DSM on OCPD

What's a "DSM", anyway?  

(from Wikipedia) The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies, and policy makers.

In other words, being formally diagnosed as having a mental disorder under whatever is the current DSM means you can (or cannot) get coverage under your health insurance policy, get considered for Social Security Disability benefits, can get prescribed various behaviorial and pharmaceutical treatments, considered for participation in studies, etc. 

Yep, it's a big deal.

It also means you are subject to the current social stigma of "having a mental disorder", and unfortunately, many people would rather admit to having herpes or AIDS than a mental disorder.  Even if being diagnosed means getting help.

Here's the CURRENT American Definition of OCPD, as defined in the DSM-IV

Obsessive-Compulsive Personality Disorder

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

(2) shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)

(3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)

(4) is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)

(5) is unable to discard worn-out or worthless objects even when they have no sentimental value

(6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things

(7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

(8) shows rigidity and stubbornness

In England and other countires, the disorder may be called Anakastic Personality Disorder

(from Wikipedia) The World Health Organization's ICD-10 defines a conceptually similar disorder to obsessive–compulsive personality disorder called (F60.5) Anankastic personality disorder.^[15]

 It is characterized by at least 3 of the following:

1. feelings of excessive doubt and caution;
2. preoccupation with details, rules, lists, order, organization or schedule;
3. perfectionism that interferes with task completion;
4. excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
5. excessive pedantry and adherence to social conventions;
6. rigidity and stubbornness;
7. unreasonable insistence by the individual that others submit exactly to his or her way of doing things, or unreasonable reluctance to allow others to do things;
8. intrusion of insistent and unwelcome thoughts or impulses.

Includes:

• compulsive and obsessional personality (disorder)
• obsessive-compulsive personality disorder

Excludes:

• obsessive-compulsive disorder

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Currently, the DSM is in the process of revision.  Here's the working version of the DSM-V for OCPD.  The final, modified version of the DSM-V is expected to be approved and published by May 2013.

(The draft disorders and disorder criteria that have been proposed by the DSM-5 Work Groups can be found on these pages.  Use the links below to read about proposed changes to the disorders that interest you.  Please note that the proposed criteria listed here are not final.  These are initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups.  At this time, visitors are no longer able to submit comments on this Web site. The work group members are currently reviewing all submitted comments, and we will be providing updates to this site to reflect any changes in proposed revisions made as a result of viewer feedback.)

The work group is recommending that this disorder be reformulated as the Obsessive-Compulsive Type.

Individuals who match this personality disorder type are ruled by their need for order, precision, and perfection.  Activities are conducted in super-methodical and overly detailed ways.  They have intense concerns with time, punctuality, schedules, and rules.  Affected individuals exhibit an overdeveloped sense of duty and obligation, and a need to try to complete all tasks thoroughly and meticulously.  The need to try to do things perfectly may result in a paralysis of indecision, as the pros and cons of alternatives are weighed, such that important tasks may not ever be completed.  Tasks, problems, and people are approached rigidly, and there is limited capacity to adapt to changing demands or circumstances.  For the most part, strong emotions – both positive (e.g., love) and negative (e.g., anger) – are not consciously experienced or expressed.  At times, however, the individual may show significant insecurity, lack of self confidence, and anxiety subsequent to guilt or shame over real or perceived deficiencies or failures. Additionally, individuals with this type are controlling of others, competitive with them, and critical of them.  They are conflicted about authority (e.g., they may feel they must submit to it or rebel against it), prone to get into power struggles either overtly or covertly, and act self-righteous or moralistic.  They are unable to appreciate or understand the ideas, emotions, and behaviors of other people. 

Instructions

A.  Type rating.  Rate the patient’s personality using the 5-point rating scale shown below.  Circle the number that best describes the patient’s personality. 

