Personality Disorders

Summary

• OCD is an anxiety disorder involving unwanted thoughts.
• OCPD is a personality disorder marked by controlling thoughts.
• People with OCPD have no compulsions and no desire to change.

Obsessive-compulsive personality disorder (OCPD) sounds a lot like obsessive-compulsive disorder (OCD). But, there are some distinct differences. OCD is an anxiety disorder involving repetitive unwanted thoughts and ritualized actions. OCPD is a personality disorder marked by controlling thoughts. One major difference between the two is in self-awareness. People with OCD are very tuned in to the negative aspects of their condition. Those with OCPD often do not think they are doing anything unusual.

What is OCD?

OCD is made up of obsessions and compulsions. Obsessions are unwanted thoughts or images that repeatedly occur in one’s mind. They can be very disruptive and disturbing. The person will often realize her obsessions are not rational. At the same time, she is not able to stop them. This leaves her feeling anxious and afraid. Some common obsessions are feeling that things are out of order or left undone. Others include feeling one’s hands are full of germs, or a feeling of coming doom.

Compulsions are rituals done in response to obsessions. These acts are an attempt to control the obsessions and the feeling of anxiety that goes with them. The person does not want to repeat the rituals, but feels compelled to do so. She feels something bad will happen if she does not do them. Doing the rituals will not make the obsessions go away but may give some brief relief. Some common compulsions include washing hands over-and-over or checking and rechecking things.

What is OCPD?

In contrast to those with OCD, people with OCPD often have no desire to change. They are convinced that their way of doing things is the best way. They demand if everyone else just followed their example, things would go smoothly. This rigid thinking often causes problems with others.

A person with OCPD is unaware of the hardship he causes others. This can be very true in the workplace. His over-attention to detail often becomes a source of frustration to his co-workers. Those working under him may feel they are being micro-managed. He also may have a hard time meeting his work deadlines.

The actual quality of work of someone with OCPD may be better than that of his peers. But, it will often come at the expense of his relationships with those peers.

Other differences

OCD usually starts in childhood. OCPD usually does not begin until the teen or early adult years. A person with OCD will be distressed about her condition. This will often prompt her to seek treatment on her own.

A person with OCPD will more likely cause distress to those around him. Most often it is when resulting conflicts threaten his job or closest relationships that he seeks treatment.

People with OCPD do not have the compulsions that are common with OCD. They also do not have the high anxiety. They are content with their way of doing things. Their obsession with lists and rules does not cause them any stress. In fact, quite the opposite is true. People with OCPD feel relieved, not burdened, when they stick to their strict routine.

Diagnosis

Having some obsessive traits or behaviors does not mean a person has OCD or OCPD. Neither does a person have to have all the traits to be diagnosed with either disorder. Proper evaluation should be done by a mental health professional. People found to have either disorder can and do recover. There is hope.

Resource

International OCD Foundation
Obsessive-Compulsive Personality Disorder (OCPD) Fact Sheet

By Kevin Rizzo

©2015-2019 Carelon Behavioral Health

Source: International OCD Foundation, https://iocdf.org/wp-content/uploads/2014/10/OCPD-Fact-Sheet.pdf; National Institute of Mental Health, www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml U.S. National Library of Medicine, National Institutes of Health, http://www.nlm.nih.gov/medlinepl us/ency/article/000942.htm; NHS Choices, www.nhs.uk/Conditions/Personality-disorder/Pages/Symptoms.aspx

Reviewed by Philip Merideth, M.D., J.D., Physician Advisor, Beacon Health Options

Summary

• Obsessed with popularity and success
• Sense of entitlement along with a lack of empathy

From reality shows to selfies, narcissism seems to be all around. Drawing attention to oneself is not only accepted, but is often encouraged by today’s cultural norms. So how much is too much? How do you know when you or a loved one has crossed the line?

Narcissism vs. narcissistic personality disorder

The term narcissism is taken from Greek legend. Narcissus fell in love with himself after seeing his own image. Today, people who seem to be self-centered or in love with their looks are sometimes viewed as narcissistic.

But, this is not the same as having narcissistic personality disorder (NPD). NPD involves an excessive feeling of self-pride along with a distinct disregard for the feelings of others. A person with NPD is driven by an obsessive need to be greatly admired and praised.

