Obsessive–compulsive personality disorder: Wikis

  

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Anankastic personality disorder
Classification and external resources
ICD-10 F60.5
ICD-9 301.4
MeSH D003193

Obsessive–compulsive personality disorder (OCPD) is a personality disorder which involves an obsession with perfection, rules, and organization. People 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.

Contents

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[1] and even to appear in childhood.[2]

Symptoms

The primary symptoms of OCPD are a preoccupation with details, rules, lists, order, organization, and schedules; being very rigid and inflexible in their beliefs; showing perfectionism that interferes with completing a task; excessive focus on being productive with their time; being very conscientious; having inflexible morality, ethics, or values; hoarding items that may no longer have value; and a reluctance to trust a work assignment or task to someone else for fear that their standards will not be met. Or the opposite to have to throw away things they no longer need as it clutters their space.

Some people with OCPD, but not all of them, show an obsessive need for cleanliness. Those that do not show this tendency are sometimes good at setting up systems to maintain cleanliness, but may not follow through with the need to clean because of other "more important" priorities. For example, the need to get a good grade or finish a project at work might cause the OCPD person to have a quite messy and unorganized home. But if that same person was suddenly unemployed or finished with other activities, they could very well start becoming obsessed with cleanliness as other activities take up less time.

Completion of a task or problem by an OCPD individual can be affected when excessive time is used in getting such to be considered right. 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 seen by some OCPD individuals as a form of lack of perfection, as is untidiness. They may routinely spend considerable time using a precise manner, as for instance putting everything in precisely the right place in precisely the right manner. OCPD sufferers can be anxious about the potential for things to go wrong in their lives and respond by hoarding money.[3] Pathological money hoarding, looking like miserliness or stinginess to other people,[3] may occur to minimize that spent on daily living.

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 may cause more problems in functioning than a major depressive episode.[9]

People with OCPD, when anxious or excited, may tic, grimace, or make noises, as in Tourette syndrome, or do impulsive[10] and unpredictable things, including risk taking. They may keep their homes 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.[citation needed]

Diagnostic criteria (DSM-IV-TR = 301.4)

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines obsessive–compulsive personality disorder (in Axis II Cluster C) as:[11]

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:
  1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
  2. 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)
  3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
  4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
  5. Is unable to discard worn-out or worthless objects even when they have no sentimental value
  6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
  7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
  8. Shows rigidity and stubbornness

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.[12] A study in 2007[13] found that OCPD is etiologically distinct from avoidant and dependent personality disorders, suggesting it is incorrectly categorized as a Cluster C disorder.

Diagnostic criteria (ICD-10) - anankastic personality disorder

The World Health Organization's ICD-10 defines a conceptually similar disorder to obsessive–compulsive personality disorder called (F60.5) Anankastic personality disorder.[14]

It is characterized by at least 3 of the following:
  1. feelings of excessive doubt and caution;
  2. preoccupation with details, rules, lists, order, organization or schedule;
  3. perfectionism that interferes with task completion;
  4. excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
  5. excessive pedantry and adherence to social conventions;
  6. rigidity and stubbornness;
  7. unreasonable insistence by the patient that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things;
  8. 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.[15][16] Any individual compulsive may exhibit none or one of the following:

  • conscientious compulsive - including dependent features
  • puritanical compulsive - including paranoid features. The compulsive experiences an extreme conflict between obedience and defiance at one level or another. These individuals often seek the armour of "God's righteousness" to purify, transform and contain them. Their hostility is likely to be vented through identification of a common enemy or seeking to scapegoat the weak. Puritanicals naturally gravitate towards radical fundamentalism but they are not limited to religious dogma. Over the course of history, and even in current politics, they have been an influential force in stirring nationalistic fervor. They can be found virtually in any institution, large or small.

Differential diagnosis: associated and overlapping conditions

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,[18] sometimes along with eating disorders.[19] People experiencing OCPD do not generally feel the need to repeatedly perform ritualistic actions – a common symptom of OCD.

Prevalence (epidemiology)

Obsessive-compulsive personality disorder occurs in about 1% of the general population. It is seen in 3%-10% of psychiatric outpatients. It is twice as common in males as females.[20]

Causes (etiology)

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.[21][22] Genetic concomitants, however, may lie dormant until triggered by events in the lives of those who are predisposed to OCPD. This perspective has important implications. Children born with a genetic predisposition may never develop the full traits. Much may depend on the context in which such children are raised. If OCPD is manifested within the context where the child with a genetic predisposition is raised, OCPD could be triggered, and thus develop in the child. So, for example, if a child is raised in a family with a parent suffering from OCPD, the child's predisposition may reveal itself through behaviours and attitudes. The converse is also true. This hypothesis, at this stage, has so far not been investigated. A second perspective suggests that children who do not inherit the genetic disposition may equally adopt family modes of interaction and behaviour.

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 (anti-depressants) 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.

Psychotherapy

See also

References

  1. ^ Lilenfeld et al. (1998). A Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa. Arch Gen Psychiatry. 55:603–10.
  2. ^ 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.
  3. ^ a b Jefferys, Don (2008). "Pathological hoarding". Australian Family Physician 37 (4): 237–241. http://www.racgp.org.au/afp/200804/23717. Retrieved October 7, 2009. 
  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: 435–41
  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: 857–68.
  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): 184–90
  9. ^ 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.
  10. ^ Stein DJ et al. (1996). Impulsivity and serotonergic function in compulsive personality disorder. J Neuropsychiatry Clin Neurosci. 8: 393–8.
  11. ^ Obsessive–compulsive personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
  12. ^ 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.
  13. ^ 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
  14. ^ Anankastic personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  15. ^ Millon, Theodore, Personality Disorders in Modern Life, 2004
  16. ^ Millon, Theodore - Personality Subtypes
  17. ^ Fromm, E Man For Himself, 1947
  18. ^ Samuels J et al. (2000). Personality disorders and normal personality dimensions in obsessive–compulsive disorder. Br J Psychiatry. Nov. 177: 457–62.
  19. ^ 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).
  20. ^ Internet Mental Health - obsessive–compulsive personality disorder
  21. ^ 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.
  22. ^ 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.
  23. ^ 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
  24. ^ Ryle, A. & Kerr, I. B. (2002) Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & Sons.

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 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 for free download online through Google Books, or through the external link shown below.
  • 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 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 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.

External links








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