Obsessive Compulsive Personality Disorder

This article describes obsessive-compulsive personality disorder. It is not to be confused with obsessive-compulsive disorder and obsessive-compulsive symptoms associated with other diseases.

Classification according to ICD-10
F60.5	Anankastic Personality Disorder
ICD-10 online (WHO version 2019)

The compulsive personality disorder or anankastic personality disorder (from ancient Greek ανάγκη anánke , German 'compulsion' , 'need'), also obsessive-compulsive personality disorder , belongs to the group of personality disorders ( cluster C ). Typical of them are rigidity , perfectionism , constant controls , feelings of doubt and fearful caution not to make mistakes.

Obsessive-compulsive personality disorder is a completely different mental disorder from obsessive-compulsive disorder - despite some similarities in the visible symptoms. The incidence in the general population is estimated to be around 1%.

description

Personality disorders are usually serious disorders of the personality and behavior of the person concerned that are not directly attributable to brain damage or any other psychiatric disorder. Personality disorders often affect different areas of the personality and are almost always associated with personal and social impairments. The resulting consequences do not necessarily have to lead to a subjective level of suffering ( ego-syntonic symptoms ).

In the specific case of compulsive personality disorder, there is often a lack of flexibility in thinking and acting. Instead, ideal images are projected frozen into the future. As a result, the people concerned find themselves in hardly solvable conflicts: They constantly strive for perfection . However, due to the excessively strict and often unattainable norms they have set themselves, it is difficult for them to carry out their tasks and projects. They tend to be never completely satisfied with their own performance. Excessive preoccupation with rules , efficiency issues, insignificant details or procedural issues disturbs your overview. As a result, the actual activity can take a back seat.

Compulsive people tend to be less effective in scheduling : important things are postponed until the last moment, while leisure activities are even planned precisely. Work and the pursuit of success are usually given priority over pleasure and social relationships. Often they try to justify their actions logically and rationally. Emotional or affective behavior of others will not be tolerated. Due to their pronounced indecision, decisions are repeatedly postponed, which is an expression of an exaggerated fear of making mistakes. This can mean that orders and projects cannot be completed at all. They are also extremely conscientious and like to take on the role of “moral apostle”. They take everything very carefully with themselves and others, and react extremely sensitively and hurt to criticism from persons in authority. Those affected tend to be depressed and often show symptoms of other obsessive-compulsive disorders , although an internal connection between the disorders cannot be immediately recognized.

The ability to express feelings is often reduced. In interpersonal relationships , those affected appear correspondingly cool and rational. The ability to adapt to the habits and peculiarities of other people is limited. Rather, other people are expected to adhere to their own principles and standards. They sometimes tend to be stingy and are often unable to part with worn or useless things, even if they have no memory value.

Demarcation

Obsessive-compulsive personality disorder must be distinguished from other disorders and differentiated diagnostically before a diagnosis is made.

There is no demonstrable association between the obsessive-compulsive symptoms in obsessive-compulsive disorder and obsessive-compulsive personality disorder. While obsessiveness in the context of compulsive (anankastic) personality disorder is perceived as an integral part of the person (" I-synton "), the symptoms of obsessive-compulsive disorder are perceived as foreign to me and not belonging to one's own personality (" I-dyston ") .

Classification

ICD-10

In the ICD-10 , anankastic [compulsive] personality disorder is classified under the code F60.5. It is listed as a specific personality disorder in the Personality and Behavioral Disorders section (F60 – F69). At least four of the following characteristics or behaviors must be present:

1. Feelings of strong doubt and excessive caution,
2. Constant preoccupation with details, rules, lists, order, organization and plans,
3. Perfectionism that hinders the completion of tasks,
4. Excessive conscientiousness and scrupulousness ,
5. Disproportionate performance-relatedness with neglect or up to the renunciation of pleasure and interpersonal relationships,
6. Excessive pedantry and adherence to social conventions,
7. Rigidity and stubbornness
8. Unfounded insistence that others subordinate themselves exactly to their own habits or unfounded reluctance to let others do something.

DSM-5

In the DSM-5 , obsessive-compulsive personality disorder is assigned to the personality disorders category. It is a profound pattern of intense preoccupation with order, perfection and psychological and interpersonal control at the expense of flexibility, open-mindedness and efficiency. It starts in early adulthood, and the pattern shows up in different situations.

At least four of the following criteria must be met:

1. Overly concerned with details, rules, lists, order, organization or plans so that the essential aspect of the activity is lost.
2. Shows a perfectionism that hinders the fulfillment of tasks (for example a project cannot be finished because one's own overstrict norms are not met).
3. Over-indulging in work and productivity to the exclusion of recreational activities and friendships (not attributable to obvious financial necessity).
4. Is overly conscientious , scrupulous and rigid in matters of morality , ethics and values (not due to cultural or religious orientation).
5. Is unable to throw things away that are worn or worthless, even if they don't even have emotional value;
6. Reluctantly delegates tasks to others or is reluctant to work with others if they don't follow their own way of working .
7. Is stingy of himself and of others; Money needs to be hoarded for feared future disasters.
8. Shows rigidity and stubbornness.

Treatments

psychotherapy

In the case of obsessive-compulsive personality disorder, neither psychotherapeutic nor pharmacological therapy approaches have been sufficiently empirically investigated in order to be able to describe with scientific certainty which is the best form of therapy. Preliminary indications exist for the effectiveness of cognitive therapy and other behavioral therapy methods .

