Although the obsessive compulsive disorder (DOC) and the obsessive compulsive disorder of personality (DOCP) share some symptomatological similarities and can consequently be confused with each other, they are actually two different clinical conditions. They are inauspicious characterized by deeply different causes, nature and course and, therefore, provide different types of treatment and prognosis.
Obsessive-compulsive (DOC) disorder
Obsessive-compulsive disorder is a disorder characterized by the presence of obsessions and compulsions.
The obsessions They are unwanted and invasive thoughts, images or impulses that cause considerable anguish to those who experience them. The compulsions These are all those manifest behaviors or the mental acts that a person feels pushed to perform in response to the appearance of the obsession, with the aim of freeing himself from the negative emotions connected to it.
People with DOC, in most cases, are aware of the irrationality of their fears and recognize that compulsions are in most cases excessive and not very useful but still feel obliged to perform them (APA, 2013).
Obsessive-compulsive personality disorder (Docp)
The obsessive compulsive personality disorder (Docp) is a personality disorder characterized by a pervasive pattern of concerns about order, perfection, control and productivity. As can be understood, this pattern acts at the expense of flexibility, opening and effective efficiency.
Individuals with Docp often have Extremely rigid rules, procedures and programs which follow inflexiblely. They can also manifest extreme criticism of themselves and others when these rules are not respected. Unlike the Adoc, people with Docp often consider their behaviors as appropriate and consistent with the context (APA, 2013).
Similarities between DOC and Docp
In addition to the name, which often confuse the non -experts, also the clinical manifestations of the DOC and Docp have some common traits. Among these we can identify:
The presence of repetitive rituals and behaviors
In both conditions there is a massive adherence to the execution of certain behaviors, often repetitive and ritualized.
In obsessive compulsive disorder, the use of these behaviors is motivated by the desire to lower the anxiety deriving from obsessive thought. In Docp, however, the link is often absent with an emotional antecedent and ritualistic behavior is motivated by an internal thrust towards a perfectionist component.
Rigidity
Both in the DOC and in the DOCP, there is arigid adherence and inflexible to compulsions and ritualistic gestures. In the doc this rigidity is determined by the attempt to reduce the intensity of the emotion associated with obsessive thought. In the Docp, however, it is linked to an excessive adherence to the rules and routine established.
Perfectionism and concern for the order
The DOCP shares with a specific variant of the DOC The tendency to assume perfectionist behavior mainly related to order and symmetry.
The substantial difference in the manifestation of this aspect in the two disorders lies in the fact that, while in the Docp concern for order and perfectionism are structural features of the personality, in the DOC with compulsions of order and symmetry the perfectionistic tendency is often linked to the appearance of obsessive magical-social thoughts.
Comorbilities between the two disorders
The differential diagnosis between obsessive compulsive disorder and obsessive compulsive disorder of personality is made even more complex by the fact that these diagnostic entities are not infrequently in comorbilities with each other.
Literature data suggest that about 10-20% of patients with DOC also meet the criteria for a DOCP diagnosis.
Commitability is an important factor to be kept in mind during evaluation since, in addition to affecting the type of treatment, it is able to significantly influence the prognosis and therapeutic outcome.
Differential diagnosis between DOC and DOCP
The main differences between DOC and Docp concern the degree of awareness, nature and function of symptoms.
Nature of symptoms
While the DOC develops starting from specific obsessions and generates compulsive behaviors specifically linked to these, the DOCP is characterized by a strong need for control and a rigid and perfectionistic behavior that is activated in a much more pervasive way and is not linked to specific mental content.
Function of symptoms
As previously mentioned, in the DOC the compulsions are carried out with the aim of reducing the anxiety generated by the appearance of the obsessions.
In the case of the Docp, however, the ritualized behaviors are considered as an integral part of the individual’s personality and are not carried out in response to specific obsessions.
Awareness (insight)
In most cases, people with DOC are able to recognize that their fears and consequent compulsive behaviors are irrational and excessive.
Although this awareness generates a profound suffering in not being able to interrupt obsessive cycles, on the other hand it represents a fundamental motivational thrust towards therapeutic change.
On the contrary, those who suffer from Docp often evaluate ritualistic behaviors as righteous and rational. This means that the push to question them, from a therapeutic perspective, is tendentially much lower.
Clinical implications
Although obsessive compulsive disorder and obsessive compulsive personality disorder share some symptomatological similarities, they are two distinct diagnostic entities with different causes and manifestations.
An accurate differential diagnosis and the evaluation of the presence of a possible comorbidity between the two manifestations They are essential elements to be able to structure effective therapeutic interventions. With a view to intervention based on the peculiar characteristics of the individual, in fact, the therapeutic approaches for the two conditions are deeply different.
The DOC responds well to a behavioral cognitive psychotherapy that provides for the use of techniques such as cognitive renovation and exposure with the prevention of response, possibly integrated by a pharmacological treatment.
In the case of DOCP diagnosis or comorbidity between the two disorders, it will be necessary to provide for a more complex intervention. This, in addition to the common cognitive-behavioral techniques, must also intervene on personological constructs that generate more rooted and pervasive thought models of thought and behavior.
Bibliography
- APA (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Pub.
- Pinto, A., Mancebo, Mc, Eisen, Jl, Pagano, Me, & Rasmussen, SA (2008). The Brown Longitudinal Obsessive Compulsive Study: Clinical Features and Syptoms of the sample at intake. Journal of Clinical Psychiatry.
- Fineberg, Na, Sharma, P., Sivakumaran, T., Sahakian, B., & Chamberlain, SR (2007). Does Obsessive-Compulsive Personality Disorder Belong Within The Obsessive-Compulsive Spectrum? CNS Spectrums.
- ANSELL, EB, Pinto, A., Crosby, RD, Becker, DF, Añez, LM, Paris, M., & Grilo, cm (2011). The prevalence and structures of Obsessive-Compulsive Personality Disorder in Hispanic Psychiatric Outpatient. Journal of Behavoral Therapy and Experimental Psychiatry
