personal and interpersonal costs of their disorder.

•American Psychiatric Association pamphlet on Personality Disorders
•American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC.
•NIMH, National Library of Medicine


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