Criteria/Symptoms/General Information

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994, pp. 672-673) describes Obsessive-Compulsive Personality Disorder as a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense or flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

• 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 or 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.

There is growing evidence that OCD represents abnormal functioning of brain circuitry, probably involving a part of the brain called the striatum. OCD is not caused by family problems or attitudes learned in childhood, such as an inordinate emphasis on cleanliness or a belief that certain thoughts are dangerous or unacceptable. Brain imaging studies using a technique called positron emission tomography (PET) have compared people with and without OCD. Those with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all. In addition, PET scans show that in patients with OCD, both behavioral therapy and medication produce changes in the striatum. This is graphic evidence that both psychotherapy and medication affect the brain.

It is important to have a medical professional diagnose OCD. The medical professionals use DXVIA DSMILR Criteria to diagnose OCD.

• About 2.3 percent of the U.S. population ages 18 to 54--approximately 3.3 million Americans--has OCD in a given year.
• OCD affects men and women equally.
• OCD typically begins during adolescence or early childhood; at least one-third of the cases of adult OCD began in childhood.
• OCD cost the U.S. $8.4 billion in 1990 in social and economic losses, nearly 6% of the total mental health bill of $148 billion.

There are not different types per se:

• Obsessions: Thoughts that increase anxiety
• Compulsions: Actions that decrease anxiety

OCD is sometimes accompanied by depression, eating disorders, substance abuse, attention deficit hyperactivity disorder or other anxiety disorders. When a person also has other disorders, OCD is often more difficult to diagnose and treat. Symptoms of OCD can also coexist and may even be part of a spectrum of other brain disorders, such as Tourette's Syndrome. Appropriate diagnosis and treatment of other disorders are important to successful treatment of OCD.

Treatments for OCD have been developed through research supported by the NIMH and other research institutions. These treatments, which combine medications and behavioral therapy (a specific type of psychotherapy), are often effective. Several medications have been proven effective in helping people with OCD: clomipramine, fluoxetine, fluvoxamine, sertraline and paroxetine. If one drug is not effective, others should be tried. A number of other medications are currently being studied.

A type of behavioral therapy known as "exposure and response prevention" is very useful for treating OCD. In this approach, a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts, and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety.

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