WordNet
- characterized by obsessions and compulsions; "obsessive-compulsive neurosis"
- a person with obsessive-compulsive characteristics
- bring disorder to (同)disarray
- a physical condition in which there is a disturbance of normal functioning; "the doctor prescribed some medicine for the disorder"; "everyone gets stomach upsets from time to time" (同)upset
- a disturbance of the peace or of public order
- caused by or suggestive of psychological compulsion; "compulsive drinking"
- a person with a compulsive disposition; someone who feels compelled to do certain things
- strongly motivated to succeed (同)determined, driven
- the complex of all the attributes--behavioral, temperamental, emotional and mental--that characterize a unique individual; "their different reactions reflected their very different personalities"; "it is his nature to help others"
- a person of considerable prominence; "she is a Hollywood personality"
- a person who has obsessions
- not arranged in order (同)unordered
PrepTutorEJDIC
- 〈U〉『無秩序』,混乱,乱雑(confusion) / 《しばしば複数形で》(社会的・政治的な)粉争,騒動 / 〈C〉(肉体的・精神的な)不調,異常,障害 / …‘の'秩序を乱す / 〈心身〉‘に'異常を起こさせる
- 強制的な,無理じいの
- 〈C〉〈U〉(他人と区別する)『個性』,性格 / 〈U〉〈C〉『人格』,人柄,風格 / 〈C〉(特にある方面での)著名人,有名人
- 妄想がとりついて;強迫観念を引き起こす / =obsessional
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/05 01:03:39」(JST)
wiki en
Not to be confused with Obsessive–compulsive disorder.
| Obsessive–compulsive personality disorder | |
|---|---|
| Classification and external resources | |
| Specialty | Psychiatry |
| ICD-10 | F60.5 |
| ICD-9-CM | 301.4 |
| MedlinePlus | 000942 |
| MeSH | D003193 |
| Personality disorders |
|---|
| Cluster A (odd) |
|
| Cluster B (dramatic) |
|
| Cluster C (anxious) |
|
| Not specified |
|
|
Obsessive–compulsive personality disorder (OCPD), also called anankastic personality disorder,[1] is a personality disorder characterized by a general pattern of concern with orderliness, perfectionism, excessive attention to details, mental and interpersonal control, and a need for control over one's environment, at the expense of flexibility, openness, and efficiency. Workaholism and miserliness are also seen often in those with this personality disorder. Rituals are performed to the point of excluding leisure activities and friendships. Persons affected with this disorder may find it hard to relax, always feeling that time is running out for their activities and that more effort is needed to achieve their goals. They may plan their activities down to the minute—a manifestation of the compulsive tendency to keep control over their environment and to dislike unpredictable things as things they cannot control.[2]
OCPD occurs in about 2–8% of the general population and 8–9% of psychiatric outpatients.[3] The disorder most often occurs in men.[4]
This is a distinct disorder from obsessive–compulsive disorder (OCD), which is an anxiety, rather than a personality, disorder, and the relation between the two is contentious. Some, but not all, studies have found high comorbidity rates between the two disorders, and both may share outside similarities – rigid and ritual-like behaviors, for example. Hoarding, orderliness, and a need for symmetry and organization are often seen in people with either disorder. However, attitudes toward these behaviors differ between people affected with either of the disorders: for people with OCD, these behaviors are unwanted and seen as unhealthy, being the product of anxiety-inducing and involuntary thoughts, while for people with OCPD they are experienced as rational and desirable, being the result of, for example, a strong adherence to routines, a natural inclination towards cautiousness, or a desire to achieve perfection.
Contents
- 1 Signs and symptoms
- 1.1 Obsessions
- 1.2 Associated conditions
- 1.2.1 Obsessive–compulsive disorder
- 1.2.2 Asperger's syndrome
- 1.2.3 Eating disorders
- 2 Cause
- 3 Diagnosis
- 3.1 DSM
- 3.1.1 Criticism
- 3.2 WHO
- 3.3 Millon's subtypes
- 3.1 DSM
- 4 Treatment
- 5 Epidemiology
- 6 History
- 6.1 Psychoanalytic
- 7 See also
- 8 References
- 9 Further reading
- 10 External links
Signs and symptoms
The main symptoms of OCPD are preoccupation with remembering and paying attention to minute details and facts, following rules and regulations, compulsion to make lists and schedules, and rigidity/inflexibility of beliefs or showing perfectionism that interferes with task completion. Symptoms may cause extreme distress and interfere with a person's occupational and social functioning.[5] Most people spend their early life avoiding symptoms and developing techniques to avoid dealing with these strenuous issues.[citation needed]
Obsessions
Some people with OCPD, but not all, show an obsessive need for cleanliness. This, and an obsessive preoccupation with tidiness, may instead make daily living difficult. Though this kind of obsessive behavior may contribute to a sense of controlling personal anxiety, tension may continue. In the case of a compulsive hoarder, attention to clean the home effectively may be hindered by the amount of clutter that the hoarder resolves to organize later.[6]
Perception of own and others' actions and beliefs tend to be polarised (i.e., "right" or "wrong", with little or no margin between the two) for people with this disorder. As it might be expected, such rigidity places strain on interpersonal relationships, with frustration sometimes turning into anger and even violence. This is known as disinhibition.[7] People with OCPD often tend to general pessimism and/or underlying form(s) of depression.[8][9][10] This can at times become so serious that suicide is a risk.[11] Indeed, one study suggests that personality disorders are a significant substrate to psychiatric morbidity. They may cause more problems in functioning than a major depressive episode.[12]
Associated conditions
Obsessive–compulsive disorder
OCPD is often confused with obsessive–compulsive disorder (OCD). Despite the similar names, they are two distinct disorders—OCD is an anxiety disorder and OCPD is a personality disorder. Some OCPD individuals do have OCD, and the two are sometimes found in the same family,[13] sometimes along with eating disorders.[14] People with OCPD do not generally feel the need to repeatedly perform ritualistic actions—a common symptom of OCD—and usually find pleasure in perfecting a task, whereas people with OCD are often more distressed after their actions.
