Friday Counseling Issues: The Personality Disorders

Today:  Obsessive-Compulsive Personality Disorder.

 

   

First, there is a difference between Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive Disorder.  Here is a quick summary of the differences:

Difference #1: Insight

Folks with OCD usually know that their thoughts are not exactly reasonable (“Did I turn off the stove?  I’d better check,” or “If I wear unmatched socks, something bad will happen to my brother.”)

By contrast, individuals with OCPD believe their sky-high standards and work ethic are not only reasonable, but the only way to get things done.

Difference #2: Distress

In OCD, the obsessions and compulsions are stressful and unpleasant. For instance, feeling convinced you just drove over someone and circling back dozens of times to check for a body turns one’s stomach into knots. By contrast, for those with OCPD, the rigid schedules and rules of the condition are often comforting and feel right.

Difference #3: Guilt

In OCD, individuals can, but not always, feel guilty about asking others to conform to their rituals (for example, “I know it’s a hassle to put on shoe covers whenever you come inside, but I really, really need you to do that.  I’m so sorry.”)  On the flip side, those with OCPD think others should conform to their methods and firmly believe they’d be better off for it.

Difference #4: Anxiety

With OCD, compulsions – the actions someone with OCD can’t resist doing, like checking, counting, or washing – are performed to reduce anxiety.  For instance, an individual with OCD might review her schedule for the day over and over again because she’s  terrified she’s forgotten to include all her appointments.

By contrast, someone with OCPD might make and review a detailed schedule in order to be comprehensive and efficient.  Anxiety isn’t part of the picture.

Difference #5: Time

By definition, OCD takes more than an hour a day.  That’s right – part of an OCD diagnosis can be the fact that the obsessions, plus the compulsions to neutralize the obsessions, suck up a lot of time. OCPD, on the other hand, is more tightly interwoven to one’s personality. Rather than being an activity unto itself, the perfectionism and control of OCPD is more of a trait, not a time suck.

Quick Tip: Think of the one-letter difference between the two acronyms: OCPD has a “p” in it, which you can pretend stands for “perfectionism,” the defining feature of the disorder.

Any way you slice it, these disorders are tough to live with.  The good news?  They’re also treatable, particularly OCD.  With work and practice, the only difference you’ll think about is what a difference good treatment makes.

(taken from: http://www.quickanddirtytips.com/health-fitness/mental-health/ocd-vs-ocpd-5-differences)

As with all the personality disorders, the person who has one thinks it is everyone else who is odd, wrong, strange, unreasonable, and needs help.  People who have OCD, as opposed to OCPD, are willing and often eager to seek help. On the contrary, OCPD people don’t think they need any help.  If only everyone else were as organized, scheduled, meticulous, PERFECT as they are, the world would be a better place.

Both of these disorders used to be classed under anxiety disorders. The new Diagnostic and Statistical Manual, however, has given OCD a place of its own, while OCPD is still under Personality Disorders.

Confused?  Think of it this way. OCPD people many not have the counting rituals, the constant handwashing, checking and rechecking of OCD, but they are absolutely convinced that their way is the ONLY right way, and they don’t mind imposing their standards on everyone else.

If you have an OCPD boss, that person will demand absolute obedience to every rule in the book, and he knows them all by heart.  He probably wrote them.  He simply doesn’t understand a cluttered desk, and will insist that his employees have prisitine  desktops. He doesn’t understand at all that some of us just don’t see the clutter, and we actually work more efficiently and productively if things are not antiseptically clean.

I knew someone who always did her wash on Monday, no matter what. No exceptions. She hung her laundry outside, even in the coldest weather, because the sun and fresh air helped kill bacteria that her boiling hot water and bleach may have overlooked.  If it rained or snowed on wash day, the clothes were hung on lines in the basement, but she worried incessantly that the clothes just weren’t as clean as if she’d been able to hang them out.

It messed up her whole week.  She could hardly wait until the following Monday.

That’s OCPD. To her, it was just normal, and she simply didn’t understand why Monday washday was not sacred to me. It bothered her. A lot.

She also ironed and mended on Tuesday, baked on Wednesday, shopped on Thursday, cleaned on Friday, and did yard work or major deep cleaning on Saturday.  Like clockwork.

OCPD people can find it difficult to make time for an unscheduled lunch date, or just taking an hour off to read or nap. Being off-schedule is intolerable.  Rules of etiquette are strictly observed, and there isn’t much spontaneous humor.

The other day, at work, I’d been doing some research during a free hour.  My desk was cluttered with several books, a legal pad full of notes, and the usual collection of pens, tissue box, and so on. It was a mess.  Didn’t bother me a bit;  it was work in progress.

When my client, a very nice lady who was seeing me for some marital help, came into my office, she stopped cold and stared at my desk. “Would you like me to help you clean that up before we start?”  she asked.

I could see that the mess would distract her completely, so I quickly gathered up, straightend up, and put things in my desk drawers. It was a pain for me, because I would have to get it out all over again. For her, it was intolerable and she wouldn’t have been able to focus on anything but my messy desk.

Treatment is helpful only when the person realizes she needs it. People with OCD respond well to cognitive behavioral therapy and treatment for anxiety.  People with OCPD  have to be persuaded that they need any help at all.

Today’s post concludes our study of the personality disorders.  I hope it’s been interesting for you, and even better, perhaps it’s been helpful.

 

Friday Counseling Issues: A Ramble

I’ve worked two full weeks now since the end of my Christmas break.  It’s amazing how fast the time is going. Christmas was such a great time, having all nine of my grandkids together.  It just went too fast.

Anyway, today I’m thinking about a couple of things that some of my clients are dealing with. Both are difficult to manage, for the client and for the therapist.

OCD is a combination of two things:  Obsession is what goes on in the brain, and compulsion is the resulting behavior.

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Some obsessions have their roots in actual events, usually somewhat traumatic. For instance, someone who gets caught in a stalled elevator may develop obsessive thoughts and fears of any small, enclosed place.  Those fears could result in compulsive behaviors such as never going into a building that has elevators; avoiding any enclosed place such as a public bathroom stall; or avoiding any room that has no windows. The person who suffers from this type of obsession may be compelled to check at least three times (pick any number) before entering a building, to make sure there are stairs, windows, and more than one door.

Veterans who come home from active duty having suffered, perhaps, traumatic brain injuries in an IED blast could very well have Post-Traumatic Stress as well. Any loud noise triggers a startle response. They may go into immediate defensive mode if they hear a car backfire, or even a balloon popping nearby. The obsession is the blast noise; the compulsion can become as serious as refusing to ever leave their house or even their own bedroom.  No TV, no music, no loud talking. If there are children in the home, they learn very quickly to play quietly.

Obsessions that are rooted in actual events are easier to treat than obsessions that have no apparent connection to reality. Take, for instance, a young man who is obsessed with the idea that he is too thin, and is unappealing to girls.  His obsession with his weight compels him to strip down several times a day, leaving his clothes in another room, making sure that he is touching nothing when he steps on the scale to make sure his weight hasn’t dropped below, say, 175 pounds.  If it should drop below that arbitrary number, he immediately begins to eat the most fattening foods he can find, and then he worries about getting a flabby belly so he does 100 crunches.  His whole day can be taken up with these obsessive-compulsive behaviors. He can’t keep a job.  He has no social life. Yet, the truth is that he is a fairly good-looking man with a normal body weight.  He is pleasant and kind, but he’s convinced that he’s a freak.

People who have OCD are often perfectionistic, which of course only makes their problem worse. There was a beautiful young woman who came to see me because her boss was threatening to fire her.  The problem?  She was too slow.  She had to type every document three times;  each document had to be proofread three times; if something was to be mailed, she had to fold it three times, put it in the envelope three times, check the address three times, position the stamp three times before gluing it down. As you can imagine,  she took three times as long as all the other girls in the secretarial pool.

What was her obsession?  She believed that if she did not take these precautions, she would make a mistake that would close down the multi-billion dollar company she worked for and collapse the economy of the whole USA.  Seriously.   She really believed that.

How do we help people who suffer?  And believe me, suffer is not an overstatement.

This is one of the few problems in which I insist my client see the doctor and get some good anti-anxiety medication. Once that is established, we begin working with Cognitive Behavioral Therapy, which addresses the obsession head on. Once the obsession begins to lose its power, the compulsions also begin to fade.

I’ve made it sound so easy.  It isn’t. Obsessive thought patterns are well-established and very difficult to remove.  It takes great strength of character to kick obsessions to the curb.

If you know someone who struggles, please don’t make fun of him; don’t tell him to just get a grip.  He wants to, he’s tried to numerous times.  He’d give anything to live your normal life, without all the fears and time-consuming rituals he feels compelled to perform.

So, not really a ramble after all.  I’m done.  And I’m not feeling terrific, so I think I’m going to go gargle some cider vinegar and maybe go back to bed.

 

Friday Counseling Issues: Psycholabels–OCD

If you truly have Obsessive-Compulsive Disorder, this picture will drive you nuts.

Remember the TV show Monk ?  True case of OCD beautifully portrayed by Tony Shalhoub.

True OCD is miserable, and has the propensity to make everyone who knows the person miserable.  It used to be classed as an anxiety disorder, but  in the latest Diagnostic and Statistical Manual, it has a classification all to itself.  You can find out what OCD is really all about here. It involves the belief that if a person repeats certain behaviors a certain number of times, then horrible things will be prevented.

If you simply like things to be kept neat and orderly, you don’t necessarily have OCD.  If you live with a complete slob who couldn’t care less about neatness, he’ll call you OCD and try to make you feel you’re the one who has a problem.  You don’t have OCD.  HE has SLOB. And someone who has SLOB may also be a hoarder, which may truly drive his spouse into OCD.

You know, all this use of psychological diagnositic labels makes ME crazy.  I have clients who come in and say, “I have Bipolar Disorder,” or OCD, or depression, or schizophrenia, or any other number of terrible things.  When I ask them when they were diagnosed or who diagnosed them, they often say, “Oh, I read about it on the internet. I fit the profile.”

At that point, I’d like to throw every computer into the Pacific.  Not the Atlantic.  The Pacific is bigger.

It is especially toxic when someone goes to the internet to diagnose someone else.  No one becomes an expert by reading something on the internet.  Not even Al Gore.

If you have someone in your family who has a tendency to go around straightening up the living room, it doesn’t necessarily mean he has OCD.  If a woman can’t go to bed until the kitchen is set to rights, it doesn’t mean she has OCD.  Some people just like things neat, clean, and orderly. That isn’t a disorder.  It’s a personality trait.

It’s a good thing some people have those traits. Otherwise, the world would be in an even bigger mess than it already is.