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Summary MHS4503 - Obsessive-Compulsive Personality Disorder
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OBSESSIVE-COMPULSIVE PD (CLUSTER C)DWANGMATIGE PERSOONLIJKHEIDSSTOORNIS
Source: DSM-V (APA, 2015)
Een pervasief patroon van preoccupatie met ordelijkheid, perfectionisme en psychische en
interpersoonlijke controle, ten koste van flexibiliteit, openheid en efficiëntie, beginnend op
jongvolwassen leeftijd en tot uiting komend in uiteenlopende contexten, zoals blijkt uit vier of meer;
o Is gepreoccupeerd met details, regels, lijstjes, orde, organisatie of schema’s, zozeer dat het
eigenlijke doel van de activiteit uit het oog verloren wordt.
o Toont een perfectionisme dat interfereert met het voltooien van taken (is bijvoorbeeld niet in
staat om een project af te ronden omdat niet wordt voldaan aan zijn of haar overmatig strikte
normen.
o Is excessief toegewijd aan werk en productiviteit, met uitsluiting van ontspannende
activiteiten en vriendschappen (niet door duidelijke economische noodzaak).
o Is overmatig consciëntieus, scrupuleus en inflexibel in zaken van moraliteit, ethiek of waarden
(niet door identificatie met een cultuur of religie).
o Is niet in stat om versleten of waardeloze voorwerpen weg te gooien, zelfs als deze geen
sentimentele waarde hebben.
o Is onwillig om taken te delegeren of met anderen samen te werken, tenzij zij zich geheel
onderwerpen aan zijn of haar manier van werken.
o Heeft zich een vrekkige stijl van geld uitgeven eigengemaakt, voor zichzelf en anderen; geld
wordt beschouwd als iets wat moet worden opgepot voor toekomstige catastrofes.
o Toont rigiditeit en koppigheid.
-Zelfbeeld: verantwoordelijk, competent
-Beeld anderen: onverantwoordelijk, incompetent
-Kernopvatting: “als er iets fout gaat, is dat mijn schuld”
-Strategie: perfectionisme, ordenen, erg je best doen, controleren, koppigheid, rigiditeit
-Emoties: angst, irritatie, schuldgevoel, spijt, teleurstelling
-Temperament: inhibitie
-Opvoeding: ouders zijn precies, stellen kind verantwoordelijk, hoge eisen
Clinical description
Individuals with OCPD show exceptionally
perfectionist tendencies, including a preoccupation
with orderliness and control at the expense of
flexibility, efficiency and productivity. They will stick
to rules, work schedules and prearranged procedures to
such a degree that the overall purpose of the activity is
lost. Divergence from a preset schedule causes them
significant distress, as does failing to achieve the
highest of standards in the things they do, and their
attention to detail and their inflexibility will often
annoy other people because of the delays and
inconvenience that this may cause.
Perfectionisme, starheid, hamsteren, preoccupatie met details en buitensporige toewijding op werk.
1
,OCD AND OCPD
Source: Eisen et al. (2006)
Abstract
This study examined the convergence between obsessive-compulsive personality disorder (OCPD)
criteria and obsessive-compulsive disorder (OCD). Baseline assessments of 629 participants 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 (n = 89) than in subjects without OCD (n = 540). 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, showing unique associations with
OCD and odds ratios ranging from 2.71 to 2.99. 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.
Introduction
While the precise estimates of OCPD in subjects with OCD have varied considerably, the result 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 PD or MDD. In terms of longitudinal associations, one study failed to find a clear
association between the course of OCD and the course of OCPD.
The current study examined the presence of OCPD criteria in individuals with and without OCD. This
is the first study using DSM-IV criteria that focuses on the relationship between specific OCPD
criteria and OCD, and thus may clarify which components of OCPD are associated with OCD. It was
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.
Method
A total of 733 pts with at least one of four personality disorders (schizotypal, borderline, OCPD and
avoidant) or MDD were recruited. For the current analyses, only 629 pts with PDs were included. The
design of the original study (data) was prospectively, to assess the course of psychiatric disorders and
psychosocial functioning in PDs.
Personality disorders were diagnosed at baseline using the Diagnostic Interview for DSM-IV
Personality Disorders (DIPD-IV). Axis I diagnoses were determined by the SCID. Analyses were
conducted using the eight criteria for DSM-IV OCPD: rigidity, miserliness, hoarding, preoccupation
with details, perfectionism, reluctance to delegate tasks, inflexibility regarding morality, and excessive
devotion to work. Chi-square analyses were conducted to examine whether the individual OCPD
criteria were more frequent in subjects with OCD than subjects without OCD.
2
, Results
Of the sample, 262 (42%) subjects met criteria for OCPD and 89 (14%) for OCD. Fifty-three (8%)
subjects met criteria for both OCPD and OCD. Of those subjects with OCPD, 20% had OCD. OCD
was significantly more frequent in subjects with OCPD compared to subjects with other personality
disorders.
Three of the eight OCPD criteria were significantly (p < .006) more common in subjects with OCD
than in subjects without OCD: hoarding, perfectionism, and preoccupation with details (see table).
Frequencies of the remaining OCPD criteria (rigidity, miserliness, reluctance to delegate, inflexible
morality, and excessive devotion to work) were not found to differ significantly between subjects with
and without OCD and the magnitude of the between groups differences on these criteria was small.
Results of the logistic regression analyses revealed that four of the eight OCPD criteria were
significantly predicted from the axis I disorders; hoarding, perfectionism, preoccupation with
details, and reluctance to delegate tasks. Examining the unique contributions of diagnoses to the
prediction of these criteria, OCD was found to be associated with significantly increased odds of
meeting the hoarding, perfectionism, and preoccupation with details criteria.
Conclusions
The results demonstrate a meaningful link between OCD and OCPD, when individual criteria are
considered. Specifically, the results reveal that not all OCPD characteristics are equally related to
OCD. 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.
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.
Together, several studies support the notion that certain features of OCPD are associated with OCD.
There are several possible interpretations. First, the data suggest a possible subtype of OCD
characterized by perfectionism and over-attention to detail, along with obsessions and
compulsions such as counting, repeating and the need for symmetry and ordering. There is
considerable evidence that hoarding is a particularly difficult OCD symptom to treat. Thus, the
presence of hoarding may represent a subtype of OCD that includes other comorbid OCPD symptoms
as well and has a more refractory course and treatment response.
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