Obsessive Compulsive Personality Disorder (OCPD)
The term “obsessive” describes the type of behavior. People with OCD are obsessed with their obsessions and compulsions.
They have difficulty changing or controlling these behaviors. Some people may not even realize they have them because they do not think about it all the time, but others are aware of them and feel guilty when they don’t perform certain actions or thoughts.
People with OCPD are often unable to stop doing something if they want to. They may not even realize that what they’re doing is wrong.
For example, some people with OCD might:
• Keep checking their phone constantly and then check it again later in the day while driving. • Avoid going into certain places because they keep thinking about how bad it would smell there or being late for work because of a thought that they will get fired from their job if they arrive too early.
• Have recurring thoughts about hurting themselves or someone else.
OCPD symptoms include:
• Having repetitive thoughts and feelings that cause you distress. • Fearing that you are going to hurt yourself or someone else.
• Being preoccupied with your worries and fears, taking unnecessary risks, and repeating the same activities over and over again until they become automatic. • Excessive worry about possible future consequences of your actions.
What Are the Different Types of OCD?
OCD has two main types of obsessions and compulsions:
1.Overt: With these, the person knows that the problem is created by their own behavior.
They might know that they’re taking too many risks and are afraid of certain things, but they feel trapped and can not stop doing them. 2. Covert: With these, the person does not recognize that their fears and thoughts are irrational, even though they might seem so. They may get angry when someone tries to point out that their fears are illogical or incorrect.
“Contamination” is a common obsession with people who have obsessive-compulsive disorder. They can fear that they have or will get sick because of the possible presence of certain substances such as blood or feces on objects or in places such as public bathrooms or kitchens.
As a result, they can be excessively concerned about sanitation and can feel compelled to wash their hands, wipe objects, or hoard supplies that can remove the possibility of a potential danger.
Rituals with this obsession are usually rigidly followed. For example, if someone knows that the “right” number of hand-washings is important for them, they will always wash their hands that same number of times, even if it takes a long time.
Other types of contamination fears include:
• Germs on objects (such as money) or in places (such as public bathrooms, kitchens, or medical facilities).
Washing can be used to ease these obsessions. People who suffer from this type of obsession may also avoid settings that include the feared object or location.
For example, someone with a nasal obsession might continually wash their hands and avoid public places to prevent the possibility of catching a cold from another person.
Some people who fear germs or contamination might also have problems with personal grooming. For example, a person might decide that they can not get dressed unless their room is perfectly clean and they can spend several hours cleaning before getting dressed.
Several factors can bring on obsessive thoughts. For example, some people begin to experience obsessive thoughts when their lives are in disarray.
This might be caused by external factors such as stress at work or school, the loss of a job or relationship, or even a major change in their lives.
Other people might have underlying obsessive tendencies that trigger the disorder. Biological, environmental, and genetic factors can all increase a person’s risk of experiencing obsessive-compulsive disorder.
How Common Is It?
It is difficult to determine how many people have obsessive-compulsive disorder because it can be hard to diagnose. In addition, some people might suffer from milder forms of the condition that cause mild distress but do not significantly impair their functioning.
Research suggests that between 2.3% and 5.2% of people in the United States experience this condition in their lifetime.
It is about three times more common in women than men and becomes more common with age. While most cases start in childhood or early adulthood, some people do not experience symptoms until their 40s or 50s.
What Causes It?
The cause of obsessive-compulsive disorder is not well understood. However, it is known that dysfunction in a part of the brain called the basal ganglia plays an important role.
In this disorder, certain areas of the brain that control reasoning, thought, and movement do not function properly. The part of the brain affected by this is called the basal ganglia.
This part of the brain can affect a person’s ability to perform certain tasks or actions. For example, if the part of the brain that causes someone to blink automatically does not work correctly, then a person might be unable to close their eyes. This would cause them to have blurry vision until the eyes are closed for several minutes.
There are several factors that might increase a person’s risk of experiencing obsessive-compulsive disorder. Some of these factors include:
Genetic factors: People who have a first degree relative with obsessive-compulsive disorder (a parent or sibling) have a slightly higher chance of developing the condition compared to people without close relatives with obsessive-compulsive disorder.
Chemical imbalances: Certain chemicals in the brain called neurotransmitters are responsible for sending messages between brain cells. There is some evidence that suggests that obsessive-compulsive disorder is caused by low levels of serotonin.
Early childhood trauma: There is some evidence that suggests that obsessive-compulsive disorder might be caused by early childhood trauma such as physical or sexual abuse.
What Are The Symptoms?
