Obsessive-Compulsive Behavior

People often confuse obsessive-compulsive disorder with obsessive-compulsive personality disorder. However, there are very distinct differences between the two, and it is necessary to understand these differences in order to receive the proper treatment for each of these conditions. An examination of the characteristics of each of these disorders provides the criteria necessary in order to distinguish obsessive-compulsive disorder (OCD) from obsessive-compulsive personality disorder (OCPD) and to recommend appropriate treatment.

OBSESSIVE-COMPULSIVE DISORDER

The characteristic of OCD is that obsessions (unwanted ideas or impulses) repeatedly come up in the mind of the person with OCD. The thoughts are always intrusive, unpleasant in nature, and almost always produce anxiety. To deal with this anxiety, people with OCD develop repetitive behaviors that are called "compulsions." The most common of these behaviors are washing and checking. Other compulsive behaviors include counting and rearranging objects in an effort to keep them in perfect alignment. These behaviors are very stereotyped, with little variation from one time to the next, and the behaviors are ritualistic in nature. Performing these rituals may give the person with OCD some relief from anxiety, but this relief is only temporary.

People with OCD generally have considerable insight into their own problems. Most of the time, they know that their obsessive-compulsive behaviors are exaggerated and senseless, but unfortunately this knowledge is not sufficient to enable them to break free from their illness. Stress often increases the intensity of obsessive-compulsive behavior. OCD tends to last for years, even decades. The symptoms may become less severe with time, and there may be intervals when the symptoms are mild, but generally OCD is a chronic illness. OCD is classified as an anxiety disorder, and without treatment this disorder will progress causing decreased functioning ability, and more impairment and anxiety in daily life.

The fact many people with OCD respond well to specific medications suggests that the disorder has a neurological basis. It is believed that people who develop OCD have a biological predisposition to stress, and that this reaction takes the form of intrusive and distressing thoughts. These thoughts eventually create a vicious cycle that the person cannot escape from without help. A description of common obsessive-compulsions is as follows:

  1. WASHING
    A person feels the need to clean or to wash their hands excessively in order to prevent contamination from an unknown origin. The obsession is that germs will lead to sickness, and the person tries to combat this thought by compulsion (acts) of excessive cleanliness.
  2. COUNTING
    A person feels the need to arrange things in a particular order, or to make things symmetrical to be acceptable.
  3. CHECKING
    A person feels the need to check things repeatedly to make sure that things are safe.
  4. SAVING
    A person feels the need to keep from throwing things out and fears that something bad will occur if items are thrown away.
  5. DOUBTING
    A person feels the need for everything to be "perfect" and fears that something bad will occur if things are not "perfect."

    6. All of these rituals are based on trying to prevent something bad from happening. For example, "Don't step on a crack or it will break your mother's back."

TREATMENT FOR OCD

Treatment options for OCD are varied and depend upon the approach taken. Often combination of antidepressants such as Anafranil and behavior modification techniques are used to lessen the frequency of obsessive-compulsive behavior. Participation in both family and group therapy has also shown to improve socialization skills and self-esteem. Regardless of the approach taken, family members should realize that flare ups and incomplete remissions are common. So with this information, what can you do to help a person who is suffering with OCD?

WHEN SOMEONE YOU LOVE HAS OCD

There are four principles that are important to remember:

  • Be supportive. Discuss OCD with the person and listen to his/her concerns. Recognize that progress made sometimes can be minimized during stressful times.
  • Be consistent. Try to keep the family routine normal and keep communication clear and simple.
  • Be positive. Try not to react critically to the person with OCD, as this person may already have a low self-image.
  • Finally, encourage the person with OCD to attend a support group and seek counseling for additional resources.

OBSESSIVE-COMPULSIVE PERSONALITY DISORDERS (OCPD)

This disorder is characterized by perfectionistic, rigid, inflexible, and excessively controlled behavior, and orderly thinking. People with OCPD differ from OCD in that the former category does not have obsessions and compulsions. While a person with obsessive-compulsive disorder (OCD) spends a lot of time cleaning in order to avoid germs, a person with OCPD will focus on orderliness and neatness.

CHARACTERISTICS OF OCPD

  1. People do not have obsessions and compulsions. Their preoccupation is not intense enough to be considered obsessions or compulsions (obsessions are the thoughts; compulsions are the actions).
  2. People with OCPD are characterized as being perfectionists; preoccupied by orderliness and mental interpersonal control.
  3. People with OCPD can be prone to depression, especially as they grow older and reflect on their lives.
  4. People with OCPD often have devotion to work, to the exclusion of leisure activities, vacations, and friendships.
  5. OCPD is present in about 1% of the population, and males are diagnosed approximately twice as often as females.

Because it is more difficult to accurately diagnose, OCPD (with the absence of the menacing obsession and compulsions that characterize OCD), the following list can be used for reference. A person is characterized as having OCPD (meets at least 4 of the following) IF:

  • Obsessive with work to the point of excluding pleasurable activities.
  • Cannot throw away or get rid of worn out or worthless objects that have no sentimental value.
  • Hoards money.
  • Is rigid and stubborn.
  • Has an extremely difficult time delegating work or tasks, unless it specifically conforms to ones' own way of thinking or doing things.
  • Has difficulty completing projects because the need for perfection interferes with completion of the project.
  • Excessively concerned with details, rules, lists, order, organization, and/or schedules so much that the point of the activity is lost.

TREATMENT OF OCPD

  1. A full medical exam should be taken in order to rule out any physical causes of obsessive-compulsive symptoms.
  2. A comprehensive psychological assessment should be done by a licensed mental healthcare provider.
  3. An evaluation for chronic substance abuse should be made.

Treatment for people with OCPD can be difficult since treatment options, which specifically do not fit the client's "ways of doing things," will often be rejected. Also, people who have OCPD often have difficulty incorporating new and changing information into their lives. Long term therapy is the treatment of choice, and usually takes a great deal of effort on the part of the client and therapist.

Therapy goals include short term symptom relief, and long term goals can focus on changing coping mechanisms to more healthy styles. Medications such as SSRI's often provide some relief, and support groups may be helpful for additional social and emotional support. In summary, OCD and OCPD share similar names but they are different and distinct disorders. A person rarely exhibits both of these disorders simultaneously.

For a CONFIDENTIAL and COMPLIMENTARY session, please call my office at (336) 882-5003.

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