Internet Mental Health

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER






Internet Mental Health Quality of Life Scale (Client Version)

Internet Mental Health Quality of Life Scale (Therapist Version)

Big 5 Factors Of Mental Illness And Code For This Disorder
(The "6th Big Factor" of Mental Health, "Physical Health", Is Coded Normal or Green)

  • Individuals with Obsessive-Compulsive Personality Disorder are intellectualized and overly "rational" in their approach to life, are emotionally constricted and rigid, and are critical of themselves and others and conflicted about anger, aggression, and authority.

  • Since adolescence or early adulthood, had rigid perfectionism, inflexibility, excessive devotion to work, and was overcontrolling.

  • Is not due to a medical or substance use disorder.

Prediction

    Can last for years or be lifelong

Problems

Occupational-Economic Problems:

  • Excessive devotion to work; stubborn; reluctant to delegate work

Conscientious (Excessive Conscientiousness):

    Excessive Conscientiousness:

  • So preoccupied with details that loses sight of the goal

  • Shows perfectionism that interferes with task completion

  • Is excessively devoted to work to the exclusion of leisure activities and friendships

  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values

  • Is unable to discard worn-out or worthless objects even when they had no sentimental value

  • Is reluctant to delegate tasks or to work with others unless they submit to exactly her way of doing things

  • Has a miserly spending style (hoarding money for future catastrophes)

  • Shows rigidity and stubbornness

  • Perseveration (repeating the same thoughts or behaviors despite clear reasons for stopping)

  • Intimacy avoidance, restricted emotional expression


SAPAS Personality Screening Test

Individuals with this disorder would answer "Yes" to the red questions:

      In general, do you have difficulty making and keeping friends?
      Would you normally describe yourself as a loner?
      In general, do you trust other people?
      Do you normally lose your temper easily?
      Are you normally an impulsive sort of person?
      Are you normally a worrier?
      In general, do you depend on others a lot?
      In general, are you a perfectionist?

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Click Here For Free Diagnosis

Limitations of Self-Diagnosis

Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder requires assessment by a qualified practitioner trained in psychiatric diagnosis and evidence-based treatment.

However, if no such professional is available, our free computerized diagnosis is usually accurate when completed by an informant who knows the patient well. Computerized diagnosis is less accurate when done by patients (because they often lack insight).

Example Of Our Computer Generated Diagnostic Assessment

Obsessive-Compulsive Personality Disorder 301.4

This diagnosis is based on the following findings:

  • So preoccupied with details that loses sight of the goal (still present)

  • Shows perfectionism that interferes with task completion (still present)

  • Is excessively devoted to work to the exclusion of leisure activities and friendships (still present)

  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (still present)

  • Is unable to discard worn-out or worthless objects even when they had no sentimental value (still present)

  • Is reluctant to delegate tasks or to work with others unless they submit to exactly her way of doing things (still present)

  • Has a miserly spending style (hoarding money for future catastrophes) (still present)

  • Shows rigidity and stubbornness (still present)

Treatment Goals:

  • Goal: stay focused on goals, and don't get lost in detail.
    If this problem persists: She will continue to be preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity will be lost. She will pay extraordinary attention to detail and repeatedly check for possible mistakes. She will be oblivious to the fact that other people tend to become very annoyed at the delays and inconveniences that result from this behavior. She will poorly allocate her time, leaving her important tasks to the last moment.

  • Goal: finish tasks without excessive, time-wasting perfectionism.
    If this problem persists: She will continue to become so involved in making every detail of a project absolutely perfect that the project may never be finished. Deadlines will be missed, and aspects of her life that are not the current focus of activity may fall into disarray.

  • Goal: spend more time in social and recreational pursuits.
    If this problem persists: She will continue to be excessively devoted to work and productivity to the exclusion of leisure activities and friendships. There may be a great concentration on household chores (e.g., repeated excessive cleaning). Hobbies or recreational activities will be approached as serious tasks requiring careful organization and hard work to master. Her emphasis will be on perfect performance.

  • Goal: be more tolerant and flexible about matters of morality, ethics or values.
    If this problem persists: She will continue to be overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values. She will be rigidly deferential to authority and rules and may insist on quite literal compliance, with no rule bending for extenuating circumstances.

  • Goal: discard worthless possessions, and not be a "pack-rat".
    If this problem persists: She will continue to be unable to discard worn-out or worthless objects even when they had no sentimental value. Eventually others may complain about the amount of space taken up by her hoarding of her possessions.

  • Goal: delegate work more, and avoid overly controlling others.
    If this problem persists: She will continue to be reluctant to delegate tasks or to work with others. She will stubbornly and unreasonably insist that everything be done her way and that others conform to her way of doing things. She will give very detailed instructions about how things should be done (e.g., how to mow the lawn, or wash the dishes) and will be surprised and irritated if others suggest creative alternatives.

  • Goal: be less miserly, and stop hoarding money.
    If this problem persists: She will continue to maintain a standard of living far below what she can afford, believing that her spending must be tightly controlled to provide for future catastrophes.

  • Goal: be less rigid and stubborn.
    If this problem persists: She will continue to be so concerned about having things done the one "correct" way that she will have trouble going along with anyone else's ideas. She will plan ahead in meticulous detail and be unwilling to consider changes. Even when compromise would be the best course of action, she will stubbornly refuse to do so, arguing that it is "the principle of the thing".