Symptoms of obsessive-compulsive disorder most often fall into four categories. These are:
Obsessions: These are unwanted and recurring thoughts, ideas, impulses, or images that seem impossible to prevent and are difficult to bring under conscious control. The content of the thoughts tends to be repugnant to the person experiencing them and are often related to issues of personal cleanliness or health, religious beliefs, or violence.
For example: A woman worried she might have AIDS and was obsessively concerned that she would pass it on to her children developed a compulsion to hang her infant over a toilet for long periods every time she fed him, just in case she dropped him. She also obsessively worried about hurting her children.
Examining her feelings of fear more closely, she recognized that the cause was a recurring thought that she would drop her baby on the toilet seat and that this would somehow infect him with AIDS through the tiny crack in the seat. This was so anxiety-provoking to her that she spent very little time with her son and developed a compulsive need to wash her hands every 15 or 20 minutes.
These thoughts seem uncontrollable and feel like they are forced into your mind.
Compulsions: These are behaviors or acts that a person engages in to try to counteract the obsessive thoughts. They typically involve a rigidly repetitive pattern of behavior.
Most often, these behaviors are done in an effort to prevent some dreaded event or situation. However, the compulsive acts generally fail to address the original concern and are usually invisible to others.
For example: A person who was worried that they would go insane and kill their infant son developed a need to walk up and down the street with him in his stroller for several hours at a time. This helped to calm her down but she mainly did it because she felt it prevented insanity and protected her son.
Anxiety: People with obsessive-compulsive disorder generally experience high levels of anxiety and an excessive or unrealistic sense of responsibility.
For example: A woman whose thoughts constantly focused on the idea that her infant son might choke to death became anxious whenever she put him down or left his side. She developed a compulsive need to keep him with her at all times, even sleeping with her and her husband in the same bed.
Anxiety is also often accompanied by depression, sleep disturbances, and problems with concentration. Physical symptoms may also be present due to the stress of dealing with obsessive-compulsive disorder.
Other characteristics: The effects of obsessive-compulsive disorder can have a significant negative impact on a person’s social and professional life, especially if the condition goes untreated or if the wrong treatment is received.
For example: A teenager with obsessive-compulsive disorder may become withdrawn and fail to form relationships with family members or friends. He or she might engage in excessive rituals or compulsions before going to school or before other activities, such as sports practice, that would keep them from being able to comply with the rigid rules of compulsions.
This may lead to academic problems and non-attendance at social functions.
A person who has the condition and is employed full time may also find it difficult to manage their symptoms and still perform their job effectively. They may become preoccupied with details that do not require their attention, while neglecting other matters that are essential to their work.
Infidelity: In some cases, obsessive-compulsive disorder may lead indirectly to marital problems.
For example: A husband or wife may be subjected to extensive questioning by the obsessive partner or need to constantly reassure them of their love. They may be repeatedly asked for intrusive details about where they have been or what they were doing.
This behavior may be so excessive that it causes the non-obsessive partner to seek intimacy outside of the relationship. A person with obsessive-compulsive disorder is not likely to engage in extramarital affairs, but is more likely to be suspicious or guarded about their partner’s potential infidelity.
When Obsessive-Compulsive Disorder Occurs: People who suffer from obsessive-compulsive disorder often experience symptoms during their childhood years. The age at which a person develops obsessive-compulsive disorder may vary, but the condition is typically first noticed in the early teenage years or during early adulthood.
Other mental health disorders that may accompany obsessive-compulsive disorder include depression, anxiety, and other types of personality disorders. These conditions make treatment more complex and may require additional medication to address them specifically.
Treatment: Obsessive-compulsive disorder can be managed effectively with the assistance of a psychiatrist or psychologist. A combination of medication and psychotherapy is typically used to treat the condition.
Medications: There are various types of medication that a doctor may prescribe for obsessive-compulsive disorder. Types of medication that may be used as treatment for the condition include:
SSRI antidepressant medications to help reduce the severity of obsessive thoughts. These medications may also help to decrease depression that may be present.
Antipsychotic drugs that work to lessen anxiety and/or depression.
Anti-anxiety drugs to help control the physical symptoms of anxiety, such as restlessness, muscle tension, and problems with sleep.
In some cases, your doctor may decide that medication is not appropriate for you and may instead suggest psychotherapy as the primary treatment method. There are various types of psychotherapy that may be used to treat obsessive-compulsive disorder, including:
Cognitive behavioral therapy (CBT) that works by changing the way a person thinks and responds to particular situations.
Exposure response prevention therapy that involves gradually exposing yourself to whatever it is that you fear, but not allowing yourself to engage in your usual compulsive behavior.
Self Help: Since obsessive-compulsive disorder is a condition that may significantly impact an individual’s life, many people who suffer from the condition find it beneficial to seek help or support from outside sources.
