Obsessive-compulsive personality disorder
We recognise that the system of personality disorder diagnosis can be considered controversial. It is completely your choice which term, if any, you want to use, knowing that your doctor or care team may use another.
We appreciate that the feelings and behaviours associated with personality disorders are very difficult to live with, and everyone deserves understanding and support. We recognise the diversity in understanding of experiences and preferences around terms individuals may wish to use. We are also aware that some professionals disagree with the system of personality disorder diagnosis, and that some people given the diagnosis find it unhelpful and stigmatising.
The terms used on Counselling Directory are those that are generally used in the UK, currently. We refer to these terms throughout, with the hope of reaching and supporting as many people as possible.
Many of us will exhibit perfectionist traits and the need for things to be clean and orderly, but for some people this perfectionism becomes a preoccupation. They will be so overly focused on orderliness and rigidly adhering to certain rules, rituals and systems that they will struggle to lead happy and fulfilling lives. Their relationships will suffer, and so will their health and well-being. Living in such a controlled and inflexible way can cause significant distress.
Individuals with these traits are typically diagnosed with a type of personality disorder known as obsessive-compulsive personality disorder (OCPD). Not to be confused with OCD (obsessive-compulsive disorder) OCPD is an enduring pattern of inner behaviour and experience that has no specific cause and can be difficult to treat. Nevertheless, many people with OCPD respond well to counselling which is a common treatment for this disorder.
This page will look closely at OCPD, exploring the symptoms, causes and how counselling can help sufferers to gain a sense of control over the condition and ultimately their lives.
What is obsessive-compulsive personality disorder?
Obsessive-compulsive personality disorder is a condition where people get so caught up in rituals, routines and their preoccupation with orderliness and control that they compromise their flexibility, openness and efficiency. The condition - which is more common in men - is pervasive across a wide range of social and personal situations but sufferers are usually not aware that their thought processes are problematic. People with OCPD strongly believe that their way of thinking and doing things is the right way, and that everyone else is wrong.
Living with OCPD
The excessive need to be meticulous and do everything to perfection often means people with OCPD are constantly on edge - worried that something may go wrong. They are prone to becoming upset or angry if they feel unable to maintain control of their physical or interpersonal surroundings, and when expressing this frustration they tend to do so with righteous indignation or in a passive aggressive manner.
Another key characteristic of OCPD is a strong devotion to work and productivity, and a preoccupation with logic and intellect. Sufferers are highly conscientious and ambitious, yet in the quest for perfection can be unproductive and inefficient. Decision-making is particularly hard for them - they have difficulty prioritising tasks and working out the best way of doing each one - and subsequently may never make a start on anything. People with OCPD will also struggle to adapt to new situations and will be resistant to change.
In terms of social interaction, people with OCPD tend to have very serious and formal relationships. During conversation they carefully hold back and speak only when they are sure what they want to say is perfect, and in terms of emotions can be quite guarded. Generally they will only express affection in a highly controlled manner. As their disorder makes them unable to consider others as equally competent, people with OCPD are unable to delegate, trust others, compromise and share responsibilities. They are also rarely generous with their time and money and feel uncomfortable in the presence of those who are emotionally expressive.
History of obsessive-compulsive disorder
It is understood that leading psychoanalyst Sigmund Freud observed and treated patients with obsessive-compulsive disorder in the early 1900s. In his written works he noted distinct peculiarities of orderliness: cleanliness and conscientiousness, parsimony and obstinacy. He also made a clear distinction between OCD and OCDP, and that the latter is a character neurosis rather than a symptomatic one. These were important observations at the time as very little was known about obsessive-compulsive personality disorder.
What is the difference between OCPD and OCD?
Although they share similarities, obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) have stark differences - most notably that OCPD is a far more complex preoccupation with perfectionism, which impacts several areas of a person's life. The other key differences between the two conditions are explored below:
- OCD is an illness with symptoms that tend to change in severity over time. OCPD however is an enduring rigid personality style, which lasts a lifetime.
- The obsessions and compulsions that characterise OCD are not associated with OCPD. Although sufferers of both conditions exhibit repetitive behaviours, the underlying motives are different. For example, while OCD sufferers may clean and tidy excessively to keep a catastrophe from taking place, people with OCPD will be more likely to do these activities to increase their productivity.
- People with OCD realise they have a problem and are likely to seek help to get their symptoms under control. However OCPD sufferers are often unaware that their behaviour is unhealthy and instead assume that other people are the problem. They believe that if everyone adhered to their strict rules everything would be fine.
- In contrast to those with OCD, OCPD sufferers have rigid views on right and wrong, and this rigidity may extend to other habits such as spending.
Usually it is family members and friends of individuals with OCPD who recognise there may be a psychological problem behind their obsession with perfectionism and orderliness. Below is a list of the most distinct obsessive-compulsive disorder symptoms that may cause concern:
- Excessive devotion to work that interferes with social and family activities.
