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 Elsa
Elsa
is a graduate teaching assistant who presented at the university counseling
center at the suggestion of her supervising professor. She is to teach two
classes, Introduction to Sociology and Research Methodology, and was given free
rein to choose the textbooks, develop the lecture content, and create homework
assignments and exam materials. When asked why she was given such latitude, her
professor remarked, “I’ve worked with her, I know she likes things her own
way.”
According
to Elsa, she knows the material in great detail, (6) having studied the entire
summer rather than allow herself time off to spend with friends. Yet, there has
been a swell of protest from students in both classes. (3)
Elsa
became a fixture at the bookstore for several weeks before the beginning of the
semester. She was obsessed with choosing just the right text, but paralyzed by
the many alternatives.
(1) Although the students feel that her lectures
are well-organized and informative, they also feel that she imposes her own
academic values onto them, and expects too much work, including weekly reports,
a comprehensive final, and a term paper, and expects everything to be proofread
and flawless. (4) Worse, they note that she is extremely critical
of everything they turn in, and seems so focused on sentence structure and
writing style that she overlooks content and meaning. (1) Due to her meticulous analysis, papers are
often not returned for many weeks. (2)
Elsa
presents as a mature young lady. With her conservative hairstyle, gray suit,
and serious manner, she seems much older than she really is. For her, therapy is just another responsibility, to be carried
out earnestly. She admits wanting to please her supervising professor, but in
the same breath reproaches her students, who “want a college degree without
doing college work.” As a teaching assistant, she has made it her duty to weed
out those who see school as a four-year vacation from responsibility. She does
not address, or emotionally acknowledge, the rather awkward reasons that brought
her to the counseling center. (3)
Elsa
is the first person in her family to attend college. She describes her father
as a proud but angry man, ruling the house by fear. Her mother insisted she do well in school and rise above their “immigrant
heritage.” Elsa attended church regularly, kept house for the family, and did
well enough to win a college scholarship, which paid most of her tuition. She
is ashamed of her sister, who left home at 15 and contacts the family only in
dire circumstances. Elsa still lives at home, which “allows me to save rent money.”
She has no social life beyond church, but states that she neither needs nor has
the time for one. Her days are well organized, with intense devotion to her
work. She becomes angry thinking about others who fail to use their time
wisely, namely, the students in her two classes.
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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