It is useful here to make a brief distinction between OCD, of which we now have a pretty good idea, and a much less known, and quite amorphous cousin of it: obsessive-compulsive personality disorder, or OCPD. I introduce it mainly because I want to avoid that readers of this blog, should they encounter the term, wonder about its nature, or mistake it for OCD itself. The information I give here was taken from a review article by the group of Fineberg et al (2007).
The relationship between OCD and OCPD has steadily been controversial. OCPD terminology changed in the handbooks over the years. Different researchers coined different titles. Don’t mind this, please.
OCPD shares with OCD these characteristics:
- difficult cognitive and behavioural flexibility, i.e.: patients have trouble to change intellectual strategies (e.g. in thinking about something, or solving a task); and can’t easily start another activity pattern when their action does not deliver the desired result;
- anxiety and fear present in both conditions; it is noteworthy that at present OCPD is listed in the main handbook for psychiatric conditions (DSM-IV, Text Revision) together with ‘avoidant’ and ‘dependent personality disorders’, whereas OCD is grouped in the ‘anxiety disorders’. It has been proposed by experts to put OCPD in the OCD spectrum disorders; but to this writer, it seems as if this will not contribute to less confusion in these matters – not the least because OCD patients generally have increased rates of numerous personality disorders per se, and not in particular OCPD.
What are the differences between OCD and OCPD?
- subjects with OCPD generally don’t show obsessions and compulsions the way that OCD patients do;
- OCPD tends to be an ego-syntonic disorder, whereas OCD is, as we know, ego-dystonic. This means that people with OCPD do not have the clear conviction that their traits (e.g. extreme perfectionism) are out of normal proportions;
- the above two differences mean in practice that OCPD does not lead to social and occupational impairment, which are two highly taxing secondary consequences in OCD; therefore general mental discomfort in OCD is considerably higher than it is in OCPD.
An interesting development in the classification disputes that are always going on, is the questioning of the proper place of hoarding compulsions. At present hoarding is a dimension reckoned to be one of the group of OCD dimensions. However, as more information became available, investigators found that hoarding is treatment-resistant, more so than other OCD dimensions. Moreover, it had to be admitted that in hoarding, self-insight generally is poor, it is almost as if hoarders must be seen as ego-syntonic. They often think that what they do is natural, self-evident, and that their urge to keep all the collected objects and even garbage will serve some meaningful future purpose. Still, hoarders are suffering from problems in a social and occupational context, which would theoretically make them pure-OCD candidates. On the other hand, you will understand that they share features with subjects that have OCPD.
So the place of hoarding in the classification of mental disorders may well be revised for the above reasons. In theory it might become an anxiety disorder of its own, apart from OCD, or a personality disorder closely related to OCPD.
I hope that the reader has some insight into OCPD by now, and also into the problems that classifying mental illness can entail.