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OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
 


Prediction: Lasts For Decades

      Occupational-Economic:
  • Excessive devotion to work; stubborn; reluctant to delegate work
      Wisdom vs Irrationality: N/A
      Courage vs Negative Emotion:
  • Perseveration (repeating the same thoughts or behaviors despite clear reasons for stopping)
      Community vs Detachment:
  • Intimacy avoidance, restricted emotional expression
      Moderation vs Over-Conscientiousness:
  • Rigid perfectionism, poor work-life balance, inflexibility
  • Rarely pays compliments; rigid morality; hypersensitivity to criticism; overcontrolling
      Justice vs Antagonism: N/A
      Medical: N/A


SYNOPSIS

Anankastic [Obsessive-Compulsive] Personality Disorder F60.5 - ICD10 Description, World Health Organization

Anankastic [obsessive-compulsive] personality disorder is characterized by feelings of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, caution, and rigidity. There may be insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder.
Obsessive-Compulsive Personality Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with obsessive-compulsive personality disorder needs to show at least 4 of the following criteria:

  • Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

  • Shows 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).

  • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).

  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).

  • Is unable to discard worn-out or worthless objects even when they have no sentimental value.

  • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.

  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

  • Shows rigidity and stubbornness.
Like all personality disorders, anankastic [obsessive-compulsive] personality disorder is a deeply ingrained and enduring behaviour pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behaviour pattern tends to be stable. It causes subjective distress and problems in social performance.

Core Features

Individuals with this disorder grow up with rigid perfectionism, intimacy avoidance, restricted emotional expression and perseveration. The core features of this disorder are: (1) extreme conscientiousness (rigid perfectionism), (2) detachment (intimacy avoidance, restricted emotional expression), and (3) negative emotion (perseveration - continuance of the same behavior despite repeated failures) . This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Lack Of Social Skills And Personality Disorders

There are social skills that are essential for healthy social functioning. Individuals with obsessive-compulsive personality disorder lack the essential social skills of moderation, work-life balance, and flexibility. Obsessive-compulsive personality disorder is not statistically related to any other personality disorder.

    Social Skills That Are Lacking In Obsessive-Compulsive Personality Disorder

    SOCIAL SKILL LOW LEVEL HIGH LEVEL
    Moderation Perfectionism Setting realistic goals; accepting “good enough” rather than demanding perfection
    Work-life balance Life is “all work and no play” Maintaining a proper balance between work and the rest of life
    Flexibility Inflexibility and risk avoidance Willingness to try new things; ability to tolerate normal disorder; taking reasonable risks

Employment-Economic Functioning

Individuals with obsessive-compulsive personality disorder have excessive devotion to work, and poor work-life balance. Occupationally, they tend to be high achievers because of their excessive devotion to work. However their inflexibility, perfectionism, preoccupation with detail, and inability to delegate work may seriously interfere with their ability to complete a given task. They experience occupational difficulties when confronted with new situations that demand flexibility and compromise.

Obsessive-Compulsive Traits

Individuals with obsessive-compulsive personality disorder are rigidly perfectionistic and insist on everything being flawless and perfect, including their own and others' performance. They become preoccupied with details, organization, and order. They may show excessive procrastination and perseveration (stubborn continuation of the same behavior despite repeated failures). They are inflexible and unwilling to take risks. Individuals with this disorder often are inflexible about matters of morality, ethics, or values. They may be miserly.

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

Detachment

Individuals with obsessive-compulsive personality disorder have difficulty in establishing and sustaining close relationships. Their emotional expression is restricted. They have difficulty expressing tender feelings, and rarely pay compliments.

    Detachment
    • Neither desires nor enjoys close relationships, including being part of a family.
    • Shows emotional coldness, detachment, or flattened affectivity.

Effective Therapies

The effectiveness of treatment for this disorder is unknown because there are no randomized controlled trials. However, amongst clinicians, there is a consensus that improvements are usually seen only with long-term therapy.

Which Behavioral Dimensions Are Involved?

The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, community, moderation, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")

    Obsessive-Compulsive Personality Disorder: Negative Emotion, Detachment, Extreme Conscientiousness
            Wisdom vs Irrationality: N/A
            Courage vs Negative Emotion:
      • Perseveration (repeating the same thoughts or behaviors despite clear reasons for stopping)
            Community vs Detachment:
      • Intimacy avoidance, restricted emotional expression
            Moderation vs Over-Conscientiousness:
      • Rigid perfectionism, poor work-life balance, inflexibility
      • Rarely pays compliments; rigid morality; hypersensitivity to criticism; overcontrolling
            Justice vs Antagonism: N/A

Prevalence

The prevalence of obsessive-compulsive personality disorder ranges from 2.1% to 7.9% in the general population. It is twice as common in males as females.

