Obsessive-Compulsive Personality Disorder - Obsessive-Compulsive Personality Overview

Written by HealthyPlace.com Staff Writer

The differential diagnosis will include distinguishing between obsessive-compulsive disorder (OCD) and OCPD. A person who has obsessions and compulsions that they experience as alien and irrational is more likely to be suffering from OCD, whereas the person who feels perfectly comfortable with self-imposed systems of extensive rules and procedures for mopping the kitchen floor probably has OCPD. In addition, the thoughts and behaviors that are found in OCD are seldom relevant to real-life problems; by contrast, people with OCPD are preoccupied primarily with managing (however inefficiently) the various tasks they encounter in their daily lives.

Some features of OCPD may occur in other personality disorders. For example, a person with a narcissistic personality disorder may be preoccupied with perfection and be critical and stingy toward others; narcissists are usually generous with themselves, however, while people with OCPD are self-critical and reluctant to spend money even on themselves. Likewise, a person with schizoid personality disorder, who lacks a fundamental capacity for intimacy, may resemble someone with OCPD in being formal and detached in dealing with others. The difference here is that a person with OCPD, while awkward in emotional situations, is able to experience caring and may long for close relationships. Certain medical conditions may also mimic OCPD, but are distinct in that the onset of the symptoms is directly related to the illness. Certain behaviors related to substance abuse may also be mistaken for symptoms of OCPD, especially if the substance problem is unrecognized.

As described earlier, diagnosis may also be complicated by the fact that behaviors similar to OCPD may be normal variants within a given culture, occupation, or religion; however, in order to fulfill criteria for the personality disorder, the behaviors must be sufficiently severe as to impair the patient's functioning.

How is Obsessive-Compulsive Personality Disorder treated?

Psychotherapeutic approaches to the treatment of OCPD have found insight-oriented psychodynamic techniques and cognitive behavioral therapy to be helpful for many patients. This choice of effective approaches stands in contrast to the limitations of traditional forms of psychotherapy with most patients diagnosed with OCD. Learning to find satisfaction in life through close relationships and recreational outlets, instead of only through work-related activities, can greatly enrich the OCPD patient's quality of life. Specific training in relaxation techniques may help patients diagnosed with OCPD who have the so-called "Type A" characteristics of competitiveness and time urgency as well as preoccupation with work.

It is difficult, however, for a psychotherapist to develop a therapeutic alliance with a person with OCPD. The patient comes into therapy with a powerful need to control the situation and the therapist; a reluctance to trust others; and a tendency to doubt or question almost everything about the therapy situation. The therapist must be alert to the patient's defenses against genuine change and work to gain a level of commitment to the therapeutic process. Without this commitment, the therapist may be fooled into thinking that therapy has been successful when, in fact, the patient is simply being superficially compliant.

Medications
For many years, medications for OCPD and other personality disorders were thought to be ineffective since they did not affect the underlying causes of the disorder. More recent studies, however, indicate that treatment with specific drugs may be a useful adjunct (help) to psychotherapy. In particular, the medications known as selective serotonin reuptake inhibitors (SSRIs) appear to help the OCPD patient with his or her rigidity and compulsiveness, even when the patient did not show signs of pre-existing depression. Medication can also help the patient to think more clearly and make decisions better and faster without being so distracted by minor details. While symptom control may not "cure" the underlying personality disorder, medication does enable some OCPD patients to function with less distress.

Prognosis
Individuals with OCPD often experience a moderate level of professional success, but relationships with a spouse or children may be strained due to their combination of emotional detachment and controlling behaviors. In addition, people with OCPD often do not attain the level of professional achievement that might be predicted for their talents and abilities because their rigidity and stubbornness make them poor "team players" or supervisors. Although there are few large-scale outcome studies of treatments for OCPD, existing reports suggest that these patients do benefit from psychotherapy to help them understand the emotional issues underlying their controlling behaviors and to teach them how to relax. Since OCPD sufferers, unlike people with OCD, usually view their compulsive behaviors as voluntary, they are better able to consider change, especially as they come to fully recognize the personal and interpersonal costs of their disorder.

• American Psychiatric Association pamphlet on Personality Disorders
• American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC.
• NIMH, National Library of Medicine

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