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Thursday, March 08, 2007

OCD versus OCPD

Obsessive-Compulsive Disorder versus
Obsessive-Compulsive Personality Disorder

I, for one, feel uncomfortable walking anywhere, except sometimes on the beach, without slippers. Or shoes. Or sandals. You know what I mean. And I really like socks on the inside of these foot coverings, too. If at all possible.

Does that make me O-C?

When I posted on bi-polar disorder I told you that none of the disorders are romantic. You don't WANT these disorders. No matter what you see on television or in the movies, having a real diagnosable mental disorder is a serious drag.

No question we like our symptoms, and many of you may even claim you're "married" to a symptom, say, depression. But what you really mean is that you like that nice little lull you get when your attention focuses inward and your body says, Stop. Oh why on earth would you want to treat that? (I can think of a few reasons, actually)

ALL of us have suffered from the symptoms of multiple mental or behavioral disorders. You know I don't use the word "ALL" all that lightly. But it's an "ALL." This one's an absolute. You can't live and not feel anxious. You can't live and not get depressed. Find me one person without an "addiction" of some kind.

These people are lying.

But to be diagnosed with a disorder is a whole other level of dis-order. It means that you have a cluster of symptoms that meet a cluster determined by real social scientists who have done research to find that indeed, symptoms cluster together and define recognizable syndromes, or disorders.

A list of symptom clusters helps therapydocs explain to people who don't believe in mental illness that if one has that particular cluster of symptoms, then that person has what we believe to be a particular mental disorder.

Even your grandfather, who doesn't believe in all this therapy nonsense gets it when he can read the symptoms on a list.

Now.

What's the difference between Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder?

The first, OCD, is an Axis I disorder, meaning the symptoms of the disorder can make the person who has them feel sick. The second, OCPD, is an Axis II disorder, a Personality Disorder, meaning the symptoms make EVERYONE ELSE sick, especially the people who live with the person who has the symptoms. But the symptom bearer can be relatively comfortable.  Not always.  Perhaps not usually.


Obsessive-Compulsive Disorder, 300.3, belongs to a family of anxiety disorders that are classified in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

Sufferers are sick with many of the following symptoms. This is almost straight out of the book. For a better explanation go to the library or Google OCD. The "bold" in the descriptions below is my attempt to get you to pay attention. If words are in bold then you should stop for a second, and think. Here are the symptoms of OCD. All of the categories, A through E, have to apply.

Obsessive-Compulsive Disorder

A) Either obsessions or compulsions:
Obsessions include:
1) recurrent and persistent thoughts, impulses, or images that are intrusive and cause marked anxiety and distress
2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
3) the person attempts to ignore, suppress, or neutralize them with some other thought or action
4) the person recognizes that they are a product of his or her own mind (not imposed from without as in thought insertion*)

Compulsions include:
1) repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2) the behaviors or mental acts are aimed at preventing or reducing the distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive.
B. At some point the individual recognizes that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.

C. The obsessions or compulsions cause marked distress, are time consuming (1 hour or more a day) or significantly interfere with normal routine, work, academics, social life or relationships.

D. If another Axis I disorder, the content of the obsessions or compulsions is not limited to that (i.e., preoccupation with drugs in the presence of substances, food for anorexics)

E. The disturbance is not due to the physiological effects of a substance or general medical condition.

That's a lot to remember, right? Now don't you have more respect for your therapists? They know (or should know) ALL of the DSM-IV-TR.

There's more to say on OCD, but let's move along to OCPD.

Obsessive-Compulsive Personality Disorder, 301.4

A pervasive (doesn't go away) pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by FOUR or more of the following:

1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

2) shows perfectionism that interferes with task completion (unable to complete a project because his or her own overly strict standards are not met)

3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)

4) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

5) is unable to discard worn-out or worthless objects even when they have no sentimental value

6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things

7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

8) shows rigidity and stubbornness

NOW

If you have either of these disorders you might consider getting therapy. Usually we see people with 300.3, the Axis I anxiety disorder in therapy because they're miserable.

Those of you with the Axis II disorder 301. 4 might be unhappy, and for sure your behavior is causing others more stress and discomfort than you realize. But you're not going to part with those moldy National Geographics form 1945 that are stacked up in the basement. You'll be yanked (against your will) into marriage or relationship therapy at some point or you'll lose the best thing you ever had. But you generally won't volunteer for it.