Support groups provide a safe environment in which individuals can share their experiences with one another.
Online support forums provide people who suffer from obsessive-compulsive disorder with an opportunity to connect with others who may be experiencing similar issues or challenges in their lives. Many of these groups are moderated by health care professionals who help to create a safe space for people to discuss their problems and concerns.
It is also important to keep in mind that obsessive-compulsive disorder is considered to be a chronic mental illness. As such, it is possible that you may continue to experience symptoms even when you are engaged in treatment.
This does not mean that you are not making progress or that the treatment is not working for you. It simply means that you may need to continue receiving treatment on an ongoing basis in order to manage your condition effectively.
Obsessive-Compulsive Disorder: Specific Treatment Approach
The specific treatment approach that is recommended for obsessive-compulsive disorder will be determined by your personal symptoms and diagnosis.
If a specific cause can be identified, it may be treated with the removal of the cause. For example, if a spinal tap triggered your symptoms, a doctor may perform another spinal tap in a better place, or prescribe medicine to reduce pressure on the brain.
If your obsessive-compulsive disorder is triggered by a medical condition, your doctor will treat that condition.
For example, if you have urinary tract infections that cause you to feel like you might infect someone, your doctor will try to prevent those infections from recurring.
In some cases, medication may be needed if other causes are not found. Antidepressants are the most commonly prescribed medicines for obsessive-compulsive disorder.
Your doctor may also refer you to a psychiatrist or psychologist who can develop an individual treatment approach that is specific to you.
The primary goals of the treatment are to reduce the symptoms, prevent complications, and help your body heal. Treatment options may include:
You may be referred to a psychiatrist or neurologist for medication, especially if your obsessive-compulsive disorder is severe. Some types of medication used to treat obsessive-compulsive disorder are:
Antidepressants. These drugs affect the levels of neurotransmitters in the brain.
They have been found effective in treating obsessive-compulsive disorder, but they take 4 to 6 weeks before their effects are noticeable.
Atypical antipsychotics. These drugs are also used to treat schizophrenia and bipolar disorder.
They help reduce obsessive thoughts by changing the level of chemicals in the brain.
Benzodiazepines. These drugs are used to treat anxiety and may help you sleep.
They can have harmful side effects, like dependence and addiction. Taking benzodiazepines long-term can also increase your risk of developing Alzheimer’s disease.
Whether your medication is in tablet or liquid form, you should take it exactly how your doctor prescribes. Do not forget to take your medicine, and do not take more than directed.
Most often, your obsessive-compulsive disorder treatment starts with a low dose and increases slowly until it reaches an effective level. This process may take several weeks or months.
Your symptoms may get worse before they get better. This is normal and should lessen as time passes.
Your doctor may also give you an injection of a medicine that can slow the progress of the disease (progressive myoclonic epilepsy). It may also reduce your risk of seizures.
Stopping or changing medicines should be done only under medical supervision. Your doctor will help you slowly reduce the amount of medication you are taking so you don’t have any withdrawal effects.
If you have questions about your medicine, do not stop taking it without asking your doctor or pharmacist first.
If the above medicines are found ineffective, your doctor may also suggest you take steroids. They can reduce or eliminate the amount of spasms in the brain, thus reducing your symptoms and the impact on your daily life.
Treating Co-Occurring Disorders
It is important to treat any other disorders you might have at the same time. For instance, many people with obsessive-compulsive disorder also have anxiety or depression.
Both of these conditions can make your obsessive-compulsive disorder worse, and treating them can help reduce the symptoms as well. If you have these conditions, your doctor will work with you to find the best treatment plan for all of them.
Not everyone responds to the same treatment. Your doctor may try several different medicines and dosages before you find the one that works best for you.
And, if one medicine stops working, your doctor may switch you to another.
In some cases, surgery might be an option. However, this surgery is much riskier than other types of surgery because of the effects of anesthesia on the brain.
Your doctor may also recommend a different treatment entirely. If your condition is affecting your ability to work, for example, your doctor might suggest a plan to manage your condition so you can keep your job.
Your doctor may also refer you to a psychiatrist or other therapist.
Sources & references used in this article:
The relation among perfectionism, obsessive‐compulsive personality disorder and obsessive‐compulsive disorder in individuals with eating disorders by S Vaknin – Posted on the Internet, March, 2007
Capacity to delay reward differentiates obsessive-compulsive disorder and obsessive-compulsive personality disorder by KA Halmi, F Tozzi, LM Thornton, S Crow… – … of Eating Disorders, 2005 – Wiley Online Library
Relationship between obsessive-compulsive personality disorder and obsessive-compulsive disorder by A Pinto, JE Steinglass, AL Greene, EU Weber… – Biological …, 2014 – Elsevier