Compulsive Personality Disorder, Case vignette (2)

A CASE OF Compulsive Personality Disorder

By: THEODORE MILLON et al.

Notes:

(1) Numbers mark aspects of the case most consistent with DSM criteria as follow, and do not necessarily indicate that the case “meets” diagnostic criteria in this respect.

(2) Patient's name has been changed in respect to confidentiality, and name mentioned is not of a real existent person.

Case of Holden

Holden reported self-doubt, guilt, and prolonged periods of diffuse anxiety. Though not overwhelming, these feelings had become more difficult to control. He now had trouble sleeping at night and experienced growing indecisiveness at work.

The immediate problem was a coming change of academic position. A new administration asked that he resign his deanship and return to teaching history. In the initial sessions, he focused on the details of the transition. He was particularly concerned about facing students in the classroom again, worried about organizing his materials, and doubted his ability to interest and discipline students. (1)   Though he had been a competent teacher before, he kept reviewing old lecture notes again and again, but with little comfort. (2)  

No mention was made about any anger regarding his demotion, or the fact that Holden had poured his life into the position, working long hours and coordinating personally with the various department heads on matters that other deans would have assigned to their secretaries. (3)   Instead, he voiced his “complete confidence in the rationality of the process” that had led to the choice of another dean. (6)   Nevertheless, he stuttered and trembled whenever he engaged members of the administration. (4)  

The second of two sons, Holden was younger than his older brother by three years. Both parents held high-level positions, and both were regarded as efficient, strict, and orderly. Life at home was always “well-planned,” with charts and schedules posted in common rooms detailing cleaning responsibilities, appointments, and even yearly physicals. Nothing was left to chance. Holden and his brother knew what they could count on in life and what was expected in return. If they failed to meet expectations, it would be treated almost as misbehavior: punishment would be swift and severe. Neither parent would tolerate expressions of anger in the family. Holden felt his brother “got away with” everything, but could only vent his feelings by tattling, which he derived great pleasure from. Not until after many sessions did Holden recognize that this was not a matter of “sticking to the rules,” but a means of dealing with his jealously of his older brother.

At 27, Holden completed his Ph.D., married a “stable girl from a good home,” and began teaching at a small college. His “fine work” in advising freshmen led to his becoming dean of freshmen, and eventually dean of students. Although he conscientiously “kept the rules,” he was accused of being a stuffed shirt lacking real human compassion. Moreover, the department heads were often angered by his refusal to bend the rules. (1)   Anyone without an earnest attitude could become an object of his wrath, (4)   to be reined in with burdensome forms and guidelines. (1)   Because of his lack of warmth and occasional harsh decisions with students, he was asked to step down.

 DSM-IV Criteria

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
(1) is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
(2) shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
(3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
(4) is over-conscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
(5) is unable to discard worn-out or worthless objects even when they have no sentimental value
(6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
(7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
(8) shows rigidity and stubbornness

References

(1) Personality Disorders in Modern Life, second edition, 2000, 2004 by John Wiley & Sons, Inc.

(2)Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

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