Obsessive Compulsive Personality Disorder: Don't Break the Rules!

Rigid adherence to rules and regulations and an overwhelming need for order and personal control are the primary characteristics of obsessive compulsive personality disorder. People living with OCPD are inflexible, perfectionists and unwilling to yield responsibilities to others.

The term obsessive compulsive personality disorder implies a relationship with obsessive compulsive disorder. Some personality disorders are considered to be less severe versions of a particular mental disorder. Schizotypal personality disorder, for instance, is considered to be a mild form of schizophrenia.

While OCD and OCPD share some symptoms, the two disorders are unrelated. Obsessive compulsive personality disorder has certain important differences from OCD. People with obsessive compulsive disorder are often aware that their obsessions are abnormal, but are compelled to perform them anyway. People with obsessive compulsive personality disorder, however, believe their need for strict order and rules is perfectly normal.

 

Obsessive compulsive disorder often interferes with the OCD sufferer's success in social and work environments. While people with obsessive compulsive personality disorder certainly have difficulties with social relationships, they usually tend to perform well in work environments.

Five percent of OCD cases show evidence of comorbid personality disorder (a personality disorder that occurs along with OCD). Interestingly, obsessive compulsive personality disorder is not the most commonly comorbid personality disorder found with OCD. Avoidant and dependant personality disorders are much more commonly associated with OCD.

OCPD symptoms tend to appear early in adulthood and are defined by inflexibility, close adherence to rules, anxiety when rules are transgressed, and unrealistic perfectionism. A person with obsessive compulsive personality disorder exhibits several of the following symptoms:

Men appear to be more susceptible to OCPD than women. A possible genetic cause has been suggested, as OCPD often runs in families. Family dynamics and parenting styles may also explain the frequency of the disorder in some families. One theory suggests that as children, people with obsessive compulsive personality disorder were consistently punished for negative behavior, failure, and rule-breaking, while receiving no praise for success and compliance. To avoid punishment, the child develops a habit of rigidly following rules that lasts into adulthood.

Obsessive compulsive personality disorder, on the surface at least, often leads to success in work environments. People with OCPD require routine and need to know where they stand in the social hierarchy, and nowhere is that hierarchy more obvious than in the workplace.

People with obsessive compulsive personality disorder are deferential and polite to those in authority, whether that person is a police officer or their work supervisor. This characteristic, coupled with their compliance with rules and tendency to devote themselves to their careers often earns OCPD workers the praise of their supervisors. To those seen as beneath them on the social or work hierarchy, however, people with OCPD can give harsh criticism and seem to exhibitself-righteousness.

When OCPD creates problems in the workplace, it is often due to two causes. First off, perfectionism and a need to repetitively check minor details for errors can prevent OCPD employees from finishing projects by their deadlines. Secondly, an insistence on observing even the most insignificant regulations, the need to micromanage projects, and obvious criticism and contempt for subordinates, can lead to conflict with, and alienation from, fellow employees.

At home, the obsessive compulsive spouse and parent are often domineering and rude, usually as he or she attempts to hold family members accountable for conforming to rules and unrealistic expectations. Financially, the OCPD individual tends to be thrifty to the point of miserliness, hoarding money for some imagined future catastrophe. This can create financial arguments in the family, in addition to constant conflicts over personal control and independence.

From the descriptions given above, one might think that the obsessive compulsive personality disorder individual was entirely in agreement with inflexible compliance about rules and regulations. Evidence suggests, however, that OCPD patients subconsciously want to break free from and rebel against rules and conformity, but their intense fear of social reprisals, punishment, and ridicule is too great. Instead, people with OCPD adopt rigid adherence to rules to avoid punishment, even as their subconscious minds rebel against such restrictions.

The conflict between outer conformity and subconscious rebellion is rarely recognized by people with OCPD, and can manifest itself as psycho-physiological conditions, including stress-induced muscle tension, anxiety, and impotence. These unsettling conditions are sometimes the reason the obsessive compulsive personality disorder sufferer initially seeks treatment.

 

People with obsessive compulsive personality disorder are also susceptible to major depressive episodes, due to stress, tension, and social rejection (people often become frustrated with the OCPD sufferer's obsession with rules and behavior). The natural physical and cognitive limitations that come with aging are difficult for the OCPD sufferer to handle, and can also trigger depression.

OCPD is diagnosed based on symptoms and personal history. As other medical conditions can mimic obsessive compulsive personality disorder, it is imperative to rule out other causes, including:

Overall prognosis for obsessive compulsive personality disorder is better than for many other personality disorders. The deference to authority and rigid self-control of OCPD patients can help during therapy, as they are less likely to abuse medication or cease treatment. Therapists need to bear in mind the hidden rebelliousness of obsessive compulsive personality disorder may lead to a subconscious rejection of treatment, even as the conscious mind accepts it.

SSRIs, or selective serotonin reuptake inhibitors, may help reduce compulsive behavior in obsessive compulsive personality disorder, and may also be used to treat depression caused by OCPD.

Long-term psychotherapy is the primary treatment for obsessive compulsive personality disorder. Combinations of medication and therapy may be more effective than psychotherapy alone. Cognitive-behavioral therapy is often used, with an emphasis on learning to accept change, uncertainty, and lack of control over certain events.

Ideally treatment helps the patient make a transition from obsessive compulsive personality disorder to a conscientious personality type (a non-clinical personality type that closely resembles OCPD). Like obsessive compulsive personality disorder, the conscientious personality type values hard work, thrift, strong moral values and attention to detail. However, the conscientious personality type is more flexible, less rigid, and better able to function than obsessive compulsive personality disorder.

While individual talk therapy can be beneficial for obsessive compulsive personality disorder, group and family therapy is more problematic. The OCPD patient will attempt to identify his or herself with the authority figure (the therapist), much as the patient would act towards social or work superiors. In doing so, the obsessive compulsive personality disorder patient distances himself from other group members. He or she may treat them with the contempt and harsh criticism reserved for subordinates and the therapy will be of little benefit.

Resources

American Psychiatric Association. Diagnostic criteria for 301.4: Obsessive-compulsive personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. American Psychiatric Association, Washington, DC, 2000.

Ekleberry, S. (2000). Dual diagnosis and the obsessive-compulsive personality disorder.

Long, P. (nd). Obsessive-compulsive personality disorder.

Mayo Foundation for Medical Education and Research (MFMER). (2004, November 23). Personality disorders: Signs and symptoms [DS00562].

National Institute of Mental Health. (2001, January). Borderline personality disorder: Raising questions, finding answers [NIH Publication No. 01-4928].

National Library of Mental Health. (updated 2003). Obsessive-compulsive personality disorder. MedlinePlus Medical Encyclopedia.