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April 20, 2013

Essay Paper on Obsessive Compulsive Personality

Obsessive Compulsive Personality, also referred to as anal character type in classical analytical literature (Abraham, 1921), has been under prominent discussion in the long history of clinical psychology and psychiatry and still continues to be a subject of debate in terms of description, psychodynamics, etiology and treatment ( Fischer& Juni, 1981).
Obsessive Compulsive Personality, according to T. Millon, is characterized by varying degree of ego-syntonic personality traits that are relatively fixed and long-lasting (Millon, 1981). The term ego-syntonic used here is a psychological term referring to behaviors, values, feelings that are in accord with or adequate to the needs and goals of the ego, or consistent with one's ideal self-image. While P.G. Emelkamp defines Obsessive Compulsive Personality having the characteristics of orderliness, severe superego, perseverance, rigidity, parsimony, emotional constriction, and obstinacy (Emelkamp, 1982)
Unlike obsessive compulsive disorder, Obsessive Compulsive Personality disorder is not rare particularly in its milder and more adaptive form. As this order is more psychiatric and not many people perceive it as a personality disorder, its general population is unknown. In fact, it can be argued that in Western culture obsessive-compulsive personality is one of the, if not the principal, social character structures, representing the general world view of the Protestant Work Ethic and capitalist social and economic organization (Honigmann,1967). But according to a rough estimate Obsessive-compulsive personality disorder occurs in about 1% of the population, although psychiatric have reported 3%–10% rates among their outpatients. The diagnosis usually takes place in late adolescence or young adulthood. In the United States, men are seen to have OCPD almost twice as often in as women. Some researchers point out this discrepancy as gender stereotyping, in that generally Western men enjoy greater consent to act in obstinate, withholding, and controlling ways.
            Obsessive-compulsive personality disorder is analyzed as a conflict between cleanliness and dirtiness, aggressiveness and submissiveness, good and bad and orderly and disorderly. Individuals with a predominantly obsessive compulsive personality are considered asymptomatic, that is, what defines the individual consists of particular collection of traits, defenses, and life-style and not the presence of psychiatric symptoms.
            It could be said as well that many of the traits characteristic of obsessional personalities, for example, perseverance, industriousness, thriftiness, ambition, self-control, and so on, are highly regarded and rewarded within capitalistic, technological societies, serve to promote in their possessors feelings of self-worth and acceptability, and generally provide them with a foundation for emotional stability and relative resistance to stress (Paykel & Prusoff, 1973).
The obsessive-compulsive personality or anal character, as it is sometimes termed, came under close scrutiny by Freud and his colleagues (Abraham, 1921/1953; Freud, 1908/1963; Jones, 1918/1961). Carr (1974) credited Esquirol, who worked in the early part of the 19th century, with the first publication relating to compulsions and similar phenomena. According to the early Freudians, the anal character, as they referred to it, arises out of conflicts between parents and child over bowel training in the 2nd to 3rd year of life. The introduction of bowel training was thought to bring with it an inevitable conflict between the child's desire to freely manipulate elimination (expulsiveness) and retention (retentiveness) and the need of the child's primary caretakers to regulate their child's anal activities and expressions in line with prevailing cultural and societal standards of cleanliness and impulse control. According to classical analytic theory, this may very well establish the groundwork for anal fixations and hence the development of a predominantly anal or obsessive-compulsive character structure in the child.
For Freud and for all later analytic and no analytic clinicians, obsessional personality or anal character is to be carefully distinguished from the psychiatric syndrome of what has been called obsessive-compulsive or obsessional neurosis. In an obsessional neurosis the individual suffers from persistent intrusion of undesired thoughts (obsessions) or urges and actions (compulsions) that he or she finds extremely difficult, if not impossible, to control and ultimately stop. Following Salzman (1968), the obsession may be viewed as a persistent ritualized thought pattern, whereas the compulsion is a persistent ritualized behavior pattern. Either or both may be salient in the clinical picture, and anxiety and distress usually are concomitants of the disorder.
