For this week's Forum, respond to the following: What are the key features that distinguish between Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive Disorder? Among the Cluster B Personality Disorders, how does a clinician differentially diagnose among Borderline, Histrionic, and Narcissistic Personality Disorders; in other words, what are the key distinguishing features among them?
Even with the resemblance in names, the link among OCD and OCPD is not as clear-cut as one would imagine. OCPD is defined as the obsession with perfection, orderliness, and control.
People with OCPD are sticklers to the max. Someone with OCPD, perfectionism really interferes with completing important tasks. Things have to be just so, and just right. Therefore, instead of delegating tasks to other people, someone with OCPD will often end up doing everything themselves, because they feel that others just won't do things correctly. Perfectionism alone, however, is not enough to indicate that someone has OCPD. People with OCPD tend to be very thorough and detail oriented, so much so that they sometimes don't see the forest for the trees and get lost in those details. Another characteristic of OCPD is difficulty in throwing out worthless or useless things, and a miserly spending style. Someone with OCPD tends to be preoccupied with rules, regulations, order and schedules, and so they get caught up in details, and can get quite stuck on questions of morals and ethics. Hence, they are very rigid and inflexible. They are often scrupulous and overly conscientious, feeling way too responsible for anything that may go wrong. Not surprisingly, they can be so devoted to their job and spend so much time at work, that they neglect their friendships and relationships.
As obsessive-compulsive disorder the obsessions are repetitive and distressing thoughts, urges, or imagery that are experienced as uncontrollable and compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to obsessions. These obsessions and compulsions are at times consuming. They create significant distress and/or interfere with a person's functioning. Ordinarily, obsessional thoughts, images, or impulses are not about typical, everyday things. Compulsions serve to avoid or reduce distress. In some cases, a person may believe they must perform compulsive acts in order to prevent something terrible from happening. For example, a person may touch things only after they have all been bleached. They believe they must perform this act in order to prevent disease.
Although OCD and OCPD share some related features, they are two different disorders. As such, it is possible for a person to have both disorders. The primary distinction between these two disorders is the presence of obsessions and compulsions, as with OCD; or the absence of them, as with OCPD.
Cluster B is called the dramatic, emotional, and erratic cluster. Disorders in this cluster share problems with impulse control and emotional regulation. It includes: Borderline Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder and Antisocial Personality Disorder.
Persons with Histrionic Personality Disorder are characterized by a pattern of excessive emotionality and attention seeking. Their lives are full of drama. They are uncomfortable in situations where they are not the center of attention. People with Histrionic Personality Disorder can appear flighty and fickle. Their behavioral style often gets in the way of truly intimate relationships, but it is also the case that they are uncomfortable being alone. They tend to feel depressed when they are not the center of attention. When they are in relationships, they often imagine relationships to be more intimate in nature than they actually are. People with Histrionic Personality Disorder tend to be suggestible; that is, they are easily influenced by other people's suggestions and opinions. A literary character that exemplifies the Histrionic Personality Disorder is the character of Blanche DuBois in Tennessee William's classic play, "Streetcar Named Desire."
People with Narcissistic Personality Disorder have significant problems with their sense of self-worth stemming from a powerful sense of entitlement. This leads them to believe they deserve special treatment, and to assume they have special powers, are uniquely talented, or that they are especially brilliant or attractive. Their sense of entitlement can lead them to act in ways that fundamentally disregard and disrespect the worth of those around them. Status is very important to people with Narcissistic Personality Disorder. Associating with famous and special people provides them a sense of importance. These individuals can quickly shift from over-idealizing others to devaluing them. However, the same is true of their self-judgments. They tend to vacillate between feeling like they have unlimited abilities, and then feeling deflated, worthless, and devastated when they encounter their normal, average human limitations. Despite their bravado, people with Narcissistic Personality Disorder require a lot of admiration from other people in order to bolster their own fragile self-esteem. They can be quite manipulative in extracting the necessary attention from those people around them. People with Borderline Personality Disorder tend to experience intense and unstable emotions and moods that can shift fairly quickly. They generally have a hard time calming down once they have become upset. As a result, they frequently have angry outbursts and engage in impulsive behaviors such as substance abuse, risky sexual liaisons, self-injury, overspending, or binge eating. These behaviors often function to sooth them in the short-term, but harm them in the longer term.
People with Borderline Personality Disorder tend to view the world in terms of black-and-white, or all-or-nothing thinking. Their tendency to see the world in black-or-white terms makes it easy for them to misinterpret the actions and motivations of others.
My question for this forum post is; "why is it called borderline personality disorder?"