OCPD - when everything has to be "just right"
Obsessive Compulsive Personality Disorder (OCPD) is the mental disorder of striving for too much success. Perfection is the ultimate goal of the OCPD person, and failure is seen as earth shattering. OCPD is the disorder that, on the outside, seems useful. A drive to succeed is very appealing, but OCPD pushes it past the line of success and into the realm of isolation, anxiety, and depression.
What is Obsessive Compulsive Personality?
A personality disorder is defined to be "...an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it" (APA, 2000). This means that the person's world perspective has, for the most part, always been skewed, with expectations that differ from the rest of his or her culture. Deeply-rooted and longstanding, the overly perfectionistic behaviors are sensible to the person with OCPD. Psychologists call this ego-syntonic, which means that the person with OCPD feels his disordered outlook is good and correct.
Personality disorders are divided into three different categories, called Clusters. Cluster A disorders are part of the schizophrenia spectrum (the "weird,") Cluster B disorders are marked by unstable behaviors (the "wild,") and Cluster C disorders are anxious or fearful (the "worried.") Avoidant, Dependent, and obsessive compulsive personality disorders fall under the "worried" category.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), commonly referred to as "the psychologist's Bible," describes all the identified mental disorders, including obsessive compulsive personality. For a diagnosis of OCPD, the person must fulfill at least 4 of the DSM criteria listed in the box below (APA, 2000).
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning in early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
- 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 over conscientious, 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
Description of Symptoms
As detailed, the person with OCPD is so occupied with striving to do a task properly that the person attempts to attain perfection. Such a person may impose all sorts of rules to maintain "efficiency," but instead only succeed in making the task more difficult (criterion 1 & 2). The person with OCPD puts work before personal relationships or leisure time (criterion 3), and draws a very strict line when it comes to moral or ethical issues (criterion 4). Hoarding with no traceable cause or sentiment was at one time thought to be a key symptom (criterion 5), however this criteria is under review and may be omitted in the next version of the DSM (Claiborne, 2009). The person with OCPD is very controlling, and has a feeling of superior competence comparing him or herself to others. He or she will entrust tasks to others only under extreme caution (criterion 6), and have strict instructions as to how they are to be carried out. The person with OCPD will save money and be stringent with it, as money is a fail-safe in case something unavoidably catastrophic occurs (criterion 7). General rigidity and stubbornness is not uncommon: the OCPD patient takes comfort in "the way it's always been done", does not favor change, and will only relent reluctantly in an argument (criterion 8).
Because it is a personality disorder, the person with OCPD is comfortable with their high standards and rigid mindset, seeing it as a virtue even though more often than not it hampers success. The person with OCPD will justify actions instead of admitting any sort of problem, because in the person's mind he or she is right.
History of Obsessive Compulsive Personality
Back in the early 1900s, Freud observed and treated patients with OCPD. From his findings, he noted, "persons with obsessive-compulsive personality disorder [OCPD] are characterized by the three 'peculiarities' of orderliness [which included cleanliness and conscientiousness], parsimony, and obstinacy." He also called it, "a neurosis connected with difficulties at the anal phase in psychosexual development," and made a distinction between Obsessive Compulsive Disorder (OCD), which he referred to as a "symptomatic neurosis" and OCPD, which he referred to as a "character neurosis" (Skodol & Gunderson, 2009). In 1918, Ernest Jones went on to describe someone afflicted with OCPD as being overly concerned with money, cleanliness, and time. The observations from these men were important at the time, because not much was known about this disorder. Literature begot the term "anal character," combining the character (personality) neurosis (anxiety), and, according to Freud, OCPD begins development in the anal phase of development (Skodal & Gunderson, 2009).
Obsessive Compulsive Personality Examples and Case Studies
The following is a summarized case study of a typical person with OCPD:
A 45-year-old lawyer seeking treatment. His wife was unhappy with their marriage, tired of his stubborn, perfectionist ways. In terms of his work, he was the youngest full partner in his firm's history, famous for handling many cases at the same time, would not turn down a new case, and was never satisfied with the quality of work performed. Once in therapy, the therapist learned more about the patient.
Few secretaries worked for him for very long because he was so critical of mistakes. He was never satisfied by the work done by his staff, to the point where he found himself constantly correcting their briefs and written documents. He could not cope with backed up assignments, because he did not know where to start. Instead, he made rigorous schedules and did not adhere to them, but not for lack of effort. He described his family in a very impersonal fashion, referring to his children as "mechanical dolls" and his wife as a "suitable mate." He had some affection for them, but it was overshadowed by his impersonal manner (APA, 2009).
In another case, a 15 year-old girl named Julianne was showing symptoms of OCPD in her schoolwork and social life. A screening with the patient showed that she was increasingly more focused on schoolwork as she progressed through school. She kept all of her old notes from previous years, "in case she needed them." She spent more and more of her time inside, working on homework, instead of interacting with her friends and family. She acknowledged that she was taking more and more time to work on assignments, but firmly believed that it was nothing to be concerned about.
In her mind, it was necessary. She spent weeks at a time working on assignments due weeks later, but not for lack of academic ability. She chose to study for a history exam weeks in advance instead of spending time with her visiting relatives. It became clear that if she were to settle for an assignment being "good enough," she would have done better in school and had more free time. That idea was out of the question to Julianne, because it would have meant that she had to lower her impossibly high standards (Franklin et al., 2007).
Impact of Obsessive Compulsive Personality
Prevalence of Obsessive Compulsive Personality
Obsessive-Compulsive Personality Disorder is seen in about 1% of the general population of the United States; however, it is seen in 3%-10% of psychiatric outpatients. It is almost twice as prevalent in males as females (McGlashan et al., 2005).
