What is Obsessive-compulsive personality disorder- An Overview

‘I need everything clean, it’s an OCD’ or ‘I need things aligned horizontally’ are some statements which are commonly used to describe one’s behaviour. But is it indeed, OCD? Obsessive-compulsive disorder (OCD) is often confused with obsessive-compulsive personality disorder (OCDP), but they are two distinct disorders. In this article, we will further understand, briefly the distinction between OCD and OCPD, the symptoms, treatment, and risk factors of OCPD and how to live with someone who has OCPD.

 

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OCD vs OCPD

OCD – obsessive-compulsive disorder is characterized as recurrent and intrusive thoughts (obsessions) which increase anxiety followed by performing repetitive or ritualistic actions (compulsions) which lower this anxiety (DSM-V, 2013).

• OCD is considered an anxiety disorder.
• People with OCD are aware of their thoughts as being unreasonable.
• The intrusive thoughts or actions take up at least an hour of the day.
• Includes actions such as constant checking, need for symmetry, repeated washing of hands etc.
• It is out of their control.
• Usually interferes with work, social, or personal life.

Personality disorders are severe conflicts in a characterological assembly and behavioural tendencies, usually leading to substantial dysfunction in personal and social life. It usually begins in late childhood or adolescent years and persists steadily throughout adulthood (Ekselius, 2018). The modern background of OCPD originate in psychoanalytic theory and can be dated back to when Freud described the anal type character (Pfohl & Blum, 1991). OCPD- obsessive-compulsive personality disorder is characterized as fixations with orderliness, perfectionism, mental and interpersonal control, at the cost of flexibility and efficiency (DSM-V, 2013).

• OCPD is a personality disorder.
• People with OCPD consider their way as the ‘right way’ and usually impose their rules and thoughts as reasonable.
• Get irritated or angry when things are not their way, such as a change in schedule.
• A person with OCPD is over conscientious and inflexible regarding the matters of ethics, values, and morality.
• Is unable to discard unwanted or insignificant objects. They are unwilling to perform tasks with others unless it is performed exactly the way they want things.
• OCPD usually interferes with interpersonal relationships, although, it may prove to be beneficial for work life.
• Typically, do not believe they require treatment or therapy.
• People in their life often feel overcriticized and controlled, which makes it challenging to live with them.

 

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CAUSES OF OCD

The literature to determine the cause for OCPD is scant. One study examined family link and found a significantly greater occurrence of OCPD in first-degree relatives of OCD probands (Samuels et al., 2000). It is difficult to determine the cause of OCPD due to its complex nature and comorbidity. Some studies suggest that OCPD is likely caused by a combination of genetic and environmental factors. Although most therapists work with the biopsychosocial model of causation, which says that the disorder may be an entwined involving social, psychological, biological, and genetic factors (Grohol, 2020). Various theories also suggest that people with OCPD may have experienced a controlled and overprotective nurturing as a child, and the symptoms of OCPD may have developed as a coping mechanism.

The International OCD Foundation estimated that men are twice as likely to be diagnosed by OCPD than women.

 

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TREATMENT OF OCD

The treatment of OCPD can be difficult due to the ego-syntonic nature of symptoms. This may lead to low motivation to seek treatment. However, the most likely treatment approaches adopted by therapists are as follows:

1. Cognitive behavioural therapy (CBT)- CBT is a commonly used treatment method by psychologists. This can prove to be vital as it can provide the person with OCPD some insight into their behaviour. The treatment involves recognizing and reorganizing the dysfunctional thoughts causing the unwanted behaviors (Pinto, 2016).
2. Psychodynamic therapies- may help the patient of OCPD to reflect on their thoughts and provide insight into their behaviour and fixation with perfectionism and orderliness. Although there is not enough published research assessing the efficacy of this approach for OCPD, such insight-oriented and psychoanalytical theories are recommended for treatment (Alex et al., 2010)
3. Medicine- Selective serotonin reuptake inhibitors (SSRIs) may be helpful to reduce anxiety regarding the obsessive-compulsive behaviours (Nall, 2019).
4. Relaxation training- involving breathing and relaxation practices that can help decrease the degree of anxiety may be helpful. The recommended relaxation practices include yoga, tai chi and Pilates.

 

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HOW TO LIVE WITH SOMEONE WITH OCPD?

It can be challenging to live and maintain a relationship with someone diagnosed with OCPD. It is essential to identify and pay attention to the obsessive-compulsive actions and behaviours of the person. Some critical factors are patience and empathy. With the rigid and ‘I have no problem’ behaviour of the OCPD patient, it can be tough to bring a quick change. Although, being patient, understanding and strategizing possible solution can help ease the anxiety and stress.

Another significant factor is communication, clear communication, and reassurance that the person does not need to be perfect and meticulous all the time may help them understand and see that their behaviour may be causing emotional harm. Second, be very supportive and caring towards the person with OCPD, make sure that the things that are very important to them are done their way as it could cause them to be aggressive and further cause tension in relationships. Make sure to not be the cause of their anxiety. Thirdly, take time out for yourself, it is evident that it is challenging to live with an OCPD patient, in the process of supporting them, one must take care of their mental health and spend time alone to rejuvenate their thoughts and energy. Lastly, it is often advised to seek help and support when OCPD interferes in functioning and relationships, the person with OCPD may be reluctant to therapy, but slow nudging and making them realize that they require treatment will help them understand their behaviour.

 

 

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Conclusion

To summarize, OCPD patients are often rigid, inflexible, and conscientious with their rules. They think that they do not have a problem. There has no significant evidence as to what causes OCPD. Researchers believe that it is a combination of biological, genetic, social and psychological factors. It is known that it can be challenging for others to work and live with them. It is advised to seek professional support to enhance the life of oneself and that of others around them.

 

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References 

Alex, R., Ferriter, M., Jones, H., Duggan, C., Huband, N., Gibbon, S., … & Lieb, K. (2010). Psychological interventions for obsessive-compulsive personality disorder. The Cochrane database of systematic reviews, (5).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Ekselius L. (2018). Personality disorder: a disease in disguise. Upsala journal of medical sciences, 123(4), 194–204.

Grohol, J. (2020). Obsessive-Compulsive Personality Disorder. Psych Central. Retrieved on October 25, 2020, from https://psychcentral.com/disorders/obsessive-compulsive-personality-disorder/

Nall, R. M. (2019, November 28). What is an obsessive-compulsive personality disorder? MedicalNewsToday. https://www.medicalnewstoday.com/articles/327158#when-to-see-a-doctor

Pfohl, B., & Blum, N. (1991). Obsessive-Compulsive Personality Disorder: A Review of Available Data and Recommendations for DSM-IV. Journal of Personality Disorders, 5(4), 363-375.

Pinto, A. (2016). Treatment of obsessive-compulsive personality disorder. In Clinical Handbook of Obsessive-Compulsive and Related Disorders (pp. 415-429). Springer, Cham.

Samuels, J., Nestadt, G., Bienvenu, O. J., Costa, P. T., Riddle, M. A., Liang, K. Y., … & Cullen, B. A. (2000). Personality disorders and normal personality dimensions in obsessive-compulsive disorder. The British Journal of Psychiatry, 177(5), 457-462.

 

Other Important Articles

• Obsessive-Compulsive Disorder
• Obsessive-Compulsive Disorder in Children and Adolescents
• Life of an OCD Sufferer