Personality Disorder: Obsessive Compulsive Disorder Diagnosis
JP is a 42-year-old man with no past medical history. He is a pleasant gentleman who is approachable and friendly. His holds a degree in accounting, and currently works as an accountant. His coworkers describe his work ethnic as superb. JP is always available to help others but he does not delegate tasks just so that they can be easily completed by another employee. He has been working in the accounting industry for 10 years, and he has no plans to change careers. JP is always available to offer assistance to his co-workers wherever they need help. JP is an overly devoted employee who spends most of his spare time doing tasks that are related to his job. At times, JP finds it difficult to complete tasks at work due to his preoccupation with organization, orderliness and handwashing.
JP is married with a with a 7-year-old son and a 5-year-old daughter. He lives in a three-bedroom apartment with his family. He describes his marriage as exciting. He stated that he is satisfied with his accomplishments in life. JP does not use any illicit drugs or substances. He occasionally drinks two cans of beer to help him to relax. However, he has not drank beer in the last 8 months. He identifies himself as a Christian and goes to church every Sunday.
JP has reported preoccupation with excessive handwashing, orderliness and organization to a point of interfering with some of his daily activities. He frequently has obsessive thoughts about things in his surroundings being dirty and disorganized. As a result of these obsessive thoughts, he developed compulsions in the form of frequent hand washing and organization. His compulsive thoughts also include checking the door knobs, faucets and the dining table to make sure everywhere is clean. The thought of his surroundings being dirty causes him a great deal of fear, anxiety and panic. He developed these obsessive-compulsive symptoms in his late 20s, but he has never been hospitalized. He is currently not on any medications. He rates his OCD at 6/10 in severity. No additional medical history or family medical history is known.
Criteria on which Diagnosis is Based
JP has Obsessive-Compulsive Personality Disorder or OCD. The DSM-5 (2013) lists preoccupation with details, perfectionism that interferes with task completion, excessive devotion to work, overconscientiousness, scrupulousness, inflexible religious belief, and a reluctance to delegate task as symptoms of OCD (APA, 2013, pp. 678-679). JP’s symptoms as described above fit that diagnosis. JP and others like him with OCD attempt to maintain a sense of control through their obsessive behaviors such as handwashing, orderliness, and strict attention to details. Often their co-workers and those around them become annoyed at the delays the obsessive behavior causes, but the person with OCD is oblivious to that (APA, 2013, p. 679). JP realizes his behavior is unusual, and he is seeking treatment so that he can learn to control it.
Treatment
The treatement for JP should consist of psychotherapy and possibly pharmacotherapy. Since he sought treatment on his own, which is common with people who have OCD, according to Sadock, Sadock and Ruiz (2014), author’s of Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences Clinical Psychiatry, he should be open to the treatment which can be very difficult for people with OCD to endure (Sadock, Sadock, & Ruiz, 2014, p. 756). These authors say, “Overtrained and oversocialized, these patients value free association and no-directive therapy highly. . . . Group therapy and behavior therapy occasionally offer certain advantages” (Sadock, Sadock, & Ruiz, 2014, p. 756). The International OCD Foundation agrees that psychotherapy can be an effective treatment for OCD. They say that cognitive behavior therapy (CBT) has been shown to be the most effective and is often paired with pharmacotherapy.
The most effective type of CBT is exposure and response prevention (ERP). That along with medications from the serotonin reuptake inhibitors class or SRIs is the most effective according to the International OCD Foundation (Internatinal OCD Foundation, 2019). Sadock, Sadock and Ruiz (2014) suggest clonazepam, clominpramine or serotonergic agents such as fluoxetine or nefazodone (Sadock, Sadock, & Ruiz, 2014, p. 757). However, pharmatherapy may not be necessary if CBT is effective.
ERP involves the patient exposing him or herself to the thoughts, images, objects and situations that make them anxious or that start their obsessions. The response prevention aspect of the treatment refers to making the choice not to engage in the compulsive behaviors once the anxiety has been triggered. A therapist guides the patient through this to start with (Internatinal OCD Foundation, 2019). The hope is that the patient will learn to make the choice to not respond of his or her own accord. However, confronting the things that make a person anxious can be scary, but having control of the situation and making the choice to confront them helps, but the patient must be committed to not giving in to the anxieties and obsessive behaviors.
How Culture Influences Personality Development
Every child wants to be seen as good, or acceptable, based on the norms of the culture in which they are raised. Children can have the same experiences when they are young and develop totally different personalities because each person interprets the experiences differently. A child will identify with parents, peers and other close acquaintances as a young child and start to break away from identifying with parents around adolescence. This helps them to identify with what they and their families believe is good in their culture or to discover for themselves what they think is good.
The effort to please parents and others in a child’s culture coincide with the socialization conditions of the child’s culture. Albert and Trommesdorff (2014) of Online Readings in Psychology and Culture explain that the “cultural context gives rise to specific socialization conditions which influence the developmental outcomes of the child” (Albert & Trommsdorff, 2014, p. 5). A child will develop traits based upon the impact the cultural values that the various influences have on the child, the socialization practices of the child, the child’s personality and the relationships the child has with others in his or her culture.
A person who develops a personality in a culture that expects a person to be fastidious, orderly and highly trained often will pursue professions such as accounting that have an orderliness to them as JP did. Such a profession may give him a sense of control in its ability to identify right and wrong procedures and solutions to problems. His culture taught him to desire this sort of organization and the OCD may have developed as part of the effort on his part to meet cultural expectations.
Conclusion
JP has many wonderful things going for him and he has the potential to have a really great life if he is successfully treated for OCD. The good news is that he can be treated. With CBT and possibly pharmacotherapy, he may be able to overcome the compulsions that make him obsessive and be able to have control over the compulsions for the rest of his life. The therapy will be difficult and painful for him because it involves him creating the anxieties that cause his obsessive behavior, but because he knows he has a problem and is seeking help, he will most likely be successful.
References
Albert, I., & Trommsdorff, G. (2014). The Role of Culture in Social Development Over the Life Span: An Interpersonal Relations Approach. Online Readings in Psychology and Culture, 6(2), 1-30. Retrieved from https://scholarworks.gvsu.edu/...
APA. (2013). Diagnostic and Statistical Manual of Mental Disordes (DSM-5) (5th ed.). Washington D.C.; London: American Psychiatric Association.
Internatinal OCD Foundation. (2019). How is OCD Treated? Retrieved from Internatinal OCD Foundation: https://iocdf.org/about-ocd/oc...
Sadock, B., Sadock, V., & Ruiz, P. (2014). Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences Clinical Psychiatry (11th ed.). Plhiladelphia; Baltimore: Wolers & Kluwer.
