Personality Disorders 101: Obsessive-Compulsive PD

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Today we’ve reached the final personality disorder in the current diagnostic system, Obsessive-Compulsive Personality Disorder (OCPD). The first port of call here is to explain why OCPD exists alongside Obsessive-Compulsive Disorder (OCD.

For someone with OCD, obsessions and compulsions are entirely personal. The person knows their obsessions and fears are irrational, but they feel forced to listen to those obsessions otherwise something bad will happen to them or people they care about. Their compulsions are carried out to prevent those bad things happening and to reduce the person’s overwhelming fear that they are guilty of letting them happen.

As a stereotypical example, consider a person with OCD whose particular obsession and compulsion centers on locking doors. The person may need to spend an hour checking that every door in their house is locked before leaving, to prevent the overwhelming consequences of leaving one unlocked. However, they will not think differently of their family members for being able to go out after only checking once. They may be envious of their family for being free from that worry, and may feel guilty over how the time spent checking intrudes upon other family members.

For someone with OCPD, rules and beliefs are not irrational and personal. Instead, their way of doing things is the correct way regardless of how complex, rigid or time consuming it may appear to others. If someone with OCPD had specific rules over the correct location of everything in their house, they would require everyone else in the house to abide by those rules exactly. If a housemate tried to do things differently, the person with OCPD would interpret it as a functional or even moral deficit.

The DSM-V describes OCPD as a pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal control, which comes at the expense of flexibility, openness, and efficiency.In the ICD, it is instead known as anankastic PD. To be diagnosed with OCPD, a person must have at least 4 of these criteria:

  • They are so preoccupied with details, rules, lists, organization, or schedules that the major points of activities are lost
  • They are so perfectionistic that it stops them completing tasks e.g. they can be unable to complete projects because they can’t meet their own overly strict standards
  • They are devoted to work and productivity ahead of anything else including leisure activities and friendships. (Only if this is not caused by obvious financial need)
  • They are overconscientious, scrupulous, and rigid about morality, ethics, or values. (Only if this is not better explained by their personal culture or religion)
  • They struggle to discard worn-out or worthless objects, even when they have no sentimental value
  • They refuse to delegate tasks or to work with others unless others work exactly as they would
  • They are miserly, and hoard money in case of future catastrophes.
  • They are rigid and stubborn

OCPD is rarely deliberately written into a character, perhaps as it’s a little-known condition. However, characters described as having OCD can often be portrayed with the controlling nature of OCPD rather than the anxious nature of OCD.  An example of this is Sheldon Cooper from The Big Bang Theory. Sheldon relies on a very rigid structure in his life and is unable do anything which breaks this structure. He throws away an untouched breakfast made for him because it was made on the wrong day of the week. He also applies this structure to his friends and especially to his room-mate Leonard, who has to sign and obey an incredibly specific “room-mate agreement” in order to stay with him.  Sheldon is not written to have OCPD, but he is a good demonstration of how the rigidity of someone with OCPD can impact someone’s life and relationships.

Studies have found that between 1.7%  and 7.8% of people will experience OCPD at some point in their life. As you would expect, it is correlated with having OCD- in one study, 27% of people with OCD also had OCPD. However, this estimate might be unrealistically high because of how similar their diagnostic criteria appear from the outside. The most-used treatment method for OCPD is long-term counselling which aims to help the person understand why they fear change and imperfection, and to help them deal with the fact that other people can’t be expected to conform to their rigid rules. People with both OCPD and OCD, or OCPD plus an anxiety disorder, can also take antidepressants to help reduce their anxiety.

Psychological Criticisms of OCPD

As many people with untreated OCPD see their approach as justified and correct, OCPD is often identified only when it becomes a problem to others. Family members who become upset by the controlling atmosphere a person with OCPD creates may lay down an ultimatum, while employers may be confused by the person’s inefficiency and difficulty working with others.

Although personality disorders are supposed to be identified through behaviour which is significantly against cultural norms, this does not work well for OCPD. Western culture celebrates hard-working, always-busy perfectionists, which socially rewards many traits of OCPD. Because people are often praised for working themselves too hard, OCPD is hard to detect until it causes dysfunction in other ways. A person may need to experience a breakdown or crisis before the depths of their perfectionism are revealed.

Finally, previous studies on OCPD have discussed the lack of exact data about OCPD. Over time, people are more likely to stop fitting the diagnostic criteria for OCPD than they are for most other PDs (although DPD and NPD were even less stable). This could be because the diagnostic criteria for OCPD have changed significantly over time as psychiatrists have tried to get more information about the condition and its effects. Some researchers believe that OCPD may be a neurologically-based condition instead of  a personality disorder, as many people with Parkinson’s disease experience a personality change which strongly resembles OCPD. Others believe there is not yet enough information to say what type of condition OCPD may be or even to be sure it actually is a unique condition.

P.S. Now that the list of current PDs is complete, I’ll talk more about the problems people have highlighted with them in a later post.

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