Obsessive-Compulsive Personality Disorder

Apr 20 • Diseases, HEALTH • 2050 Views • Comments

Obsessive-Compulsive Personality Disorder is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

When rules and established procedures do not dictate the correct answer, decision making may become a time-consuming, often painful process. Individuals with Obsessive-Compulsive Personality Disorder may have such difficulty deciding which tasks take priority or what is the best way of doing some particular task that they may never get started on anything.

They are prone to become upset or angry in situations in which they are not able to maintain control of their physical or interpersonal environment, although the anger is typically not expressed directly. For example, a person may be angry when service in a restaurant is poor, but instead of complaining to the management, the individual ruminates about how much to leave as a tip. On other occasions, anger may be expressed with righteous indignation over a seemingly minor matter.

People with this disorder may be especially attentive to their relative status in dominance-submission relationships and may display excessive deference to an authority they respect and excessive resistance to authority that they do not respect.

Individuals with this disorder usually express affection in a highly controlled or stilted fashion and may be very uncomfortable in the presence of others who are emotionally expressive. Their everyday relationships have a formal and serious quality, and they may be stiff in situations in which others would smile and be happy (e.g., greeting a lover at the airport). They carefully hold themselves back until they are sure that whatever they say will be perfect. They may be preoccupied with logic and intellect.

Symptoms of 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)
  • 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 significant rigidity and stubbornness

As with all personality disorders, the person must be at least 18 years old before they can be diagnosed with it.

Obsessive-Compulsive personality disorder is approximately twice as prevalent in males than females, and occurs in about 1 percent of the general population.

Like most personality disorders, Obsessive-Compulsive personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

How is Obsessive-compulsive Personality Disorder Diagnosed?

Personality disorders such as obsessive-compulsive personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose obsessive-compulsive personality disorder.

Many people with obsessive-compulsive personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for obsessive-compulsive personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Obsessive-compulsive Personality Disorder

Researchers today don’t know what causes obsessive-compulsive personality disorder. There are many theories, however, about the possible causes of obsessive-compulsive personality disorder. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Treatment of Obsessive-compulsive Personality Disorder

Treatment of obsessive-compulsive personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder.

Psychotherapy

As with most personality disorders, individuals seek treatment for items in their life which have become overwhelming to their existing coping skills. These skills may be somewhat limited, in the first place, because of their disorder. While they may be generally effective enough in most instances to shield the client from stress and emotional difficulties, during times of increased stress, work pressure, family problems, etc. the underlying disorder will become more evident in day-to-day behaviors.

As with most personality disorders, treatment is often focused on short-term symptom relief and the support of existing coping mechanisms while teaching new ones. Long-term or substantive work on personality change is usually beyond most clinician’s skill levels, and patient’s budgets. Obsessive-compulsive personality disorder is especially resistant to such changes, because of the basic makeup of this disorder.

Short-term therapy will be most likely to be beneficial when the patient’s current support system and coping skills are examined. Those skills which are not currently working could be reinforced with additional skill sets. Social relationships can also be examined, reinforcing strong, positive relationships while having the client re-examine negative or harmful relationships. One important aspect is to try and have the individual examine and properly identify their feeling states, rather than just intellectualizing or distancing themselves from their emotions. This can be accomplished through a variety of techniques, such as feeling identification (e.g., the “feeling faces”) at the onset of every therapy session. Homework might include writing feelings down in a journal, especially as they notice them. Proper identification and realization of feelings can bring about much change in and of itself.

Individuals suffering from obsessive-compulsive personality disorder often are not in touch with their emotional states as much as their thoughts. Leading the client away from describing situations, events, and daily happenings and to talking about how such situations, events and daily happenings made them feel may be helpful. Sometimes the patient may complain he or she doesn’t remember or know how he or she felt at the time; the journal becomes a useful tool at this point.

Therapy with people who have this disorder can sometimes be trying, since they can see the world in a very “all-or-nothing” manner. Beck’s cognitive therapy doesn’t seem to be all that effective in treatment, and cognitive approaches in general probably aren’t useful in this case. Clinicians must be willing to undergo verbal attacks on their professionalism and knowledge, as such skepticism about a therapist’s treatment approach from the client with this disorder can be expected. Clinicians should also be careful about engaging the client within these verbal attacks or intellectual discussions, as they continue to distance the patient from his or her feelings. And take the focus off of the client and onto unrelated matters (e.g., a therapist’s professional training).

Most people who suffer from this personality disorder (and the different, but related, obsessive-compulsive disorder) lead relatively normal lives, may have a family, friends, and work regularly. Clinicians should be careful not to overgeneralize psychopathology and look to change aspects of the patient’s personality he or she is not ready or willing to change. This means, in effect, that if the way they relate to others in their environment (which a clinician might characterize as a personality disorder) is working for them, a clinician should not seek to change it 180 degrees without the client’s purposeful consent. Therapy will most often be most effective when it focuses on correcting short-term difficulties currently being experienced. It will become increasingly less effective when the goal of therapy is complex, long-term personality change.

Although a group therapy modality may be helpful and an effective treatment option, most people who suffer from this disorder will not be able to withstand the minimum social contact necessary to gain a healthy group dynamic. They may quickly become ostracized by the group for pointing out other people’s deficits and “wrong-headed” ways of doing things.

Hospitalization

Hospitalization is rarely needed for people who suffer from this disorder, unless an extreme or severe stressor or stressful life event occurs which increases the compulsive behaviors to an extent where regular daily activites are halted or present possible risks of harm to the patient. Hospitalization may also be needed when the obsessive thoughts do not allow the individual to conduct any usual activities, paralyzing them in bed or with their accompanying compulsive behaviors.

Medications

In most cases, medication for this disorder is not indictated unless the individuals is also suffering from a clearly delineated Axis I diagnosis as well. However, newer medications such as Prozac, an SRRI, have been approved for the treatment of obsessive-compulsive disorder and may provide some relief to individuals with the personality disorder. Long-term use, though, is rarely indicated, appropriate, or beneficial.

Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Support groups, though, offer an excellent adjunct to continuing medication check-ups once a month, and a way to gain emotional and social support through the community. These groups also allow others to ensure the client is doing well and promotes the client’s independence and stability. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.

Such support groups are recommended to individuals suffering from this disorder, especially if they have found therapy unhelpful or too expensive.

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