Some OCPD features are common in those afflicted with OCD. For example, perfectionism, hoarding, and preoccupation in details (which are three characteristics of OCPD) were found in people with OCD and not in people without OCD, showing a particular relationship between these OCPD traits with OCD.[15] The reverse is also true: certain OCD symptoms appear to have close parallels in OCPD ones. This is particularly the case for checking and ordering and symmetry symptoms. OCPD samples who have OCD are particularly likely to endorse obsessions and compulsions regarding symmetry and organization.[16] Washing symptoms, which are among the most common OCD symptoms, don't appear to have much of a link with OCPD, in contrast.
There is significant similarity in the symptoms of OCD and OCPD, which can lead to complexity in distinguishing them clinically. For example, perfectionism is an OCPD criterion and a symptom of OCD if it involves the need for tidiness, symmetry, and organization. Hoarding is also considered both a compulsion found in OCD and a criterion for OCPD in the DSM-IV. Even though OCD and OCPD are seemingly separate disorders there are obvious redundancies between the two concerning several symptoms. Regardless of similarities between the OCPD criteria and the obsessions and compulsions found in OCD, there are discrete qualitative dissimilarities between these disorders, predominantly in the functional part of symptoms. Unlike OCPD, OCD is described as invasive, stressful, time-consuming obsessions and habits aimed at reducing the obsession related stress. OCD symptoms are at times regarded as ego-dystonic because they are experienced as alien and repulsive to the person. Therefore, there is a greater mental anxiety associated with OCD.[2]
In contrast, the symptoms seen in OCPD, though they are repetitive, are not linked with repulsive thoughts, images, or urges. OCPD characteristics and behaviors are known as ego-syntonic, as persons with the disorder view them as suitable and correct. On the other hand, the main features of perfectionism and inflexibility can result in considerable suffering in an individual with OCPD as a result of the associated need for control.[2]
A 2014 study also found a second difference between OCPD and OCD: samples afflicted with OCPD, regardless of the presence of comorbid OCD, are more rigid in behavior and have a greater delayed gratification than either those afflicted with OCD or healthy control samples.[17] Delayed gratification is a measure of self-control — it expresses one's capacity to suppress the impulse to pursue more immediate gratification in order to acquire greater rewards in the future.
Recent studies using DSM-IV criteria have persistently found high rates of OCPD in persons with OCD, with an approximate range of 23% to 32% in persons with OCD. Some data suggest that there may be specificity in the link between OCD and OCPD. OCPD rates are consistently higher in persons with OCD than in healthy population controls using DSM-IV criteria.[2]
Asperger's syndrome
There are considerable similarities and overlap between Asperger's syndrome and OCPD,[18] such as list-making, inflexible adherence to rules, and obsessive aspects of Asperger's syndrome, though the former may be distinguished from OCPD especially regarding affective behaviors, worse social skills, difficulties with Theory of Mind and intense intellectual interests e.g. an ability to recall every aspect of a hobby.[19] A 2009 study involving adult autistic people found that 40% of those diagnosed with Asperger's syndrome met the diagnostic requirements for a co-morbid OCPD diagnosis.[20]
Eating disorders
Stiff and rigid personalities have been consistently linked with eating disorders, especially with Anorexia Nervosa.[21][22] Divergences between different studies as to the incidence of OCPD among anorexics and bulimics, however, has been found, which may in part reflect differences in the methodology chosen in different studies, as well as the difficulties of diagnosing personality disorders.[22] In the table below, results are shown for the frequency of OCPD among anorexics (non-specified subtype, AN), restricting anorexics (RAN), binge/purge anorexics as well as anorexics with a history of Bulimia Nervosa (BPAN), and normal-weight bulimics (BN).