Symptoms of NPD

People with NPD have an inflated sense of entitlement. They project an image of being special and they expect to be treated that way. They do not care how this may negatively affect others. They likely will have little trouble making friends, but will have a hard time keeping them.

A person with NPD will be obsessed with popularity and success. He will do what it takes to reach his goals, no matter what the impact on others. He will often exaggerate his accomplishments to get noticed. He has no problem using others for his own gain.

NPD is often shown as arrogance and hostility toward others. A person with this disorder may engage in verbal abuse or bullying. This will result in conflicts in relationships, whether at home, work, or school.

Self-esteem vs. self-centered

It is not known what causes NPD. The way one is brought up is thought to play a role. Some believe parents can push their kids toward narcissism by over-praising trivial achievements. Others blame social media for making and encouraging a culture of self-centeredness. More research needs to be done to look at the causes of NPD.

Having a good self-image is a healthy part of growing up. A person who has an inner confidence will not have to rely so much on the praise of others. People with NPD are often over-compensating for their own lack of confidence. While they seem to look down on most people, they are also insecure and jealous of others.

Diagnosis and treatment

People with NPD can be helped through talk therapy. But, the very nature of the disorder will likely stop them from seeking help. A sense of entitlement along with a lack of empathy keeps them in denial. It may take the threat of job loss or divorce before they will seek treatment. When the need for too much attention and special treatment disturbs all relationships, it should be checked out.

Just showing some signs of narcissism does not mean a person has NPD. Proper evaluation should be done by a mental health expert. Most people want the attention and approval of others. We all want to be liked. Posting selfies and trying to attract followers online is not a cause for alarm. If you think you may have the disorder, you likely do not. People with NPD are not bothered by how they act or how it affects others.

Resource

American Psychological Association
Reflecting on narcissism: Are young people more self-obsessed than ever before?

By Kevin Rizzo

©2015-2019 Carelon Behavioral Health

Source: U.S. National Library of Medicine, National Institutes of Health, www.nlm.nih.gov/medlineplus/ency/article/000934.htm; American Psychological Association, www.apa.org/monitor/2011/02/narcissism.aspx; NHS Choices, www.nhs.uk/Conditions/Personality-disorder/Pages/Symptoms.aspx; Encyclop￦dia Britannica Inc., www.britannica.com/EBchecked/topic/403458/Narcissus

Reviewed by Philip Merideth, M.D., J.D., Physician Advisor, Beacon Health Options

Summary

• OCPD differs from OCD
• Person is obsessed with order and control
• Person is unlikely to seek treatment

What is OCPD?

Obsessive-compulsive personality disorder (OCPD) is not the same as obsessive-compulsive disorder (OCD). OCD is an anxiety disorder involving unwanted thoughts and the need to do rituals or actions that temporarily lower feelings of anxiety. OCPD is a personality disorder involving a rigid focus on rules, order and interpersonal control. People with OCPD may feel there is nothing unusual with their thoughts or actions and may see themselves as rational and logical. They only feel nervous when they are not able to do things their way.

OCPD is a personality disorder. This means the person will think and act differently than most people. People with OCPD are very concerned with order and control. They can become wrapped up with lists and rules. They tend to be very legalistic and perfectionistic. They strongly believe their way is the right way. So, they may feel others should follow their way of thinking and of doing things.

Traits of OCPD

A person with OCPD will be overly attentive to detail. This can make it hard to complete tasks on time. He will also have a hard time delegating work to others. This is because he believes no one else can do the job the right way.

He may be described as a “workaholic” or a “control freak.” He might do well at his job, but not get along well with his co-workers or boss. He often will neglect family because of his devotion to work. It may take the threat of losing his job or his family before he will notice he has a problem and seeks help.

People with OCPD can be very stingy with their time and money. They also tend to hoard things that seem to have little or no value. Their strict following of the letter of the law can cause them to be overly religious or moralistic.

Diagnosis and treatment

OCPD most often starts when a person is a teen or young adult. It affects men much more often than women. A person with OCPD is unlikely to seek treatment because he does not see any need for treatment.

It is not known what causes OCPD. Genes may be a factor, or the way one is brought up may be the cause. Some believe it is a result of being raised in an overly strict setting.