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Anankastic [Obsessive-Compulsive] Personality Disorder F60.5 - ICD10 Description, World Health Organization

Anankastic [obsessive-compulsive] personality disorder is characterized by feelings of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, caution, and rigidity. There may be insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder.

ICD-10 International Personality Disorder Examination Screening Questions

  • I'm not fussy about little details (False).

  • I'm a very cautious person.

  • I spend too much time trying to do things perfectly.

  • People think I'm too strict about rules and regulations.

  • I work so hard I don't have time for anything else.

  • People think I'm too stiff or formal.

  • It's hard for me to get used to a new way of doing things.

  • I usually try to get people to do things my way.

ICD-10 Diagnostic Criteria (For Research)

A. The general criteria of personality disorder must be met:

  • Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm').

  • The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e. not being limited to one specific 'triggering' stimulus or situation).

  • There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior.

  • There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.

  • The deviation cannot be explained as a manifestation or consequence of other adult mental disorders.

  • Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation.

B. At least four of the following must be present:

  • Feelings of excessive doubt and caution.
      (E.g., "I'm a very cautious person.")

  • Preoccupation with details, rules, lists, order, organization or schedule.
      (E.g., "I'm fussy about little details.")

  • Perfectionism that interferes with task completion.
      (E.g., "I spend too much time trying to do things perfectly.")

  • Excessive conscientiousness and scrupulousness.
      (E.g., "People think I'm too strict about rules and regulations.")

  • Undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships.
      (E.g., "I work so hard I don't have any time left for anything else.")

  • Excessive pedantry and adherence to social conventions.
      (E.g., "People think I am too stiff or formal.")

  • Rigidity and stubbornness.
      (E.g., "It's hard for me to get used to a new way of doing things.")

  • Unreasonable insistence that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things.
      (E.g., "I usually try to get people to do things my way.")

Obsessive-Compulsive Personality Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with obsessive-compulsive personality disorder needs to show at least 4 of the following criteria:

  • Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

  • 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).

  • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).

  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).

  • Is unable to discard worn-out or worthless objects even when they have no sentimental value.

  • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.

  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

  • Shows rigidity and stubbornness.

  • This enduring pattern of inner experience and behavior must deviate markedly from the expectations of the individual's culture.

  • This enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

  • This enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  • Empirically Derived Taxonomy for Personality Diagnosis: Obsessive-Compulsive Personality Disorder

    (This section uses an alternative classification system to that of the American Psychiatric Association)

    These individuals:

    • Become absorbed in details (often to the point of missing what is important).

    • Self-critical, expecting themselves to be "perfect", and to be equally critical of others, whether overtly or covertly.

    • Are excessively devoted to work and productivity to the detriment of leisure and relationships.

    • See themselves as logical and rational, uninfluenced by emotion.

    • Prefer to operate as if emotions were irrelevant or inconsequential.

    • Think in abstract and intellectualized terms.

    • Are controlling, oppositional, and self-righteous or moralistic.

    • Adhere rigidly to daily routines, becoming anxious or uncomfortable when they are altered, and to be overly concerned with rules, procedures, order, organization, and/or schedules.

    • Are prone to being stingy and withholding (e.g., of time, money, affection).

    • Are inhibited and constricted, and have difficulty acknowledging or expressing wishes, impulses, or anger.

    • Rationality and regimentation generally mask underlying feelings of anxiety or anger.

    • See themselves as emotionally strong, untroubled, and in control, despite evidence of underlying insecurity, anxiety, or distress.

    • Deny or disavow their need for nurturance or comfort, often regarding such needs as weakness.

    • Tend to be conflicted about anger and aggression.

    • Are often conflicted about authority, struggling with contradictory impulses to submit versus defy.

    • May be preoccupied with concerns about dirt, cleanliness, or contamination.

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    Diagnostic Features

    Obsessive-Compulsive Personality Disorder is characterized by a chronic preoccupation with rules, orderliness, and control. This disorder is only diagnosed when these behaviors become persistent and disabling. Obsessive-Compulsive Disorder should not be confused with Obsessive-Compulsive Personality Disorder. The majority of individuals with Obsessive-Compulsive Disorder do not have Obsessive-Compulsive Personality Disorder.

    Individuals with Obsessive-Compulsive Personality Disorder grow up with rigid perfectionism, intimacy avoidance, restricted emotional expression and perseveration. The core features of this disorder are: (1) extreme conscientiousness (rigid perfectionism), (2) detachment (intimacy avoidance, restricted emotional expression), and (3) negative emotion (perseveration - continuance of the same behavior despite repeated failures). Obsessive-Compulsive Personality Disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. Obsessive-Compulsive Personality Disorder should not be diagnosed if its symptoms can be better explained as due to another mental disorder, Substance Use Disorder, or another medical condition.

    Individuals with Obsessive-Compulsive Personality Disorder have excessive devotion to work, and poor work-life balance. Occupationally, they tend to be high achievers because of their excessive devotion to work. However their inflexibility, perfectionism, preoccupation with detail, and inability to delegate work may seriously interfere with their ability to complete a given task. They experience occupational difficulties when confronted with new situations that demand flexibility and compromise.