| Study | AN | RAN | BPAN | BN |
|---|---|---|---|---|
| Arderluh et al. (2009)[23] | 71.4% | 46.7%—64% | 40% | |
| Halmi et al. (2005a)[24] | 31% | 32% | 24% | |
| Halmi et al. (2005b)[22] | 6% | 11-13% | 0% | |
| Anderluh et al. (2003)[23] | 61% | 46% | ||
| Matsunaga et al. (1999)[25] | 43.8% | 25% | 25% |
Regardless of the prevalence of the full-fledged OCPD among eating disordered samples, the presence of this personality disorder and its over-controlled quality has been found to be positively correlated with a range of complications in eating disorders, as opposed to impulsive features—those linked with histrionic personality disorder, for example—which predict better outcome from treatment.[26] OCPD predicts including more severe anorexic symptoms,[27] worse remission rates,[27] and the presence of aggravating behaviors such as compulsive exercising.[28] Compulsive exercising in eating disordered samples, along with smaller lifetime BMI and illness duration among anorexics,[29] also correlates positively and significantly with an important OCPD trait, perfectionism.[30]
Perfectionism has been linked with Anorexia Nervosa in research for decades. Researchers in 1949 described the behavior of the average anorexic girl as being "rigid" and "hyperconscious", observing also a tendency to "[n]eatness, meticulosity, and a mulish stubbornness not amenable to reason [which] make her a rank perfectionist".[21] Perfectionism is a life enduring trait in the biographies of anorexics; it is felt before the onset of the eating disorder, generally in childhood;[23] during the illness, and also, after remission.[31] The incessant striving for thinness among anorexic women is itself a manifestation of this trait, of an insistence upon meeting unattainably high standards of performance.[32] Because of its chronicity, those with eating disorders also display perfectionistic tendencies in other domains of life than dieting and weight control. Over-achievement at school, for example, has been observed among anorexics,[32][33][34] as a result of their over-industrious behavior.[32][35][36] A Swedish study found that hospitalization for eating disorders was around twice more common among girls who took advanced courses and achieved high average grades than among those who had medium or low grades.[37] The link with over-achievement was particularly high among those hospitalized for AN, which was 3.5 times as common among those with high grades as in those with other grade levels.[37] In some individuals with Bulimia Nervosa, the seemingly conflicting traits of impulsivity and perfectionism are present.[22]
Apart from perfectionism, other OCPD traits have been observed in the childhoods of the eating disordered in much higher frequency than among control samples, including among their unaffected sisters.
| Childhood OCPD trait | AN[38] | RAN[23] | BPAN[23] | BN[23] | OCPD[39] | OCPD+OCD[39] | OCD (without OCPD)[39] | Sisters of anorexics[38] | Control samples[23][38][39] |
|---|---|---|---|---|---|---|---|---|---|
| Perfectionism | 78% | 65.4% | 72.2% | 50.0% | 85.2% | 67.9% | 42.9% | 31% | 0—24% |
| Inflexibility | 31% | 76.9% | 61.1% | 25.0% | 66.7% | 50.0% | 32.1% | 9% | 0—5% |
| Rule-bound trait | 41% | 61.5% | 77.8% | 50.0% | 22% | 15—17.9% | |||
| Doubt and cautiousness | 28% | 27.3% | 46.7% | 21.4% | 3% | 0—5% | |||
| Order and symmetry | 6% | 38.5% | 31.3% | 10.7% | 66.7% | 46.4% | 17.9% | 3% | 0—3.6% |
Like those afflicted with OCPD, anorexics and bulimics also tend to have a great need for order and symmetry in their activities and surroundings,[31][40] something seen in their relationship with a third disorder, OCD. Eating disorders are largely comorbid with OCD;[41] with some studies showing that OCD symptoms are nearly as severe among anorexics as among a classic OCD sample, and that this remains so even after discounting food- and weight-related obsessions and compulsions.[42] The eating disordered are less likely, however, to develop the multi-object obsessions and compulsions of classic OCD pacients, who self-report symptoms related to a multitude of themes such as violence, sex, washing, moral taboos etc.. The symptoms of both anorexics[43] and bulimics[44] tend to be more restricted to symmetry and orderliness concerns. The same has been noted in samples afflicted with comorbid OCPD and OCD, who are more likely harbor obsessions and compulsions about symmetry and order than those have OCD only.[16] At least one paper has made an explicit link between OCPD and the OCD symptoms endorsed by anorexics, noticing that in the samples under study—one with both restrictive anorexia and OCD and another from OCD but no present eating disorder—those with comorbid AN and OCD were more likely to be diagnosed with OCPD than those with OCD only (38.1% vs 8.7%).[25] In a larger sample which included anorexic bingers and bulimics, it was found that all three eating disordered groups were more like to develop symptoms about order and symmetry than the OCD-only group.[45] Among women recovered from AN, orderliness concerns remain higher than among control samples without an eating disorder history.[31]
The obsessive compulsive personality traits of over-attention to details and inflexibility have also been found in cognitive testing of anorexics;[46] this group, compared to healthy controls, will display average to above average performance in tests requiring accuracy and the avoiding of errors[46] but poorly on tests requiring mental flexibility and central coherence, i.e., the ability to integrate details of information into a bigger narrative.[47] Over-attention to details among anorexics and weak central coherence are linked with a well-known cognitive failure in this group, that of missing "the big picture", a characteristic also of the cognitive style of those with OCPD.[48]
