Date Presented: November 1, 2014 1

A WOMAN’S JOURNEY

Can Elements of OCPD Help

Women Be Effective?

Presented by: Gerald Nestadt MD

Disclosures

• None

October 27, 2014 2

Why ask this question?

…it seems that effective women have

these features

Is this true?

… recognize the features; but not sure we

like the features/cost

What are the costs?

Obsessive-Compulsive

Personality Disorder

OCPD is a personality (disorder) with a

constellation of specific traits

Different from a “state”; i.e. not a change from

ones’ usual pattern of functioning.

It is not an illness/disease;

There is NO “broken part”

It is NOT OCD

Personality Traits

…enduring patterns of

perceiving, relating to and

thinking about the environment

and oneself, and are exhibited in

a wide range of important social

and personal contexts.

Obsessive-Compulsive

Personality (Disorder) Features

Preoccupation with details, rules, lists, order, or schedules

Perfectionism that interferes with task completion

Excessive devotion to work and productivity

Overconscientious, scrupulous and inflexible

OCPD

Inability to discard worn or worthless objects

Reluctance to delegate tasks

Miserly spending style

Rigidity and stubbornness

Percent (%) Prevalence of

Compulsive Personality Traits

Five-factor Solution for DSM

Personality Attributes

Factors

Compulsive Aloof Neurotic

Avoidant

Impulsive

Callous

Egocentric Prevalence

Obsessive-Compulsive

Excessive work devotion 0.51 0.14 0.07 0.01 0.16 16.35

Perfectionism 0.69 -0.02 0.10 - 0.09 0.17 26.37

Preoccupied with details 0.67 0.06 0.21 -0.08 0.11 19.64

Hoarding behaviors 0.29 0.11 0.23 0.09 -0.06 27.20

Overconscientiousness 0.69 0.12 0.01 - 0.13 0.07 18.41

Miserliness 0.54 0.15 0.05 - 0.02 0.05 8.10

Reluctant to delegate 0.79 0.01 0.09 0.06 0.14 29.26

Rigidity 0.68 0.19 0.04 0.27 0.09 43.27

Prevalence (%) of DSM-III compulsive personality

traits and disorder weighted to the general

population

Compulsive

score 3+

Compulsive

score 6+

DSM-III

disorder

Total 20.0 (2.0) 3.3 (0.8) 1.7 (0.6)

SexMale 26.0 (3.5)* 5.7 (2.0) 3.0 (1.5)

Female 15.2 (2.1) 1.4 (0.6) 0.6 (0.4)

Education< 12 grade 16.6 (2.5) 2.0 (0.8) 0.9 (0.6)*

13 + grade 23.9 (3.2) 4.9 (1.6) 4.5 (2.2)

Prevalence (%) of DSM-III compulsive personality traits

and disorder weighted to the general population

Compulsive

score 3+

Compulsive

score 6+

DSM-III

disorder

Marital Status

Married 29.4 (3.8) 4.7 (1.7) 3.1 (1.4)

Widowed 16.1 (4.1) 0.9 (0.5) 0.2 (0.2)

Sep./Div. 13.1 (3.2) 3.9 (1.9) 1.8 (1.5)

Never married 9.2 (2.6) 2.0 (1.4) --

EmploymentEmployed 25.8 (3.6) 4.8 (1.7) 3.3 (1.4)*

Unemployed 15.2 (2.5) 2.1 (0.9) 0.5 (0.5)

Income< $10,000 15.8 (2.2) 1.4 (0.7) 0.4 (0.4)*

> $10,000 28.8 (4.3) 7.1 (2.3) 4.1 (1.8)

Birth OrderEldest sibling 24.9 (2.3) 4.5 (1.0) 3.1 (1.6)

Not eldest Sibling 16.5 (3.7) 2.8 (1.8) 1.3 (0.8)

Dimension Perspective

(Personality)

Assumptions:

– People differ from one another in their

psychological attributes.

– Such attributes can be construed as (affective)

dimensions of variations. (graded/quantified)

– People who deviate to an extreme along such

dimensions may be vulnerable to emotional

distress in particular circumstances.

Potentials Provocations Responses

(Personality) (Life Circumstances) (Neurotic Symptoms)

Emotive triad.

Generalized Anxiety Disorder and Alcohol Use

Disorders by Compulsive and Antisocial Personality

Probability of Obsessions and Compulsions

by Compulsive Personality Score

GAF score in 1996-1999

by personality traits in 1981.

55

60

65

70

75

80

OCPD BPD Avoidant

0

1 or 2

>2

**

*

GAF s

core

* Significant at p<0.05

…it seems that effective women

have these features

Is this true? YES

More likely :

Successful in producing a desired or intended result

Getting things done

Social, occupational, and family successes

But it depends……

… recognize the features; but not

sure we like the features/cost

What are the costs?

Increased possibility of distress,

anxiety, and depression

Family, social, and occupational costs

OCD ≠ OCPD

22

OCD

Obsessions:

Unbidden thoughts (images) that intrude and

are difficult to expel, despite their unwanted

nature.

Compulsions:

Actions (behavioral/mental) that the person

feels compelled to do, despite the recognition

that they are unwarranted.

Epidemiology

Prevalence:

Common disorder, ~2% in population; ~5-6 million Americans.

Disability:

Considered among the ten most disabling disorders by the WHO.

Cost to society:

$8.4 billion in social & economic costs;

6% of total mental health bill ($148 billion).

Management of OCPD

• Education and guidance

• Treat symptomatically

• Pharmacology: selective-serotonin

reuptake inhibitors

Knowledge = Empowerment

Recognize your own style; its yours

Listen… or even ask

Listen to yourself: is it worth it

What’s making me anxious? Angry? Demoralized?

Is it in my power to change this?

Conclusions

Effective women have some compulsive

features

Be aware of taking care of yourself

It’s fine to have a few foibles or idiosyncrasies