    Individuals with Obsessive-Compulsive Personality Disorder are rigidly perfectionistic and insist on everything being flawless and perfect, including their own and others' performance. They become preoccupied with details, organization, and order. They may show excessive procrastination and perseveration (stubborn continuation of the same behavior despite repeated failures). They are inflexible and unwilling to take risks. Individuals with this disorder often are inflexible about matters of morality, ethics, or values. They may be miserly.

    Individuals with Obsessive-Compulsive Personality Disorder have difficulty in establishing and sustaining close relationships. Their emotional expression is restricted. They have difficulty expressing tender feelings, and rarely pay compliments.

    Like all personality disorders, Obsessive-Compulsive Personality Disorder is a deeply ingrained and enduring behavior pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behavior pattern tends to be stable.

    Course

    Obsessive-Compulsive Personality Disorder usually begins by early adulthood, and has a chronic course.

    Complications

    In Obsessive-Compulsive Personality Disorder, the individual's chronic preoccupation with rules, orderliness, and control seems to prevent many of the complications (e.g., drug abuse, reckless sex, financial irresponsibility) that are common to some other personality disorders.

    Individuals with this disorder often become upset when control is lost. They then either emotionally withdraw from these situations, or become very angry. These individuals usually express affection in a highly controlled or stilted fashion and may be very uncomfortable in the presence of others who are emotionally expressive. They often have difficulty expressing tender feelings, and rarely pay compliments.

    Occupationally, these individuals tend to be high achievers with an excessive devotion to work. However, inflexibility, perfectionism, preoccupation with detail, and inability to delegate work may seriously interfere with their ability to complete a given task. They experience occupational difficulties when confronted with new situations that demand flexibility and compromise. Many of the features of Obsessive-Compulsive Personality Disorder overlap with "type A" personality characteristics (e.g., preoccupation with work, competitiveness, and time urgency), and these features are associated with an increased risk for heart attack.

    Having obsessive-compulsive personality traits - being very conscientious and insisting on the rule of law - can be very advantageous during peacetime in a democracy. However, under a dictatorship, these same traits can get you killed. The first people Hitler murdered were those that conscientiously opposed his dictatorship.

    It's one thing for armies to conscientiously oppose tyranny; however, it's often fatal for single individuals to conscientiously oppose a dictator and his police state (e.g., voicing opposition to Assad in Syria). This is an example of how the same personality trait may be very advantageous in one circumstance, and very dangerous in another circumstance.

    Comorbidity

    Personality disorders are an overlooked and underappreciated source of psychiatric morbidity. Comorbid personality disorders may, in fact, account for much of the morbidity attributed to axis I disorders in research and clinical practice. "High percentages of patients with Schizotypal (98.8%), Borderline (98.3%), Avoidant (96.2%), and Obsessive-Compulsive (87.6%) Personality Disorder and Major Depressive Disorder (92.8%) exhibited moderate (or worse) impairment or poor (or worse) functioning in at least one area."
    Some other disorders frequently occur with this disorder:

      Non-Personality Disorders

              Mood Disorders:
        • Persistent Depressive Disorder (Dysthymia)
        • Possible comorbidity with Bipolar Disorder, Major Depressive Disoder
              Anxiety Disorders:
        • Generalized Anxiety Disorder, Social Anxiety Disorder (Social Phobia), Specific Phobias
              Obsessive-Compulsive and Related Disorders:
        • 47% of individuals with Obsessive-Compulsive Disorder have Obsessive-Compulsive Personality Disorder
              Eating Disorders

      Personality Disorders

        No comorbid personality disorders.

    Associated Laboratory Findings

    No laboratory test has been found to be diagnostic of this disorder.

    Prevalence

    The prevalence of Obsessive-Compulsive Personality Disorder ranges from 2.1% to 7.9% in the general population. It is twice as common in males as females.

    Controlled Clinical Trials Of Therapy

    Click here for a list of all the controlled clinical trials of therapy for this disorder.

    Psychotherapy

    Obsessive-Compulsive Personality Disorder is a very common disorder; yet there are no randomized controlled trials on psychotherapy for this disorder. However, amongst clinicians, there is a consensus that improvements are usually seen only with long-term therapy.

    Pharmacotherapy

    There are currently no medications approved by the FDA to treat this disorder. Vitamins and dietary supplements are ineffective for all Personality Disorders.

    A Dangerous Cult


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    Videos


    Stories

    Rating Scales

    Core Features Of Obsessive-Compulsive Personality Disorder

    The core feature of Obsessive-Compulsive Personality Disorder is fear of failure. Individuals with this disorder desperately attempt to avoid failure by being perfectionistic, over-workng, being inflexibile and avoiding risk taking. Unfortunately all these coping strategies backfire, and only increase the risk of failure.

      Fear Of Failure: The Core Feature Of Obsessive-Compulsive Personality Disorder

      • Perfectionism:
        In the past week, did your perfectionism prevent you from completing an important task?

      • Work-life imbalance:
        In the past week, were you a workaholic - i.e., your life was almost "all-work-and-no-play"?

      • Intimacy avoidance:
        In the past week, did you avoid close friendships or romantic relationships?