            Freud (1908/1963) delineated one particular constellation of traits, namely, obstinacy,
parsimony, and orderliness, that constitute the core of what he termed the anal retentive or
anal character type and that arise from sublimations of and reaction formations against infantile anal erotic impulses that press for expression. In Freud, orderliness refers to both exceptional bodily cleanliness and a high degree of reliability and conscientiousness in the performance of all actions, however inconsequential. Parsimony involves frugality and, in the extreme, stinginess and avarice, whereas obstinacy involves strong tendencies to be negativistic, defiant, and even hostile in relation to authority figures. According to Freud, orderliness develops from the internalization of parental demands for bowel control, whereas parsimony develops from the continuation of the infantile tendency to retain feces, both because of the erotic pleasure that accompanies retention and because of the fear of losing the overvalued product. Freud viewed obstinacy as developing from resistance to parental demands. In the traditional psychoanalytic model, considerable aggression, that is, anal sadistic impulses and attitudes, is generated in the child as a result of his or her struggle to insure autonomy. When this struggle leads to fixations or developmental arrests at the anal stage, the infantile unresolved aggression is expressed in later life in any number of ways, for example, in passive- aggressive withholding behavior (or other indirect means of defying the wishes or dictates of others) or in the adoption of extremely conventional, over socialized or reactionary attitudes via reaction formation and identification with the aggressor. The adoption of reactionary attitudes is oftentimes linked with an aggressive, hypercritical, and controlling attitude toward others. Regardless of the exact form taken by infantile aggression in specific individuals, ambivalent attitudes toward the expression of hostile feelings and impulses particularly, but also toward all manifestations of the affect and impulse life, are thought to be paramount in the personality makeup of the adult obsessive.
A number of investigators have sought to substantiate relationships between toilet training practices and the development of anal character traits as originally proposed by Freud (e.g., Beloff, 1957; Bernstein, 195S). The majority of these studies have focused largely on the age toilet training was initiated, the age it was brought to completion, and the degree to which it may have been inordinately lax or severe. The designs typically involved the collection of retrospective accounts, usually by mothers, of the toilet training period in an attempt to relate these parental recollections of when and how training proceeded to the degree of the offspring's anal orientation, as measured by teacher and parent ratings, response to anality questionnaires, and performance on various behavioral tests (S. Fisher & Greenberg, 1977).
A review of these studies offers, at best, meager support for the hypothesized relationship between toilet training practices and the development of anal or obsessive-compulsive character structure. Orlansky (1949) concluded that knowledge of sphincter training was insufficient to substantiate or disprove the Freudian position. Speculating that strict toilet training is simply one expression of a more general pattern of parental rigidity, Finney found, as predicted, that clinicians' ratings of general rigidity in a sample of mothers bore a significant positive relationship to the degree of the child's anal orientation.
The results of these studies, which are indicative of comparable degrees of anal orientation in children and their parents, suggest a number of possibilities regarding etiology. It may be that obsessive-compulsive personality or anal character structure emerges from repeated contact, association, and clashes throughout childhood between the child and figures such as parents, teachers, and relatives directly involved in caretaking responsibilities, who are themselves fairly rigid, controlling, and generally obsessional in their style of relating to the children in their charge. As Carr (1974) has pointed out, even if a relationship between rigid toilet training practices and obsessional traits could be shown, this association could easily be interpreted as a function of childhood training in general rather than of specific repressive toilet training.
It may be, then, that toilet training practices are not causal in any strict sense, but are a correlate of a larger and more influential child-rearing pattern. In this view, obsessive-compulsive style is seen as largely socially learned behavior that results from the imitation and modeling of significant others over a number of years throughout the childhood period.
In the development of obsessive-compulsive personality, the possible role played by constitutional influences still remains in the realm of speculation because, to date, there has been little empirical research in this area. A study by Hays (1972), however, of the family pedigrees of 17 psychiatric patients, mostly female, that carried a diagnosis of psychotic depression and had premorbid obsessive-compulsive personalities did find evidence to support an interaction effect of genetic predisposition, sex of the child, and child-rearing style in the genesis of obsessive-compulsive personality.
Some theorists and clinicians stress the need for obsessive-compulsive personality style as a character defense or armor for the ego against the ambiguities, uncertainties, and anxieties inherent in human existence (e.g., Becker, 1974; M; Salzman, 1968; Strauss, 1966). There is yet, however, no statistical evidence to support the theorizing of these clinicians, who work largely within an existential-phenomenological framework that rarely generates statistical data.
Despite some ambiguities and inconsistencies in the voluminous clinical literature, there appears to be considerable consistency in the personality descriptions that emerge. This is true even when one compares psychoanalytic descriptions of the anal character with descriptions of the obsessive-compulsive character of obsessive personality that emerge from less heavily psychoanalytically influenced theoreticians and practitioners. The latter accept the analytic description of the character, but do not necessarily agree with its etiologic assumptions concerning psychogenesis in the anal stage of psychosexual development.
            Ingram (196la), for instance, compared descriptions of the obsessive personality found in leading psychiatric texts with descriptions of the anal character given in the classical psychoanalytic papers of Freud, Abraham, and Jones and found highly similar descriptions with numerous features in common, for example, the characteristics of orderliness, persistence, and rigidity. For descriptive purposes Ingram felt there was no point in distinguishing between the two terms. The terms obsessional, obsessive, or obsessive-compulsive personality appear to be the preferred terms insofar as no etiologic assumptions are implied by them.
