Index

Obsessive-Compulsive Personality Disorder (OCPD)
What it is and how to deal with it

OCPD includes a spectrum of behavioral traits characterized by an obsession for perfectionism, excessive orderliness and the need to control one's environment.[1]  This pattern of behavior frequently interferes with the efficient accomplishment of tasks and makes normal interpersonal relationships difficult. OCPD is classified as a 'personality disorder' although the idea that it is a 'disorder' may be controversial to some.

Obsessive characteristics are often portrayed as amusing, as in the TV series "Monk" in which actor Tony Shalhoub plays the role of Adrian Monk, a detective whose obsession for minute details helps him solve crimes while also crippling him to the point of requiring an assistant. If this sounds like you or someone you know, then read on to learn more about this personality type, and how to either live with it or deal with those who have it.

Origins and Characteristics
Current research indicates that obsessive compulsive behavior may originate in a feedback loop involving three brain areas: the frontal lobe (prefrontal and frontal cortices), the striatum and the thalmus. The loop involves multiple circuits and signals that can stimulate or inhibit brain activity. The frontal lobe, which is responsible for functions such as error detection, working memory and goal-directed behavior, sends a signal through the striatum. The striatum either passes the signal forward, or acts like a brake and inhibits it. The thalmus, which in part controls subconscious movements, receives the signal from the striatum and sends it back to the frontal lobe. If the signal is too strong, it may disrupt frontal lobe activity. One theory suggests that misfiring in one or more neural circuits within the loop triggers the obsessive compulsive behavior.

OCPD is also known as 'Anankastic personality disorder'. Sigmund Freud in his Three Essays on the Theory of Sexuality referred to this personality type as 'anal-retentive'. He postulated that the personality veered in this direction during ego-conflict and a need to assert bodily control during potty training. This desire for control over bodily functions then becomes extrapolated to encompass the world as a whole, and the child grows up wishing things to behave in a rigidly controlled and predictable manner. According to Saul McLeod, children who develop in this manner will become an adult who "hates mess, is obsessively tidy, punctual and respectful of others." He goes on to note that, "They can be stubborn and tight-fisted with their cash and possessions."[2]  It is important to understand that those 'suffering' from this disorder may not actually be 'suffering' at all. So long as things are done in an orderly manner which pleases them, they may well be perfectly happy. However, it can be frustrating for those with OCPD to be surrounded by more lackadaisical people – and equally frustrating for the latter to deal with the former.

Symptoms of Obsessive Compulsive Personality Disorder
OCPD symptoms generally appear early in adulthood and are defined by inflexibility, close adherence to rules, anxiety when rules are disregarded, and unrealistic perfectionism. These are some of the symptoms of OCPD:

• abnormal preoccupation with rules, lists and minor details
• excessive devotion to work while disregarding social and family activities
• perfectionism that interferes with task completion because performance can always be improved
• hoarding and refusal to throw anything away
• stinginess or lack of generosity
• inflexible attitude towards morals or ethical code
• upset when rules or established routines are disrupted

Not To Be Confused With OCD
There is a tendency to confuse OCPD with Obsessive Compulsive Disorder (OCD). However, the similarities are merely superficial. Obsessive Compulsive Disorder is widely assumed to be a simple matter of people becoming fixated upon the correct operation of minor details within their lives. This is an understandable misconception, as the ritualistic 'compulsions' are the only element of the disease which many people witness. However, for an obsessive-compulsive, the compulsions are merely the tip of the iceberg. While someone with an obsessive personality is typically 'obsessed' with lifestyle factors which could realistically impact upon their lives, the situation for someone with obsessive-compulsive disorder is quite different. Those with OCD suffer from excessive doubts, worries, or superstitions. These thoughts are extremely disturbing, and just too terrible to ignore. Sufferers get caught in traumatic thought-cycles which suggest such horrible scenarios that they feel compelled – superstition style – to enact rituals which they believe may lessen the chance of their terrible thoughts manifesting. They do this even though they are logically aware that to do so is highly irrational.