      • Inflexibility:
        In the past week, were most other people more flexible about changing things than you were?

      • Risk avoidance:
        In the past week, were most other people more willing to take risks than you were?

    Lack Of Social Skills In Personality Disorders

    There are social skills that are essential for healthy social functioning. Individuals with obsessive-compulsive personality disorder lack the essential social skills of moderation, work-life balance, and flexibility. Obsessive-compulsive personality disorder is not statistically related to any other personality disorder.

    Social Skills That Are Lacking In Obsessive-Compulsive Personality Disorder

    SOCIAL SKILL OBSESSIVE-COMPULSIVE PERSONALITY NORMAL
    Moderation Perfectionism Setting realistic goals; accepting "good enough" rather than demanding perfection
    Work-life balance Life is "all work and no play" Maintaining a proper balance between work and the rest of life
    Flexibility Inflexibility and risk avoidance Willingness to try new things; ability to tolerate normal disorder; taking reasonable risks


    How Was Order vs. Chaos Seen 2,800 Years Ago

    At the start of Greek civilization (9th century BCE), the ancient Greeks believed that a titanic struggle between two gods, order (Chronos) vs. disorder (Chaos) controlled their lives. The meaning of our word "chaos" dates back to these ancient times. The god Chronos was the god of Time and Order (hence our word "chronology"). The ancient Greeks saw that their crops and their cities took time to grow. They believed that, before the beginning of Time (Chronos), all that existed was unformed disorder (Chaos). However, with the beginning of Time (Chronos) there became order and the universe formed. The ancient Greeks believed that nothing lasted for ever, because eventually Time (Chronos) would destroy it. These ancient Greeks believed that those individuals that allied with Chronos by making long-term plans, and living an ordered life, would be rewarded. Whereas, they believed that those individuals that allied with Chaos by being impulsive, and living a disordered life, would be punished. This battle between individuals living an ordered, law-abiding life vs. those living a chaotic, law-breaking life continues today - 2,800 years after the ancient Greeks first conceptualized this struggle.

    A Good Life

    How does one live a good life?

    One approach to answering this question is to study the behavior of individuals who live troubled lives. Could the opposite of their maladaptive behavior define how to live a good life?

    Consider the troubled lives of people with obsessive-compulsive personality disorder. Individuals with this disorder are inflexible and perfectionistic.

    Could the opposite of the maladaptive behaviors seen in obsessive-compulsive personality disorder be a clue to how to live a good life? All religions stress the importance of being conscientious. Unfortunately, in obsessive-compulsive personality disorder, there is excessive conscientiousness.


    Obsessive-Compulsive Personality Disorder The Opposite Of Obsessive-Compulsive Personality Disorder
    Excessive Conscientiousness: Normal Conscientiousness:
    Shows rigidity and stubbornness Flexible, not overly rigid and stubborn
    Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values Not overly inflexible about morality, ethics or values
    So preoccupied with details that loses sight of the goal Not overly preoccupied with details, rules, etc.
    Shows perfectionism that interferes with task completion Not overly perfectionistic
    Is excessively devoted to work to the exclusion of leisure activities and friendships Good work-life balance
    Is unable to discard worn-out or worthless objects even when they had no sentimental value Able to discard worn-out or worthless objects
    Is reluctant to delegate tasks or to work with others unless they submit to exactly her way of doing things Able to delegate tasks and responsibilities
    Has a miserly spending style (hoarding money for future catastrophes) Generous

    Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

    Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

    "Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.


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    Treatment Guidelines

    Setting Goals In Therapy

      Questions To Ask When Setting Goals

      In The Past Week:
      • WHO: was your problem?

      • EVENT: what did he/she do?

      • RESPONSE: how did you respond to that event?

      • OUTCOME: did your response help?

      • TRIGGER: what did you do that could have triggered this problem?

      • GOAL: what life skill(s) do you have to work on? (from checklist)

      Example Of Setting Goals In Interviewing A Person With Obsessive-Compulsive Personality Disorder

      In The Past Week:
      • WHO: was your problem?
        "My wife."

      • EVENT: what did he/she do?
        "My wife complained that I am spending too much time at work, and not enough time with her and our children."

      • RESPONSE: how did you respond to that event?
        "I told her that I have a big project at work, and that it is taking much more time to complete than I thought."

      • OUTCOME: did your response help?
        "No. My wife says that I've used this same excuse for as long as we've been married."

      • TRIGGER: what did you do that could have triggered this problem?
        "I want to make sure that I don't screw up on this project; so I'm rechecking everything I'm doing. But I'm procrastinating too much on finishing this project. I'm becoming paralyzed, and I now fear I'll never finish this project on time."

      • GOAL: what life skill(s) do you have to work on? (from checklist)
        "I want to work on: (1) Moderation ("Setting realistic goals; accepting "good enough" rather than demanding perfection"), and (2) Work-Life Balance ("Maintaining a proper balance between work and the rest of life")."


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    Self-Help Resources

    Improving Positive Behavior

    Philosophers for the past 2,500 years have taught that it is very beneficial to start the day with goal-setting, and end the day with a brief review.

    This habit of planning your day in the morning, and reviewing your day in the evening, is a time-proven technique for more successful living.

