Mental Health Spotlight: OCPD

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Today I’m bringing you a post about OCPD – Obsessive-Compulsive Personality Disorder by James Keenan from Celtic Riverside. Until speaking to James, I had no idea that OCPD existed, so I was really keen to have him on board to share with you his experience of this to raise awareness of a disorder that is not as widely known.

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Ugh, pop culture. Let’s get rid of this right out of the gate.

OCPD is not OCD. Obsessive-Compulsive Disorder (OCD) is an obsessive-compulsive disorder along with body dysmorphic disorder, hoarding disorder, trichotillomania, and excoriation disorder. They are a distinct category of disorder once part of the larger Anxiety class in the DSM that were separated into Anxiety Disorders, Obsessive-Compulsive Disorders, and Trauma and Stressor-Related Disorders in the DSM V. There’s a lot of research into the co-morbidity of OCPD and OCD, but I do not have the latter and cannot speak much to the latter.

No, I do not compulsive flip light switches every time I enter or exit a room. Not only are pop culture representations of OCD often harmful to those who have it, but they are also uniquely annoying to someone with OCPD which is an entirely separate thing.

What I have is a personality disorder.

Those exist in three separate clusters:

Cluster A – the “odd, eccentric” cluster consisting of the Paranoid, Schizoid, and Schizotypal Disorders

Cluster B – the “dramatic, emotional, erratic” cluster consisting of Borderline Personality Disorder, Narcisstic Personality Disorder, Histrionic Personality Disorder, and Antisocial Personality Disorder

Cluster C – the “anxious, fearful” cluster consisting of Avoidant Personality Disorder, Dependent Personality Disorder, and my long-time friend Obsessive-Compulsive Personality Disorder.

Before we set up shop in the OCPD world though, I do need to mention anxiety. In addition to all of the “fun” I am about to discuss with OCPD, I also live with Generalised Anxiety Disorder, Social Anxiety Disorder, and Panic Disorder (all part of the Anxiety class mentioned earlier), and all of which come with their own flavour of intolerable nonsense. Perhaps they are connected, with the OCPD leading to the GAD and social anxiety (which, in turn, created my panic disorder), or they all simply existed together – my OCPD went un-diagnosed until the anxiety became so severe that just about lost my ability to function.

Criteria

My case of OCPD, though beyond my awareness, is textbook. So perhaps the best place to start is to lay out the diagnostic criteria for OCPD and just walk through those. See, as my therapist was assisting me with all of the anxiety disorders it became increasingly obvious to her that OCPD might be looming behind everything (more on that later). She began planting little tests and questions throughout our sessions to see how I would respond, and that ultimately lead to the diagnosis.

  1. Impairments in Personality Functioning
    1. Impairments in Self Functioning
      1. Identity: Sense of self-derived predominantly from work or productivity; constricted experience and expression of strong emotions
      2. OR Self-direction: Difficulty completing tasks and realising goals associated with rigid and unreasonably high and inflexible internal standards of behaviour; overly conscientious and moralistic attitudes.
    2. AND (not OR) Impairments in Interpersonal Functioning
      1. Empathy: Difficulty understanding and appreciating the ideas, feelings, or behaviours of others
      2. OR Intimacy: Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others
  2. Pathological Personality Traits via
    1. Compulsivity Rigid perfectionism: Rigid insistence on everything being flawless, perfect, without errors or faults, including one’s own and others’ performance; sacrificing of timeliness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organisation, and order.
    2. AND Negative Affectivity Perseveration: Persistence at tasks long after the behaviour has ceased to be functional or effective; continuance of the same behaviour despite repeated failures.
  3. Stable Across Time, Consistent Across Situations
  4. Not Better Understood as a Reflection of a Developmental Stage or Socio-Cultural Environment
  5. Not the Result of a Substance or Medical Condition

With respect to the obsessive-compulsive aspect of the disorder, a list of more specific examples also appears from which at least four must be true of the individual:

  • He or she obsesses over details, rules, lists, schedules, and organisation in general, to the extent that the overall point of the activity is lost.
  • The individual’s preoccupation with perfectionism interferes with his or her ability to get things done (e.g., the individual is unable to finish a project because he or she has set overly strict standards).
  • He or she is overly devoted to work and productivity, which results in the exclusion of leisure activities as well as close relationships.
  • The individual is too conscientious and inflexible when it comes to their morals or ethics (not including those related to culture or religion).
  • He or she is unable to get rid of old or worthless objects even when they are of no sentimental value to the individual.
  • The individual is unwilling or hesitant to work with others unless they agree to follow his or her exact way of doing things.
  • He or she is rather stingy with money; the individual saves an excessive amount for future catastrophes.
  • He or she is overly rigid and/or stubborn.

Work

That’s all great if you want to the scientific, clinical definition of the disorder. You could have easily picked up the DSM-V and read all of this for yourself. We are here to discuss what this looks like in reality and how it affects a person, so let us apply these criteria to my particular case.