That's it for now. Any questions?

This obsessive blogging has GOT to stop, by the way, don't you agree?

*Thought insertion is a symptom of schizophrenia. One who suffers from this disorder actually hears a voice that does not exist that is inserting thoughts into his or her mind, i.e., the FBI is listening to this phone call, watch what you say.

Copyright 2007, TherapyDoc

30 comments:

J said...

Part C (and many of its DSM iterations) always seemed wishy-washy to me as in the long-term 1. these things can wax and wane vastly and 2. who decides when it's significant distress or interference (especially if a person either just gives into it finally and it becomes automatic or, otherwise, if it involves a heavy dose of avoidance which they knowingly/unknowingly build into their life)? Regarding who decides, either way it seems it could take a bigger toll than either a patient or therapist could readily see, esp. if the latter is only with you for 50 min/week. Eh, I was trying to be concise but think I'm just sounding confusing now.

Anyway, the hoarding thing doesn't seem quite right either.

But maybe I'm just being an...nevermind.

TherapyDoc said...

C. The obsessions or compulsions cause marked distress, are time consuming (1 hour or more a day) or significantly interfere with normal routine, work, academics, social life or relationships.

It's not hard at all. Remember, we're talking about an ANXIETY disorder. I, for one, can readily feel the anxiety of an anxiety disordered patient.

The 1 hour plus a day tends to be PLUS. The amount of time that anxiety eats up makes the diagnosis quite clear.

It is also very clear that the thoughts (obsessions) and/or behaviors (compulsions) characteristic of OCD do interfere with normal life.

Hoarding is characteristic of OCPD (remember, you only need 4 from the list). It stands out very clearly, as well, when you take a history.

You asked about "significance". The wonderful thing about the DSM is that research findings for each cluster of symptoms of a diagnosis have been repeated (are reliable) and have been validated (studies all study the same things). Findings are significant for 99% of a population, meaning the null hypothesis (a person is not sick) has been rejected for 99% of those individuals who have a particular cluster.

The DSM also tells us whether or not that population is morbid (meaning has been hospitalized for mental illness) or general.

My point was to clarify the huge difference between Axis I and Axis II disorders, and to relieve those of you who are forever concerned about diagnosis.

In fact, therapists treat symptoms REGARDLESS of an actual diagnosis.

They keep us in business.

Curiosity.Killer said...

I've been diagnosed with personality disorder years ago, and had no idea what it really meant until today. You described me to the T, and the dot, and the slash, and the...

Anyhow, my best friend is diagnosed Obsessive Compulsive Disorder -- and we got along fabulously.

At least that's what I thought -- until I read your post - and realized, she never even listened to me in the first place.

I just lost my original thought.

TherapyDoc said...

Don't judge her too harshly. It ain't easy being so programmed by emotion. Anxiety is much more than what used to be called "neurotic," meaning a variant of irrational. It can be irrational, no doubt, but it's very real and debilitating.

Get along anyway, I say. Friends are premium.

socialworker/frustrated mom said...

that was a great distinction I find it hard to tell the difference, great post. There is a fuzzy line some ppl have both and in real life it's hard to tell the diff even though by reading the dsm it seems much easier.

Curiosity.Killer said...

I was trying to be funny with that comment -- I meant I had no idea what it was like in her head. I was just sitting comfortably while everyone else are squirming -- and I didn't know why in the world they're so uncomfortable.

Anyhow, gotta say -- it was refreshing to have it all figured out. Thanks.

Paula said...

Hi,

Found your blog from Jew Eat Yet.

Your description of OCPD coincides with my father's behavior. Since he's had a stroke, it's actually worse.

It gives me comfort to know that my instincts were right.

TherapyDoc said...

Paula, it's always harder as people age and get sick. Personalities seem to get worse as people age, not better. In functional families members talk and work together, often around a sick parent. Not easy at all.

Grace said...

I could just cry after reading this-my husband is a text book example of OCPD and has driven me to the point of divorcing him. I've been in marriage counseling BY MYSELF for 6 months as he 'has no issues'. When it came time to go to an attorney and he learned of the COSTS, only then was he willing to go to counseling. I strongly suspect it's more for the fear of 'losing money' than opening himself up to psychotherapy.