Having some OCPD traits does not mean a person has OCPD. Neither does a person need to have all the traits to have the disorder. Proper evaluation should be done by a mental health expert. OCPD can often be treated with talk therapy. Sometimes a mixture of medication and talk therapy works best. With treatment, people with OCPD can learn to be less demanding on themselves and others.

Helping someone with OCPD

Living with or working with someone who has OCPD can be a challenge. This is because the person firmly believes her way is the best way. In her mind, it is everyone else who needs to adapt to her standards. This can make others feel stressed when they are around her. It is important not to take her criticism personally. Setting up healthy limits will help stop the feeling of being overly controlled.

If the person does reach out for help, be supportive. Offer to go to group therapy sessions or just be ready to talk. Help her resolve conflicts without getting too emotionally involved in the issues.

Resource

International OCD Foundation
Obsessive Compulsive Personality Disorder (OCPD) Fact Sheet

By Kevin Rizzo

©2015-2019 Carelon Behavioral Health

Source: International OCD Foundation, https://iocdf.org/wp-content/uploads/2014/10/OCPD-Fact-Sheet.pdf; NHS Choices, www.nhs.uk/Conditions/Personality-disorder/Pages/Symptoms.aspx

Reviewed by Philip Merideth, M.D., J.D., Physician Advisor, Beacon Health Options

Summary

• Experts disagree on the role social media plays
• More research is needed
• Social media is not the cause of personality disorders

The rise of social media

Social media is all around. It can be hard to ignore. The world is right at our fingertips. So is self-promotion. Social networking sites such as Facebook, Twitter, Instagram, and LinkedIn are just a click away. Users can promote themselves or their businesses all day, every day. The benefits of having such reach are clear. But what about the downsides?

Could social media be making us more selfish and less social?

To the casual viewer, especially older adults, the answer may likely be yes. Not having grown up with today’s technology, it may be hard for older people to relate. They simply do not see texting as a valid form of socializing. All they see is a group of people staring at their phones. And what is the reason for taking and sharing all those selfies? How can they see that as anything other than being selfish?

The rise of narcissism?

Experts differ on the role social media plays in our own growth. Some research shows a possible link between social media use and a rise in narcissism. Other studies seem to dispute these findings. Some experts believe that older generations were just as selfish as young people are today. One study suggests that social media may even grow our good will for others.

Social media is still evolving. So is technology. It will take much more time and research to note the long-term effects of social media use.

Personality disorders

Showing some selfish or unsocial traits does not mean a person has a disorder. Personality disorders are marked by odd and disturbing actions that get in the way of a person’s relationships. The person is often upset. She sometimes seems to be in her own world. She has a hard time keeping friendships. She may try to hide from people. She may even try to harm herself or threaten to harm others.

Narcissistic personality disorder (NPD)

People with NPD have an overblown sense of self-pride. They also have little or no good will for others. They will use a person’s weakness for their own gain. They will demand the attention and favor of others. This is often fueled by their own insecurities. Their actions cause problems with relationships whether at home, work, or school.

Antisocial personality disorder (ASPD)

ASPD is not the same as being shy or simply dodging people. A person with ASPD can be hostile or manipulative toward others. He will take advantage of and bully people without showing any regret. He has no sense of guilt and may blame others for his problems. He may struggle with substance use and his actions may even lead him into prison.

Personality disorders and social media

It is not clear whether social media is making our society more selfish. Further research is needed. What is clear, though, is that social media is not the cause of personality disorders. NPD, ASPD, and other personality disorders are serious and complex. In many cases the true causes are unknown. Evaluations should be made by a mental health provider.

People with personality disorders can be helped with proper care. This includes talk and sometimes medication therapy, peer support, and recovery plans. This is especially true when the person is affected by other mental health issues.

Resources

American Psychological Association
Facebook: Friend or foe?
Reflecting on narcissism: Are young people more self-obsessed than ever before?

