Obsessive-Compulsive Personality Disorder (OCPD)

Obsessive-Compulsive Personality Disorder, or OCPD, is characterised by perfectionism and an excessive concern with maintaining order (Barlow & Durand, 2009). This perfectionism is often dysfunctional because such individuals are always careful not to make mistakes as such, check for minor details and errors. Because they are often preoccupied with trivial details, they use time poorly which can prevent OCPD employees from finishing projects and meeting their deadlines (Butcher, Mineka & Hooley, 2009).

At an interpersonal level, they will often have difficulty delegating tasks to others while they will frequently be viewed as being quite rigid and stubborn (Butcher, Mineka & Hooley, 2009). Individuals with this disorder are extremely conscientious, scrupulous, and inflexible about matters of morality, ethics and values and usually hold very strict standards of performance.

It is important to note that individuals with this disorder do not have true obsessions or compulsive rituals that are the source of extreme anxiety or distress in the Axis I Obsessive Compulsive Disorder (Butcher, Mineka & Hooley, 2009). It is important to distinguish between OCPD and obsessive-compulsive disorder (OCD), which is an anxiety disorder characterised 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 behaviours or mental acts (compulsions).

The Differences between OCD and OCPD

While there appears to be some overlap between these two disorders, there are a number of ways to tell these disorders apart. The biggest difference between OCD and OCPD is the presence of true obsessions and compulsions. Obsessions and compulsions are not present in OCPD. People with obsessive compulsive disorder (OCD) are often aware that their obsessions are abnormal, but are compelled to perform them anyway. People with obsessive compulsive personality disorder (OCPD) believe their need for strict order and rules is perfectly normal. Obsessive compulsive disorder often interferes with the OCD sufferer’s success in social and work environments.

While people with obsessive compulsive personality disorder certainly have difficulties with social relationships, they usually tend to perform well in work environments. In addition, individuals with OCD will usually seek help for the psychological stress caused by having to carry out compulsions or the disturbing content or themes of their obsessions. In contrast, if one has OCPD, they will usually seek treatment because of the conflict caused between them and their family and friends related to their need to have others conform to their way of doing things.

Associated Features and Diagnosis

The essential feature of Obsessive-Compulsive Personality Disorder is that individuals may have difficulty deciding which tasks take priority or what is the best way of doing particular tasks. For example, a sufferer of this disorder will get quite upset if even minor variations of his daily routines occurred. They are prone to becoming angry or upset in situations where they are not able to maintain control of their physical or interpersonal environment.

Affection is expressed in a highly controlled manner even in the presence of others who are emotionally expressive. They often hold back to ensure that what they will say is perfect. Individuals with this disorder experience occupational difficulties and distress particularly when confronted with situations that demand flexibility and compromise (APA, 2000).

DSM-IV- TR Diagnostic Criteria for OCPD

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, organisation 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 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 ways 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

(APA, 2000)

Treatment Focus

Individuals seek treatment for issues in their life that 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 behaviours. 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.

Obsessive-compulsive personality disorder is especially resistant to such changes, because of the basic makeup of this disorder. Short-term therapy will most likely be beneficial when the client’s current support system and coping skills are examined. Those skills that 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 intellectualising 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 realisation of feelings can bring about much change (Levin, 2005).

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 client 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 (Levin, 2005).

Therapists 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. Therapists 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. Therapists should be careful not to overgeneralise 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 therapist might characterise as a personality disorder) is working for them, a therapist should not seek to change it 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 (Levin, 2005).

References:

  • American Psychiatric Association, (2000). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Text Revision. Washington, DC: American Psychiatric Association.
  • Barlow, D.H., & Durand, V.M. (2009). Abnormal psychology: An integrative approach (5th ed.). Belmont, CA: Wadsworth Cengage Learning.
  • Butcher, J.N., Mineka, S., & Hooley, J.M. (2007). Abnormal Psychology. Boston: Allyn & Bacon.

Source: http://www.mentalhealthacademy.com.au/