Both anorexics and non-eating disordered OCPD samples have also been found to share the trait of increased self-control, an above average ability to delay gratification in the name of a greater good to be received in the future. Among anorexics specifically, this trait is manifested in their capacity to repress a key natural urge, that of satisfying hunger, in order to be 'rewarded' with weight loss.[49] In a 2012 paper, it was verified this trait exists among anorexics also beyond food and weight themes.[49] The anorexics, especially those of the restricting type, were observed to save money handled to them by researchers more persistently than a control sample of healthy women.[49] A similar experiment was tested on four non-eating disordered samples—one with OCPD only, another from OCD only, a third afflicted with both OCPD and OCD, and a sample of healthy controls. Delay gratification was found to be pronounced among those with OCPD but not those with OCD only or the control samples, who had similar performances to one another.[17] Delayed gratification, they found, was highly correlated with the severity of OCPD, i.e., the greater the capacity to delay gratification in a person afflicted with OCPD, the more impairing was the disorder.[17] As the authors noticed, while many psychiatric disorders—substance abuse, for example—may be marked by impulse deregulation, OCPD and anorexia nervosa stand out as the only disorders shown to spring forth from the opposite quality: excessive self-control.[17]
Some family studies have also found a close genetic link between OCPD and anorexia. Lilenfeld et al. 1998, compared for a variety of psychiatric diagnoses three sets of women—one suffering from the restricting type of anorexia nervosa, another from bulimia nervosa, and a group of control women without an eating disorder—plus their respective relatives unaffected by eating disorders. They found a much higher incidence of OCPD among anorexics and their relatives (46% and 19%, respectively) than in the control samples and the latter's own relatives (5% and 6%, respectively). What's more, the rates of OCPD among relatives of Anorexics with that personality disorder and those without it were about the same—evidence, in the authors' words, "suggesting shared familial transmission of AN and OCPD".[50] In this study, bulimics and their relatives were not found to have elevated rates of OCPD (4% and 7%, respectively). Strober et al. 2007, in a similarly intended study, also found much higher incidence of OCPD among relatives of restrictive anorexics than among relatives of a normal control sample (20.7% vs. 7%). Along with diagnoses of OCD and Generalized Anxiety Disorder, OCPD was the one that best distinguished between the two groups.[51]
Cause
Researchers have set forth both genetic and environmental theories for what causes OCPD. Under the genetic theory, people with a form of the DRD3 gene will probably develop OCPD and depression, particularly if they are male.[52][53] But genetic concomitants may lie dormant until triggered by events in the lives of those who are predisposed to OCPD. These events could include trauma faced during childhood, such as physical, emotional, or sexual abuse, or other psychological trauma. Under the environmental theory, OCPD is a learned behavior.
Diagnosis
DSM
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a widely used manual for diagnosing mental disorders, defines obsessive–compulsive personality disorder (in Axis II Cluster C) as an extensive pattern of preoccupation with perfectionism, orderliness, and interpersonal and mental control, at the cost of efficiency, flexibility and openness. Symptoms must appear by early adulthood and in multiple contexts. At least four of the following should be present:[54]
- Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
- 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).
- Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
- Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
- Is unable to discard worn-out or worthless objects even when they have no sentimental value.
- Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
- Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
- Shows rigidity and stubbornness.
Criticism
Since the DSM-IV-TR was published in 2000, some studies have found fault with its OCPD coverage. A 2004 study challenged the usefulness of all but three of the criteria: perfectionism, rigidity and stubbornness, and miserliness.[55] A study in 2007[56] found that OCPD is etiologically distinct from avoidant and dependent personality disorders, suggesting it is incorrectly categorized as a Cluster C disorder.
WHO
The World Health Organization's ICD-10 uses the term anankastic personality disorder (F60.5).[57] Anankastic is derived from the Greek word ἀναγκαστικός (Anankastikos: "compulsion").
It is characterized by at least three of the following:
- feelings of excessive doubt and caution;
- preoccupation with details, rules, lists, order, organization, or schedule;
- perfectionism that interferes with task completion;
- excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
- excessive pedantry and adherence to social conventions;
- rigidity and stubbornness;
- unreasonable insistence by the individual that others submit exactly to his or her way of doing things or unreasonable reluctance to allow others to do things;
- intrusion of insistent and unwelcome thoughts or impulses.