    Note: When each of the following videos finishes; you must exit YouTube (by manually closing the window) in order to return to this webpage.



    Morning Meditation (5-Minute Video)



    Afternoon Meditation (Learn How To Have Healthy Relationships)



    Evening Meditation (5-Minute Video)



    Life Satisfaction Scale (Video)



    Healthy Social Behavior Scale (Video)



    Mental Health Scale (Video)




    Click Here For More Self-Help



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      "In physical science a first essential step in the direction of learning any subject is to find principles of numerical reckoning and practicable methods for measuring some quality connected with it. I often say that when you can measure what you are speaking about and express it in numbers you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be."

      Lord Kelvin (1824 – 1907)


    • The best summary on bad research is given by Laura Arnold in this TEDx lecture. If you read nothing else about research, you owe it to yourself to watch this short video - it is excellent!

    • Canadian researchers who commit scientific fraud are protected by privacy laws: There are criminals in every community - even in the scientific research community (especially if a lot of money is at stake). Criminal researchers can hide their fraud behind outdated privacy laws.

    • The power of asking "what if?"

    • The active placebo effect: 2300 years ago, the Greek Stoic philosophers taught that it is not the objective event, but our subjective judgment about the event, that determines our behavior. The active placebo effect bears witness to this ancient wisdom.

    • Criteria For High Quality Research Studies

    • It is troubling that a recent study found that two-thirds of important psychological research studies couldn't be replicated. High quality research must meet the following criteria:

      • Randomized Controlled Trial:
        Ask: Was the trial randomized? Was the randomization procedure described and was it appropriate? The best research design is to have research subjects randomly assigned to an experimental or control group. It is essential that confounding factors be controlled for by having a control group or comparator condition (no intervention, placebo, care as usual etc.).

      • Representative Sample:
        Ask: Do the research subjects represent a normal cross-section of the population being studied? Many psychological research studies using university students are flawed because their subjects are not representative of the normal population since they are all W.E.I.R.D. (White, Educated, Intelligent, Rich, and living in a Democracy).

      • Single Blind Trial:
        Ask: Was the treatment allocation concealed? It is essential that the research subjects are kept "blind" as to whether they are in the experimental or control group (in order to control for any placebo effects).

      • Double Blind Trial (Better Than Single Blind Trial):
        Ask: Were blind outcome assessments conducted? In a double blind study, neither the research subjects nor the outcome assessors know if the research subject is in the experimental or control group. This controls for both the placebo effect and assessor bias.

      • Baseline Comparability:
        Ask: Were groups similar at baseline on prognostic indicators? The experimental and control groups must be shown to be comparable at the beginning of the study.

      • Confounding Factors:
        Ask: Were there factors, that weren't controlled for, that could have seriously distorted the study's results? For example, research studies on the effectiveness of mindfulness cognitive therapy in preventing depressive relapse forgot to control for whether the research subjects were also simultaneously receiving antidepressant medication or other psychological treatments for depression.

      • Intervention Integrity:
        Ask: Was the research study protocal strictly followed? The research subjects must be shown to be compliant (e.g., taking their pills, attending therapy) and the therapists must be shown to be reliably delivering the intervention (e.g., staying on the research protocol).

      • Statistical analysis:
        Ask: Was a statistical power calculation described? The study should discuss its statistical power analysis; that is whether the study size is large enough to statistically detect a difference between the experimental and control group (should it occur) and usually this requires at least 50 research subjects in the study.

        Ask: Are the results both statistically significant and clinically significant? The results should be both statistically significant (with a p-value <0.05) and clinically significant using some measure of Effect Size such as Standardized Mean Difference (e.g., Cohen's d >= 0.33). The summary statistics should report what percentage of the total variance of the dependent variable (e.g., outcome) can be explained by the independent variable (e.g., intervention). In clinical studies, the study should report the number needed to treat for an additional beneficial outcome (NNTB), and the number needed to treat for an additional harmful outcome (NNTH).

          Number Needed To Benefit (NNTB): This is defined as the number of patients that need to be treated for one of them to benefit compared with a control in a clinical trial. (It is defined as the inverse of the absolute risk reduction.) Note: Statistically, the NNTB depends on which control group is used for comparison - e.g., active treatment vs. placebo treatment, or active treatment vs. no treatment.

          Number Needed To Harm (NNTH): This is defined as the number of patients that need to be treated for one of them to be harmed compared with a control in a clinical trial. (It is defined as the inverse of the absolute increase in risk of harm.)

          Tomlinson found “an NNTB of 5 or less was probably associated with a meaningful health benefit,” while “an NNTB of 15 or more was quite certain to be associated with at most a small net health benefit.”

        Ask: Does the researcher accept full responsibility for the study's statistical analysis? The researcher should not just hand over the study's raw data to a corporation (that may have $1,000 million invested in the study) to do the statistical analysis.

      • Completeness of follow-up data:
        Ask: Was the number of withdrawals or dropouts in each group mentioned, and were reasons given for these withdrawals or dropouts? Less than 20% of the research subjects should drop out of the study. The intervention effect should persist over an adequate length of time.