By Kevin Rizzo

©2015-2019 Carelon Behavioral Health

Source: American Psychological Association, www.apa.org/monitor/2011/10/facebook.aspx and www.apa.org/monitor/2011/02/narcissism.aspx; U.S. National Library of Medicine, National Institutes of Health, www.nlm.nih.gov/medlineplus/ency/article/000921.htm; NHS Choices, www.nhs.uk/Conditions/Personality-disorder/Pages/Symptoms.aspx; Psychology Today, www.psychologytoday.com/blog/close-encounters/201501/are-selfies-sign-narcissism-and-psychopathy

Reviewed by Philip Merideth, M.D., J.D., Physician Advisor, Beacon Health Options

Summary

• Rooted in poor self-esteem
• Lying for many reasons, or no reason at all
• Not officially a mental disorder
• Suggests deeper psychological problems

Almost everyone has encountered a pathological liar—the type of person who in one conversation claims to have dined with the Queen of England, danced back-up for Madonna, and dived with great white sharks. The problem for pathological liars is that their attempts to impress often backfire.

Instead of getting the love and attention they seek, they usually earn scorn and ridicule. A habit of lying can quickly ruin a person’s reputation and interfere with his ability to establish meaningful relationships.

We all lie, in many different ways, many times a day—mainly to avoid hurting ourselves or others. Experts believe that children figure out by the age of 4 that they can mislead others with lies. But what makes a person leap from social- or self-defense lying to habitual, compulsive lying? 

Why they lie

Some psychologists theorize that a chronic liar is trying to deceive herself as much as she is trying to deceive others. Because of poor self-esteem, she wants to believe her lies, and often does believe them, at least while she’s telling them.

Some of the hallmarks of pathological liars include telling outrageously dramatic stories, telling fibs that are easily disputed, changing stories when challenged and, most importantly, lying even when there’s no apparent benefit in telling the lie. Compulsive liars lie for many reasons, including no reason at all, but most often they lie to:

• Feel admired
• Gain popularity
• Control and manipulate
• Compensate for feelings of inadequacy and low self-esteem
• Cover up failures

Although not officially designated as a mental disorder, pathological lying is often seen as the tip of the iceberg for deeper psychological problems including narcissistic personality disorder, antisocial personality disorder, and obsessive-compulsive disorder. Narcissists, for example, constantly fear being revealed as frauds and, thus, weave ever-increasing lies to bolster their fragile self-esteem. People with antisocial personality disorder do not experience guilt and, therefore, lying becomes an easy option.

One psychologist came up with the term “double consciousness” to describe the ability of a habitual liar to carry two stories in his head at any time: the real story and the desired one. Some simply get addicted to the instant gratification associated with telling the desired, ego-boosting lie.

Other research indicates that many pathological liars have a neurological imbalance: Their verbal skills are high, but there’s a slight impairment in the frontal lobes, the part of the brain that censors speech. It has also been reported that children with such brain disorders as autism have a hard time lying successfully, further making a case for a physical connection.

Often, pathological lying masks problems related to childhood, including trauma, neglect, lack of attention, lack of guidance, or failure by parents to set realistic limits. Some researchers suggest that pathological liars often have parents who are pathological liars and that lying was part of the family dynamics.  

Help for problem liars

Understanding why a person lies all the time is key to solving the problem. In that way, pathological lying is similar to such other addictions as overeating, drinking, gambling, or shoplifting. What is the person trying to compensate for with his problem behavior, what needs is he trying to fill? To get to the root of pathological lying and to develop an appropriate plan of action, therapy is commonly recommended.

The first step, however, is for the person to admit she has a problem. If you would like to help a pathological liar, you should consult a mental health expert for guidance. An intervention in a proper setting with caring individuals may be in order.

Self-help steps for pathological liars include:

• Making a conscious decision not to lie
• Keeping a written record of all lies, even small ones
• Understanding the “why” behind each lie; for example, is the lie for self-promotion or pain/conflict avoidance?
• Seeking therapy

By Amy Fries

©2005-2019 Carelon Behavioral Health

Source: “A Highly Inflated Version of Reality: Researchers Challenge Notions About What Drives the Chronic Liar” by Benedict Carey, Los Angeles Times, March 3, 2003; “Knowing Why People Lie Is Positive Step by Doris Wild Helmering, St. Louis Post-Dispatch, Oct. 26, 1998; “Truth About Lies: They Tell a Lot About a Liar” by Richard A. Friedman, MD, New York Times, Aug. 5, 2003; “When Lives Are Spun from Skein of Lies” by Alison Bass, Boston Globe, June 6, 1988