It includes:
- compulsive and obsessional personality (disorder)
- obsessive-compulsive personality disorder
Also, it excludes:
- obsessive-compulsive disorder
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
Millon's subtypes
Theodore Millon identified five subtypes of the compulsive personality (2004).[58][59] Any compulsive personality may exhibit one or more of the following:
| Subtype | Description | Compulsive personality traits |
|---|---|---|
| Conscientious | Including dependent features | Rule-bound and duty-bound; earnest, hardworking, meticulous, painstaking; indecisive, inflexible; marked self-doubts; dreads errors and mistakes. |
| Bureaucratic | Including narcissistic features | Empowered in formal organizations; rules of group provide identity and security; officious, high-handed, unimaginative, intrusive, nosy, petty-minded, meddlesome, trifling, closed-minded. |
| Puritanical | Including paranoid features | Austere, self-righteous, bigoted, dogmatic, zealous, uncompromising, indignant, and judgmental; grim and prudish morality; must control and counteract own repugnant impulses and fantasies. |
| Parsimonious | Including schizoid features. Resembles Fromm's hoarding orientation[60] | Miserly, tight-fisted, ungiving, hoarding, unsharing; protects self against loss; fears intrusions into vacant inner world; dreads exposure of personal improprieties and contrary impulses. |
| Bedeviled | Including negativistic features | Ambivalences unresolved; feels tormented, muddled, indecisive, befuddled; beset by intrapsychic conflicts, confusions, frustrations; obsessions and compulsions condense and control contradictory emotions. |
Treatment
| This section's factual accuracy is disputed. (December 2013) |
Treatment for OCPD includes psychotherapy, cognitive behavioral therapy, behavior therapy or self-help. Medication may be prescribed. In behavior therapy, a patient discusses with a psychotherapist ways of changing compulsions into healthier, productive behaviors. Cognitive analytic therapy is an effective form of behavior therapy.[61][62]
Treatment is complicated if the patient does not accept that they have OCPD, or believes that their thoughts or behaviors are in some sense correct and therefore should not be changed.[citation needed] Medication alone is generally not indicated for this personality disorder, but fluoxetine has been prescribed with success.[63] Selective serotonin reuptake inhibitors (SSRIs) may be useful in addition to psychotherapy by helping the person with OCPD be less bogged down by minor details and to lessen how rigid they are.
Certain psychiatric medications can help control the obsessions and compulsions of OCD. Most commonly, antidepressants are tried first. Antidepressants may be helpful for OCD because they may help increase levels of serotonin, which may be lacking where OCD exists.
Antidepressants that have been specifically approved by the Food and Drug Administration (FDA) to treat OCD include Clomipramine (Anafranil), Fluvoxamine (Luvox), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), and Sertraline (Zoloft).
However, many other antidepressants and other psychiatric medications on the market also may be used to treat OCD off-label. Off-label use is a common and legal practice of using a medication to treat a condition not specifically listed on its prescribing label as an FDA-approved use. When choosing a certain medication in general, the goal of OCD treatment with medications is to effectively control signs and symptoms at the lowest possible dosage. Which medication is best depends on each individual situation. It can take weeks to months after starting a medication to notice an improvement in symptoms.[64] With obsessive-compulsive disorder, it's not unusual to have to try several medications before finding one that works well to control symptoms. Medical practitioners also might recommend combining medications, such as antidepressants and antipsychotic medications, to make them more effective in controlling symptoms. It is unwise to make changes to medication without talking to the medical practitioner who prescribed it, even where some improvement has come about. Relapse of OCD symptoms may occur if medication is changed or abandoned. For best effects, medication should ideally be reduced gradually. It may take up to two years to bring symptoms under control so that dosages of medication can be reduced. If symptoms recur on a lower dose of medication, it might be necessary to continue medication indefinitely, or at least until the condition is under control.[65]
People with OCPD are three times more likely to receive individual psychotherapy than people with major depressive disorder.[66][67] There are higher rates of primary care utilization.[68][69] There is no treatment for OCPD that has been thoroughly validated. There are no known properly controlled studies of treatment options for OCPD.[2][70][71] More research is needed to explore better treatment options.[2]
Epidemiology
Estimates for the prevalence of OCPD in the general population range from 2.1% to 7.9%.[54] A large American study found a prevalence rate of 7.9%, making it the most common personality disorder.[72] Men are diagnosed with OCPD about twice as often as women.[54] It may occur in 8–9% of psychiatric outpatients.[3]
A University of Colorado Colorado Springs study comparing personality disorders and Myers-Briggs Type Indicator types found that the disorder had a significant correlation with the Introverted (I), Sensing (S), Thinking (T), and Judging (J) preferences.[73]
History
Psychoanalytic
In 1908, Sigmund Freud named what is now known as obsessive–compulsive or anankastic personality disorder "anal retentive character".[citation needed] He identified the main strands of the personality type as a preoccupation with orderliness, parsimony (frugality), and obstinacy (rigidity and stubbornness). The concept fits his theory of psychosexual development.
