An individual with obsessive-compulsive personality disorder is characterized as emotionally constricted, persevering, indecisive, stubborn, and orderly. There is a pervasive pattern of perfectionism and inflexibility. These individuals are preoccupied with rules, regulations, orderliness, neatness, details, and the achievement of perfection. Individuals with this disorder appear very formal and serious, usually lack a sense of humor, and may have restricted ability to show warm and tender feelings. They may appear stubborn, possessive, stingy, uncreative, and unimaginative. The slightest disruption in their daily routine may promote anxiety, sometimes to the point of panic attacks. These individuals are preoccupied with trivial details and rules and do not appreciate changes in routine. Obsessive-compulsive personalities frequently are found in vocations that value accuracy, orderliness, and moral rectitude more than warmth and sociability.
Individuals with obsessive-compulsive personality disorder commonly have a stable marriage and occupational success, yet usually have few friends. They have difficulty relaxing and enjoying life. These individuals appear serious most of the time. It is difficult for them to take vacations, admit pleasure, or display emotions. Much of their time is spent in organizing, making lists, or keeping notebooks and mental notes in an attempt to keep their lives neat and orderly.Risk: Obsessive-compulsive personality disorder, which usually begins in early adulthood, is twice as likely to occur in men as women. Incidence and Prevalence: Prevalence was 1% in one American community sample. Between 3% to 10% of patients go to psychiatric outpatient clinics to seek treatment for the disorder (DSM-IV-TR 728). |
Source: Medical Disability Advisor
History: According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision), the individual with obsessive-compulsive disorder presents a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency. The disorder begins by early adulthood and presents in a variety of contexts.
The obsessive-compulsive personality displays four or more of the following: preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost; perfectionism interfering with task completion (unable to complete a project because his or her own overly strict standards are not met); excessive devotion to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity); being overly conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification); inability to discard worn out or worthless objects even when they have no sentimental value; reluctance to delegate tasks or to work with others unless they submit to exactly his or her way of doing things; miserly spending style toward both self and others (money is viewed as something to be hoarded for future catastrophes); or rigidity and stubbornness.
In the psychiatric interview, individuals with obsessive-compulsive personalities may present with conventional and meticulous dress. Their posture may be unusually stiff, hair unusually neat, mood serious, and speech monotone. They may give very detailed and accurate historical accounts, and are prone to lengthy monologues. Physical exam: As with all personality disorders, the psychiatric interview and mental status exam are the most useful diagnostic tools. The physical exam is usually not helpful in the diagnosis of this disorder. Tests: Psychological testing such as the Minnesota Multiphasic Personality Inventory - 2 (MMP-2) or Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) can help identify and classify personality disorders in conjunction with the history obtained in the psychiatric interview and information obtained during the mental status exam. |
Source: Medical Disability Advisor
In general, individuals with obsessive-compulsive personalities recognize that they have problems unlike those with other personality disorders. These individuals know they suffer from their inflexibility and realize they do not permit themselves to have good feelings. Individual psychotherapy may be helpful, but treatment is difficult since these individuals tend to see the world as "all-or-nothing" or "black-or-white."
Therapy should focus on current feelings and situations with goals to provide short-term symptom relief, support existing coping mechanisms, and teach new coping mechanisms. Excessive time should not be spent on examining the psychological basis of the condition, since the personality is resistant to change. Treatment is often a long and complex process. Struggles for control should be avoided as individuals may distance themselves from their feelings by attacking the credentials of the therapist. Group therapy and cognitive behavior therapy may offer certain advantages, but efforts to alter thinking habits (cognitive therapy) are rarely helpful in this disorder. These individuals are likely to point out other people's shortcomings and may become ostracized by the group or struggle to take over. Because these individuals often lack insight into their emotions, writing down feelings in a journal as soon as they become apparent may be helpful.
