MHAW19: The Disorder You Probably Haven't Heard Much About But Think You Know - OCPD [Guest Post]
What Is (or Isn't) OCPD?
Let’s get rid of this right out of the gate: OCPD is not OCD.
Obsessive Compulsive Disorder (OCD) is an obsessive-compulsive disorder along with body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder (also known as dermatillomania). They are a distinct category of disorder once part of the larger Anxiety class in the DSM that were separated into Anxiety Disorders, Obsessive-Compulsive Disorders, and Trauma and Stressor-Related Disorders in the DSM V. There’s a lot of research into the co-morbidity of OCPD and OCD, but I do not have the latter and cannot speak much to the latter.
No, I do not compulsive flip light switches every time I enter or exit a room. Not only are pop culture representations of OCD often harmful to those who have it, they are uniquely annoying to someone with OCPD which is an entirely separate thing.
What Is a Personality Disorder?
Personality disorders exist in three separate clusters:
Cluster A – the “odd, eccentric” cluster consisting of the Paranoid, Schizoid, and Schizotypal Disorders
Cluster B – the “dramatic, emotional, erratic” cluster consisting of Borderline Personality Disorder, Narcisstic Personality Disorder, Histrionic Personality Disorder, and Antisocial Personality Disorder
Cluster C – the “anxious, fearful” cluster consisting of Avoidant Personality Disorder, Dependent Personality Disorder, and my long-time friend Obsessive-Compulsive Personality DisorderDiagnostic Criteria for OCPD
My case of OCPD, though beyond my awareness, is textbook. So perhaps the best place to start is to lay out the diagnostic criteria for OCPD and just walk through those. See, as my therapist was assisting me with all of the anxiety disorders it became increasingly obvious to her that OCPD might be looming behind everything (more on that later). She began planting little tests and questions throughout our sessions to see how I would respond, and that ultimately lead to the diagnosis.1. Impairments in Personality Functioning
A. Identity: Sense of self derived predominantly from work or productivity; constricted experience and expression of strong emotions
B. OR Self-direction: Difficulty completing tasks and realising goals associated with rigid and unreasonably high and inflexible internal standards of behaviour; overly conscientious and moralistic attitudes.
2. AND (not OR) Impairments in Interpersonal Functioning
A. Empathy: Difficulty understanding and appreciating the ideas, feelings, or behaviours of others
B. OR Intimacy: Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others
3. Pathological Personality Traits via
A. Compulsivity Rigid perfectionism: Rigid insistence on everything being flawless, perfect, without errors or faults, including one’s own and others’ performance; sacrificing of timeliness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organisation, and order.
B. AND Negative AffectivityPerseveration: Persistence at tasks long after the behaviour has ceased to be functional or effective; continuance of the same behaviour despite repeated failures.
C. Stable Across Time, Consistent Across Situations
D. Not Better Understood as a Reflection of a Developmental Stage or Socio-Cultural Environment
E. Not the Result of a Substance or Medical Condition
With respect to the obsessive-compulsive aspect of the disorder, a list of more specific examples also appears from which at least four must be true of the individual.
- He or she obsesses over details, rules, lists, schedules, and organisation in general, to the extent that the overall point of the activity is lost.
- The individual’s preoccupation with perfectionism interferes with his or her ability to get things done (e.g., the individual is unable to finish a project because he or she has set overly strict standards).
- He or she is overly devoted to work and productivity, which results in the exclusion of leisure activities as well as close relationships.
- The individual is too conscientious and inflexible when it comes to their morals or ethics (not including those related to culture or religion).
- He or she is unable to get rid of old or worthless objects even when they are of no sentimental value to the individual.
- The individual is unwilling or hesitant to work with others unless they agree to follow his or her exact way of doing things.
- He or or she is rather stingy with money; the individual saves an excessive amount for future catastrophes.
- He or she is overly rigid and/or stubborn.
The Reality of OCPD
It’s possible that OCPD is the reason that generalised anxiety and social anxiety became facets of my life so early. I define myself through my work, and persevere in the pursuit of perfection and principle to the point that it alienates me from others. I was never anti-social, but I have always been an introvert and social anxious (three separate things often used, inappropriately, as synonyms). Isolation as a cost of maintaining those principles is a price worth paying to me usually.
In other cases it can be crippling in that I want a relationship but feel I cannot overcome my imperfections or some other deficiency to attain it. For all my effort, some people appear to live according to my values to a greater degree and with more grace than I ever could. That applies more pressure. That creates more stress. That worsens the anxiety.
I stow away resources for the inevitably catastrophe. What if my wife or I becomes seriously ill or injured one day? Insurance only does so much, and I will need a reserve to stave off ruin. What about unemployment? What if we retire and then live longer than expected with limited income? Save, save, save – obsess for a rainy day that may never arrive.
Even without the anxiety, mental health defines my life. Everything that is terrible about me has ties to the anxiety and the OCPD. Everything that is wonderful about me does, too. My standards are high out of empathy for the impact my life has on others. My anxiety is high because of that.
The real sin here?
I, like many people with OCPD, do not particularly want treatment. In a weird way, despite all of the associated problems with it, I want to be a better person. I have high standards that completely revolve around helping others and being kind. Even in my zero tolerance for unkindness, it hurts me to be unkind in response. Cutting off a person is my “weapon” of choice, and then I feel conflicted that this response is akin to burying my head in the sand. What else can I do? I have no means other than compassion to persuade someone else to behave differently and I cannot control what they do.
I am doing everything I can, if not to fix the problem, not to contribute to the problem and to help victims that we already failed to protect.
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If you are struggling right now and feel like you need to talk to someone, The Samaritans can be reached at 116 123.
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