The Diagnostic and Statistical Manual of Mental Disorders, the mental health professional's handbook, fourth edition, text revision (2000), also called DSM-IV-TR, classifies obsessive-compulsive personality disorder in Cluster C, together with the avoidant and dependent personality disorders. The disorders in this group are considered to have fretfulness and fear as common traits. Similarly the European counterpart of DSM-IV-TR , the ICD-10, refers OCPD as "anankastic personality disorder."

            Over the past two decades, several questionnaires and scales have been devised that purport to measure obsessional traits and characteristics (Allen & Tune, 197S; Beloff, 1957). Kline (1969) argued that there has really not been an abundance of empirical research on obsessional personality, primarily because there is no fully accepted measure of obsessional traits or obsessional symptoms. Most, if not all, of the existing scales are not standardized, nor is there sufficient evidence for their reliability and validity to justify a rational choice of one over the other. According to Kline the major personality inventories, like the Sixteen Personality Factor Questionnaire (Cattell & Eber, 1957), the Eysenck Personality Inventory, the Maudsley Personality Inventory, and the Minnesota Multiphasic Personality Inventory (MMPI), do not contain a measure of obsessional traits and characteristics. The Psychasthenia scale of the MMPI, designated as Scale 7, is sometimes referred to as a measure of obsessive-compulsiveness; however, there is good reason to suspect that the Psychasthenia scale is more a general measure of classically neurotic concerns, preoccupations, and characteristics, namely, anxiety, withdrawal, immobilization, agitation, and so on, rather than a specific measure of obsessive compulsive behavioral tendencies (Dahlstrom, Welsh, & Dahlstrom, 1972). One of the more promising measures to date is the Lazare-Klerman Trait Scales (Lazare et al, 1966, 1970), a factor analytically derived instrument that purports to measure obsessional, hysterical, and or a dependent personality. This self-report inventory contains 140 true-false items that are scored into 20 trait scores, each based on seven items. These 20 traits are reported in four separate factor analytic studies to combine to three orthogonal factors that closely mirror obsessive, hysterical, and oral character traits, as described in the clinical literature (Lazare et al., 1966, 1970; Paykel & 230 JERROLD M.POLLAK Prusoff, 1973).
Several studies have addressed the issue of whether obsessional symptoms can be reliably differentiated from obsessional personality traits and characteristics. As discussed earlier, the distinction between personality and symptoms was emphasized by Freud and his contemporaries, as well as by virtually all later clinicians.
The results of two studies (Ingram, 1961b; C M. Rosenberg, 1967) suggest that there is some relationship between obsessional neurosis and obsessional personality. However, clinical observation suggests that at least some obsessional neurotics never could be said to have had a
premorbid obsessional character makeup (Rack, 1977).
In addition, as Paykel and Prusoff (1973) pointed out, obsessional patients with a corresponding premorbid obsessional makeup represent a small and not necessarily typical segment of individuals with obsessive-compulsive personalities. Clearly there is no necessary one-to-one relationship between obsessional personality and obsessional neurosis, despite the occasional finding that more obsessive-compulsive neurotics, than would be expected by chance, show evidence of a premorbid obsessional personality.
A number of studies have attempted to discover whether obsessive-compulsive personalities respond in experimental situations in ways congruent with predictions made from theory and clinical observation. B. G. Rosenberg (1953) compared the performance of psychotherapy patients with pronounced obsessive-compulsive tendencies with a normal control group on a visual memory ask that involved choosing from a multiple- choice format the ambiguous design previously seen in tachistoscopic presentation. The alternative choices varied in terms of degree of symmetry, and as expected, he found that obsessive-compulsive subjects tended to favor the more symmetrical choices. This was interpreted as reflecting a particular need to impose order, uniformity, and congruity on visual perception. It is an interesting finding that has never been directly cross-validated.
More research on the relationship of obsessive-compulsive personality to measures of aesthetic sensitivity and indices of creative thinking in verbal and nonverbal mediums is also recommended. The particular kinds of meanings ascribed by obsessive-compulsive personalities to critical life situations and tasks, for example, vocational choice, marriage, death and dying, and so on, would also be an interesting area to explore. Is there, for example, a difference in the way obsessional personalities conceptualize or personify death and dying, as opposed to the perceptions of individuals considerably less obsessional in their orientation to life or of individuals with fundamentally different personality styles, for instance, those designated as oral, hysterical, impulsive, and so forth? If differences are found, are they, in fact, consistent with clinical observation and predictions from theory? A study of meaning would begin to focus more on how obsessional personalities experience the world and might produce empirical data that would help to better evaluate the existential, phenomenological points of view on obsessional personality style (Becker, 1974).


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