1) Obsessive-compulsive personality disorder
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000942.htm
Obsessive-compulsive personality disorder is a condition in which a person is preoccupied with rules, orderliness, and control.
Causes
This disorder tends to occur in families, so genes may be involved. Obsessive-compulsive personality disorder most often occurs in men.
Obsessive-compulsive personality disorder should not be confused with obsessive-compulsive disorderobsessive-compulsive disorder (OCD), although the two conditions share some of the same symptoms.
Symptoms
A person with this personality disorder has symptoms of perfectionism that usually begin in early adulthood. This perfectionism may interfere with the person's ability to complete tasks, because their standards are so rigid. People with this disorder may emotionally withdraw when they are not able to control a situation.
People with obsessive-compulsive personality disorder believe that their preoccupations are appropriate. They tend to be high achievers and feel a sense of urgency about their actions. They may become extremely upset if others disturb their rigidly ordered routines.
Exams and Tests
Some of the common signs of obsessive-compulsive personality disorder include:
- Excessive devotion to work
- Inflexibility
- Inability to throw things away, even when the objects have no value
- Lack of generosity
- Limited expression of affection
- Perfectionism
- Preoccupation with details, rules, and lists
- Reluctance to allow others to do things
Treatment
Medications such as selective serotonin reuptake inhibitors (for example, Prozac) may help reduce obsessions and compulsions. Cognitive-behavioral therapy may also help. Medications in combination with talk therapy may be more effective than either treatment alone.
Outlook (Prognosis)
The outlook for people with obsessive-compulsive personality disorder tends to be better than that for other personality disorders. This may be because the self-imposed rigidness and control of obsessive-compulsive personality disorder may prevent many of the complications such as drug abuse, which are common in the other personality disorders.
However, the social isolation common with this illness may lead to feelings of depression later in life.
Possible Complications
- Relationship difficulties
- DepressionDepression
When to Contact a Medical Professional
Call for an appointment with your health care provider if perfectionism is interfering with your job or relationships.
Alternative Names
Personality disorder - obsessive-compulsive
References
Moore DP, Jefferson JW. Obsessive-compulsive personality disorder. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2004: chap 142.
Update Date: 10/17/2008
Updated by: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Timothy A. Rogge, MD, private practice in Psychiatry, Kirkland, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
2) Obsessive-compulsive disorder
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000929.htm
Obsessive-compulsive disorder is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions).
Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing the obsessive rituals can cause great anxiety.
Causes
Obsessive-compulsive disorder (OCD) is more common than was once thought. Most people who develop it show symptoms by age 30.
There are several theories about the cause of OCD, but none have been confirmed. Some reports have linked OCD to head injury and infections. Several studies have shown that there are brain abnormalities in patients with OCD, but more research is needed.
About 20% of people with OCD have tics, which suggests the condition may be related to Tourette syndromeTourette syndrome. However, this link is not clear.
Symptoms
- Obsessions or compulsions that are not due to medical illness or drug use
- Obsessions or compulsions that cause major distress or interfere with everyday life
There are many types of obsessions and compulsions. One example is an excessive fear of germs and the compulsion to repeatedly wash the hands to ward off infection.
The person usually recognizes that the behavior is excessive or unreasonable.
Exams and Tests
Your own description of the behavior can help diagnose the disorder. A physical exam can rule out physical causes, and a psychiatric evaluation can rule out other mental disorders.
Questionnaires, such as the Yale-Brown Obsessive Compulsive Scale (YBOCS), can help diagnose OCD and track the progress of treatment.
Treatment
OCD is treated using medications and therapy.
The first medication usually considered is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). These drugs include:
- Citalopram (Celexa)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
If an SSRI does not work, the doctor may prescribe an older type of antidepressant called a tricyclic antidepressant. Clomipramine is a TCA, and is the oldest medication for OCD. It usually works better than SSRI antidepressants in treating the condition, but it can have unpleasant side effects, including:
- Difficulty starting urination
- Drop in blood pressure when rising from a seated position
- Dry mouth
- Sleepiness
In some cases, an SSRI and clomipramine may be combined. Other medications, such as low-dose atypical antipsychotics (including risperidone, quetiapine, olanzapine, or ziprasidone) have been shown to be helpful. Benzodiazepines may offer some relief from anxiety, but they are generally used only with the more reliable treatments.
Cognitive behavioral therapy (CBT) has been shown to be the most effective type of psychotherapy for this disorder. The patient is exposed many times to a situation that triggers the obsesive thoughts, and learns gradually to tolerate the anxiety and resist the urge to perform the compulsion. Medication and CBT together are considered to be better than either treatment alone at reducing symptoms.
Psychotherapy can also be used to:
- Provide effective ways of reducing stress
- Reduce anxiety
- Resolve inner conflicts
Outlook (Prognosis)
OCD is a long-term (chronic) illness with periods of severe symptoms followed by times of improvement. However, a completely symptom-free period is unusual. Most people improve with treatment.
Possible Complications
Long-term complications of OCD have to do with the type of obsessions or compulsions. For example, constant handwashing can cause skin breakdown. However, OCD does not usually progress into another disease.
When to Contact a Medical Professional
Call for an appointment with your health care provider if your symptoms interfere with daily life, work, or relationships.
Prevention
There is no known prevention for this disorder.
Alternative Names
Obsessive-compulsive neurosis; OCD
References
Blais MA, Smallwood P, Groves JE, Rivas-Vazquez RA. Personality and personality disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 39.
Feinstein RE, Connelly JV. Personality disorders. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 60.
Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164:5-53.
Stein DJ, Denys D, Gloster AT, et al. Obsessive-compulsive disorder: diagnostic and treatment issues. Psychiatr Clin North Am. 2009;32:665-685.
Update Date: 2/11/2010
Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Michelle Benger Merrill, MD, Instructor in Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
