PSY4761: Personality disorders. Extensive elaboration of the learning objectives associated with task 3: Obsessive-compulsive disorder. Includes citations and notes from the tutorial in orange. For all tasks, see the bundle.
1. What is the clinical picture (phenomenology) of Obsessive-Compulsive PD?
DSM-V criteria obsessive-compulsive personality disorder
Een diepgaand patroon van preoccupatie met ordelijkheid, perfectionisme, beheersing van
psychische en intermenselijke processen, ten koste van soepelheid, openheid en efficiëntie,
beginnend in de vroege volwassenheid en tot uiting komend in diverse situaties, zoals blijkt
uit vier (of meer) van de volgende kenmerken:
1. is gepreoccupeerd met details, regels, lijsten, ordening, organisatie of schema’s, wat zo
ver gaat dat het eigenlijke doel uit het oog verloren wordt
2. toont een perfectionisme dat het afmaken van een taak bemoeilijkt (bv. onvermogen iets
af te maken omdat het niet aan de eigen overtrokken eisen voldoet)
3. is overmatig toegewijd aan werk en productiviteit met uitsluiting van ontspannende
bezigheden en vriendschappen (niet te verklaren door een duidelijke economische
noodzaak)
4. is overdreven gewetensvol, scrupuleus en star betreffende zaken van moraliteit, ethiek
of normen (niet te verklaren vanuit culturele of godsdienstige achtergrond)
5. is niet in staat versleten of waardeloze voorwerpen weg te gooien, zelfs als ze geen
gevoelswaarde hebben
6. is er afkerig van taken te delegeren of om met anderen samen te werken, tenzij dezen
zich geheel onderwerpen aan zijn manier van werken
7. heeft zich een stijl van gierigheid eigen gemaakt ten aanzien van zichzelf en anderen;
geld wordt gezien als iets dat opgepot moet worden voor toekomstige catastrofes
8. toont starheid en koppigheid
2. How can you differentiate between, obsessions, compulsions and obsessive personality
traits? How can they be distinguished in practice?
VIDEO
OCPD is egosyntonic (zien hun gedrag niet als problematisch), OCD is egodystonic (ze
hebben door dat hun gedragingen niet ‘normaal’ zijn aan de norm)
Compulsies zijn terugkomende handelingen of gedragingen (voortkomend uit obsessies) die
voorkomen bij dwang, maar bij OCD hebben de mensen het gevoel dat ze niet bij hen horen
OCPD ligt het dichtste bij de gezonde persoonlijkheid
3. What is the relationship between Obsessive-Compulsive PD and Obsessive-Compulsive
Disorder? Are obsessive-compulsive personality traits necessary or sufficient to develop
OCD?
Eisen, J., Coles, M., Schea, M.T., Pagano, M., Stout, R., Yen, S., Grilo, C., & Rasmussen, S.
(2006). Clarifying the convergence between Obsessive Compulsive Personality Disorder
Criteria and Obsessive Compulsive Disorder. Journal of Personality Disorders, 20, 294-305.
Abstract
In this study we examined the convergence between obsessive-compulsive personality
disorder (OCPD) criteria and obsessive-compulsive disorder (OCD). Baseline assessments of
the Collaborative Longitudinal Personality Disorders Study were used to examine the
associations between OCPD criteria and diagnoses of OCD. Three of the eight OCPD criteria
,(hoarding, perfectionism, and preoccupation with details) were significantly more frequent
in subjects with OCD than in subjects without OCD. Logistic regressions were used to predict
the probability of each OCPD criterion as a function of Axis I diagnoses (OCD, additional
anxiety disorders, and major depressive disorder). Associations between OCD and these
three OCPD criteria remained significant in the logistic regressions. In addition, other anxiety
disorders and major depressive disorder showed few associations with specific OCPD
criteria. This study suggests variability in the strength of the relationships between specific
OCPD criteria and OCD. The findings also support a unique relationship between OCPD
symptoms and OCD, compared to other anxiety disorders or major depression. Future
efforts to explore the link between Axis I and Axis II disorders may be enriched by conducting
analyses at the symptom level.
Introduction
There has been longstanding interest in the relationship between certain temperamental
traits such as perfectionism and rigidity and the development of clear-cut obsessions and
compulsions. The criteria for obsessive-compulsive personality disorder (OCPD) have
changed considerably over the past several decades. Criteria such as rigidity, miserliness,
preoccupation with details, inability to throw out worn-out or worthless objects (hoarding),
and reluctance to delegate tasks stem from Freud’s original notion of the anal character
characterized by orderliness, parsimony, and obstinacy and were expanded by Abraham’s
description of the anal character.
The prevalence of OCPD in community samples has been estimated to be 0.9% to 2%,
while obsessive-compulsive disorder (OCD) is thought to affect 2% to 3% of the general
population. Comorbidity between OCPD and OCD has been investigated. Several studies
using the stringent DSM-III criteria found low rates (0–6%) of OCPD in OCD subjects;
however, another study found that 19% of OCD subjects met criteria for OCPD.