      • Handling of missing data:
        Ask: Was the statistical analysis conducted on the intention-to-treat sample? There must be use of intention-to-treat analysis (as opposed to a completers-only analysis). In this way, all of the research subjects that started the study are included in the final statistical analysis. A completers-only analysis would disregard those research subjects that dropped out.

      • Replication of Findings:
        Ask: Can other researchers replicate this study's results? The research study's methodology should be clearly described so that the study can be easily replicated. The researcher's raw data should be available to other researchers to review (in order to detect errors or fraud).

      • Fraud:
        Ask: Is there a suspicion of fraud? In a research study, examine the independent and dependent variables that are always measured as a positive whole number (e.g., a variable measured on a 5-point Likert-type scale ranging from "1 = definitely false to 5 = definitely true" etc.). For each of these variables, look at their sample size (n), mean (M) and standard deviation (SD) before they undergo statistical analysis. There is a high suspicion of fraud in a study's statistics:

        • If the M is mathematically impossible (online calculator): This is one of the easiest ways to mathematically detect fraud. The mean (M) is defined as "the sum (Sum) of the values of each observation divided by the total number (n) of observations". So: M = Sum/n. Thus: (Sum) = (M) multiplied by (n). We know that, if a variable is always measured as a positive whole number, the sum of these observations always has to be a whole number. For these variables to test for fraud: calculate (M) multiplied by (n). This calculates the Sum which MUST be a positive whole number. If the calculated Sum isn't a positive whole number; the reported mean (M) is mathematically impossible - thus the researcher either cooked the data or made a mistake. A recent study of 260 research papers published in highly reputable psychological journals found that 1 in 2 of these research papers reported at least one impossible value, and 1 in 5 of these research papers reported multiple impossible values. When the authors of the 21 worst offending research papers were asked for their raw data (so that its reliability could be checked) - 57% angrily refused. Yet such release of raw data to other researchers is required by most scientific journals. (Here is an example of a research paper filled with mathematically impossible means.)

        • If the SD is mathematically impossible (online calculator): When researchers fraudulently "cook" their data, they may accidently give their data a mean and standard deviation that is mathematically impossible for a (normally distributed) strictly positive variable (because the "cooked" M and SD would mathematically require the strictly positive variable's range of data to include negative numbers). For a normally distributed sample of size of 25-70, this occurs when the SD is greater than one-half of the M; for a sample size of 70+, this occurs when the SD is greater than one-third of the M [using these formulas].

        • If the SD/M is very small (i.e., the variable's standard deviation is very small compared to the mean suggesting data smoothing).

        • If the SD's are almost identical (i.e., the variables have different means but almost identical standard deviations).

        • If the 4th digit of the values of the variables aren't uniformly distributed - since each should occur 10% of the time (Benford's Law).

        • If the researcher is legally prevented from publishing negative findings about a drug or therapy because that would violate the "nondisclosure of trade secrets" clause in the research contract (i.e., it is a "trade secret" that the drug or therapy is ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical trials fail to publish their results.

        • If the researcher refuses to release his raw data to fellow researchers (so that they can check its validity). In order to be published in most scientific journals, a researcher must promise to share his raw data with fellow researchers. Thus a researcher's refusal to do so is almost a sure indicator of fraud.

        The most common type of scientific fraud is when a research study's data contradicts the study's own conclusions.

    • Calling Bullshit In The Age of Big Data - "Bullshit is language, statistical figures, data graphics, and other forms of presentation intended to persuade by impressing and overwhelming a reader or listener, with a blatant disregard for truth and logical coherence." Reading the syllabus of this university course should be required reading for every student of mental health. This syllabus is absolutely fantastic!

    • Statistical Methods in Psychology Journals: Guidelines and Explanations - American Psychologist 1999

    • Not All Scientific Studies Are Created Equal - video

    • The efficacy of psychological, educational, and behavioral treatment

    • Estimating the reproducibility of psychological science

    • Psychologists grapple with validity of research

    • Industry sponsorship and research outcome (Review) - Cochrane Library

    • 'We've been deceived': Many clinical trial results are never published - (text and video)

    • Junk science misleading doctors and researchers

    • Junk science under spotlight after controversial firm buys Canadian journals

    • Medicine with a side of mysticism: Top hospitals promote unproven therapies - Are some doctors becoming modern witchdoctors?

    • When Evidence Says No, But Doctors Say Yes


    • Cochrane Reviews (the best evidence-based, standardized reviews available)

    Research Topics

    Obsessive-Compulsive Personality Disorder - Latest Research (2016-2017)


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    Which Behavioral Dimensions Are Involved?

    Research has shown that there are 5 major dimensions (the "Big 5 Factors") of personality disorders and other mental disorders. There are two free online personality tests that assess your personality in terms of the "Big 5 dimensions of personality". Although not computerized online, the Big Five Inventory (BFI) is a 44-item test often used in personality research.

    This website uses these 5 major dimensions of human behavior to describe all mental disorders. (This website adds one more dimension, "Physical Health", but our discussion will focus on the first 5 major dimensions.)

    These major dimensions of human behavior seem to represent the major dimensions whereby our early evolutionary ancestors chose their hunting companions or spouse. To maximize their chance for survival, our ancestors wanted companions who were agreeable, conscientious, intelligent, sociable, emotionally stable, and physically healthy.