His family has had a provincial way of looking at mental illness that sounds like something out of the Middle Ages-and it shows. One sister is quite ill but refuses therapy at all costs-despite the damages to her children.

Thank You.

ProphetessMarcia said...

Awesome article, I love the writing style lol I have OCD and it is true, I often seek help from the symptoms (I am a pure O). Yet, those with OCPD can remain unaware that their actions are bothersome of others or whatnot. I wish I could bother others from time to time and give myself a rest LOL

Anonymous said...

I need help, please! my wife is a perfect match for OCPD and I am very worried for she is forcing my 3 year old Son into her "rules" making him suffer a lot, also she has started to hit me and threaten me with knives. She of course things that I am totally responsible for our bad relationship and although in my ignorance I would accept it was 50-50 for I react to her compulsions and obsessions with being lees loving and caring, when a causing of her suggested she was a OCD person after we spent 15 days in his house I was shocked to read this article. How can I get her to take treatment when we went to therapy and she did not want to come back after the Dr. indicated our issue would resolve if she just "let go" PLEASE HELP ME!

therapydoc said...

Dear ANONYMOUS,
First of all, I don't give personal advice on the Internet. That isn't the purpose of this blog. But in general, if someone is threatening someone else, I tell them to involve law enforcement, for police have specially trained domestic violence teams.

I always tell people to try another therapist, too, if the first doesn't meet your expectations and needs.

The other option I suggest to people who are dealing with potential child endangerment is your state or country's protective services. In the United States each state has a Department of Child and Family Services with a protective services unit.

I'm sorry that I can't help you, personally.

couchpotatoteddy said...

Hi,

I was diagnosed with depression since July 2008 and have since been on 50mg of fluoxetine per day. However, I do feel like I am suffering from OCPD although my psychiatrist did not point it out. I am a little apprehensive if I were to tell my psychiatrist that I think I am suffering from OCPD. She may think that I am doubting her professionalism. Then again, I read that fluoxetine can alleviate depression and OCD symptoms. But I have yet to see much effect! Can someone out there help me?! As mentioned in the article, one diagnosed with OCPD makes people around him/her sick! I feel like I am invading my gf's privacy and I cannot help but think that she isn't being truthful to me. I recognise that the problem lies on me, but somehow I cannot control my emotions! I am a year two engineering undergraduate and my academic result has suffered as a result of this!

therapydoc said...

It's a tough thing to live with for you, too, and maybe I didn't stress that enough. For sure you should tell the doctor you're seeing your thoughts. It's likely the doc already made the diagnosis, but if not, a good professional trusts what the patient says about his/her feelings. If you don't know you, how can anyone else? Good luck and stay hopeful. You can manage it, if not all the time, then most of the time, and be very loveable in spite of it.

therapydoc said...

And you're loveable already, not to worry.

Anonymous said...

I have a boss that may have OCPD. They are overly concerned with order; have a hard time making important decisions because they are more concerned with the aesthetics and what others may think rather than the welfar of the staff; extremely miserly with spending money even when we are in desperate need of office supplies; they come across as a workaholic yet they come in late every day and claim they stay late at night to make up the time (yet, you had better not be late); they seem to be focuses on minute stuff instead of seeing the big picture and planning ahead; they are also very much in control of their parents and constantly making medical appointments for them as well as accompanying them to all their appointments; as for their own personal medical appointments, they like to go from one doctor to another and do not seem to be able to follow what any of them say; when anyone else in the office has a medical condition or if a family member has anything similar to their family member, yours is no where near as serious as theirs; there also appears to be a lack of empathy at times; also does not listen to suggestions of others (they may initially agree with what is presented then will totally go against them when push comes to shove). Does this sound like someone with OCPD or would you say they have another type of personality disorder or a combination of disorders? My co-workers and I are having a hard time dealing with this and everyone has been searching for another job or thinking about retirement. Our boss is basically a nice person, but not a very effective boss.

therapydoc said...

Maybe, but you don't have the right to complain. As my father-in-law, OBS, used to say, You pay the bills, you call the shots.

Anonymous said...

Hi all!

My name is Danae and I am the Administrator of an O.C.P.D. Support Forum. I simply would like to extend the offer to those suffering with O.C.P.D. to join our site.

Our link is: http://ocpd.forumotion.net

Hope to hear from you soon!