OCPD was first included in DSM-II, and was largely based on Sigmund Freud's notion of the obsessive personality or anal-erotic character style characterized by orderliness, parsimony, and obstinacy.[2]
The diagnostic criteria for OCPD have gone through considerable changes with each DSM modification. For example, the DSM-IV stopped using two criteria present in the DSM-III-R, constrained expression of affection and indecisiveness, mainly based on reviews of the empirical literature that found these traits did not contain internal consistency.[2] Since the early 1990s, considerable research continues to characterize OCPD and its core features, including the tendency for it to run in families along with eating disorders[74] and even to appear in childhood.[75] According to the DSM-IV, OCPD is classified as a 'Cluster C' personality disorder. There was a dispute about the categorization of OCPD as an Axis II anxiety disorder. It has been argued that it is more appropriate for OCPD to appear alongside OC spectrum disorders including OCD, body dysmorphic disorder, compulsive hoarding, trichotillomania, compulsive skin-picking, tic disorders, autistic disorders, and eating disorders.[76]
Although the DSM-IV attempted to distinguish between OCPD and OCD by focusing on the absence of obsessions and compulsions in OCPD, OC personality traits are easily mistaken for abnormal cognitions or values considered to underpin OCD. Aspects of self-directed perfectionism, such as believing a perfect solution is commendable, discomfort if things are sensed not to have been done completely, and doubting one's actions were performed correctly, have also been proposed as enduring features of OCD.[77] Moreover, in DSM-IV field trials, a majority of OCD patients reported being unsure whether their OC symptoms really were unreasonable.[78]
See also
- Analysis paralysis
- Compulsive hoarding
- Germaphobia
- Jobsworth
- Scrupulosity
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- ^ Skodol AE et al. (2002). Functional Impairment in Patients With Schizotypal, Borderline, Avoidant, or Obsessive–Compulsive Personality Disorder. Am J Psychiatry 159:276–83. February.
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...even in the category of young women with low IQs, some had brilliant school records. This probably is the result of the persistence in work that characterizes anorexic patients.
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- ^ a b Southgate, Laura (2008). "Information processing bias in anorexia nervosa". Psychiatry Research 160 (2): 221–7. doi:10.1016/j.psychres.2007.07.017. PMID 18579218.
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- ^ Bender, Donna S.; Skodol, Andrew E.; Dyck, Ingrid R.; Markowitz, John C.; Shea, M. Tracie; Yen, Shirley; Sanislow, Charles A.; Pinto, Anthony; Zanarini, Mary C.; McGlashan, Thomas H.; Gunderson, John G.; Daversa, Maria T.; Grilo, Carlos M. (2007). "Ethnicity and Mental Health Treatment Utilization by Patients with Personality Disorders". Journal of Consulting and Clinical Psychology 75 (6): 992–999. doi:10.1037/0022-006X.75.6.992.
- ^ De Reus, Rob J.M.; Paul M.G. Emmelkamp (February 2012). "Obsessive–compulsive personality disorder: A review of current empirical findings". Personality and Mental Health 6 (1): 1–21. doi:10.1002/pmh.144. Retrieved 14 March 2013.
- ^ Grant, Bridget F.; Hasin, Deborah S.; Stinson, Frederick S.; Dawson, Deborah A.; Chou, S. Patricia; Ruan, W. June; Pickering, Roger P. (2004). "Prevalence, Correlates, and Disability of Personality Disorders in the United States". The Journal of Clinical Psychiatry 65 (7): 948–58. doi:10.4088/JCP.v65n0711. PMID 15291684.
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- ^ Lilenfeld et al. (1998). "A Controlled Family Study of Anorexia Nervosa and Bulimia Nervosa". Arch Gen Psychiatry 55 (7): 603–10. doi:10.1001/archpsyc.55.7.603. PMID 9672050.
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- ^ Fineberg, N. A., Sharma, P., Sivakumaran, T., Sahakian, B., & Chamberlain, S. (2007). "Does Obsessive-Compulsive Personality Disorder Belong Within the Obsessive-Compulsive Spectrum". CNS Spectrum 12 (6): 467–474, 477–482.
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- ^ Foa, EB; Kozak MJ; Goodman WK; Hollander E; Jenike MA; Rasmussen SA (1995). "obsessive-compulsive disorder". DSM-IV field trial. 152 (Am J Psychiatry): 90–96.
Further reading
- Baer, Lee. (1998). "Personality Disorders in Obsessive–Compulsive Disorder". In Obsessive–Compulsive Disorders: Practical Management. Third edition. Jenike, Michael et al. (eds.). St. Louis: Mosby.
- Cheeseman, Gwyneth D. (2013). "All You Need To Know About OCPD and Perfectionism". Willows Books Publishing. UK. OCPD Tightrope Walking
- Freud, S. (1959, original work published 1908).Character and Anal Eroticism, in The Standard Edition of the Complete Psychological Works of Sigmund Freud, 9, 170–71. James Strachey, ed. London: Hogarth. ISBN 978-0-7012-0067-1 ISBN 0-7012-0067-7
- Jenike, Michael. (1998). "Psychotherapy of Obsessive–compulsive Personality". In Obsessive–Compulsive Disorders: Practical Management. Third edition. Jenike, Michael et al. (eds.). St. Louis: Mosby.
- Kay, Jerald et al. (2000). "Obsessive–Compulsive Disorder". In Psychiatry: Behavioral Science and Clinical Essentials. Jenike, Michael et al. Philadelphia: W. B. Saunders.
