Obsessive-Compulsive Personality Disorder DSM-5 301.4 (F60.5)
DSM-5 Category: Personality Disorders
Introduction
The Diagnostic and Statistical Manual (5th ed., DSM-5, The American Psychiatric Association, 2013) defines personality disorders as an enduring pattern of experiences and behaviors that deviate significantly from the norms of the individual's culture, divided into Cluster A, Cluster B, and Cluster C disorders based on similar patterns of behavior. These differences must be pervasive, stable across time, and lead to distress or impairment. Evidence of this deviation is often apparent by adolescence or early adulthood, and persists across time (The American Psychiatric Association, 2013).
Obsessive-compulsive personality disorder is included in the Cluster C personality disorder category, and is hallmarked by a consistent pattern of perfectionism, preoccupation with orderliness, and a pervasive need for mental and interpersonal control. This need for control and sameness often leads to a loss of flexibility and efficiency (The American Psychiatric Association, 2013).
Symptoms of Obsessive-Compulsive Personality Disorder
Obsessive-compulsive personality disorder presents as a pattern of stubbornness and rigidity, and leads to a preoccupation with details, organization, schedules, lists, and rules, often to the extent that the original purpose of the task is forgotten, and often remains incomplete. The obsession with rules often overflows into inflexibility in matters of ethics and morality, much more so than can be accounted for by cultural or religious affiliation (The American Psychiatric Association, 2013).
Some forms of obsessive-compulsive personality disorder also present as obsession with work and productivity to the point of complete exclusion of leisure activities and interpersonal relationships. Individuals presenting in this manner will often refuse to delegate tasks unless others will follow the same methods of doing things, despite being overwhelmed by their workload. It is important to note that this “workaholic” mindset is considered normal in some cultures, and in those instances should not be diagnosed as obsessive-compulsive personality disorder (The American Psychiatric Association, 2013).
Additionally, individuals with obsessive-compulsive personality disorder demonstrate miserly spending habits, and are reluctant or unable to discard objects, even when they harbor no sentimental value, though these behaviors to differentiate from the symptoms of pathological hoarding (The American Psychiatric Association, 2013).
Diagnosis of Obsessive-Compulsive Personality Disorder
Obsessive-compulsive personality disorder is diagnosed via patient report of symptoms compared to the diagnostic criterion included in the DSM-5. Individuals who show at least half of the symptoms qualify for diagnosis, but patients often do not seek counseling or diagnosis until the symptoms begin to cause significant distress and impairment in daily functioning (The American Psychiatric Association, 2013).
Additionally, it is important to distinguish between obsessive-compulsive personality disorder, which involves pervasive behavior patterns, and obsessive-compulsive disorder, hallmarked by the presence of true obsessions and compulsions with fear of drastic outcomes if ignored (The American Psychiatric Association, 2013).
Co-morbidity of Obsessive-Compulsive Personality Disorder
Obsessive-compulsive personality disorder is often co-diagnosed with obsessive-compulsive disorder, as the core set of symptoms are shared. Obsessive-compulsive disorder is hallmarked by obsessive thoughts and compulsive actions, which are not seen in obsessive-compulsive personality disorder. If symptoms of both disorders are present, then they should both be coded for in diagnosis (The American Psychiatric Association, 2013).
The tendency for miserly spending and hoarding of items in obsessive-compulsive personality disorder often leads to a co-diagnosis of hoarding disorder. Similarly, some patterns of behavior found in obsessive-compulsive personality disorder are also seen in other personality disorders. It is important that clinicians carefully consider whether there is simply an overlap of symptoms or a need for comorbid diagnosis (The American Psychiatric Association, 2013).
Occasionally symptoms of obsessive-compulsive personality disorder may present as a result of medical disorders associated with the central nervous system, or substance use. It is important to consider these factors when deciding to diagnose obsessive-compulsive personality disorder (The American Psychiatric Association, 2013).
It is interesting to note that some studies have shown a link between obsessive-compulsive personality disorder and certain anxiety disorders, namely anorexia nervosa and hyperchondriasis, and Parkinson's disease, though further research is needed to fully understand the mechanisms leading to this link (Starcevic & Brakoulias, 2014).
Prevalence of Obsessive-Compulsive Personality Disorder
Obsessive-compulsive personality disorder is considered one of the most prevalent personality disorders and is estimated to affect between 2.1% and 7.9% of the general population. Due to the stubborn nature of the disorder, it is estimated that these prevalence rates may reflect significant under-reporting, as many individuals who would otherwise be diagnosed with obsessive-compulsive personality disorder do not seek treatment as long as self-management of symptoms is possible (The American Psychiatric Association, 2013).
Treatment of Obsessive-Compulsive Personality Disorder
Due to the stubborn and rigid nature of obsessive-compulsive personality disorder, attempts for long term change of personality characteristics are often futile. Instead, treatment should focus on the use of cognitive or behavioral therapies to identify sources of stress and to learn adequate coping skills (The American Psychiatric Association, 2013). Specifically, cognitive-behavioral and psychodynamic approaches in combination with social skills training appear to be the most effective forms of treatment (Simon, 2009).
One method of approach for teaching coping strategies to those diagnosed with obsessive-compulsive personality disorder is to focus on metacognition. By assisting patients in learning to identify the patterns of thought that trigger their stress, symptoms and interpersonal functioning can be significantly improved (Dimaggio et al., 2011).
In one study, it was noted that individuals with obsessive-compulsive personality disorder who experienced minor disruptions in the therapeutic relationship, experienced relapses in symptoms, and used the experiences to facilitate learning and change experienced greater improvement in symptoms than those who maintained continuous therapy without opportunities to practice their coping skills (Strauss, et al., 2006).
Currently, while it is not uncommon to prescribe antianxiety medications to cope with the inherant stress of obsessive-compulsive personality disorder, there is insufficient research regarding controlled studies of pharmacotherapy use for this disorder. Further studies should be done to determine whether medications are in fact an effective component of treatment (de Reus & Emmelkamp, 2012)
Outcomes for Obsessive-Compulsive Personality Disorder
Despite obsessive-compulsive personality disorder being considered one of the most prominent personality disorders diagnosed, there are an unknown number of individuals who are capable of living with this disorder without the need to seek treatment. Even for those who do seek psychiatric treatment to cope with the anxieties inherent with obsessive-compulsive personality disorder, the general consensus is that patients should expect to experience normal psychosocial functioning within the parameters of the disorder.
References
American Psychiatric Association, The (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
de Reus, R.J.M, & Emmelkamp, P.M.G. (2012). Obsessive-compulsive personality disorder: A review of the current empirical findings. Personality and Mental Health, 6(1), 1-21.
Dimaggio, G., Carcione, A., Salvatore, G., Nicolo, G., Sisto, A., & Semerari, A. (2011). Progressively promoting metacognition in a case of obsessive-compulsive personality disorder treated with metacognitive interpersonal therapy. Psychology and Psychotherapy-Theory Research and Practice, 84(1), 70-83.
Simon, W. (2009). Follow-up psychotherapy outcome of patients with dependent avoidant and obsessive-compulsive personality disorders: Meta-analytic review. International Journal of Psychiatry in Clinical Practice, 13(2), 153-165.
Starcevic, V., & Brakoulias, V. (2014). New diagnostic perspectives on obsessive-compulsive personality disorder and its links with other conditions. Current Opinion in Psychiatry, 27(1), 62-67.
Strauss, J.L., Hayes, A.M., Johnson, S.L., Newman, C.F., Brown, G.K., Barber, J.P., Laurenceau, J.P., & Beck, A.T. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidance and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2), 337-345.
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