5 = Very Good Match: patient exemplifies this type

4 = Good Match: patient significantly resembles this type

3 = Moderate Match: patient has prominent features of this type

2 = Slight Match: patient has minor features of this type

1 = No Match: description does not apply 

B.  Trait ratings.  Rate extent to which the following traits associated with the Obsessive-Compulsive Type are descriptive of the patient using this four-point scale:   

0 = Very little or not at all descriptive

= Mildly descriptive

= Moderately descriptive

= Extremely descriptive 

1. Compulsivity: Perfectionism                            

Insistence on everything being flawless, without errors or faults, including own and others’ performance; conviction that reality should conform to one’s own ideal vision; holding oneself and others to unrealistically high standards; sacrificing of timeliness to ensure every detail is correct

2. Compulsivity: Rigidity

Being rule- and habit-governed; belief that there is only one right way to do things; insistence on an unchanging routine; difficulty adapting behaviors to changing circumstances; processing of information on the basis of fixed ideas and expectations; difficulty changing ideas and/or viewpoint, even with overwhelming contrary evidence

3. Compulsivity: Orderliness       

Need for order and structure; insistence on everything having a correct place or order and on keeping them so; intolerance of things being “out of place”; concern with details, lists, arrangements, schedules

4. Compulsivity: Perseveration

Persistence at tasks long after behavior has ceased to be functional or effective; belief that lack of success is due solely to lack of effort or skill; continuance of the same behavior despite repeated failures.

5. Negative Emotionality: Anxiousness

Feelings of nervousness, tenseness, and/or being on edge; worry about past unpleasant experiences and future negative possibilities; feeling fearful and threatened by uncertainty

6. Negative Emotionality: Pessimism

Having a negative outlook on life; focusing on and accentuating the worst aspects of current circumstances; expecting the worst outcome

7. Negative Emotionality: Guilt/shame

Having frequent and persistent feelings of guilt/ shame/ blameworthiness, even over minor matters; believing one deserves punishment for wrongdoing

8. Introversion: Restricted Affectivity

Lack of emotional experience and display; emotional reactions, when evident, are shallow and transitory; unemotional, even in normally emotionally arousing situations

9. Antagonism: Oppositionality

Displaying defiance by refusing to cooperate with requests, meet obligations, or complete tasks; behavioral resistance to performance expectations; resentment and undermining of authority figures.

As you can tell, OCPD is just one wild, swinging, party-in-a-basket, no? 

No. 

People who have OCPD are not bad people.  The problem suffered by those who love someone with OCPD, is that those who have OCPD are frequently in denial that their thinking and behaviors are driven by OCPD.  Therefore, they are logical, we are wrong.  We just don't get it.

Here's the typical pattern with an OCPD person.

#1 - Denial, Denial, Denial.  There is nothing wrong with them.  9,999,999 people could tell them the earth is round, and they would insist that it is flat.  Therefore, they don't need help.  We need help, because obviously we are delusional.

So, most of those with obvious OCPD cannot be dragged, kicking and screaming, in to a psychiatrist capable of evaluating and diagnosing their OCPD behaviors.

#2 - They've been in to a psychiatrist, they've been diagnosed.  Possibly years back, either as a condition of staying in a relationship, or because their own pain drove them to it.  Now they have loaded Denial 2.0.  They may admit they have some OCPD tendencies, sometimes, but there's really nothing wrong with them, on a day-to-day basis.  The psychiatrist was clearly unqualified.   There was something wrong with the test.  They might have had tendencies, once, but they don't anymore.  They're happy just the way they are; their OCPD characteristics give them an edge.

#3 - They've been diagnosed, they are actively working to combat their OCPD behaviors, with various combinations of therapy, medications, group interactions with others who have OCPD, prayer and meditation.

The third group does not seem to be the largest one. 

Saddest of all, as much as those who love a person with OCPD truly suffer, the person who has it suffers just as much, if not more.  They are lonely, anxious people, and they truly want to be loved and appreciated. 

If they could only find someone to do it the Right Way.