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Personality disorders
Personality 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 Guidelines
Conditions 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
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below, clear evidence is usually required of the presence of at least three of the traits or
behaviours given in the clinical description.
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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

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http://counsellingresource.com/lib/distress/personality-disorder/icd-notes/
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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.
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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.
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OCD is an illness with symptoms that 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 the obsessions and compulsions that 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

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http://www.ocfoundation.org/uploadedfiles/maincontent/find_help/ocpd%20fact%20sheet.pdf
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http://www.mayoclinic.org/diseases-conditions/personality-disorders/basics/symptoms/con-20030111
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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 usually seek help for the
distress caused by their obsession or compulsions, individuals with OCPD will usually seek
treatment because 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.
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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.

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http://ocd.about.com/od/diagnosis/f/OCD_OCPDFAQ.htm
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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 Treatment
Although 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 proper diagnosis. As with all forms of mental-illness, a proper diagnosis is essential to
ensure the proper treatment.
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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.

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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.
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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 as black and white -- 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.
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What causes obsessive thoughts?

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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 a malfunctioning gene that 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, the Collaborative 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 of childhood 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 such verbal
abuse were 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.
. Overly sensitive children, who have what researchers call high reactivity, are
more likely to develop shy, timid or anxious personalities.
a. 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.
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Peers. Certain factors can help prevent children from developing personality
disorders.
. Even a single strong relationship with a relative, teacher or friend can offset
negative influences, say psychologists.
Researchers today dont know what causes obsessive-compulsive personality
disorder. There are many theories, however, about the possible causes of obsessive-
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.
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How to treat OCPD?
Professional Help is Needed for Accurate Diagnosis and Treatment
Although 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 proper diagnosis. As with all forms of mental-illness, a proper diagnosis is essential to
ensure the proper treatment.

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http://psychcentral.com/disorders/obsessive-compulsive-personality-disorder-symptoms/
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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.
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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.
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Treatment of obsessive-compulsive personality disorder typically 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.
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http://ocd.about.com/od/otheranxietydisorders/a/OCD_OCPD.htm
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http://psychcentral.com/disorders/obsessive-compulsive-personality-disorder-symptoms/
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http://psychcentral.com/disorders/obsessive-compulsive-personality-disorder-symptoms/
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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 their feeling 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
from describing situations, events, and daily happenings and to talking about how such
situations, events and daily happenings made them feel may 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
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his or her feelings. And take the focus off of the client and onto unrelated matters (e.g., a
therapist's professional training).
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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.
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