OCPD shares some of the same symptoms as obsessive-compulsive disorder (OCD), such as a general desire for order, but is a different disorder and as such should not be confused. OCD is an anxiety disorder (APA, 2000). OCPD is, as described above, a personality disorder. Most people with OCPD do not have OCD, and likewise most people with OCD do not have OCPD. The main difference is that someone with OCD is focused on particular distressing obsessions such as repeated hand-washing or abnormal fears of danger. Perfection for them is a sterile, danger-free environment. OCPD involves a more broad approach; a constant mindset of order and compulsion. The OCPD person is not distressed by his or her condition, whereas the OCD person is disturbed by his or her abnormal thoughts and actions.
Social Perceptions and Stereotypes of Obsessive Compulsive Personality
The number one misperception that the public has is confusing obsessive compulsive personality with the disorder OCD. Besides that, however, there is little to no confusion about OCPD. The public perception is that OCPD is tied to the word "neat freak," which, while incomplete, is often true.
People with OCPD usually have problems with social relationships, which can lead to clinical depression. They tend to focus on organization, perfection, or improvement over fun or social activities. They spend an excessive amount of time and energy planning an event, but are then unable to enjoy the actual event or spending the time with others, especially if it does not go as planned. This gives the appearance of a non-social person. Those with obsessive-compulsive personality disorder who do find long-term relationships may be demanding toward their partner and children, holding them to the same unrealistic standards they impose on themselves, as seen in the first case study (Williams, 2009).
OCPD is on the better end of the spectrum of mental disorders, however. An OCPD person can live a relatively normal life, and tend to be productive at work. They are less likely to engage in substance abuse, which is common to other mental disorders (Williams, 2009).
Treatment of Obsessive Compulsive Personality
Research on the treatment of OCPD has been more frequent in the past few years, but is still a relatively untouched area of psychology.
While therapeutic practices are constantly being revised, the methods held in psychodynamic therapy for a patient with OCPD have shown to be effective. The goals in psychodynamic therapy are to help the patient identify his or her feelings towards a situation. Encouraging him or her to stop and think about why a lack of control over a situation would be so worrisome is a common method, as well as helping the patient to accept his or her "humanness." The therapist reminds patients with OCPD that they are just as prone to error as anyone else, and a mistake is not as bad as they may believe. In fact, detailing a situation where excessive control can cause ignorance of intimate relations and inefficiency are very effective as well. The patient is usually very critical of his or herself, so modification of that harsh superego is also a high priority of this school of therapy (Gabbard & Newman, 2007).
The methods of cognitive therapy are another way to treat OCPD that has shown to be effective. The therapist listens to the OCPD patient while they express their concerns. The therapist has the patient realize the effect that their attempts to exert control have on their feelings. Extreme beliefs, like "I am a failure if I make a mistake," are only detrimental to the patient. The goals of therapy are to relieve this belief so the patient is not always so worried about errors (Gabbard & Newman, 2007).
Medication for OCPD
A side effect of OCPD is frequent anxiety or depression, but not usually to the point of a serious disorder. Medication like serotonin reuptake inhibitor (SSRI) antidepressants, such as Prozac, Zoloft, or Paxil, may help to reduce anxiety and depression. It is important to note that they do not cure OCPD, and are instead partial remedies that improve the person's ability to cope (Williams, 2009).
Obsessive Compulsive Personality Summary
The origins, manifestation, and treatment of Obsessive-Compulsive Personality Disorder are still relatively unknown. What we do know has been uncovered in the past decade, and it still provokes the question: What drives a person to excel? What can we learn from patients with OCPD? The fear of even a minor failure is cataclysmic in the eyes of the OCPD person, and they are often very successful in life, however uptight and insecure.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.-text revision). Washington, DC.
- American Psychiatric Association. (2009). Mental Disorders In Adults: Obsessive-Compulsive Personality Disorder. In Cases From DSM-IV-TR Casebook and Its Treatment Companion. American Psychiatric Publishing, Inc.
- Claiborn J. (2009). Hoarding: Where Does It Belong? Northeast Occupational Exchange Portland, Maine. OC Foundation. www.ocfoundation.org/hoarding/about-hoarding/hoarding-where-does-it-belo.... Accessed 05/13/2009.
- Franklin, ME, Piacentini, JC, and D'Olio, C. (2007). Obsessive-compulsive personality disorder: Developmental risk factors and clinical implications. In Personality disorders in childhood and adolescence. Eds A. Freeman and M.A. Reinecke, Wiley: Hoboken, NJ.
- Gabbard, G.O. and Newman, C.F. (2007). Psychotherapy of obsessive-compulsive personality disorder. In Oxford Textbook of Psychotherapy. Eds. Gabbard, G.O., Beck, J.S., Holmes, J. Oxford University Press.
- McGlashan TH, Grilo CM, Sanislow CA, Ralevski E, Morey LC, Gunderson JG, Skodol AE, Shea MT, Zanarini MC, Bender D, Stout RL, Yen S, Pagano M. (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. American Journal of Psychiatry, 162(5): 883-9.
- Skodol, A.E. and Gunderson, J.G. (2009). Personality Disorders, Chapter 20. In The American Psychiatric Publishing Textbook of Clinical Psychiatry, 5th Edition. Eds Hales, RE, Yudofsky, SC, Gabbard, GO. American Psychiatric Publishing, Inc.
- Williams, M.T. (2009). Obsessive-Compulsive Personality Disorder: When Everything Has to Be "Just Right." OCD Resource Center of Florida, www.ocdhope.com/oc-personality-disorder.php. Accessed 05/12/09.