Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Obsessive-Compulsive Personality Disorder


Related Terms

  • Repetitive Task Disorder

Differential Diagnosis

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Length of disability may be linked to presence of other medical or psychiatric conditions, life circumstances, and individual response to treatment and recommendations.

Medical Codes

ICD-9-CM:
301.4 - Obsessive-compulsive Personality Disorder; Anancastic Personality; Obsessional Personality

Overview

An individual with obsessive-compulsive personality disorder is characterized as emotionally constricted, persevering, 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 have difficulty coping with 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.

Although obsessive-compulsive personality disorder and obsessive-compulsive disorder (OCD) are similar names, the manifestations of these disorders are quite different. Individuals with obsessive-compulsive personality disorder do not have intrusive thoughts, images, or urges nor do they have repetitive behaviors as a response to these intrusions. Instead, obsessive-compulsive personality disorder involves a pervasive and enduring maladaptive pattern of perfectionism and rigid control. Individuals who have symptoms of both OCD and obsessive-compulsive personality disorder may receive both diagnoses (DSM-5).

Incidence and Prevalence: Prevalence ranges from 3% to 10% in individuals attending psychiatric outpatient clinics (DSM-IV-TR). Estimated prevalence ranges from 2.1% to 7.9%; the disorder is one of the most prevalent personality disorders in the general population (DSM-5).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Obsessive-compulsive personality disorder, which usually begins in early adulthood, is twice as likely to occur in men as in women.

Source: Medical Disability Advisor



Diagnosis

History: According to both the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), 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 (DSM-IV-TR, DSM-5).

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 (DSM-IV-TR, DSM-5).

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 (MMPI-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.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor



Treatment

In general, individuals with obsessive-compulsive personalities recognize that they have problems unlike those with other personality disorders. These individuals know that 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. Techniques may include desensitization, flooding, saturation, and/or thought stopping. 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 they may struggle to take the group 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 used to treat coexisting or resultant depression and anxiety. The use of tricyclic antidepressants to reduce depression may be indicated. Selective serotonin reuptake inhibitors (SSRIs) 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



Prognosis

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 individuals 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. A moderate or poor level of function according to the GAF can refer to an individual 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

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



Ability to Work (Return to Work Considerations)

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.

Risk: Risk may be minimized by providing a structured work environment in which the individual's routine is relatively unvaried and predictable. Individuals with obsessive-compulsive personality disorder are well-suited to working on solitary job tasks that require punctuality, order, and accuracy.

Capacity: Capacity is typically unaffected by this disorder. Individuals who are routinely required to delegate job tasks or work with others may exhibit poor job performance and may require job reassignment.

Tolerance: Tolerance is usually not a concern with this diagnosis. Individuals lacking insight into their condition may benefit from learning strategies to cope with their maladaptive behavioral patterns.

Source: Medical Disability Advisor



Maximum Medical Improvement

MMI is expected at 12 months of treatment or less.

Note: MMI is estimated under the assumption that the vagaries involved in psychiatric diagnoses have been taken into consideration.

Source: Medical Disability Advisor



Failure to Recover

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?
  • 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?
  • Does individual have any other mental disorders that complicate treatment?

Source: Medical Disability Advisor



References

Cited

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. American Psychiatric Association, 2013.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Source: Medical Disability Advisor






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