Personality disordersPersonality disorder diagnoses under the ICD-10 system each refer to a set of symptoms specific to that personality disorder and a set of diagnostic guidelines which apply to all personality disorders. A personality disorder is a severe disturbance in the characterological constitution and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption. Personality disorder tends to appear in late childhood or adolescence and continues to be manifest into adulthood. It is therefore unlikely that the diagnosis of personality disorder will be appropriate before the age of 16 or 17 years. General diagnostic guidelines applying to all personality disorders are presented below; supplementary descriptions are provided with each of the subtypes.Diagnostic GuidelinesConditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:1. markedly disharmonious attitudes and behaviour, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;2. the abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;3. the abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;4. the above manifestations always appear during childhood or adolescence and continue into adulthood;5. the disorder leads to considerable personal distress but this may only become apparent late in its course;6. the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is usually required of the presence of at least three of the traits or behaviours given in the clinical description.[footnoteRef:2] [2: http://counsellingresource.com/lib/distress/personality-disorder/icd-notes/]

What is OCPD?Obsessive compulsive personality disorder is also called anankastic personality disorder. It is mental health condition in which a person is preoccupied with rules, the need for order, and everything around them to be perfect and in their control. This disorder causes major suffering and distress, especially in the area of personal relationships. It is characterized with feelings of doubt, excessive consciousness, checking and preoccupation with details, stubbornness, caution and rigidity. Personality disorder 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 patient that others submit to exactly 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.

Do I have OCPD?You can recognize the person suffering from OCPD by their excessive devotion to work that impairs social and family activities, excessive fixation with lists, rules and minor details. They seek perfectionism in work, which interferes with ability to finish tasks. They rigidly follow moral and ethical codes. There is often a tendency to hoard things and difficulty to get rid of old and unnecessary things. OCPD can easily be confused with OCD. The difference between obsessive-compulsive personality disorder and obsessive-compulsive disorder is that people with OCD have insight into their condition and experience unwanted thoughts as unreasonable. However, people with OCPD think that their way is the best way and feel comfortable with self-imposed system of rules. Thoughts and behaviours of people with OCD are not related to real-life concerns; their concerns are unrelated to managing everyday situations, but have deeper, unconscious meaning. On the other side, people with OCPD are preoccupied with daily routines and rules and procedures they have to follow. OCD often interferes with persons family and social life, as well as with work performance. That is not completely the case with people with OCPD their obsessive personality structure enhances their work performance, while their family and social life suffers because of their rigidity and lack of spontaneous behaviour. People with OCD feel tormented by their involuntary thoughts and behaviours and are aware they need treatment in order to feel better and improve the quality of their life and relationships. People with OCPD do not think they require any type of help or treatment. They even think that others are the ones who need to change in order to fulfil their standards.[footnoteRef:3] [3: http://www.ocfoundation.org/uploadedfiles/maincontent/find_help/ocpd%20fact%20sheet.pdf]

People with OCPD are preoccupied with details and rules; they cannot function if the perfection in work is not achieved. It often leads to inability to finish work projects due to dedicating too much time making sure that every single thing is done perfectly and according to their strict standards. They like having control over other people, tasks and situations and are unable to delegate tasks with others. In most cases, they neglect friends and family being excessively committed to work or a project. [footnoteRef:4] [4: http://www.mayoclinic.org/diseases-conditions/personality-disorders/basics/symptoms/con-20030111]

OCD is an illness withsymptomsthat change in severity over time, while OCPD reflects an overly rigid personality style that does not change much over a person's lifetime.OCPD is not associated with theobsessionsandcompulsionsthat are so prominent in OCD. Although people with OCD and OCPD might both carry out repetitive behaviours, the underlying motive is very different. While someone with OCD might repeatedly write out lists or organize items around the home to keep a catastrophe from taking place, someone with OCPD would be more likely to do these activities to increase their efficiency or productivity.While people with OCD usually want to get rid of their symptoms, it is not uncommon for people with OCPD to see nothing wrong with their behaviour and to feel that "other people" are the problem. Likewise, although people with OCD will usuallyseek helpfor the distress caused by their obsession or compulsions, individuals with OCPD will usually seek treatmentbecause of conflict between themselves and family and friends related to their need to have others conform to their way of doing things.People with OCPD often have very rigid views on "right versus wrong," and this rigidity may extend to spending habits; people with OCPD are often described as miserly. Neither of these is a defining characteristic of OCD.In comparison to those with OCD, people with OCPD tend to be more ruled by perfectionism and have a higher need for order and control in both their personal and professional lives. It is not uncommon for individuals with OCPD to become irritated by others who do not value order, perfectionism and exactness to the same extent that they do. Because of this perfectionism, it is not uncommon for people with OCPD to overly devote to work.[footnoteRef:5] [5: http://ocd.about.com/od/diagnosis/f/OCD_OCPDFAQ.htm]

