Up until recently, I never paid much attention to Obsessive Compulsive Personality Disorder (OCPD). I think I mentioned in an earlier post that I have been reading Too Perfect: When Being in Control Gets Out of Control by A. Mallinger and J. DeWyze, and it has been a real eye-opener for me. Many people with OCPD have trouble with hoarding, and a couple of the criteria are reluctance to throw out things and miserly spending style.
I guess that when I first learned about it, I lumped it in with Obsessive Compulsive Disorder (OCD), but it actually is very different. However, some people with OCPD have OCD, and they sometimes run in the same families.
In case you are not familiar with it, OCPD is basically extreme perfectionism and rigidity. People who have it tend to have unrealistically high standards for themselves and others. This can interfere with the ability to get tasks done. It can also severely impair relationships as often people with OCPD cannot tolerate having things done any way other than their own. They can be obsessively bound by rules, order, schedules, etc. They become overwhelmed by anxiety if they feel they do not have control over every little thing around them, and as this anxiety increases, they go to more extreme measures to regain control.
Now that I know about it, I can recall several past situations where it would have been helpful to know I was dealing with someone with OCPD. The trouble is, OCPD is vastly underdiagnosed. I do not think I have ever worked with someone officially diagnosed with it. It is similar to Korsakoff's dementia in that the person who has it does not feel he or she has a problem. People around them may tell them they have a problem, but they are unable to see it, and therefore feel the problem must be with the people around them. If they do end up seeking treatment, it is often due to anxiety or depression associated with their OCPD.
People with OCPD can vary dramatically in their housekeeping:
Some people are obsessively clean or tidy. I have a friend whose husband cannot tolerate having anything left out. If she leaves a book on the coffee table, it gets thrown out. Yet he has a huge collection of his own that took up most of their apartment before they moved to a bigger place. It is helpful to understand that there may be a reason why he is so controlling.
I once received a referral for a woman where the issue listed was, "Husband feels she needs to work on her housekeeping." When I arrived at the apartment, it was spotless. I found out the woman did all the housekeeping and laundry, and her husband spent most of his time complaining about how she did it.
His complaints seemed completely unreasonable too. He stated that his pants were wearing out, and it must be because of how she was doing the laundry. When I asked a little further, I found out he only had two pairs of pants that he wore all the time. I suggested that the pants were wearing out because he wore them so frequently, but he could not see it.
I stifled my impulse to tell him to stuff it and do the laundry himself, and instead worked on empowering his wife by encouraging her to participate in activities outside of the home. However, I think it would have been helpful if I had understood that he had a personality disorder. It definitely would have explained that feeling in my gut when I saw him - the same feeling I get when dealing with people with other personality disorders.
Perhaps it would have helped me have more empathy for him to understand that he was not intentionally being so rude, but that he was desperately looking for control over his environment, and he needed that control in order to feel safe.
Some people with OCPD can be obsessive about labeling and organizing. Their house may be stuffed, but it will all be on shelves, in alphabetical order, with labels or charts. Making lists is a favourite occupation. I walked into one woman's house that had shelving from floor to ceiling on every wall, including down the hallway, making her bedroom inaccessible. The shelving was all full of labelled items. They often fear that they will forget what they have, so they want it all to be in view.
Her house was a hazard because they shelving was unstable, and exiting would have been difficult if there were a fire. Yet there was no convincing her to part with any of her possessions.
Many people with OCPD have a really hard time parting with things. They hear that voice that says, "What if I need it someday?" much louder than most other people. To them, if they were to part with the object and then find out they need it, that would be a massive failure. They also can have a high level of anxiety feeling that they must save enough money (and objects) for any imaginable future event. Trust me, they can imagine many more terrible future events than most people.
I worked with one woman for a long time, who lived in a small apartment. Nobody could convince her that she would not ever need six buckets.
Many people with OCPD feel they must part with items the right way. With the same woman, it was not good enough to just give her possessions to charity, she insisted on giving each item to the charity that could use it the most. This complicated the process of sorting because she could not just have the regular piles - keep, throw away, and give away. She had keep, throw away, and then about 10 other categories of give away. It also meant that giving it away meant 10 trips instead of 1.
The other thing, is that if there is a chance they could someday fix and item, they cannot part with it. They have a hard time acknowledging their limitations, and that they realistically will not get around to fixing it.
People with OCPD often have trouble completing tasks due to their perfectionism. Because it was so complicated, the woman had a lot of trouble actually getting to the give-away part.
She wanted to sort her cupboards, but it was not enough just to go through what was there and organize it. Instead, she insisted that she needed to make a written inventory of everything she had. In the time I was working with her, she never did get around to sorting her cupboards.
People with OCPD can have a hard time accepting help. Other people cannot do things to their standards, so they are reluctant to delegate any tasks. Having other people touch their things, and move things around can be extremely stressful because the other person will not organize things the right way. For someone with OCPD, there is only one right way.
When I think back to my clients who hoarded, many of them likely would have fit the criteria for OCPD, yet I am surprised that with all of the reading on hoarding that I did, I did not come across OCPD before now. The two seem to be so closely tied together, that it seems we could really benefit from integrating the information on dealing with hoarding with the information on dealing with OCPD. I still have a lot of thinking to do on what this means for intervention strategies.
One thing I was wondering, is what percentage of people who hoard also have OCPD? Have there been any studies done on this? Based on my experiences, it likely would be pretty high, but I am wondering what other people have observed.
Here's the link for the book I referred to: