Obsessive-compulsive personality disorder

The so-called anxious disorders of Cluster C include avoidant personality disorder (APD), dependent personality disorder (DPD), and obsessive-compulsive personality disorder (OCPD). Like the Cluster A disorders, these personality disorders are typically unobtrusive and may escape clinical detection for many years. Over time, patients adapt their life styles to these illnesses by decreasing their social contacts in an effort to minimize anxiety. In so doing, they further decrease the likelihood of encountering mental health professionals. 

Obsessive-Compulsive Personality Disorder (OCPD). Despite the similarity in name, OCD and OCPD are not closely related. Therefore, the medications used to treat OCD are not necessarily helpful for OCPD. As a result, we also cannot offer any specific medication recommendations for the treatment of OCPD. The overall anxious nature of the illness and the likelihood that such patients have comorbid depression or anxiety disorders may, however, guide medication selection. 

In one single-blind study, 17 schizotypal patients were given a modest dose of halopehdol (i.e., 2 to 12 mg per day), which produced some benefit, although many were sensitive to the adverse effects of this drug (216). The study by Goldberg et al. (217) also found that thiothixene benefited both schizotypal disorder and borderline personality disorder (BPD). Similarly, low-dose antipsychotics had a modest effect in patients with both schizotypal and obsessive-compulsive personality disorders (218). 

Obsessive-compulsive disordet is rare in obsessive-compulsive personalities. One study found that only 6% of these personality disorders have OCD thus, it is quite likely that the two conditions are distinct (260). The implication for treatment is that agents helpful for OCD (e.g., clomipramine) may not benefit obsessive-compulsive personality disorder. Definitive studies to address this issue have not been conducted, however. 

Patients with this disorder not only have a disturbed eating pattern but also problems with impulse control, often resulting in drug or alcohol abuse, self-mutilation, kleptomania, and sexual disinhibition. They also may have symptoms of obsessive-compulsive disorder or obsessive-compulsive personality disorder ( 498). In these individuals, manipulation of food is associated in varying degrees with alcohol and drug abuse. They are typically poor candidates for pharmacotherapy and, not surprisingly, have been unresponsive to a variety of psychotropics. 

Obsessive-compulsive personality disorder a pattern of preoccupation with orderliness, perfectionism, and control. 

Light KJ, Joyce PR, Luty SE, Mulder RT, Fiampton CM, Joyce LR, Miller AL, Kennedy MA (2006) Preliminary evidence for an association between a dopamine D3 receptor gene variant and obsessive-compulsive personality disorder in patients with major depression. Am J Med Genet B Neuropsychiatr Genet 141 409-413... 

Some similarities exist between OCD and obsessive-compulsive personality disorder (OCP) however, there are notable differences. For treatment purposes, it is important to distinguish between OCD and OCP. With OCD the person feels "under attack" by the obsessions and compulsive rituals the symptoms are quite painful and ego-dystonic. In contrast, OCP traits (perfectionism, stinginess, emotional rigidity, over-devotion to work) are experienced as a part of oneself, or ego-syntonic. 

Panic disorder is characterized by the occurrence of panic attacks that occur spontaneously and lead to persistent worry about subsequent attacks and/or behavioral changes intended to minimize the likelihood of further attacks. Sporadic panic attacks are not limited, however, to those with syndromal panic disorder as they do occur occasionally in normal individuals and in those with other syndromal psychiatric disorders. The hallmark of panic disorder is that the panic attacks occur without warning in an unpredictable variety of settings, whereas panic attacks associated with other disorders typically occur in response to a predictable stimulus. For example, a person with acrophobia might experience a panic attack when on a glass elevator. A patient with obsessive-compulsive disorder (OCD) with contamination fears may have a panic attack when confronted with the sight of refuse, and a combat veteran with post-traumatic stress disorder (PTSD) may experience a panic attack when a helicopter flies overhead or an automobile backfires. 

Obsessive-Compulsive Disorder (OCD). The obsessions and compulsive rituals of OCD can sometimes resemble the odd behavior of a Cluster A personality disorder. The most helpful difference may be that the rituals of OCD are ego-dystonic while the eccentricity of Cluster A personality disorder tends to be ego-syntonic. Usually, the OCD patient is aware of the excessive nature of the obsessions and wishes to be rid of them. The Cluster A patient tends to embrace the odd behavior and draw comfort from it. 

Obsessive-compulsive disorder (OCD) is characterized by recurrent, intrusive, and distressing thoughts, images, or impulses (obsessions) and repetitive, seemingly purposeful behaviors that a person feels driven to perform (compulsions). 

Jenike MA, Surman OS, Cassem NH, et al Monoamine oxidase inhibitors in obsessive-compulsive disorder. J Clin Psychiatry 144 131-132, 1983 Jenike MA, Baer L, Minichiello WE, et al Concomitant obsessive-compulsive disorder and schizotypal personality disorder. Am J Psychiatry 143 530-533, 1986 Jenike MA, Flyman S, Baer L, et al A controlled trial of fluvoxamine in OCD. Am J Psychiatry 147 1209-1215, 1990... 

The book concludes with Chapter 13 and Chapter 14 on disorders that require separate consideration. The first group includes Panic, Obsessive-Compulsive, Post-Traumatic Stress, Somatoform, and Dissociative disorders. Although traditionally these are classified as anxiety disorders, their symptoms and varied treatment responsivity require a separate series of discussions. Finally, certain groups of patients are considered in light of their specialized needs when contemplating psychotropic drug therapy. They include the pregnant patient, children and adolescents, the elderly, the personality disordered, as well as patients whose conditions are complicated by medical problems (e.g., the alcoholic patient the HIV-infected patient). 

Baer L, Jenike MA, Ricciardi JN, et al. Standardized assessment of personality disorders in obsessive-compulsive disorder. Arch Gen Psychiatry 1990 47 826-830. 

In 23 patients with obsessive-compulsive disorder who had not responded to a 6-month course of fluvoxamine (300 mg/day), olanzapine (5 mg/day) was added in an open comparison (28). There was a significant reduction in the mean score on the Yale-Brown Obsessive-Compulsive Scale concomitant schizotypal personality disorder was the only factor significantly associated with a response. The most common adverse effects were mild to moderate weight gain and sedation. 

Other psychiatric illnesses, particularly the anxiety disorder, are also risk factors for development of major depressive disorder. Persons with anxiety disorders (panic disorder, obsessive compulsive cUsorder, social phobia, generalized anxiety disorder, and posttrauma tic stress disorder) go on to develop major depressive cUsorder over the course of 5-20 years in over 50% of cases. 

Obsessive-compulsive disorder is classified as an anxiety disorder. Other anxiety disorders are panic attacks, agoraphobia (the fear of public places), phobias (fear of specific objects or situations), and certain stress disorders. This illness becomes increasingly more difficult to the patient and family, because it tends to consume more and more of the individuahs time and energy. While a person who is suffering from an obsession is aware of how irrational or senseless the fear is, he or she is overwhelmed by the need to perform ritualistic behavior in order to relieve the anxiety connected with the obsession. 

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