Course

Obsessive-compulsive personality disorder has a chronic course.

Complications

In obsessive-compulsive personality disorder, the individual's chronic preoccupation with rules, orderliness, and control seems to prevent many of the complications (e.g., drug abuse, reckless sex, financial irresponsibility) that are common to some other personality disorders.

Comorbidity

Personality disorders are an overlooked and underappreciated source of psychiatric morbidity. Comorbid personality disorders may, in fact, account for much of the morbidity attributed to axis I disorders in research and clinical practice. "High percentages of patients with schizotypal (98.8%), borderline (98.3%), avoidant (96.2%), and obsessive-compulsive (87.6%) personality disorder and major depressive disorder (92.8%) exhibited moderate (or worse) impairment or poor (or worse) functioning in at least one area."
Some other disorders frequently occur with this disorder:

    Non-Personality Disorders

            Depressive Disorders:
      • Persistent depressive disorder (dysthymia)
            Anxiety Disorders:
      • Generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias
            Obsessive-Compulsive and Related Disorders:
      • 47% of individuals with obsessive-compulsive disorder have obsessive-compulsive personality disorder

    Personality Disorders

      No comorbid personality disorders.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Primate Evolution

Of all the personality disorders, obsessive-compulsive personality disorder is unique; in that it is only found in humans and not in other higher primates (e.g., bonobos, chimps, orangutans). Only humans show perfectionism, over-work, and rigid inflexibility in problem-solving. Other primates will only work when they are hungry; whereas humans work regardless of their hunger. Other primates employ almost random problem-solving behaviors; whereas only human problem-solving can be perfectionistic and inflexible. Thus, in terms of primate evolution, obsessive-compulsive personality disorder was the last personality disorder to evolve.

Core Behaviors Of Obsessive-Compulsive Personality Disorder


The core feature of obsessive-compulsive personality disorder is fear of failure. Individuals with this disorder desperately attempt to avoid failure by being perfectionistic, over-workng, being inflexibile and avoiding risk taking. Unfortunately all these coping strategies backfire, and only increase the risk of failure.

    Fear Of Failure: The Core Feature Of Obsessive-Compulsive Personality Disorder

    • Perfectionism:
      In the past week, did your perfectionism prevent you from completing an important task?
    • Work-life imbalance:
      In the past week, were you a workaholic - i.e., your life was almost "all-work-and-no-play"?
    • Intimacy avoidance:
      In the past week, did you avoid close friendships or romantic relationships?
    • Inflexibility:
      In the past week, were most other people more flexible about changing things than you were?
    • Risk avoidance:
      In the past week, were most other people more willing to take risks than you were?

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Recent research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.

Setting Goals In Therapy

    Questions To Ask When Setting Goals

    In The Past Week:
    • WHO: was your problem?
    • EVENT: what did he/she do?
    • RESPONSE: how did you respond to that event?
    • OUTCOME: did your response help?
    • TRIGGER: what did you do that could have triggered this problem?
    • GOAL: what life skill(s) do you have to work on? (from checklist)

    Example Of Setting Goals In Interviewing A Person With Obsessive-Compulsive Personality Disorder

    In The Past Week:
    • WHO: was your problem?
      "My wife."

    • EVENT: what did he/she do?
      "My wife complained that I am spending too much time at work, and not enough time with her and our children."

    • RESPONSE: how did you respond to that event?
      "I told her that I have a big project at work, and that it is taking much more time to complete than I thought."

    • OUTCOME: did your response help?
      "No. My wife says that I've used this same excuse for as long as we've been married."

    • TRIGGER: what did you do that could have triggered this problem?
      "I want to make sure that I don't screw up on this project; so I'm rechecking everything I'm doing. But I'm procrastinating too much on finishing this project. I'm becoming paralyzed, and I now fear I'll never finish this project on time."

    • GOAL: what life skill(s) do you have to work on? (from checklist)
      "I want to work on: (1) Moderation ("Setting realistic goals; accepting “good enough” rather than demanding perfection"), and (2) Work-Life Balance ("Maintaining a proper balance between work and the rest of life")."

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