Danae

Anonymous said...

um...if you say that ALL people have a "behavioral disorder"...doesn't that make it not a disorder anymore? you're such a genius ha ha

therapydoc said...

Genius? Heaven help me. so not.

samartin said...

Therapydoc,

My fiance and I believe he has OCPD. It is seriously impeding his ability to complete papers and delegate work on partner assignments in law school. He has trouble throwing or giving away useless/duplicate items (we have two sets of furniture). He has the flexiblity and stubbornness issues that are also listed in your post. We live in the Chicago suburbs (Schaumburg), and would like to treat his problem. Do you know of a therapist (or a way to find one) that would be skilled in treating OCPD in our area? Thank you!

Lynda said...

Do NOT marry this man, 10 years from now you will be living a lonely life, pushing him away and he won't even figure it out because he is NEVER wrong, and according to him, what is wrong. My husband has OCPD, all the elements described except perhaps the excessive morals part. I can never do anything right, he hovers if I cook to ensure not one little spatter comes out of the pan, the rubbish is analysed long before the bin men come, our staff have a hell life having to meet his perfectionist standards, his office is an awful mess, boxes of papers from 10 years ago that he will sort out this weekend, for two years now he hasn't turned up for our annual holiday, too much work to do, and if he does come away with me for a weekend he's up all night the night before getting his work up to date and I pick him up at 6am on the way to the airport. But to him, there's nothing wrong. Today again he cut his own hair and it looks awful, the barber charges $10 - we're multi-millionaires! You will end up doing everything on your own, he will gradually stop doing anything with you.

Lynda said...

Do NOT marry this man, 10 years from now you will be living a lonely life, pushing him away and he won't even figure it out because he is NEVER wrong, and according to him, what is wrong. My husband has OCPD, all the elements described except perhaps the excessive morals part. I can never do anything right, he hovers if I cook to ensure not one little spatter comes out of the pan, the rubbish is analysed long before the bin men come, our staff have a hell life having to meet his perfectionist standards, his office is an awful mess, boxes of papers from 10 years ago that he will sort out this weekend, for two years now he hasn't turned up for our annual holiday, too much work to do, and if he does come away with me for a weekend he's up all night the night before getting his work up to date and I pick him up at 6am on the way to the airport. But to him, there's nothing wrong. Today again he cut his own hair and it looks awful, the barber charges $10 - we're multi-millionaires! You will end up doing everything on your own, he will gradually stop doing anything with you.

thecreativestudent said...

I have a hypothetical question: is it possible for general anxiety disoder or depression to cause OCD-like symptoms?

For example, hypothetically, could general anxiety disorder cause a sufferer to get a really strong desire to jump out a 5th floor window, not because they want to die, but because they can't get this thought out of their head that the cool air against their skin would feel nice as they fell, and doing it would make everything peaceful and nice? Hypothetically, this would be bad enough that they would have to force themselves to sit against the furthest wall and try to think about other things for over an hour, and happened many times.

Hypothetically, would it be possible for things like this to happen just because of general anxiety disorder?

Anonymous said...

I get what you're trying to say, but take issue a little with the impression you give that the person with OCPD feels fine about themselves. Maybe there are some who do, but speaking of my friend with OCPD; the terrible angst, depression, burden and stress she experienced from:

a) not being able to maintain jobs and personal relationships successfully and not really understanding why people reacted badly to her or how to fix it,

b) the burden of completing day to day tasks - cooking, cleaning, managing her physical health needs, becuase she did everyting the hardest way, due to her need to log and track everything and her perfectionism. It could take her hours to get out of the house in the morning because the list of things she needed to do was so cumbersome and she could not simplify it.

c) the burden of all the 'stuff' she had - keeping everything from all aspects of her life, so she couldn't track wheat from chaff in her home, and all the things she kept represented and endless list of unfinished projects that weighed her down.

d) the fact that she could not complete the activities that meant most to her in life - such as writing - though she was an excelent writer, she couldnt prioritise her time between writing and other unimportant tasks - so she never had time for what was important and perfectionism meant she would draft and redraft her writing and never be happy with the work and sometimes just not starting on it becuase of fear it would not live up to her own standards.

All this made her seem very self absorbed because her internal life was so overwhelmingly complex, but it was not a happy state.

Anonymous said...

