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