Introduction
A personality disorder can best be described as a persistent pattern of inner behavior and experience that markedly contrasts with a person’s culture; is inflexible and pervasive, and normally appears in the adolescent stage or early adulthood. Such behavior or experience tends to be quite stable but with time, leads to impairment or actual distress. For an individual to be diagnosed as suffering from a personality disorder, he or she must persistently demonstrate the classified behavior to the extent that their ability to function occupationally or socially is thus considered to be suffering from some form of impairment. Personality disorders are therefore differentiated from personality traits in the sense that the former are inflexible, abnormal behavioral patterns observed over a long duration, and which deviate from normal or acceptable cultural norms (Boyd 436-437, 476).
Obsessive-compulsive personality disorder
Obsessive-compulsive personality disorder (OCPD) is the term used to refer to a mental condition in which a victim is too preoccupied with perfectionism, orderliness, and interpersonal and mental control, at the expense of efficiency, openness and flexibility. Order, control and quality are very admirable human traits but in persons suffering from the OCPD, these traits get to very unhealthy extremes. Persons suffering from OCPD are often overly disciplined, fastidious, rigid, orderly, critical, meticulous, obstinate, white and black thinkers, as well as hair splitters. Such people are also very often obsessed with moral lapses and infractions of others; are overly frugal, conscientious and inflexible. These behavioral characteristics appear to be inborn temperants or a part of the person’s basic personality structure. In some cases, symptoms of OCPD overlap with giftedness whereby traits become highly similar to behaviors observed in some of the perfectionist gifted children (Webb et al., 89).
OCPD is the most common personality disorder identified in the general population and the most interesting aspect about the disorder is that; it is highly associated with higher education and marriage, whereby victims of the disorder are identified as having higher incomes than those without the disorder. In OCPD like in most of the other personality disorders, little evidence has been made available that identifies any biological formulation of the disorder. Biologically, victims of OCPD are however likely to have suffered from anhedonic temperant during infancy. First born children have also been identified to be more prone to compulsive style of behavior than their siblings. Individuals suffering from OCPD have been noted to have grown up in families that placed great emphasis on rule-following and productivity, while overlooking interpersonal relationships and emotional expressivity. Due to the type of environment that they grow up in, such individuals fail to acquire adequate empathy skills or other skills necessary for interaction with others. They are also said to have lacked sufficient love or value from their caretakers, a fact that leads to the development of overwhelming doubt. The obsessive pattern in return develops as a device for preventing any feelings or thoughts that could lead to loss of pride, shame, or feelings of weakness or deficiency (Sperry 180, 182-183).
Compulsive patterns characterizing OCPD are therefore mainly the result of parental overprotection and over-control that consistently sets certain distinct limits and restrictions on a child’s behavior. Parents teach such children to observe a deep sense of personal responsibility towards others and to feel guilty if such responsibilities are not fulfilled in due course. For these children, play is considered as irresponsible, shameful, and sinful behavior that is bound to lead to some dire consequences. Their parents encourage them to resist any natural inclinations towards playful behavior and impulse gratification, and such parents also use guilt imposition as a means towards controlling a child’s behavior. The sense of responsibility towards others tends to be overvalued in these children who later become OCPD victims. They learn to behave in a pleasing, polite and loyal manner towards their seniors. Self criticism serves as a weapon of keeping them in line while opportunities for adventure and risk taking are reduced as the person strives for perfection (Boyd 472; Sperry 183).
Symptoms of OCPD begin in early adulthood and include a myriad of details. Victims of OCPD are occupied with schedules, details, organization, order, lists and rules to such an extent that they lose major purpose or point of getting involved in an activity. When the victim dwells so much on perfectionism, he or she is unable to complete scheduled projects due to his/her overly rigid or strict standards that cannot be achieved. OCPD victims tend to overlook friendships and leisure activities in favor of excessive devotion to their work and its productivity. Matters of ethics, values, or morality appear to be irrelevant to such a person and he or she will most often be inflexible, scrupulous, and over conscientious about the same. A victim also displays a tendency to be overly obsessive with objects and is often unable to discard those that have become worn-out and of no sentimental value. Relegation of duties is rare with such a person and when it takes place, it can only be extended to those who are able to submit to the victim’s style of handling matters. Victims of OCPD are misers not only to themselves but also towards others and money is considered an investment for future in-eventualities. A victim will also show a degree of stubbornness and rigidity towards issues (Webb et al., 90; Boyd 470; Sperry 180).
