Personality Disorder: Obsessive Compulsive Disorder Diagnosis

JP is a 42-year-old man with no past medical history. He is a pleasant gentleman who is approachable and friendly. His holds a degree in accounting, and currently works as an accountant. His coworkers describe his work ethnic as superb. JP is always available to help others but he does not delegate tasks just so that they can be easily completed by another employee. He has been working in the accounting industry for 10 years, and he has no plans to change careers. JP is always available to offer assistance to his co-workers wherever they need help. JP is an overly devoted employee who spends most of his spare time doing tasks that are related to his job. At times, JP finds it difficult to complete tasks at work due to his preoccupation with organization, orderliness and handwashing.

JP is married with a with a 7-year-old son and a 5-year-old daughter. He lives in a three-bedroom apartment with his family. He describes his marriage as exciting. He stated that he is satisfied with his accomplishments in life. JP does not use any illicit drugs or substances. He occasionally drinks two cans of beer to help him to relax. However, he has not drank beer in the last 8 months. He identifies himself as a Christian and goes to church every Sunday.

JP has reported preoccupation with excessive handwashing, orderliness and organization to a point of interfering with some of his daily activities. He frequently has obsessive thoughts about things in his surroundings being dirty and disorganized. As a result of these obsessive thoughts, he developed compulsions in the form of frequent hand washing and organization. His compulsive thoughts also include checking the door knobs, faucets and the dining table to make sure everywhere is clean. The thought of his surroundings being dirty causes him a great deal of fear, anxiety and panic. He developed these obsessive-compulsive symptoms in his late 20s, but he has never been hospitalized. He is currently not on any medications. He rates his OCD at 6/10 in severity. No additional medical history or family medical history is known.

Criteria on which Diagnosis is Based

JP has Obsessive-Compulsive Personality Disorder or OCD. The DSM-5 (2013) lists preoccupation with details, perfectionism that interferes with task completion, excessive devotion to work, overconscientiousness, scrupulousness, inflexible religious belief, and a reluctance to delegate task as symptoms of OCD (APA, 2013, pp. 678-679). JP’s symptoms as described above fit that diagnosis. JP and others like him with OCD attempt to maintain a sense of control through their obsessive behaviors such as handwashing, orderliness, and strict attention to details. Often their co-workers and those around them become annoyed at the delays the obsessive behavior causes, but the person with OCD is oblivious to that (APA, 2013, p. 679). JP realizes his behavior is unusual, and he is seeking treatment so that he can learn to control it.

Treatment

The treatement for JP should consist of psychotherapy and possibly pharmacotherapy. Since he sought treatment on his own, which is common with people who have OCD, according to Sadock, Sadock and Ruiz (2014), author’s of Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences Clinical Psychiatry, he should be open to the treatment which can be very difficult for people with OCD to endure (Sadock, Sadock, & Ruiz, 2014, p. 756). These authors say, “Overtrained and oversocialized, these patients value free association and no-directive therapy highly. . . . Group therapy and behavior therapy occasionally offer certain advantages” (Sadock, Sadock, & Ruiz, 2014, p. 756). The International OCD Foundation agrees that psychotherapy can be an effective treatment for OCD. They say that cognitive behavior therapy (CBT) has been shown to be the most effective and is often paired with pharmacotherapy.

The most effective type of CBT is exposure and response prevention (ERP). That along with medications from the serotonin reuptake inhibitors class or SRIs is the most effective according to the International OCD Foundation (Internatinal OCD Foundation, 2019). Sadock, Sadock and Ruiz (2014) suggest clonazepam, clominpramine or serotonergic agents such as fluoxetine or nefazodone (Sadock, Sadock, & Ruiz, 2014, p. 757). However, pharmatherapy may not be necessary if CBT is effective.

ERP involves the patient exposing him or herself to the thoughts, images, objects and situations that make them anxious or that start their obsessions. The response prevention aspect of the treatment refers to making the choice not to engage in the compulsive behaviors once the anxiety has been triggered. A therapist guides the patient through this to start with (Internatinal OCD Foundation, 2019). The hope is that the patient