A favourite story of my father’s is my first day of preschool. I’m the oldest of three and so my first day of school was everyone’s first day of school. At home, I played with my toys and cleaned up after myself – everything had a place and everything in its place. I saw relationships among objects and had them organised accordingly. I played alone and quite contently. What school would mean to all of that was anyone’s guess. My father feared how I would react to the situation.

On that day, he took me to the classroom, introduced me to my teacher, and gave me a moment to look around the room. The teacher had placed a nameplate at a seat, clearly designated for me, and an art project of some sort lay beside it.

“So this is what we’re doing”, my brain might have thought.

I walked over to the seat, sat down, and promptly began working on the project. I waved goodbye to my stunned father and we said we would see one another later that day. Of course he would be back. For now, my purpose was completing this art project. I may not have known why it needed doing, but they wanted it done, it wasn’t hurting anyone, and I did not have anything more pressing to do – so I did it. They would be happy.

That story about sums up my entire childhood. My parents never placed explicit pressure on me to perform, but I felt that my performance would win their approval. Had I attempted something and failed, they would have stood behind me all the same. I had no reason to fail though. My best effort was well beyond what anyone was asking. If anything, my greatest obstacle through most of grade school was boredom and complacency – being too nonchalant about my effort and failing as a result of that.

My friends deepened the predicament. Very early on I became known as one of the “smart kids”. School was effortless.

“What is the capital of Georgia? James?”

“Tbilisi”.

“Georgia, United States”.

Before I could switch gears came the chorus of, “Oh! James got one wrong!”

Girls, who as I have covered in other posts were the centre of my universe, loved talking to me in the context of work. If they needed help on a project or completing an assignment, they felt comfortable approaching me. They never asked me to do the work for them, they simply wanted my help and enjoyed providing it. Outside that context, I felt invisible.

Sports were a different story because sports are all about production, too. I was no Olympian, but I was capable. I scored goals, made shots, made catches, made saves – I was a young athlete you wanted on your team for many sports. Here, too, I was able to engage with many male classmates. Outside practice and game time I struggled mightily with most of them. Only the few who played games, activities with measurable outcomes, succeeded in socialising with me.

When my great grandfather and best friend (same man) died in sixth grade, I threw myself at work. A family friend got me a job working the ice cream fountain and bussing tables at a restaurant. The adults there could not believe how hard and fast I worked. They sang my praises constantly. Older classmates talked to me as an equal rather than as a kid. Without work, I was lost. I have worked full-time since I was 14 years old. On vacation, I check emails and respond to items. Sure, they can handle it while I’m gone. But I’m the guy not even vacation can slow down. Damn, he’s on top of things!

Perfection

The obsession with (and defining value through) work is one thing, but the perfectionism was another.

“To the best of your ability” became the phrase of nightmares. The funny thing about perfection is that one never attains it and that much is obvious. The imperfection is so obvious, in fact, that it becomes hard to determine where the “best of my ability” line appears in the sand.

There we are – the best of my ability. Except that could be worded a little better. That is not quite the right shade I wanted. Sure, that conveys the message I want it to convey, but the tone feels a little askew. Let’s fix those things. Okay, now these other parts are not quite right…

Yes, I abhor this blog. “Some crappy writing for a perfectionist” – I throw words down with very little revision in this blog just to combat that terrible aspect of my personality. The quality of the writing infuriates me. Have you read any of my novels? No, because my perfectionism keeps them all on my desk to spare you the inadequate prose.

Things can always be better and, therefore, what I have before me is not my best.

All of you folks who are content to have it done and out of the way? You just do not give a crap. That’s not true, but I know that is what I imply when I suggest that the only way for me to prove that I do care is to develop an ulcer on every single project.

Logic and Morality

All of this perfectionism is tied up in logic and morality. I am an empathetic person (if you go back to the diagnostic criteria, my impairment in interpersonal functioning is 100% the intimacy. I excel at empathy but build walls between my enjoyment of others and my work. I am a stoic. I am the Byronic hero.

Because if not now, when? If not me, who? The world is an imperfect place and if I am not constantly working against that then I am letting down people who matter.

Feminism? If you are a woman you do not get to take a break from misogyny. That’s your reality at all times. Why should I enjoy the privilege of taking a break from working against that?

Civil rights? Sure, as a white male I can just not care about many civil rights issues. I have those rights. My life would be fine. What sort of prick lounges on a float in the pool, sipping on a cocktail while everyone else toils in the yard? I’ll enjoy the pool when everybody can.

My sense of morality is not informed by the law (in fact, I adamantly oppose the application of the law in cases because it runs contrary to morality, instead of serving some corporate or private interest). My sense of morality is not informed by religion, which I oppose both on the grounds that 1) it has no evidence and 2) the threat of eternal damnation (being raised Catholic) is a poor excuse to act right. Being decent to other people is reason enough to behave morally.

My sense of morality comes from the social contract and a tangential application of logic. Everything is permitted to the extent that it does not infringe on the right of others to do whatever they wish. My right to swing my arm stops at the edge of your face. In the broadest sense, I am a deontologist. When that fails, I become a utilitarian – how does one maximise the benefit and minimise the harm?