Not every person with ocpd projects despair onto everybody close to them. although I have ocpd and relate to this, more quickly I will withdraw for fear of wronging somebody or the fear of how i will react to being wronged.

It can be (relatively) selfless too, in recent social gatherings if I have to energy to attend and I see some obnoxious act done to somebody I don't think deserved it - I will stew in hatred for the person and my lack of understanding for why they did that.

I see the irony, so I just shut up and make robot small talk while I try to process the minor event in some other way. Sometimes I reach a good conclusion and put the thought away, other times it's a black hole.
The stuff about being supercritical of others and double for the self seems true, but I'm still an intelligent person who learns about how to interact with people.

Maybe I can't give much hope to spouses considering a split, but I get caught for seeming fake and disinterested. For others as well, the flat-toned mild empathy in place of sincere vulnerability might be shield instead of a sword.

I guess, take to heart what those with experience have to say, but don't assume a cookie-cutter interpretation. Keep your hopes in check, but there has to be others similar to me who have more symptoms in the 'for' column of ocdp, but do not coincide with everything about the illness.

therapydoc said...

Thanks for that great insight, Anon. Of course OCPD has nothing to do with intelligence. If anything, the two might be positively correlated.

Anonymous said...

Just discussed with my dr symptoms I've had for a long time, that are really troublesome now.
House all cluttered, sink full of dirty dishes and I go clean out a closet or drawer. I have many Health problems but cant blame them for my mess.
Asked dr if I had something like OCD and after we discussed it he came up with OCPD.
Thankfully not as bad as some of these blogs. (my ex fits in perfect for OCD) could you imagine the 2 of us together???
happy to have sights like this to look up info.

ocpersonality said...

This is B & W thinking. I have OCPD and I drive myself crazy. Not others. Do schizoids drive others crazy just because it is a personality disorder?

I have to be perfect not others. They can be perfect as well if they want to be. It's their life.
I have to be on time.
I have to put extra effort on everything.
I have to be really really sick in order to take day off. If I can give at least something from myself I'm not really sick.
I can not complain about anything. I just suck it up.
I'm obedient. I have to be.


This is not OCD more like OCPD.

On top of that I have AvPD which is caused by OCPD. There is no way that I am going to have a partner because there is so much uncertainty these days. Think about divorce statistics or just simply making mistakes while searching th right one. I'm a loner.

Satya said...

I have a gf (had a gf) who I came to realize over time is suffering from a weird combination (as near as I can tell after spending many hrs researching her oftentimes disturbing patterns of behavior) of OCPD, passive/aggressive disorder, Borderline Personality Disorder and PTSD. Powerful, swirling, disruptive energy.

As I read many of the posts here, I found myself kind of freaked out. So many of the symptoms mentioned over and over again describe this woman's behavior. For example; not once during our ten month relationship did she claim responsibility for any of her disruptive, hurtful actions. I've found out through mutual friends that over her life, she's created a whole train wreck of relationships that ended badly, creating many enemies along the way. I do wish that someone in this group of friends had given me some insight, some warning about the nature of this woman, before I fell so deeply in love with her.

That brings up another thing. There were times when I was left wondering if this woman isn't a saint or buddha of some sort. I still wonder about that. Although, I'm realizing that this perception is more than likely the result of her putting on and using one of her many masks which she hides behind in her futile, exhaustive attempt to prevent others from seeing or discovering the fact that she's really suffering from her mental illness. It's very sad and there seems to be nothing I can do to help her.

I'm 61 and for most of my adult life I've suffered from manic depression (bipolar disorder) At any rate, as my relationship with this oftentimes supremely sweet woman went on, her odd, disruptive, nervous energy gradually became more than I could bear. Another thing, she became more and more controlling and manipulative toward me as time went on. Does this fit somewhere in the list of symptoms of OCPD, or some other mental health issue which I may not be aware of? It got to the point where I began to feel as if I were walking on broken glass. Not being able to do anything right in her eyes. This was especially painful to me, being a highly sensitive individual. Each energetic, psychic barb she threw at me was painful, confusing, difficult to bear. And she says she wasn't aware of consciously doing this nor of the harm it was causing me.

If I were a trained mental health professional and had the knowledge and energy to interact with her in an effective way that would allow both of us to maintain our separate spaces, yet still carry on a loving relationship, we might still be together. But I don't have that knowledge nor capability.