- MacFarlane, Malcolm M. (ed.) (2004). Family Treatment of Personality Disorders. Advances in Clinical Practice. Binghamton, NY: The Haworth Press.
- Penzel, Fred. (2000). Obsessive–Compulsive Disorders: A Complete Guide to Getting Well and Staying Well. Oxford University Press, USA. MPN 0195140923
- Ryle, A. & Kerr, I. B. (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & Sons. ISBN 978-0-470-85304-7.
- Salzman, Leon. (1995).Treatment of Obsessive and Compulsive Behaviors, Jason Aronson Publishers. ISBN 1-56821-422-7
External links
- DSM IV-TR year 2000 criteria for OCPD
- MedlinePlus Encyclopedia Obsessive–compulsive personality disorder
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UpToDate Contents
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- 1. 成人における強迫性障害：疫学、病因、臨床症状、経過、および診断 obsessive compulsive disorder in adults epidemiology pathogenesis clinical manifestations course and diagnosis
- 2. 人格障害 personality disorders
- 3. パーソナリティ障害患者との治療関係へのアプローチ approaches to the therapeutic relationship in patients with personality disorders
- 4. 成人における強迫性障害に対する心理療法 psychotherapy for obsessive compulsive disorder in adults
- 5. 統合失調症における不安 anxiety in schizophrenia
English Journal
- Prospective investigation of a PTSD personality typology among individuals with personality disorders.
- McDevitt-Murphy ME, Shea MT, Yen S, Grilo CM, Sanislow CA, Markowitz JC, Skodol AE.SourceDepartment of Psychology, University of Memphis, Memphis, TN 38152, USA.
- Comprehensive psychiatry.Compr Psychiatry.2012 Jul;53(5):441-50. Epub 2011 Aug 23.
- This study investigated the replicability of a previously proposed personality typology of posttraumatic stress disorder (PTSD, and explored stability of cluster membership over a 6-month period. Participants with current PTSD (n = 156) were drawn from the Collaborative Longitudinal Personality Diso
- PMID 21864834
- Psychometric analysis of the Korean version of the Disgust Scale-Revised.
- Kang JI, Kim SJ, Cho HJ, Jhung K, Lee SY, Lee E, An SK.SourceDepartment of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Goyang, 410-719 South Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 120-752 South Korea.
- Comprehensive psychiatry.Compr Psychiatry.2012 Jul;53(5):648-55. Epub 2011 Aug 9.
- OBJECTIVE: Disgust is a basic emotion associated with feelings of revulsion and withdrawal behaviors from dangerous situations. The aim of this study was to examine the psychometric properties of the Disgust Scale-Revised (DS-R), a tool designed to measure individuals' responses to various disgust-p
- PMID 21831367
Japanese Journal
- Deep Brain Stimulation : Issues and Prospects
- 深谷 親,小林 一太,大島 秀規,山本 隆充,片山 容一
- Japanese Journal of Neurosurgery 22(3), 200-206, 2013
- … As DBS has become more widely used, psychiatric symptoms and personality changes induced by DBS have sometimes been observed. … On the other hand, clinical research on DBS by stimulating the CBTC circuit for depression and obsessive compulsive disorder is being carried out in Western countries. …
- NAID 130003379602
- 人口動態調査死亡票における自殺死亡者の精神疾患について
- 瀧澤 透
- 日本公衆衛生雑誌 59(6), 399-406, 2012
- 目的 統合失調症やうつ病など精神疾患は自殺の危険因子とされるが，自殺死亡の実態は十分に把握されていない。本研究は人口動態統計の自殺死亡について，死亡票の「死亡の原因」欄などにある精神疾患の記載状況を調査集計することで，自殺死亡における精神疾患の実態を明らかにすることを目的とする。<br/>方法 調査対象は平成20年人口動態統計の自殺死亡30,229人であり，方法は目的外使用による死亡票 …
- NAID 130003397950
- 摂食障害と全般性社交不安障害,治療的観点から(シンポジウム:摂食障害と併存する精神神経疾患,2010年,第51回日本心身医学会総会ならびに学術講演会(仙台))
- 永田 利彦
- 心身医学 51(7), 609-614, 2011-07-01
- … 摂食障害を併存症の観点から,気分スペクトラム障害や強迫スペクトラム障害としてとらえることが提唱されてきた.一方,社交不安障害(social anxiety disorder:SAD)は,併存率の高さの割に注目されてこなかったが,スピーチ恐怖症から全般性社交不安障害へと概念が拡大し,薬物療法の有効性も知られるようになった.通院中の女性摂食障害患者266例を対象に,社交不安障害の併存の有無によって比較した予備的な結果では,91例(34%)が …
- NAID 110008673136
Related Links
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- Obsessive-Compulsive Personality Disorder is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the ... Obsessive-Compulsive Personality Disorder is characterized by a ...