People with OCD are often aware that their obsessions are abnormal, but are compelled to perform them anyway. People with OCPD, however, believe their need for strict order and rules is perfectly normal. OCD often interferes with success in social and work environments, while people with OCPD have difficulties with social relationships, but they usually perform well in work environments.

Someone with an obsessive personality may feel perfectly happy with their set of self-imposed rules, while an obsessive-compulsive is invariably rendered horribly unhappy by their obsessions and compulsions. Furthermore, an obsessive-compulsive is aware that their disturbing thought-loops are highly irrational, yet are helpless within their grip, while someone with an obsessive personality typically believes their own 'obsessions' to be entirely reasonable and may become frustrated when it is suggested otherwise. A clinical study found that OCD and OCPD are both impairing disorders marked by compulsive behaviors, but they can be differentiated by the presence of obsessions in OCD and by excessive capacity to delay reward in OCPD.[3]  Those with OCD are struggling against a neurological condition which distresses them, and 90% of this struggle is located within their own minds. Those with obsessive personalities are living under self-imposed rules which may seem rigid and 'anal' to others, but which cause no direct unhappiness to the sufferer. To confuse the two is not only upsetting for those with OCD (who feel that their horrific mental anguish is being dismissed as 'finicky behavior' on account of their compulsions), but is to label those who may merely like things 'just so' with mental illness.

OCD is an inherited trait.
Dr. Gerald Nestadt, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, has conducted studies to determine the genetic causes of Obsessive-Compulsive Disorder. In one study, the onset of obsessive-compulsive symptoms was strongly related to the occurrence of obsessive traits or symptoms in the relatives.[6] The only risk factor identified for OCD is having a member of the family with the disease. Finding the genetic markers associated with the illness could lead to the development of treatments that change or affect the condition.

If Someone You Know Has OCPD...
Relationships with people with OCPD can often be extremely difficult. A problem frequently reported by those living in close proximity with people with OCPD is that the 'sufferer' is completely oblivious to their 'condition'. They believe their uncompromising stance on varying aspects of domestic and lifestyle management to be completely reasonable, and consider their frustrated companions to be the unreasonable party when they protest at such inflexible boundaries. In many ways, of course, OCPD is useful - anyone with a tendency to let the washing up pile into teetering towers will ruefully admit that sometimes it is good to be taken to task upon the matter. However, a constant need for perfection and routine can become wearing after a while. Especially so when you take into consideration the anger which many with OCPD demonstrate when their standards are not met.  E. Wannemuehler states that someone with OCPD invariably believes that "what they are thinking is right".[4]  An OCPD sufferer "tends to insist that others live up to these standards and can get very angry when others don't comply". This can ruin many otherwise promising relationships. Probably the best thing to do in these circumstances is to attempt (gently but persistently) to convince the OCPD sufferer that they do, in fact, have a problem and should thus be aware of it and moderate their behavior accordingly. Greater self-awareness may induce them to be more forgiving or understanding of the 'failings' of those around them.

Treatment
If you have OCPD, and it is really becoming a problem for you and your interactions with others, you could consider a course of Cognitive Behavioral Therapy. CBT is described by the Association for Behavioral and Cognitive Therapies as treatments that focus on teaching clients specific skills.[5]  They allow therapists to pinpoint emotional triggers and train patients to recognize and combat their own thought and emotional patterns. Once you learn to distinguish between thoughts and feelings and you develop the skills to notice, interrupt, and correct biased thoughts independently you may learn to control your mental state and perhaps overcome the worst of your hang-ups.

Brain activity is regulated by several neurotransmitters such as serotonin, dopamine and glutamate. In 2007, researchers at Duke University Medical Center found that eliminating from the brain the Sapap3 protein which modulates glutamate resulted in obsessive-compulsive grooming in mice. Other researchers began looking for glutamate-modulating medications already approved by the Food and Drug Administration. The studies focused on minocycline, a broad spectrum antibiotic which is used to treat acne. A weekly dose of the antibiotic for 12-weeks gradually reduced the obsessive compulsive symptoms in some subjects.[7]  Additional study will be needed to evaluate the results because antibiotics kill many bacteria that reside in the colon and constitute the microbiome.

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