People experiencing personality disorders attract the attention of mental health specialists or clinicians due to the negative consequences that their abnormal behavior brings upon themselves or others. Victims of OCPD on the other hand seek mental health care as a result of certain negative experiences such as anxiety attacks, sexual impotence, spells of immobilization and exhaustive fatigue. A victim’s physical symptoms such as sexual, sleep or eating patterns; social problems and interpersonal relationships are essential for the diagnosis or nursing assessment of OCPD. Victims are often diagnosed with such typical characteristics as anxiety, insomnia, and risk of loneliness, sexual dysfunction, decisional conflicts, and impaired social interactions. Victims of OCPD are well aware of their ability to improve the quality of their life but find any effort towards change to be anxiety provoking. To help such victims, the nurse-patient relationship has to be very supportive, and based on the acceptance that the patient has an inward desire for rigidity and order. Such an approach will help the patient to gain enough confidence towards attempting or trying out new behaviors. But modifying a compulsive pattern that was established way back in childhood is not an easy process and takes place through a long-term undertaking (Boyd 472-473).
There are several ways of establishing diagnosis and subsequent treatment for OCPD. During the clinical interview, collateral information, psychological testing and observation make up an important part of the patient’s self-report. It is however a difficult and challenging task to interview OCPD victims because of their ambivalence, perfectionism and circumstantial dynamics that make up their obsessive-compulsive nature. Although victims are often willing to talk about such aspects as diet, their medical history or even exercise patterns, they are at the same time unwilling to go into details; therefore undermining the value of talking about them as a lead way to the treatment process. They hardly accept the clinician’s assurance that problems can be solvable or the fact that they can once again live a life in which there is less control of things. OCPD victims often reject empathy and believe that their suffering is less important when compared to the problems it brings about. For a clinician, the best approach towards engaging these individuals in a therapeutic leverage is by helping them to keep in touch with anger as well as other feelings. The clinician must also try to focus on the client’s real feelings as well as their expression and limit any discussion that intellectually dwells on affects (Sperry 184-188).
OCPD is a disabling disorder and effective treatment requires a combination of behavior, psychodynamic and pharmacologic therapies in order to achieve any physiologic and behavioral alterations. Treatment methods include but are not limited to cognitive-behavioral treatment, interpersonal approach, as well as group therapy. Treatment of OCPD is a lengthy process and one that is also very complex. Due to the tendency in OCPD victims to display difficulty in embracing new and changing information, the learning process requires a lot of effort and patience on the parts of both the patient and clinician. OCPD clients are rigid in nature and clinicians need to use only those techniques that have prior approval by the patient. The best treatment for OCPD is one that offers short-term relief of symptoms and supports existing mechanisms of coping while teaching new ones. His is because long-term personality change is normally beyond the skill levels of most clinicians and the budget of most patients (Sperry 189-195, 209).
Conclusion
Treatment of OCPD should have the outcome goal of helping the victims to achieve some degree of compromise and balance instead of the desire to be superhuman. Both clinicians and patients must however have a clear understanding that episodes of anxiety are bound to occur throughout a lifetime, and that continuous therapy does not offer any guarantee against distress in one’s life. Psychotherapy however helps to increase interpersonal relationship and coping skills (Sperry 188).
Works Cited
Boyd, Mary A. Psychiatric nursing: Contemporary practice. Baltimore, MD: Lippincott Williams & Wilkins, 2007.
Sperry, Len. Handbook of diagnosis and treatment of DSM-IV-TR personality disorders. London, UK: Routledge, 2003.
Webb, James T., Amen Edward R., Webb Nadia, Goerss Jean, Beljan Paul, Richard F., and Olenchack Ph.D. Misdiagnosis and dual diagnosis of gifted children and adults: ADHD, bipolar, OCD, Asperger’s depression and other disorders. Scottsdale, AZ: Great Potential Press, Inc., 2005.