Pharmacotherapy is usually not needed in uncomplicated cases but may be utilized to treat coexisting or resultant depression and anxiety. The use of tricyclic antidepressants to reduce depression may be indicated. Selective serotonin reuptake inhibitors may be helpful if obsessive-compulsive signs and symptoms persist and the patient actually develops obsessive compulsive disorder. Hospitalization is rarely needed. |
Source: Medical Disability Advisor
 |
| ACOEM's Practice Guidelines, the gold standard in effective medical treatment of occupational injuries and illnesses, are provided in this section to complement the disability duration guidelines.* |
| |
|
| |
| * The relationship between the MDGuidelines (MDA) content and ACOEM's guidelines is approximate and does not always link identical diagnoses. The user should consult the diagnostic codes in both guidelines, as well as the clinical descriptions, before assuming an equivalence. |
Source: ACOEM Practice Guidelines
| During the course of obsessive-compulsive personality disorder, the incidence of symptomatic episodes is unpredictable and variable. Obsessions and compulsions may evolve from time to time as in other major depression and psychosomatic disorders. Treatment is often a long process for these individuals. Therapy often helps individuals deal with conflicts and symptoms in the short-term but rarely has much effect on the underlying personality disorder. One study found that 87.6% of patients who present with the diagnosis have a moderate or poor level of social, academic, and occupational function based on psychiatric interviews using the Longitudinal Interval Follow up Evaluation and Global Assessment of Function (GAF) from the DSM-IV-TR (Skodol). A moderate or poor level of function according to the GAF can refer to a patient who, in addition to having poor academic and occupational performance and/or difficulty in their personal relationships, also has more severe psychiatric symptoms such as suicidal or homicidal ideation, or who hears or sees things that are not there. |
Source: Medical Disability Advisor
| Complications occur with the coexistence of another mental disorder such as an anxiety disorder, mood disorder, or substance abuse or dependence. Other complications may include a change in financial, occupational, or marital status related to personality conflicts. |
Source: Medical Disability Advisor
| Time-limited work restrictions and accommodations should be individually determined based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The purpose of the restrictions/accommodations is to help maintain the worker's capacity to remain at the workplace without a work disruption and to promote timely and safe transition back to full work productivity. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual fit criteria for obsessive-compulsive personality disorder?
-
Has diagnosis been confirmed?
-
Have other underlying medical and psychiatric disorders been ruled out?
Regarding treatment:
- Has individual established a trusting, therapeutic rapport with physician/therapist? If not, what can be done to foster this relationship?
-
Has individual been provided with a detailed and clearly presented account of the disease process and treatment options?
-
Because trust is necessary for an effective therapeutic relationship, has individual been given documentary evidence in the form of specific laboratory test results (ECG, x-rays, actual reports from literature)?
-
Is individual able to participate as an informed partner in the healing process?
-
Is individual on an effective drug therapy program?
-
Have ritual and anxiety levels become intolerable? Would removal from the external environmental stresses lessen symptoms to a more tolerable level?
-
Would individual benefit from brief inpatient treatment?
-
Is therapist experienced with and able to handle the intricacies of obsessive-compulsive personality disorders?
-
In what type of therapy is individual currently involved?
-
Has therapy included desensitization techniques, flooding techniques, saturation therapy, and/or thought-stopping techniques? What other options would be appropriate at this point?
-
Is individual involved in a group therapy session? Would this be a good adjunct to present therapy?
-
Is individual's family involved in therapy or treatment plan? Can this be implemented?
Regarding prognosis:
- Is individual able to moderate or control obsessive-compulsive personality disorder traits?
-
Would extended or additional therapy be beneficial at this time?
|
Source: Medical Disability Advisor
| CitedFrances, Allen, Harold Alan Pincus, and Michael B. First, eds. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association, 1994.Skodol, Andrew, et al. "Functional Impairment in Patients with Schizotypal, Borderline, Avoidant, or Obsessive -Compulsive Personality Disorder." American Journal of Psychiatry 159 2 (2002): 276-283. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment. If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is published with the understanding that the author, editors, and publisher are not engaged in rendering medical, legal, accounting or other professional service. If medical, legal, or other expert assistance is required, the service of a competent professional should be sought. We are unable to respond to requests for advice. Any Sales inquiries should include an email address or other means of communication.
|