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COMPULSIVE PERSONALITY DISORDER

Symptoms and Signs

According to DSM-IV, the essential feature is "a preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency." Patients with compulsive personality disorder experience distress associated with indecisiveness and difficulty.

They are generally depressed and feel suppressed anger about feeling controlled by others, and they demonstrate extreme sensitivity to social criticism and excessively conscientious, moralistic, scrupulous, and judgmental behavior. Painstaking attention to details.

Natural History & Prognosis

Full-blown Axis I obsessive-compulsive disturbances may break out periodically and remit. Kringlen (1965) noted the presence of characteristics of compulsive personality disorder in 72% of individuals who developed symptoms.

Despite the compulsive individual's worry about the loss of impulse control, the incidence of sexual or aggressive behavior.

Differential Diagnosis

Compulsive personality disorder must be distinguished from obsessive-compulsive disorder, in which the patient experiences obsessive thoughts.

Compulsive personality disorder must also be differentiated from schizoid and paranoid personality disorders. Obsessive traits (often seen in persons successfully engaged in professional careers) must be distinguished from full-blown compulsive personality disorder.

Epidemiology

Compulsive personality disorder is frequently diagnosed in men and is believed to be common, especially in the oldest children of a family. Prevalence is estimated to be 1% in community samples and 5% to 10% in psychiatric settings.

Etiology & Pathogenesis

Genetic Factors: Twin and adoption studies have demonstrated that there is a genetic contribution to compulsive personality disorder.

Psychological Factors: According to Freud, compulsive personality disorder is caused by arrest at the anal level of psychosexual development that results in repetitive power struggles with authority figures, dominance-submission conflicts.

Disturbance in the stage of development characterized by the issue of autonomy versus shame and self-doubt predisposes to development of compulsive personality disorder. Family life is characterized by constrained emotions.

Treatment

Insight-oriented psychoanalytic psychotherapy is the treatment of choice. The focus must be on feelings rather than thoughts and would emphasize the clarification of the defenses of isolation of affect (intellectualized distancing from emotions) and displacement.

Group and behavioral therapy may be helpful in developing skills.

Compulsive Personality Disorder in Medical Practice

When they are confronted with physical illness, individuals with compulsive personality disorder are particularly troubled by the sense of loss of control over bodily functions. Feelings of shame and vulnerability for being in a weakened condition are typical.

A scientific approach on the part of the physician--as conveyed in thorough history taking and careful diagnostic workups.

Patients with compulsive personality disorder are not reassured by vague impressionistic overviews of their prognosis.

The healing process may be promoted by harnessing patients' innate thoroughness through encouraging such self-monitoring activities as measurement of fluid intake and output and weight fluctuations and control of graduated exercise programs.