For example, although both OCD and OCPD may involve being excessively engaged in tasks that require exquisite attention to detail such as list-making, individuals with OCD: use these tasks to reduce anxiety caused by obsessional thoughts. For example, if you have OCD you might make a list over and over again to prevent the death of a loved one. In contrast, if you have OCPD you might justify list-making as a good strategy to improve efficiency. are usually distressed by having to carry out these tasks or rituals. In contrast, people with OCPD view activities such as excessive list making or organization of items around the home as necessary and even beneficial. spend a much greater amount of time engaged in these tasks or rituals than people with OCPD.In addition, if you have OCD, you will usually seek help for the psychological stress caused by having to carry out compulsions or the disturbing content or themes of your obsessions. In contrast, if you have OCPD, you will usually seek treatment because of the conflict caused between you and family and friends related to your need to have others conform to your way of doing things.Finally, whereas the severity of OCD symptoms will often fluctuate over time, OCPD is chronic in nature, with little change in personality style.Professional Help is Needed for Accurate Diagnosis and TreatmentAlthough there are clear conceptual differences between OCD and OCPD, in practice these disorders can at times be difficult to tell apart. In addition, sometimes a person can be affected by both OCD and OCPD. In these complex cases, the clinical experience of a qualified mental health professional such as psychiatrist or psychologist is often needed to make a properdiagnosis. As with all forms of mental-illness, a proper diagnosis is essential to ensure the proper treatment.[footnoteRef:6] [6: http://ocd.about.com/od/otheranxietydisorders/a/OCD_OCPD.htm]

When rules and established procedures do not dictate the correct answer, decision making may become a time-consuming, often painful process. Individuals with Obsessive-Compulsive Personality Disorder may have such difficulty deciding which tasks take priority or what is the best way of doing some particular task that they may never get started on anything.They are prone to become upset or angry in situations in which they are not able to maintain control of their physical or interpersonal environment, although the anger is typically not expressed directly. For example, a person may be angry when service in a restaurant is poor, but instead of complaining to the management, the individual ruminates about how much to leave as a tip. On other occasions, anger may be expressed with righteous indignation over a seemingly minor matter.People with this disorder may be especially attentive to their relative status in dominance-submission relationships and may display excessive deference to an authority they respect and excessive resistance to authority that they do not respect.Individuals with this disorder usually express affection in a highly controlled or stilted fashion and may be very uncomfortable in the presence of others who are emotionally expressive. Their everyday relationships have a formal and serious quality, and they may be stiff in situations in which others would smile and be happy (e.g., greeting a lover at the airport). They carefully hold themselves back until they are sure that whatever they say will be perfect. They may be preoccupied with logic and intellect.A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individuals culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.[footnoteRef:7] [7: http://psychcentral.com/disorders/obsessive-compulsive-personality-disorder-symptoms/]

Individuals who suffer from this disorder have difficulty in incorporating new and changing information into their lives, so new learning takes place only over a great deal of time and with as much effort on both the clinician's and client's part. Their ability to work with others is equally affected, since they see the world asblackandwhite-- their way of doing things and the wrong way of doing things. Naturally, this faulty logic will also be translated into their therapeutic relationship with the clinician and their treatment. It is therefore unlikely the clinician will have much success in using techniques or treatment modalities which haven't first been approved by the patient for use. Sometimes this may be done simply by stating the effectiveness of a given treatment for a specific problem, citing relevant research studies. More often, though, this technique won't be effective.[footnoteRef:8] [8: http://psychcentral.com/disorders/sx26t.htm]