Since personality disorders are character structures acquired at an early stage, psychodynamic psychotherapy methods can be just as effective as behavioral approaches. Psychodynamic procedures may have a more profound and lasting effect than practicing procedures that rely primarily on psychoeducation . Psychoeducation helps the affected patient to better deal with his personality structure in the here and now, but only marginally affects self-development.

The declaration oriented psychotherapy by Rainer Sachse has developed specific therapeutic approaches, as well as trouble-free and therapy theoretical concepts for the treatment of difficult to treat personality disorders. It is of fundamental importance for therapy that the therapist first perceives the client's central (relationship / interaction) motives and the strongest schemata and reacts to them correctly in order to establish a trusting and productive therapeutic relationship. The therapist can then make the client's previously unconscious and uncontrollable schemas transparent and the disadvantages (“costs”) of his rigid, dysfunctional behavior patterns (explication process, generation of motivation to change). This allows these patterns to be worked on and changed therapeutically with the client, and more sensible alternative courses of action can be developed and stabilized.

Medication

So far there are no reliable studies on whether psychopharmacological treatment can permanently improve the symptoms of the compulsive personality disorder. The findings on the effectiveness of treatment with SSRIs for additional depression ( comorbidity ) are contradictory.

Since there is no specific psychopharmacological standard therapy, the approach is always symptom-oriented in individual cases. This means that one does not treat the compulsive personality disorder as such, but rather the particularly distressing symptoms that may be present as a result of the personality disorder. For example, the following psychotropic drugs can be used: serotonin reuptake inhibitors , atypical antipsychotics , mood stabilizers , anti- epileptics . The treatment depends on the specific complaints in each individual case.

literature

• Nicolas Hoffmann, Birgit Hofmann: Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive Disorders. Therapy and self-help. Springer, Berlin / Heidelberg 2010, ISBN 978-3-642-02513-6 .
• Michaela Städele: Work Addiction and Compulsive Personality Disorder. A theoretical and empirical discussion. Müller, Saarbrücken 2008, ISBN 978-3-639-06430-8 .
• Rainer Sachse: Personality Disorders. Guide to psychological psychotherapy. Hogrefe, Göttingen 2013, ISBN 978-3-8017-2542-6 .

Web links

• Universitätsmedizin Berlin Charité: Personality Disorders.

Individual evidence

1. ↑ Personality disorders: epidemiology. In: psychiatriegespraech.de. Retrieved on November 18, 2012 : "1.7–6.4% according to Maier, Reich, Zimmerman and Coryell" 
2. ↑ Lee Baer: Personality Disorders in Obsessive Compulsive Disorder. Michael Jenike et al. (Ed.): In Obsessive Compulsive Disorders: Practical Management. 3. Edition. 1998.
3. ↑ ^{a b c} AWMF : Old S2 guidelines for personality disorders (valid from 2008 to 2013) ( Memento from January 23, 2013 in the Internet Archive ). P. 10
4. ^ Nicolas Hoffmann, Birgit Hofmann: Obsessive-compulsive personality disorder and obsessive-compulsive diseases. Therapy and self-help. Springer, Berlin / Heidelberg 2010, p. 19.
5. ↑ Eugen Bleuler: Textbook of Psychiatry. Springer 1983.
6. ^ Gwyneth D. Cheeseman: All You Need To Know About OCPD and Perfectionism. Willows Books Publishing, 2013.
7. ^ S3 guideline for obsessive-compulsive disorder of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN). In: AWMF online (as of 2013)
8. ↑ Peter Falkai, Hans-Ulrich Wittchen (ed.): Diagnostic and statistical manual of mental disorders DSM-5 . Hogrefe, Göttingen 2015, ISBN 978-3-8017-2599-0 , pp. 931 .
9. ↑ M. Ehrmann: Psychosomatic Medicine and Psychotherapy. A textbook on a psychoanalytic basis. 2007.
10. ↑ F. Kanfer, D. Schmelzer: Guide to behavior therapy - psychotherapy as an opportunity. Springer, 2001.
11. ^ Franziska Dietz: Psychology. Basics, disease models and psychotherapy. Marburg 2006.
12. ↑ Rainer Sachse, Stefanie Kiszkenow-Bäker, Sandra Schirm: Clarification -oriented psychotherapy of compulsive personality disorder (=  practice of psychotherapy for personality disorders ). 1st edition. Hogrefe, Göttingen 2015, ISBN 3-8017-2713-0 .
13. ^ Rainer Sachse, Oliver Püschel, Jana Fasbender, Janine Breil: Clarification-oriented schema processing. Effectively change dysfunctional schemes . Hogrefe, 2008, ISBN 3-8017-2190-6 .
14. ^ Rainer Sachse, Meike Sachse, Jana Fasbender: Clarification-oriented psychotherapy of personality disorders. Basics and concepts (=  practice of psychotherapy for personality disorders ). Hogrefe, Göttingen [a. a.] 2011, ISBN 3-8017-2350-X .
15. ^ S2 guideline psychiatry: Page no longer available , search in web archives: Personality disorders. (Status 05/2008), accessed on March 30, 2014.
16. ^ Brigitte Vetter: Psychiatry. 7th edition. Stuttgart 2007.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !