Tag Archives: Obsessive-Compulsive Disorder

Obsessive-Compulsive Personality Disorder (OCPD) #Write31Days

31 Days of Mental Health

Welcome to day 2 in the #Write31Days challenge on mental health. When you

Welcome to day 18 in the #Write31Days challenge on mental health. To be honest, this challenge is proving harder than I expected and I’m glad we have only two more weeks of it to go. Today, I’ll continue writing on personality disorders in cluster C. The last one in this category is obsessive-compulsive personality disorder (OCPD).

Obsessive-compulsive personality disorder is characterized by extreme orderliness, perfectionism and the need for mental and interpersonal control. People with OCPD find it hard to make decisions when rules and procedures do not strictly dictate the right path to follow. People with OCPD may also become upset when they don’t have full control over their physical or social environment. However, they often do not directly express their anger. For example, sometimes instead of expressing their frustration, the person with OCPD may worry and ruminate over their lack of control. At other times, they may express their anger very strongly when others deviate even minorly from the rules.

In order to be diagnosed with OCPD, a person has to meet four or more of the following criteria:


  1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

  2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).

  3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).

  4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).

  5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.

  6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.

  7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

  8. Shows significant rigidity and stubbornness.

OCPD, for clarity’s sake, is distinct from obsessive-compulsive disorder (OCD). Though some studies have found high rates of co-occurrence between the two disorders, others have not. On the surface, the two disorders share some common behavior patterns, such as ritualistic tendencies. Hoarding, a need for symmetry and orderliness are also common in both disorders. A major difference between OCD and OCPD is that people with OCD are distressed by their obsessions and compulsions, whereas people with OCPD feel they are fully justified in their need for orderliness. As a result, while people with OCD commonly seek treatment, people with OCPD (like most people with personality disorders) often do not.

Anxiety

One of the Friday Reflections prompts for this week is to write about anxiety. How does it affect me and what do I do to cope? I will write here about my experiences with various types of anxiety. It ties in nicely with last Monday’s post, in which I share tips for relaxation. However, throughout this post, I will share some coping strategies that have and haven’t worked for me too.

In the psychiatrist’s manual, DSM-5, there are various types of anxiety disorders. Now I don’t have a diagnosis of any of these disorders, but they are a good reference point for the various types of anxiety that people may experience.

Generalized anxiety disorder (GAD) is a condition in which a person feels anxious or worried about a variety of situations. This worry is accompanied by a feeling of restlessness, fatigue, difficulty concentrating, irritability, sleep disturbance and/or muscle tension. Generalized anxiety disorder often co-occurs with depression.

Though I haven’t had a diagnosis of GAD, partly because my owrrying can be explained by my autism, I have been a chronic worrier all my life and experienced many of the associated symptoms I mentioned above. Antidepressants can help this type of anxiety and in fact are more effective for GAD than for depression. I have been taking the antidepressant Celexa since 2010 with moderate success.

Some people worry about specific things happening to them. For example, I have a lot of anxiety about getting a serious illness. This is called hypochondria or health anxiety. In the psychiatrist’s manual, it is classified as a somatic symptom disorder rather than an anxiety disorder, but the symptoms overlap with those of anxiety disorders. Some doctors have tried antidepressants for health anxiety and documented significant improvement in their patients. It is also commonly thought that people’s health anxiety lessens, ironically, when they do get seriously ill.

My health anxiety is associated with compulsive behaviors. For example, when I was a child, I was afraid of contracting leprosy. As a means of keeping my worry at bay, I’d count my fingers and toes, since I heard that people who had leprosy had those fall off.

Later on, when I lived independently, obsessive worrying and the resulting compulsive behaviors extended to other situations. For example, I’d be afraid of carbon monoxide poisoning and would have to check that my heating was off and windows open at night. I often checked this twenty or thirty times a night.

Obsessive compulsive disorder (OCD) is classified in DSM-5 under its own category separate from anxiety disorders. The obsessive compulsive spectrum also includes disorders that aren’t commonly seen as anxiety disorders, such as hoardng and trichotillomania (compulsive hair pulling). However, OCD used to be seen as an anxiety disorder. Antidepressants can help, but so can exposure and response prevention. In this type of psychotherapy, the patient is gradually taught to lessen the compulsive response (eg. checking) to a feared scenario. For example, people who have hygiene-related compulsions gradually move from say a three-hour shower down to normal shower time, decreasing their time under the shower by one minute a day. For me personally, my obsessions and compulsions related to the risk of carbon monoxide poisoning decreased dramatically when I was hospitalized.

Another type of anxiety disorder is specific phobia. Everyone probably has something they are fearful of, but a specific phobia is only diagnosed when the fear and resulting avoidance of situations greatly impairs the person’s daily functioning. Similar to OCD, specific phobias are treated with exposure therapy, where the person is gradually intrduced to the feared situation or object and learns to endure the fear. For example, a person with a spider phobia might be first intrduced to pictures of spiders, then videos, then look at a live spider, etc. You can also be asked to simply imagine the feared scenario (eg. looking at a spider). After all, with certain phobias, it is not feasible for the therapist to take the client on to the real experience.

A final type of anxiety is social phobia. A person with social phobia is extremely fearful of social situations because of the fear of making mistakes or being criticized. As a result, people with social phobia avoid certain or all social situations. Many autistic people develop social anxiety as a result of their real social ineptness. I for one do not consider myself that socially anxious, but when I filled out a social phobia questionnaire online, it said I had very sevre social phobia. This is probably because I get overwhelmd by social situations easily and avoid them because of this.

People with social phobia, often children, may also suffer from a co-existing condition called selective mutism. This is an inability to talk in certain situations (eg. at school) while the child has adequate speech in other situations (eg. with parents). I displayed signs of selective mutism as a teen. Though this was in part anxiety-related, it also related to my autism.

There are still many other types of anxiety and related disorders, such as panic disorder and agoraphobia. Post-traumatic stress disorder (PTSD) also used to be classified as an anxiety disorder. I used to have a diagnosis of PTSD and still have some of its symptoms, but I may discuss this at a later time.

Reflections From Me

Obsessive and Compulsive Behaviors in Autism #AtoZChallenge

Welcome to day fifteen in the A to Z Challenge on autism. Today, I will focus on obsessive and compulsive behaviors as they occur in autistic people.

The obsessive-compulsive spectrum encompasses a number of disorders that may co-exist with autism spectrum disorders. Even people with autism without an additional diagnosis often display obsessive an compulsive behaviors. In fact, the repetitive behaviors that are a core symptom of autism are often thought of as obsessive.

The first way in which obsessive and compulsive behaviors present themselves is in autistic people’s obsessive interests. Autistic people often engage in one specific interest that may be unusual in either intensity or focus. I will focus on unusual fasicnations when we arrive at the letter U. The obsessive nature of interests however also manifests itself in the way in which people often are hard to break free from their special interest. Many autistic people are cheerful or even elated as long as they can engage in their special interest and get a bit depressed when they’re being redirected.

Collecting is a common type of special interest in autistic people. This can go to the extreme of hoarding, which is on th eobsessive-compulsive spectrum. The main feature of hoarding is an irrational, persistent difficulty to discard things that the person no longer needs and that aren’t of value. This is a long-standing pattern, not just related to a single life event (such as the inability to discard something inherited from a loved one). Hoarding is not simply the passive acccumulation of stuff that a person doesn’t discard; it involves an actual effort not to discard objects. Autistic people commonly collect seemingly worthless items such as bits of string or paper scraps. This may be easily seen as hoarding by non-autistic family members. When compulsive collecting interferes with a person’s organizational or decision-making skills, it is time to seek help.

As I said, more classic obsessive-compulsive traits or even full-blown obsessive-compulsive disorder (OCD) are also common in autistics. This may be related to unusual fears, which I will also discuss in my letter U post. Obsessive-compulsive behaviors may involve repeated counting, checking or washing, but in my own case, repeatedly asking the same questions was also part of it. Repetitively talking about the same subject, may also be a compulsion for an autistic person. For example, my husband and I are trying to prepare for me to go live with him. A lot is still unclear, but I have a compulsion to tell the staff every detail of what we’re trying to work on repeatedly.

Lastly, the stereotypical, self-stimulatory behaviors that are a core symptom of autism, may also be seen as compulsions. For example, trichotillomania, the compulsive pulling out of one’s own hair, is on the obsessive-compulsive spectrum in the DSM-5 (the psychiatrist’s manual). This condition is also fairly common in autistics, as are other seemingly compulsive movements. Then again, these behaviors can also be seen as a sensory symptom, which I will discuss in my letter S post.