Obsessive compulsive personality disorder

Template:DiseaseDisorder infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]

Synonyms and keywords: Compulsion; compulsive gambling; obsession; perfectionism, ritual

Overview

Obsessive compulsive personality disorder (OCPD), or anankastic personality disorder, is a personality disorder that is characterized by a general psychological inflexibility, rigid conformity to rules and procedures, perfectionism, moral code, and/or excessive orderliness.

Obsessive compulsive personality disorder (OCPD) is often confused with obsessive-compulsive disorder (OCD). This could be due to the more commonly known OCD and the similarities in name of the two disorders, however the mindsets are typically different and unrelated.

Those who are suffering from OCPD do not generally feel the need to repeatedly perform ritualistic actions, a common symptom of OCD. Instead, people with OCPD tend to stress perfectionism above all else, and feel anxious when they perceive that things are not "right".

People with OCPD may hoard money for future use, keep their home perfectly organized, or be anxious about delegating tasks for fear that they won't be completed correctly. There are four primary areas that cause anxiety for OCPD personalities: time, relationship, uncleanliness, and money. There are few moral gray areas for a person with fully developed OCPD; actions and beliefs are either completely right, or absolutely wrong. As might be expected, interpersonal relationships are difficult because of the excessive demands placed on friends, romantic partners and children.

Diagnostic criteria (DSM-IV-TR)

The DSM-IV-TR, a widely-used manual for diagnosing mental disorders, defines that for a patient to be diagnosed with obsessive-compulsive personality disorder, they must exhibit at least four of the following traits:

Preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
Showing 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)
Excessive devotion to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
Being overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
Inability to discard worn-out or worthless objects even when they have no sentimental value
Reluctance to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
Adopting a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
Shows rigidity and stubbornness

It is important to note that while a person may exhibit any or all of the characteristics of a personality disorder, it is not diagnosed as a disorder unless the person has trouble leading a normal life due to these issues.

Mnemonic

A mnemonic that can be used to remember the criteria for OCPD is LAW FIRMS.

L – Loses point of activity (due to preoccupation with detail)
A – Ability to complete tasks is gone (compromised by perfectionism)
W – Worthless objects (unable to discard)
F – Friendships (and leisure activities) excluded (due to a preoccupation with work)
I – Inflexible, overconscientious (on ethics, values, or morality, not accounted for by religion or culture)
R – Reluctant to delegate (unless others submit to exact guidelines)
M – Miserly (toward self and others)
S – Stubbornness (and rigidity)

History

Sigmund Freud was the first person to characterize what is now known as obsessive-compulsive or anankastic personality disorder as the anal-retentive character. This fixation fit into his theory of psychosexual development.

Treatment

Treatment for OCPD normally involves psychotherapy and self help. Medication is generally not indicated for this personality disorder in isolation, but Fluoxetine has been prescribed with success. Anti-anxiety medication will reduce the feeling of fear and SSRIs can replace the chronic frustration with a sense of well-being, as well as 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

Behavior therapy — Talking with a psychotherapist about ways to change compulsions into healthier, productive actions.
Psychotherapy — Talking with a trained counselor or psychotherapist who understands the condition.
Pharmacotherapy - A psychiatrist can prescribe medications which may make self-management and participation in other therapies possible and/or more productive.

Self help

Educating family and friends about the condition will help them to manage behavioral problems more sympathetically, and to watch out for the warning signs.
Support groups may also be helpful in accepting and changing obsessive-compulsive behaviors.
Relaxation, meditation, exercise, regular sleep, and a balanced diet are all important factors in maintaining this focus.
Consult your healthcare provider if you are having difficulty sleeping and/or you are experiencing problems that prevent you from exercising regularly.
Keeping a diary may help the individual to identify those stressful situations that help to trigger compulsive reactions, enabling them to focus on more constructive activities.
Retained items, the result of hoarding, should be released, simultaneously reducing the shame associated with hoarding. Having an assistant to cull hoarded, collected, and stored items will facilitate the process.

Books

Salzman, Leon. Treatment of Obsessive and Compulsive Behaviors, Jason Aronson Publishers, 1995. ISBN 1-56821-422-7
Shapiro, David. Autonomy and Rigid Character, Basic Books, 1984. ISBN 0-465-00568-3
Shapiro, David. Neurotic Styles, Basic Books, 1965. ISBN 0-465-09502-X
Penzel, Fred. "Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well"