Obsessive Compulsive Personality Disorder

The cardinal feature of this personality disorder is an exaggerated & pervasive attempt to:
(a) Control their closed ones.
(b) Control their own thoughts & emotions.

•They lack internal sense of security.
•They are inflexible & Stubborn.

Epidemiology:

👉1% in general population.
👉10% in psychiatric patients.
👉Males>Females.

⭐⭐Some obsessive compulsive traits are sanctioned in some cultures, So a personality disorder should not be diagnosed unless the traits are markedly beyond the average for the culture.

Aetiology:

1. Biological factors & learning seem to be involved in the aetiology of obsessive compulsive personality disorder

2. Personality may be partly inherited.

3. Theories for the development of obsessive compulsive personality disorder:

🅰️ Early Psychodynamic Theories: linked obsessive compulsive personality disorder to anal phase of psychosexual development (2-4yrs of age), when libidinal drives come into conflicts with parental attempts to socialize the child, especially in sphincter control & toilet training.

🅱️ Later Psychoanalytic Theories: emphasized earlier manifestations of child’s autonomy versus parental wishes.
The expression of drives & emotions including anger is shaped by parental response and may evoke shame & criticism.

4. Developmental Factors:
Obsessive compulsive personality disorder is seen more commonly in societies in which:
(a) Open expression of emotions is discouraged
(b) Individual emotions are subordinated to the group .

Clinical Features:

ICD-10 Criteria: Anankastic personality disorder(F60.5)

1. Feelings of excessive doubt & caution.

2. Preoccupation with details, rules, lists order, organization or schedule.

3. Perfectionism that interferes with task completion.

4. Excessive conscientiousness (wish to do one’s job well & thoroughly), scrupulousness (strict attention to minute details) & undue preoccupation with productivity to the exclusion of pleasure & interpersonal relationships.

5. Excessive pedantry (excessive concern with minor details) & adherence to social conversations (traditional way of doing things.)

6. Rigidity & stubbornness.


7. Unreasonable insistence that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things.

8. Intrusion of insistent & unwelcome thoughts or impulses.

Course:

In past it was thought that most obsessive compulsive personality disorders evolve to full obsessive compulsive disorder. But recent researches indicate that most obsessive compulsive disorder patients do not have a comorbid obsessive compulsive personality disorder.

Comorbitity:

👉Depression (Late onset depression is a common occurence.)
👉Anxiety disorder
👉Somatofrom disorder
👉Obsessive compulsive disorder
👉Hypochondriasis

⭐⭐They do well in jobs that demand working with details, order & structured procedures.

Differential Diagnosis:

👉Obsessive compulsive disorder:

Diagnosis of OCD is made when occupational & personal functioning is severely impaired.

•In many cases of obsessive compulsive personality disorder, the behaviours are ego syntonic.

👉Narcissistic personality disorder.

👉Schizoid personality disorder.

⭐⭐⭐Not all individuals with obsessive traits have obsessive compulsive personality disorder. Obsessive traits can be adaptive in some situations, it is only when they are maladaptive, inflexible & persistently cause functional impairment that a obsessive compulsive personality disorder is diagnosed.

Treatment:

👉For anxiety & distress due to doubts & scruples:
•Antidepressants
•Benzodiazepines
👉Psychological cognitive treatment.

Reference:

  • New Oxford Textbook of Psychiatry(2nd edition).
  • ICD-10 Classification of Mental and Behavioural Disorders.

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