Abnormal Psychology

Total words: 1839

The first time that I went to my friend, Jason's house I noticed that this 25 year old bachelor was excessively neat. I thought this was quite an unusual quality for a single, busy guy, but took it at face value as I didn't know anything about psychological disorders at the time. As our friendship grew and we spent more time together, I started to notice more "strange" behaviors, especially revolving around cleaning at first. No matter what time of day or night I visited my friend, everything in his apartment was spotless. And I mean everything! Every drawer was organized with every item of clothing facing the exact same direction. Every Item hung in his closet was color coded with all the black shirts perfectly ironed (by him) and hung together and every other color of shirt or pants only hung with other items of like color and style. There was never a glass on the kitchen counter or a dish in the sink. The coffee table had all the magazines organized in alphabetical order and all edges lined up together. The refrigerator had all food items facing a certain direction and positioned on the shelf precisely. If you happened to pick up a magazine, then replace it on the stack, he would reposition the magazine as it had been before you picked it up. If you took your jacket off, and just sort of placed it over the back of a chair, Jason would immediately hang it up, in a color coded way of course.

I started to think that this guy was just excessively neat, but always felt uncomfortable because I didn't want to mess anything up in his place. Whenever we sat down at a table in a restaurant he would straighten out the condiments aligning the salt and pepper shakers and also, position his napkin and fork just so. He had a lot of good qualities so I overlooked this annoying behavior and tried to concentrate on his positive attributes. As we grew closer and talked more on the phone, I would often ask "What are you doing!" He inevitably answered, "Cleaning!" I usually had the same response, "Oh, I thought you cleaned everything yesterday." "I did, but just noticed I missed a couple of spot." This repartee went on almost daily. When Jason felt closer to me, he began to confide in me that he was having a hard time concentrating and found himself not accomplishing much each day ( he had recently lost his job) because he found himself getting caught up in making extensive "to do" lists. He said that he felt compelled to make these lists because he wanted to make sure that he got things done "the right way." In the textbook Abnormal Psychology - An Integrative Approach, they describe obsessive-compulsive personality disorder: "People who have obsessive-compulsive personality disorder are characterized by a fixation on things being done "the right way." and "...this preoccupation with details prevents them from actually completing much of anything." After listening to Dr. Mays lecture on this disorder and reading the book, I began to understand my friend's problems a little better. The diagnostic criteria for obsessive-compulsive personality disorder included what I felt were many of Jason's complaints, including:

1.Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. This particular criteria very well fit Jason and was getting in the way of him leading a peaceful life.

2.Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because of his own overly strict standards are not met).
This is the reason Jason had lost his job! Even though he was utilizing his organization skills at work, his boss felt he was not completing his projects in a timely manner.

3.Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships ( not accounted for by obvious economic necessity).
Yes, this makes sense - he told me he didn't feel able to spend time having fun and also, unfortunately I was his only friend.

4.Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
Jason has already reached the DSM-IV-TR quota for this criteria. He had problems at work with many co-workers because they felt that they could not humanly live up to his inflexible, overconscientious expectations and had to participate in an abundance of co-worker impromptu meetings at the behest of his boss.

5.Is reluctant to delegate tasks or to work with others unless they submit to exactly his way of doing things. A reason for our first argument. Everything and I mean everything had to be done his way because as he explained "I have already written down and thought about the way to handle this and know it is the right way to do it and you'll just have to trust me on this." This criteria also caused problems with his boss, who often asked Jason to do a task a certain way and Jason would not comply because he knew a better and more "right way" to do it than what his boss had requested.

6.Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes. Oh my, this criteria exactly hit the nail on the head in terms of Jason's spending style. He often complained to me that his family called him "cheap" and I understood why!

7.Shows rigidity and stubbornness. Jason fit the diagnostic criteria for this as well and he told me that his teachers at school had often described him as "stubborn" to his parents in parent-teacher meetings in his youth.