If people shared my sense of morality, we would have no crime even without government. Fear of punishment is not the driving force behind it. A selfish notion of maximising life, liberty, and the pursuit of happiness through the suspension of some freedom is the driving force. To this day I infuriate my wife with an adherence both to formal and personal rules.

“Just turn around here”.

“It says no U-turn”.

“Yes, but no one is around, so just do it really quick.”

That sign is not there to annoy me. That sign is there because the act of making a U-turn in that location poses some sort of risk to myself and other drivers. Perhaps the risk is cars approaching too quickly from behind not expecting me to be in the middle of a turn. Perhaps it is oncoming traffic or turning vehicles that may not have time to react to my U-turn. Jeopardising myself and anyone unfortunate enough to enter that area to correct my mistake quickly is unacceptable to my mind.

I’m looking at you, jerks who cut across multiple lanes of traffic to make the turn you were not in a position to make rather than continuing safely and making an appropriate correction.

I expect my family, friends, and even strangers to hold me to those standards. Likewise, but to a less severe extent, I hold the people in my life to those standards. I was never one for conflict so these matters of principle rarely devolve into a shouting match, but I make it clear that our continued associated hinges on their adherence to a standard.

How severe are we talking? I don’t think very, but, then again, I have a personality disorder.

As a clearer example, if you are inclined to make sexist jokes the feminist in me will call out the behaviour. “Don’t make sexist jokes”, I would say.

“It’s just a joke”.

“It’s not though”, I would respond, “because you make jokes like that and it makes sexist attitudes seem normal. It’s not taboo as it ought to be. And when it becomes normal, people push the next boundary and the next. That sexist joke of yours contributes to a culture where some men feel entitled to women sexually, going so far as to assault them. You aren’t going to make those jokes in my company, and while I cannot stop you actually making the jokes I can address the ‘in my company’ part of that”.

I am the guy in the bench-clearing brawl talking to his teammates and trying to de-escalate the situation, talking to the cooler heads on the other side about calming their teammates.

“You sound kind of like a self-righteous prick”.

Yeah, a bit. Thank goodness OCPD is not my only concern and I have the social anxiety to keep it in check. I worry endlessly about what other people think of me, including this awareness that others may see me as a self-righteous prick and so I try to compensate and silence how I address these matters with others. Most of the burden for these moral standards falls on me to enforce about myself.

I do not preach values and morality beyond what I consider basic human decency – standards that are so elementary that it infuriates many of us that we have to explain it to other human beings. Things like, “Don’t hate people because of skin colour” and “don’t assault other people”.

Summary

It’s possible that OCPD is the reason that generalised anxiety and social anxiety became facets of my life so early. I define myself through my work, and persevere in the pursuit of perfection and principle to the point that it alienates me from others. I was never anti-social, but I have always been an introvert and social anxious (three separate things often used, inappropriately, as synonyms). Isolation as a cost of maintaining those principles is a price worth paying to me usually.

In other cases it can be crippling in that I want a relationship but feel I cannot overcome my imperfections or some other deficiency to attain it. For all my effort, some people appear to live according to my values to a greater degree and with more grace than I ever could. That applies more pressure. That creates more stress. That worsens the anxiety.

I stow away resources for the inevitable catastrophe. What if my wife or I become seriously ill or injured one day? Insurance only does so much, and I will need a reserve to stave off ruin. What about unemployment? What if we retire and then live longer than expected with limited income? Save, save, save – obsess for a rainy day that may never arrive.

Even without the anxiety, mental health defines my life. Everything that is terrible about me has ties to the anxiety and the OCPD. Everything that is wonderful about me does, too. My standards are high out of empathy for the impact my life has on others. My anxiety is high because of that.

The real sin here?

I, like many people with OCPD, do not particularly want treatment. In a weird way, despite all of the associated problems with it, I want to be a better person. I have high standards that completely revolve around helping others and being kind. Even in my zero tolerance for unkindness, it hurts me to be unkind in response. Cutting off a person is my “weapon” of choice, and then I feel conflicted that this response is akin to burying my head in the sand. What else can I do? I have no means other than compassion to persuade someone else to behave differently and I cannot control what they do.

I am doing everything I can, if not to fix the problem, not to contribute to the problem and to help victims that we already failed to protect.

It’s not perfect, and that frustrates me. As I type this, the gaping holes are obvious. I hear myself sounding like a magnanimous, self-righteous, holier-than-thou tool. Anything less than that feels like I am excusing my imperfections and poor behaviours. I am not holier than thou, but I aspire to be. I think there’s grace, humility, and humanity in that effort – that counts for something, right?

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Thank you so much for sharing your experience, James! Don’t forget that you can keep up with James on his blog Celtic Riverside or on Twitter.

On a more personal note – I had keyhole surgery yesterday morning. I’ve got the next four days off to recover but I’m not sure how much of that time I’m going to be able to use on replying to comments and publishing new posts, so it might be a little bit slow on here for a little while.

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