Obsessive–compulsive personality disorder
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.[1]
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. [2][3]According to the National Institute for Mental Health:
- OCPD has some of the same symptoms as obsessive-compulsive disorder (OCD). However, people with OCD have unwanted thoughts, while people with OCPD believe that their thoughts are correct.[4]
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 hoarder, attention effectively to clean the home may be hindered by the amount of clutter that the hoarder resolves later to organize.[5]
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 relationships, with frustration sometimes turning into anger and even violence. This is known as disinhibition.[6] People with OCPD often tend to general pessimism and/or underlying form(s) of depression.[7][8][9] This can at times become so serious that suicide is a risk.[10] 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.[11]
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.[12][13] 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.
Diagnosis
DSM
The Diagnostic and Statistical Manual 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:[14]
- 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.[15] A study in 2007[16] 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 Organization's ICD-10 uses the term (F60.5) Anankastic personality disorder.[17]
- 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 Millon identified five subtypes of compulsive.[18][19] Any individual compulsive may exhibit some or one of the following:
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,[21] sometimes along with eating disorders.[22] 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 psychotherapy 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.
Psychotherapy
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.[25]
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 (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[26] and even to appear in childhood.[27]
See also
References
- ^ Taber's Cyclopedic Medical Dictionary 18th ed 1968
- ^ Taber's Cyclopedic Medical Dictionary 18th ed 1968
- ^ http://www.psyweb.com/mdisord/jsp/ocpd.jsp
- ^ http://www.nlm.nih.gov/medlineplus/ency/article/000942.htm
- ^ Jefferys, Don (2008). "Pathological hoarding". Australian Family Physician 37 (4): 237–241. http://www.racgp.org.au/afp/200804/23717. Retrieved October 7, 2009.
- ^ Villemarette-Pittman NR et al. (2004). Obsessive–compulsive personality disorder and behavioral disinhibition. Psychol. Jan: 138(1):5–22.
- ^ Pilkonis PA, Frank E. (1988). Personality pathology in recurrent depression: nature, prevalence, and relationship to treatment response. Am J Psychiatry. 145: 435–41
- ^ 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.
- ^ Shea MT et al. (1992). Comorbidity of personality disorders and depression; implications for treatment. J Consult Clin Psychol. 60: 857–68.
- ^ Raja M, Azzoni A. (2007). The impact of obsessive–compulsive personality disorder on the suicidal risk of patients with mood disorders. Psychopathology. 40(3): 184–90
- ^ Skodol AE et al. (2002). Functional Impairment in Patients With Schizotypal, Borderline, Avoidant, or Obsessive–Compulsive Personality Disorder. Am J Psychiatry 159:276–83. February.
- ^ 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.
- ^ 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.
- ^ Obsessive–compulsive personality disorder. Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
- ^ 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.
- ^ 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): 645–53
- ^ Anankastic personality disorder. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
- ^ Millon, Theodore, Personality Disorders in Modern Life, 2004
- ^ Millon, Theodore - Personality Subtypes
- ^ Fromm, E Man For Himself, 1947
- ^ Samuels J et al. (2000). Personality disorders and normal personality dimensions in obsessive–compulsive disorder. Br J Psychiatry. Nov. 177: 457–62.
- ^ 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).
- ^ 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
- ^ Ryle, A. & Kerr, I. B. (2002) Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & Sons.
- ^ Internet Mental Health - obsessive–compulsive personality disorder
- ^ Lilenfeld et al. (1998). A Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa. Arch Gen Psychiatry. 55:603–10.
- ^ 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: 242–7.
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: Mosby.
- 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: Hogarth. 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: Mosby.
- 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 Press, USA. MPN 0195140923
- Ryle, A. & Kerr, I. B. (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & Sons. ISBN 978-0-470-85304-7.
- Salzman, Leon. (1995).Treatment of Obsessive and Compulsive Behaviors, Jason Aronson Publishers. ISBN 1-56821-422-7
External links