    Dimensions of Human Behavior That Are Impaired in Obsessive-Compulsive Personality Disorder

    THE POSITIVE SIDE OF THE "BIG 5" PERSONALITY DIMENSIONS THE NEGATIVE SIDE OF THE "BIG 5" PERSONALITY DIMENSIONS THIS DISORDER
    Agreeableness Antagonism       Agreeableness
    Conscientiousness Disinhibition       Excessive Conscientiousness
    Intellect Decreased Intellect       Intellect
    Sociability (Extraversion) Detachment       Sociability (Extraversion)
    Emotional Stability Negative Emotion       Emotional Stability


    The 5 Major Dimensions of Mental Illness

    The Big 5 Factors or dimensions of mental illness each has a healthy side and an unhealthy side. Thus the Big 5 Factors are: (1) Agreeableness vs. Antagonism, (2) Conscientiousness vs. Disinhibition, (3) Intellect vs. Decreased Intellect, (4) Sociability (Extraversion) vs. Detachment (Introversion), and (5) Emotional Stability vs. Negative Emotion.

    The problems that are diagnostic of this disorder are highlighted in   Pink  . Other problems that are often seen in this disorder are highlighted in   Yellow  .



    Treatment Goals for Obsessive-Compulsive Personality Disorder

    CONSCIENTIOUSNESS VS. DISINHIBITION
    .
    CONSCIENTIOUSNESS
    .
    Description: Conscientiousness is synonymous with being self-disciplined, industrious and orderly. The Conscientiousness dimension measures the behaviors that are central to the concept of SELF-CONTROL - organizing and controlling one's behavior in order to achieve one's goals. This involves traits like paying attention, controlling impulses, and delaying gratification. High conscientiousness is associated with better: longevity, health, school and job performance. (This dimension appears to measure the behaviors that differentiate behavioral order and inhibition from chaos and disinhibition.)
    Descriptors: Industrious, self-disciplined, rule-abiding, organized
    Language Characteristics: Many positive emotion words (e.g. happy, good), few negative emotion words (e.g. hate, bad), more perspective, careful to check that information is conveyed correctly, straight to the point, formal, few negations, few swear words, few references to friends, few disfluencies or filler words, many insight words, not impulsive.
    Research: Higher scores on Conscientiousness predict greater success in school and at work. *MRI research found that Conscientiousness was associated with increased volume in the lateral prefrontal cortex, a region involved in planning and the voluntary control of behavior.
    "I do a thorough job. I want everything to be 'just right'. I want every detail taken care of."
    "I am careful."
    "I am a reliable hard-worker."
    "I am organized. I follow a schedule and always know what I am doing."
    "I like order. I keep things tidy."
    "I see that rules are observed."
    "I do things efficiently. I get things done quickly."
    "I carry out my plans and finish what I start."
    "I am not easily distracted."
    .
    Rigid Perfectionism
    .
    "Even though it drives other people crazy, I insist on absolute perfection in everything I do."
    "I simply won't put up with things being out of their proper places."
    "People complain about my need to have everything all arranged."
    "People tell me that I focus too much on minor details."
    "I have a strict way of doing things."
    "I postpone decisions."
    .
    DISINHIBITION
    .
    Description: Disinhibition is synonymous with being distractible, impulsive and disorganized.
    Descriptors: Distractible, impulsive, irresponsible, disorganised, unreliable, careless, forgetful
    Language Characteristics: Few positive emotion words, many negative emotion words, less perspective, less careful, more vague, informal, many negations, many swear words, many references to friends (e.g. pal, buddy), many disfluencies or filler words, few insight words, impulsive.
    .
    * Irresponsibility:
    "I've skipped town to avoid responsibilities."
    "I just skip appointments or meetings if I'm not in the mood."
    "I'm often pretty careless with my own and others' things."
    "Others see me as irresponsible."
    "I make promises that I don't really intend to keep."
    "I often forget to pay my bills."
    .
    * Impulsivity:
    "I usually do things on impulse without thinking about what might happen as a result."
    "Even though I know better, I can't stop making rash decisions."
    "I feel like I act totally on impulse."
    "I'm not good at planning ahead."
    .
    * Distractibility:
    "I can't focus on things for very long."
    "I am easily distracted."
    "I have trouble pursuing specific goals even for short periods of time."
    "I can't achieve goals because other things capture my attention."
    "I often make mistakes because I don't pay close attention."
    "I waste my time ."
    "I find it difficult to get down to work."
    "I mess things up."
    "I don't put my mind on the task at hand."
    .
    * Reckless Risk Taking:
    "I like to take risks."
    "I have no limits when it comes to doing dangerous things."
    "People would describe me as reckless."
    "I don't think about getting hurt when I'm doing things that might be dangerous."
    .
    * Hyperactivity:
    "I move excessively (e.g., can't sit still; restless; always on the go)."
    "I'm starting lots more projects than usual or doing more risky things than usual."
    .
    * Over-Talkativeness:
    "I talk excessively (e.g., I butt into conversations; I complete people's sentences)."
    "Often I talk constantly and cannot be interrupted."
    .
    * Elation:
    "I feel very happy or exhilarated."
    "I'm feeling a rush of good feelings."
    .
    ("Conscientiousness vs. Disinhibition" modified from "PID-5" by Kreuger RF, Derringer J, Markon KE, Watson D, Skodol AE and Between facets and domains: 10 aspects of the Big Five)
    *MRI Research: Testing predictions from personality neuroscience. Brain structure and the big five.