My friend has met 7 out of the 8 diagnostic criteria for obsessive-compulsive personality disorder as described in the DSM-IV-TR. He only needed to meet 4 criteria to qualify for obsessive-compulsive disorder, and I am getting worried. My curiosity leads me to investigate many legitimate sources and in my studies have been further enlightened by the following that I feel is particularly relevant to my friend Jason, and reads as follows: Individuals with OCPD often come in for treatment because their productivity or cognitive skills are slipping. They complain of depression and an inability to be productive. "These individuals appear to be particularly sensitive to natural changes in cognitive skills due to normal aging" (Turkat). Over the five years I have known my friend he has progressively complained more often about his declining cognitive skills. Another reason individuals with OCPD come in for treatment has to do with psychophysiological difficulties. They frequently experience psychosomatic disorders due to the problems they have with discharging tension. "They may also experience severe anxiety, immobilization, impotence, and excessive fatigue" (Millon). Another major complaint of Jason's. A third reason these individuals come in for treatment is a result of someone else's concern about their behavior. They may have received a negative performance evaluation on the job because they hare having difficulty getting along with others. Jason's boss often talked to him about trying to get along better with his co-workers, in fact he made several ultimatums to that effect. Interpersonal difficulties for people with OCPD are related to their failure to grasp the impact of their own behavior. They are quite inept at reading other people's emotions and experiencing and understanding their own. This was a major issue between Jason and I and finding this research finally lends some understanding to our frustrating interpersonal difficulties."They usually deny they are having problems with others on the job and see the supervisor as having made false accusations." (Turkat) Individuals with OCPD live in the future (compared to the Cluster B individuals who live mostly in the present). They are obsessed with foreseeing all dangers and possible mistakes. Their behavior has the defensive quality of warding off parental or authority figure's anger by double-checking that no mistakes have been made (Stone)OCPD defenses are intellectualization, isolation of affect, undoing, reaction formation, displacement, and regression. These defenses are used to control anxiety at all costs with the heavy price of personal constriction (McCullough & Maltsberger, Gabbard & Atkinson). This allows individuals with OCPD to appear deliberate and poised. However, they must manage the internal turmoil of their unresolved struggle between obedience and defiance which threatens to upset the balance they have so carefully developed. They must control against both external eruption of their anger and the internal disruption of emotions and impulses.

After delving over much research regarding OCPD, I suggested to Jason that he might read some literature I had found and copied for him regarding what I thought could really be a personality disorder. He complied, and admitted to me that he "saw himself in what he had read .I convinced him to see a psychiatrist just to see if he could help him get back on his feet, and surprisingly Jason made an appointment. Sure enough he was diagnosed with Obsessive-compulsive personality disorder and feels much better that at least there are other people with the same disorder and research had provided various forms of treatment. " Medication helpful to obsessive-compulsive disorder, e.g., clomipramine, is unlikely to benefit individuals with OCPD." (Janicak, et al.) When Jason read this information he felt worried that maybe he would not be able to control his disorder and get his life in order. "Even if medication is tried, individuals with OCPD may have some difficulty with compliance because of their fear of loss of control. Alternatively, they may develop unrealistic expectations of medication (Ellison & Adler) "Overall, therapy is the treatment of choice for OCPD (Sperry).

I was talking to my friend Jason a few days ago and he is feeling hopeful about "getting himself together" but was a little alarmed when he asked me if I had ever experienced the following symptoms: Pounding heart, sweating, shaking and trembling, feeling of choking, chest pain, nausea, fear of losing control. "Oh yes, It sounds like you're having a panic attack!" I told him, then decided I would move to another state and change my phone number before it is too late!

Works Cited

Abnormal Psychology, An Integrative Approach, David H. Barlow, V. Mark Durand
Millon, Theodore, Davis, Rodger (1996). Disorders of Personality DSM-IV and Beyond. New York: John Wiley & Sons.
Adler, David A. (1990). "Personality Disorders: Theory and Psychotherapy," Treating Personality Disorders. Adler, David A., editor. San Francisco: Jossey-Bass Inc.
Sperry, Len, M.D., Ph.D. (1995). Handbook of Diagnosis and Treatment of the DSM-IV Personality Disorders. New York: Brunner/Mazel.
Janicak, Philip G., M.D., Davis, John M., M.D., Preskorn, Sheldon H., M.D., Ayd, and Frank J., Jr., M.D. (1993) Principles and Practice of Psychopharmacotherapy. Baltimore, MD: Williams & Wilkins.
McCullough, Philip K., M.D. & Maltsberger, John T., M.D. (1996) "Obsessive-Compulsive Personality Disorder,' in Synopsis of Treatments of Psychiatric Disorders, Second Edition. Gabbard, Glen O., M.D. and Atkinson, Sarah D., M.D. (Eds). Washington D.C.: American Psychiatric Press
Turkat, Ira Daniel (1990). The Personality Disorders, A Psychological Approach to Clinical Management. New York: Pergamon Press.

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