What causes obsessive thoughts?Research suggests that genetics, abuse and other factors contribute to the development of obsessive-compulsive, narcissistic or other personality disorders.In the past, some believed that people with personality disorders were just lazy or even evil. But new research has begun to explore such potential causes as genetics, parenting and peer influences: Genetics.Researchers are beginning to identify some possible genetic factors behind personality disorders.a. One team, for instance, has identified amalfunctioning genethat may be a factor in obsessive-compulsive disorder.b. Other researchers are exploring genetic links to aggression, anxiety and fear traits that can play a role in personality disorders.Childhood trauma.Findings from one of the largest studies of personality disorders, theCollaborative Longitudinal Personality Disorders Study, offer clues about the role of childhood experiences.One study found a link between the number and type of childhood traumas and the development of personality disorders. People with borderline personality disorder, for example, had especially high rates ofchildhood sexual trauma.Verbal abuse.Even verbal abuse can have an impact. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, told them they didnt love them or threatened to send them away. Children who had experienced suchverbal abusewere three times as likely as other children to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood.High reactivity.Sensitivity to light, noise, texture and other stimuli may also play a role.a. Overly sensitive children, who have what researchers call high reactivity, are more likely to develop shy, timid or anxious personalities.b. However, high reactivitys role is still far from clear-cut. Twenty percent of infants are highly reactive, but less than 10 percent go on to develop social phobias.Peers.Certain factors can help prevent children from developing personality disorders.a. Even a single strong relationship with a relative, teacher or friend can offset negative influences, say psychologists.Researchers today dont know what causesobsessive-compulsivepersonality disorder. There are many theories, however, about the possible causes ofobsessive-compulsive personality disorder. Most professionals subscribe to a biopsychosocial model of causation that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individuals personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be passed down to their children.[footnoteRef:9] [9: http://psychcentral.com/disorders/obsessive-compulsive-personality-disorder-symptoms/]

How to treat OCPD?Professional Help is Needed for Accurate Diagnosis and TreatmentAlthough there are clear conceptual differences between OCD and OCPD, in practice these disorders can at times be difficult to tell apart. In addition, sometimes a person can be affected by both OCD and OCPD. In these complex cases, the clinical experience of a qualified mental health professional such as psychiatrist or psychologist is often needed to make a properdiagnosis. As with all forms of mental-illness, a proper diagnosis is essential to ensure the proper treatment.If you or a loved one is experiencing symptoms of either OCD or OCPD, be sure to consult a qualified mental health professional so that you or your family member is able to get the proper care.[footnoteRef:10] [10: http://ocd.about.com/od/otheranxietydisorders/a/OCD_OCPD.htm]

Personality disorders such as obsessive-compulsive personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose obsessive-compulsive personality disorder.Many people with obsessive-compulsive personality disorder dont seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a persons life. This most often happens when a persons coping resources are stretched too thin to deal with stress or other life events.A diagnosis for obsessive-compulsive personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.[footnoteRef:11] [11: http://psychcentral.com/disorders/obsessive-compulsive-personality-disorder-symptoms/]

Treatment of obsessive-compulsivepersonality disordertypically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms.[footnoteRef:12] [12: http://psychcentral.com/disorders/obsessive-compulsive-personality-disorder-symptoms/]

As with most personality disorders, treatment is often focused on short-term symptom relief and the support of existing coping mechanisms while teaching new ones. Long-term or substantive work on personality change is usually beyond most clinician's skill levels, and patient's budgets. Obsessive-compulsive personality disorder is especially resistant to such changes, because of the basic makeup of this disorder.Short-term therapy will be most likely to be beneficial when the patient's current support system and coping skills are examined. Those skills which are not currently working could be reinforced with additional skill sets. Social relationships can also be examined, reinforcing strong, positive relationships while having the client re-examine negative or harmful relationships. One important aspect is to try and have the individual examine and properly identify theirfeeling states, rather than just intellectualizing or distancing themselves from their emotions. This can be accomplished through a variety of techniques, such as feeling identification (e.g., the "feeling faces") at the onset of every therapy session. Homework might include writing feelings down in a journal, especially as they notice them. Proper identification and realization of feelings can bring about much change in and of itself.Individuals suffering from obsessive-compulsive personality disorder often are not in touch with their emotional states as much as their thoughts. Leading the client away fromdescribingsituations, events, and daily happenings and to talking about how such situations, events and daily happenings made themfeelmay be helpful. Sometimes the patient may complain he or she doesn't remember or know how he or she felt at the time; the journal becomes a useful tool at this point.Therapy with people who have this disorder can sometimes be trying, since they can see the world in a very "all-or-nothing" manner. Beck's cognitive therapy doesn't seem to be all that effective in treatment, and cognitive approaches in general probably aren't useful in this case. Clinicians must be willing to undergo verbal attacks on their professionalism and knowledge, as such skepticism about a therapist's treatment approach from the client with this disorder can be expected. Clinicians should also be careful about engaging the client within these verbal attacks or intellectual discussions, as they continue to distance the patient from his or her feelings. And take the focus off of the client and onto unrelated matters (e.g., a therapist's professional training).[footnoteRef:13] [13: http://psychcentral.com/disorders/sx26t.htm]

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Support groups, though, offer an excellent adjunct to continuing medication check-ups once a month, and a way to gain emotional and social support through the community. These groups also allow others to ensure the client is doing well and promotes the client's independence and stability. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.Such support groups are recommended to individuals suffering from this disorder, especially if they have found therapy unhelpful or too expensive.[footnoteRef:14] [14: http://psychcentral.com/disorders/sx26t.htm]

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