    The "Big 5 Factors" of Personality as Shown In Dogs

    The same "Big 5 Factors" of personality found in humans can be found in dogs. This makes sense because dogs, like humans, are a social species.



    AGREEABLENESS VS. ANTAGONISM
    .
    Agreeableness ("Friend")
    .
    Dog is friendly towards unfamiliar people.
    Dog is friendly towards other dogs.
    When off leash, dog comes immediately when called.
    Dog willingly shares toys with other dogs.
    Dog leaves food or objects alone when told to do so.
    .
    Antagonism ("Foe")
    .
    Dog is dominant over other dogs.
    Dog is assertive with other dogs (e.g., if in a home with other dogs, when greeting).
    Dog behaves aggressively towards unfamiliar people.
    Dog shows aggression when nervous or fearful.
    Dog aggressively guards coveted items (e.g., stolen item, treats, food bowl).
    Dog is quick to sneak out through open doors, gates.

    CONSCIENTIOUSNESS VS. DISINHIBITION
    .
    Conscientiousness ("Self-Controlled")
    .
    Dog works at tasks (e.g., getting treats out of a dispenser, shredding toys) until entirely finished.
    Dog works hard all day herding or pulling a sleigh (if a "working dog" on the farm or in the snow). *
    Dog is curious.
    .
    Disinhibition ("Disinhibited")
    .
    Dog is boisterous.
    Dog seeks constant activity.
    Dog is very excitable around other dogs.

    INTELLECT VS. DECREASED INTELLECT
    .
    Open To Experience ("Open-Minded")
    .
    Dog is able to focus on a task in a distracting situation (e.g., loud or busy places, around other dogs).
    .
    Closed To Experience ("Closed-Minded")
    .
    Dog is slow to respond to corrections.
    Dog ignores commands.
    Dog is slow to learn new tricks or tasks.

    SOCIABILITY (EXTRAVERSION) VS. DETACHMENT
    .
    Sociability ("Approach")
    .
    Dog is attention seeking (e.g., nuzzling, pawing or jumping up on family members looking for attention and physical contact).*
    Dog seeks companionship from people.
    Dog is affectionate.
    .
    Detachment ("Avoidance")
    .
    Dog is aloof.
    Dog gets bored in play quickly.
    Dog is lethargic.

    EMOTIONAL STABILITY VS. NEGATIVE EMOTION
    .
    Emotional Stability ("Safety")
    .
    Dog tends to be calm.
    Dog is relaxed when greeting people.
    Dog is confident.
    Dog adapts easily to new situations and environments.
    .
    Negative Emotion ("Danger")
    .
    Dog is anxious.
    Dog is shy.
    Dog behaves fearfully towards unfamiliar people.
    Dog exhibits fearful behaviors when restrained.
    Dog avoids other dogs.
    Dog behaves fearfully towards other dogs.
    Dog behaves submissively (e.g., rolls over, avoids eye contact, licks lips) when greeting other dogs.
    .
    Modified from Jones, A. C. (2009). Development and validation of a dog personality questionnaire. Ph.D. Thesis. University of Texas, Austin.

    * New items added by Phillip W. Long MD


    Personality Difference Between Dogs and Humans

    Dogs and humans are strikingly similar on 4 of the "Big 5 Factors" of personality. However, dogs and humans are quite different on the "Conscientiousness" factor - because the canine brain is designed for hunting, not building. That's why dogs don't build dog houses.

    The Brain and the "Big-5 Factors" of Personality In A Social Species

    The "Big-5 Factors" of personality represent basic brain functions in social species. For example, when a male approaches a female, the female must: (1) decide whether the male is friend or foe ["Agreeableness"], (2) decide if this represents safety or danger ["Emotional Stability"], (3) decide whether to approach or avoid him ["Sociability"], (4) decide whether to be self-controlled or disinhibited ["Conscientiousness"], and (5) learn from this experience ["Openness to Experience"].

    The "Big-5 Factors" of Human and Cat Personality

    Cats are a social species, but less social than dogs. Nevertheless, cats also show the "Big 5 Factors" of personality.



    The "Big 5" Dimensions of Personality and Personality Disorders

    There are two free online personality tests that assess your personality in terms of the "Big 5" dimensions of personality. The following diagram shows the relationship between the "Big 5" dimensions of personality and personality disorders. This diagram is based on the research of Sam Gosling, Jason Rentfrow, and Bill Swann, Gerard Saucier, Colin G. DeYoung, and Douglas Samuel and Thomas Widiger.


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    Obsessive-Compulsive Personality Disorder Scores High On Conscientiousness

    In personality testing, individuals with Obsessive-Compulsive Personality Disorder often have a high conscientiousness test score.

    Personality Disorders And Conscientiousness

    High scores on the personality dimension of conscientiousness measure order and rule-keeping (e.g., Obsessive-Compulsive Personality Disorder); whereas low scores on conscientiousness measure chaos and rule-breaking (e.g., Borderline Personality Disorder and Antisocial Personality Disorder).

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