Sorting out Obsessive-Compulsive Disorders

At the risk of stating the obvious, it's all summed up in the single word personality. Obsessive-compulsive disorder (OCD) is defined primarily in terms of specific behaviors . O bsessive-compulsive personality disorder (OCPD), on the other hand, is better understood as an expression of an individual's entire personality, philosophy and worldview. Let's take a closer look at each.

Obsessive-compulsive disorder (OCD) is an anxiety disorder, a condition of the brain often characterized by intrusive, anxiety-producing thoughts. These thoughts can express themselves in repetitive or ritualistic behaviors aimed at reducing distress. Obsessions are the thoughts and urges associated with OCD, such as recurrent, anxious thoughts about germs or personal safety. Excessive hand-washing or door-checking are common examples of compulsions (the behaviors associated with OCD). Adding a level of complication to the disorder is the fact that a person with OCD can have obsessions without compulsions, and vice versa.

Obsessive-compulsive personality disorder (OCPD) is a syndrome that characterizes a person's overall orientation towards life. In general, this perspective can be described as "rigid," "inflexible" and/or "perfectionistic." An OCPD person demands that everything be organized according to a particular system or method. He loves rules and regulations, and order and control are matters of the utmost importance to him. As a result, he often has difficulty with people who can't or won't abide by his standards. This in turn can sometimes make him stingy, miserly, judgmental and withdrawn. It's also common for an individual with OCPD to undertake projects with a great deal of initial energy and zeal only to leave them unfinished when obstacles and imperfections arise. The disorder is more common among men than women, and most psychologists agree that it cannot be accurately diagnosed until about 18 years of age.

It can be difficult to live with an individual who suffers from either of these disorders. In both situations the two temptations are 1) to deny that the condition exists, or 2) to cater to the obsession, allowing it to shape the entire household's way of life. Both of these extremes should be avoided.

In confronting simple OCD, it's crucial to remember that a person with this disorder may realize that his obsessions are unrealistic but may be anxious and driven by them anyway. You can help by lovingly challenging false or anxious perceptions that drive compulsive behaviors. It can also be beneficial to objectify the obsessive-compulsive disorder by separating it from your spouse's personality. For example, if he says, "Do you think I should go back and check the door?" you can respond, "That's your OCD talking, not you." Keep your interactions on this point as light and playful as possible. Humor can sometimes provide the objective point of view that's needed to break the chain.

Where OCPD is concerned, the good news is that, of the ten clinically recognized personality disorders, this one is the most easily treatable. Since in this case it isn't possible to make a distinction between behavior and personality, we recommend a diagnosis by a qualified mental health professional. Counseling is considered the best route to improvement and recovery. Through therapies such as cognitive-behavioral therapy (CBT), individuals with OCPD can learn to question their basic assumptions about life and soften the rigidity of their outlook and behavior. This approach should be adopted only if you and your spouse agree that it's necessary, and only after a thorough psychiatric evaluation.

Focus on the Family's Counseling Department can provide you with a list of referrals to psychologists in your area who specialize in the treatment of OCD and OCPD. Our staff would also be more than happy to discuss your spouse's situation with you over the phone. You can reach one of our licensed counselors at this number.

For further information, we recommend that you visit the website of the International OCD Foundation.

You may also find it helpful to consult the book Brain Lock: Free Yourself from Obsessive-Compulsive Behavior by Jeffrey M. Schwartz and Beverly Beyette (available through Amazon.com and at many local bookstores). Both the book and the website are secular in nature, and as a result we can't guarantee that all of the perspectives they represent are fully compatible with Focus on the Family's Christian worldview. In spite of this, we believe that they contain a great deal of material that may prove useful.

This information has been approved by the Physicians Resource Council of Focus on the Family.

Resources
The Other Side of Darkness (book)
International OCD Foundation - International OCD Foundation

Referrals
Hart Institute - The Hart Institute offers articles and resources that emphasize new advances in mental, emotional, physical and relational health in the context of practical Biblical wisdom.

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