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★リンクテーブル★
| リンク元 | 「人格障害」「強迫性人格障害」「obsessive-compulsive」「compulsive personality disorder」 |
| 関連記事 | 「disorder」「compulsive」「obsessive」「compulsive personality」「personality」 |
「人格障害」
- 精神系 090515 I
DSM-IV
A群人格障害
- 他人から見て奇異、風変わりな印象を与え、内向的で社会から孤立し、引きこもる傾向があり、社会の辺縁に身を置く。
- 他者への根強い不信の念があり、しかるべき根拠がないのに、自分に対する敵意を感じたり、馬鹿にする、他人が利用する、危害を加えるなどという疑念を抱く。
- きわめて内向的で、人との接触に乏しく、自分の中に引きこもり、周囲から変わり者と見なされていることも少なくない。親しい友人や信頼できる友人がなく、他人との親密な関係に欠ける。他人との感情の分かち合い、優しさ、温かさがない。
- 統合失調質人格障害の諸特徴にくわえて、他人に対する被害的内容を中心とした関係念慮、テレパシーや超能力への関心、また話が要領を得ず論理的なまとまりを欠く、不適切な思考が出没するといった明らかな病的障害が認められるもの。
B群人格障害
- 情動面の激しさと不安定さがあり、外向的だが、時に他者に対する関係は嵐が来たように激しく攻撃的となる。
- 行動：他者に対する攻撃性が目立ち、喧嘩、他者への暴力、器物破損などが繰り返される。社会規範が守れず、盗みや暴力、あるいは薬物乱用のため警察に逮捕されることが少なくない。職を転々と変えたりして、持続的な就労がなされない。社会的な責任感を欠き、無責任な行動だらしなさが目立つ。
- 感情・情動：不安定かつ荒々しい気象で、些細なことを我慢できず易怒的となる。罪悪感、後悔の念、優しさに欠け、他者に対する憎しみ、冷酷な感情を抱く。また不安感は乏しい。
- 対人関係：自己中心的で共感性を欠き、しばしば誇大的で、他者に対し、支配的あるいは操作的な態度が目立ち、長期的な人間関係を維持できない。
- 人格の様々な領域における不安定性と自己の空虚感が目立つ
- 感情・情動：挿間的に出現する強い不快感、いらいら、不安の出現
- 行動：こうした空虚感や抑うつを伴う感情・情動不安定の中で、突然、手首切傷や薬を大量に服用した自殺企図、あるいは性的逸脱、薬物乱用、浪費、過食などが衝動的な行為の形で出現する。
- 対人関係：友人や初対面の人を前にして限られた時間なら表面的には如才ない。身近な他者に対し、しがみつくような形の依存的態度が目立ち、他者との適切な距離がとれない。
- 対人関係にもっとも大きな特徴がある。劇場の演技に比較される、他人の注意を引こうとする度を過ぎた自己顕示的行動が多い。
- 自分には実際以上に優れた才能、力があるという度を超した自負心を持つ
- 他人の注意を自分にずっと引きつけ、賞賛されたいという自己顕示的欲求を持つ
- 他者の自己評価には過敏で、些細な批判的な言葉や態度で容易に傷つき、手ひどい羞恥心や屈辱感を味わう。
C群人格障害
- 不安げで、臆病で内向的
- 他人と親しく交わりたい、他人に自分を受け入れてもらいたいという願望を強く持っている者の、自信がなく、劣等感があり、低い自己評価のため他者の批判や拒絶を気にし、恥をかくことや非難されることをおそれて、対人関係は浅くなる。
- 自分の信頼できる人に著しい依存を見せ、面倒を見てもらいたいという強い願望を持ち、その人へ自分をゆだね、没主体的な従属的な振る舞いをする。
- 過度の秩序意識や、几帳面さと完全主義が認められ、そのため、日常生活や仕事の場面で柔軟性を欠き、かたくなな態度が目立つ。
USMLE
- Q book p.405 12
「強迫性人格障害」
- obsessive compulsive
- 英
- obsessive-compulsive personality disorder, compulsive personality disorder
- 関
- 強迫性格、強迫性人格。C群人格障害、人格障害
- 同
- 強迫性パーソナリティ障害
「obsessive-compulsive」
- n.
- 強迫神経症の人、強迫神経症患者
- adj.
- 強迫
「compulsive personality disorder」
「disorder」
- 障害：個人的苦痛や機能の障害があるので「疾病」とは言えるものの、その背景にある臓器障害がもう一つはっきりしない場合に用いられる。(PSY.9)
- n.
- 注意
- vt.
- 乱す、乱雑にする。(人)の(心身の)調子を狂わせる。
- vi.
「compulsive」
- adj.
- 強制的な。(心理的に)やむにやまれぬ。(心理)衝動強迫の
- (小節などが)人を引き込む、とりこみする、目が離せない
- n.
- (心理)強迫神経症者。きまじめな人
「obsessive」
- adj.
- 度を超した
- (～に)とりつかれている(about)。(病的に)執拗な、強迫的な
- n.
- 妄想狂、強迫観念にとりつかれている人
- 関
- obsess, delusion, delusional
「compulsive personality」
「personality」
- n.