Investigations using the DSM-III-R criteria found frequencies of OCPD as high as 30% in
samples of OCD patients. Alluding to the impact of evolving definitions of OCPD, based on a
literature review, it was noted that studies using the DSM-III-R criteria diagnosed OCPD at
double the rate of studies using DSM-III criteria. While the precise estimates of OCPD in
subjects with OCD have varied considerably, the results all suggest that the diagnosis of
compulsive personality is not a developmental precondition for OCD; however, OCPD has
been found to occur with greater frequency in individuals with OCD than in individuals with
panic disorder or major depressive disorder.
Additional support of the association between OCD and OCPD has been found in a
general clinical sample and primary personality disordered samples. More recently, reports
based on the Collaborative Longitudinal Personality Disorders Study (CLPS) have investigated
the link between the two disorders in individuals with personality disorders. A study
reported that 20.9% of their subjects with DSM-IV OCPD met criteria for OCD. This is
elevated compared to community samples (2-3%).
Additional work using family designs and retrospective reports of childhood traits
also suggests a link between OCPD and OCD. A significantly greater frequency of OCPD was
found in first degree relatives of OCD probands compared to relatives of control probands
(11.6% vs. 5.8%). Examining the course of development of OCD, results showed that a
substantial proportion of the OCD patients endorsed having perfectionism, hypermorality,
ambivalence, and excessive devotion to work prior to the onset of their OCD. This
constellation of traits may be the precursor of the adult OCPD. This finding also suggests that
, there may be a subtype or phenotype of OCD characterized by OCPD traits as well as
compulsions related to perfectionism (e.g., symmetry compulsions, the need to do things
“just right,” or compulsions driven by a sense of incompleteness).
The current study examined the presence of OCPD criteria in individuals with and
without OCD. We utilized a large sample of subjects recruited for a longitudinal personality
disorders project, thereby encouraging careful evaluation of personality disorder criteria and
increasing statistical power. We hypothesized that certain OCPD criteria, specifically
perfectionism and hoarding, would be more common in subjects with OCD, whereas other
OCPD criteria, specifically rigidity, miserliness, and excessive devotion to work, would not
differ between the two groups. We further hypothesized that such associations would be
specific to OCD (i.e., would not be present for other anxiety disorders, or for major
depressive disorder).
Discussion
The results demonstrate a meaningful link between OCD and OCPD, when individual criteria
are considered. Specifically, the current results reveal that not all OCPD characteristics are
equally related to OCD. The data show that the relationship between OCPD and OCD is
primarily due to criteria of hoarding, perfectionism, and preoccupation with details, and is
not driven by criteria of inflexible morality, excessive devotion to work, rigidity, or
miserliness. This suggests that OCPD, as currently defined in the DSM-IV, is not a
developmental precondition for OCD, as was proposed by Pierre Janet. Instead, findings
suggest that the relationship between OCD and OCPD is comprised of symptoms from both
Janet’s and Freud’s conceptualizations (perfectionism and hoarding/preoccupation with
details, respectively), but that there are also some symptoms from each theory that are not
involved in linking these two disorders (e.g., reluctance to delegate tasks).
Given the finding that particular symptoms link OCPD and OCD, it is important to
examine the specificity of this relationship. Perhaps hoarding, perfectionism, and
preoccupation with details are associated with psychopathology in general and are not
specific to OCD. Indeed, perfectionism has been shown to play a role in many forms of
psychopathology; however, results of the current study showed that of five anxiety disorders
studied, the unique contributions from OCD were the most predictive of the likelihood of
having OCPD criteria. Specifically, the presence of OCD predicted elevated odds of having
three OCPD criteria. In contrast, the unique contributions of social phobia, panic disorder
with agoraphobia, panic disorder without agoraphobia, and major depression did not predict
elevated odds of having any of the OCPD criteria. Interestingly, GAD was associated with
significantly increased odds of having preoccupation with details and reluctance to delegate
tasks. Although speculative, the OCPD traits found to also be elevated in GAD in the current
study, namely preoccupation with details and a reluctance to delegate tasks, may be
associated with the construct of intolerance of uncertainty, a characteristic shown to be
associated with both GAD and OCD.
The current findings of specificity of which criteria link OCPD and OCD are in keeping
with an earlier study that examined the symptom overlap between these two disorders. In
that study, the frequency of specific OCPD criteria in subjects with OCD varied considerably.
The majority (±80%) of OCD patients had difficulty with perfectionism and indecisiveness,
suggesting the possibility that these symptoms may be developmental markers for OCD or
characteristics that are part of the syndrome of OCD. In contrast, rigidity, inability to express
warmth, and excessive devotion to work were seen less frequently in OCD subjects (±20%).
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