- Preoccupation with details, lists and schedules.
- Difficulty expressing emotion.
- Lack of generosity and unexplained frugality.
- Rigid following of moral and ethical codes.
- Hoarding of worn out, worthless objects.
- An overwhelming need to be punctual.
- A sense of righteousness about how things 'should' be done.
- Stiff, formal, rigid mannerisms.
- Perfectionism that interferes with the completion of tasks.
- Reluctancy to work in teams or delegate.
- Miserly spending style.
Other symptoms people with OCPD may have include:
- Sense of entitlement.
- Passive aggressive behaviour.
- Objectification of others.
- Tunnel vision.
Someone with OCPD does not have to have all of these symptoms to have a personality disorder. There is a specific diagnostic criterion that health professionals will use to diagnose obsessive-compulsive disorder symptoms and this can be found in the American Psychiatric Association's Diagnostic and Statistics Manual (DSM). OCPD is defined as a cluster C (anxious or fearful) personality disorder and the patient must have at least four or more of the distinct OCPD symptoms in order to be diagnosed.
Causes of obsessive-compulsive personality disorder
As with many personality disorders, the causes of obsessive-compulsive personality disorder are unknown. There are however many theories highlighting various risk factors that may contribute to its development.
A number of experts support the biopsyhcosocial model of causation, which means OCPD is likely to be the result of biological and genetic factors combined with social elements (i.e. how a child interacts in their early environment and learns coping skills to help them deal with stress). Evidence shows that obsessive-compulsive personality disorder runs in families which supports the genetic link, although environmental factors may also add to a person's chances of developing the condition.
In particular, the nature of a child's upbringing and the caregiving they receive is considered to play a vital role. A person with OCPD may have had overly controlling or distant parents and while growing up felt the need to be 'perfect' or overly obedient in order to win their affection. Alternatively, he or she with the condition may have been raised in a strict authoritarian environment, such as a religious group, where rigid adherence to rules and regulations was commonplace.
Getting help for OCPD
In the majority of cases, obsessive-compulsive personality disorder is unlikely to be the reason why people with the condition seek help. Often it tends to be the result of other problems in their life, such as stress, work, and relationship problems which on top of their disorder is making their lives incredibly difficult. Up until this point, many people with OCPD are completely unaware of the discomfort that his or her behaviour and rigidity is causing themselves and those around them.
Making an appointment with the doctor is the first important step to seeking help for obsessive-compulsive personality disorder. Here assessments will be carried out to identify symptoms and distinguish between OCD. A doctor also needs to rule out any medical conditions or other personality disorders which may mimic OCPD. Ultimately however, the health professional will be looking for signs that a person's behaviours and thought patterns are so severe that they are causing significant impairment to an individual's interpersonal and occupational functioning.
As with most personality disorders, counselling and psychotherapy tends to be the most effective treatment for OCPD, although therapists will need to ensure their techniques are accurately tailored to every aspect of a sufferer's cognitive schema - in particular their rigid view of the world and others. Medication is also offered to help individuals with their rigidity and compulsiveness, but this symptom control tends to be more effective when used in combination with psychotherapy.
Aims of psychotherapy
Counsellors specialising in treating individuals with OCPD will be aware that their client will need to feel in control of the situation so their therapeutic methods will probably need to be approved. There is also the difficulty of trying to earn their client's trust, but therapists will ensure that any new and changing information is carefully incorporated into therapy so that clients can adjust gradually. Furthermore, therapists need to ensure their client feels comfortable enough to open up and share their thoughts and feelings. OCPD sufferers struggle to express emotions, so techniques will be used to help them examine and identify their feeling states at their own pace.
The most common approach used in obsessive-compulsive disorder treatment is cognitive behavioural therapy. This is used to help individuals with a wide range of psychological disorders and is designed to alter a person's way of thinking by challenging automatic and unhealthy interpretations of the world and themselves. These interpretations tend to be driven by core beliefs established during childhood, and therapists will aim to replace them with healthier and more accurate ones. In the majority of OCPD cases, clients find CBT valuable for understanding the emotional issues that underly their controlling behaviours and unhealthy thought patterns.
Psychodynamic therapy is used to help people with OCPD identify feelings towards a situation and then stop and think about why they fear not having a sense of control. Therapists will help the client to accept their humanity - focusing on the idea that they are just as prone to error as anyone else and that making mistakes is natural. In some cases therapists may also use the angle of encouraging clients to recognise how their excessive control and need for perfectionism can be to the detriment of their relationships and efficiency. A fundamental aspect of psychodynamic therapy is to modify a harsh and critical sense of self to soften a client's need to outperform and control every situation.
What should I be looking for in a counsellor or psychotherapist?
Whilst there are currently no official regulations in place that stipulate what level of training and experience a counsellor needs to treat obsessive-compulsive personality disorder, we do recommend that you check your therapist is experienced in the area for which you are seeking help.
The NHS recommends psychotherapy as a form of treatment for personality disorders.
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