Institute Satori

Obsessive-compulsive personality disorder (OCPD) or anankastic personality disorder is a disorder characterized by perfectionism, general psychological inflexibility, rigidity, conformity to rules and procedures, perfectionism, morality, and/or order and regularity. A person with OCPD becomes preoccupied with uncontrollable thought patterns and patterns of action. Symptoms can cause great distress and interfere with an individual’s professional and social functioning. People with OCPD try to develop their intellect to a level of omniscience. This need, coupled with perfectionism, leads them to take risks, to be indecisive, to procrastinate (hesitate) in order not to make any mistakes. All this leads them to rigidity and discomfort with their emotional life, which is beyond conscious control.

Obsessive-Compulsive Personality Disorder (OCPD) is a fairly common disorder, especially among men in Western culture (American Psychiatric Association, 1987). This is partly because the moderate expression of certain traits of this lifestyle is highly valued by society, such as: accuracy, self-discipline, control of emotions, perseverance (constancy), reliability and courtesy. In some individuals, however, these traits are expressed to such an extent that it leads to either significant functional deterioration or personal distress.

OCPD means that the obsessive individual is rigid, perfectionist, dogmatic, reflective, moralistic, inflexible, indecisive, and emotionally and cognitively blocked (Beck and Freeman, 1990: Cognitive Therapy of Personality Disorders). OCPD is often confused with obsessive-compulsive disorder (OCD). OCD is characterized by obsessions that contain persistent, ritualized thought patterns, or compulsions that represent persistent, ritualized behavioral patterns. Individuals with OCD know that their behavior is problematic, while OCPD symptoms are part of a person’s personality and are therefore generally unaware of their problematic behavior. People with OCPD generally do not feel the need to perform repetitive ritual acts (such as excessive hand washing), while this is a common symptom for people with OCD. Meanwhile, those with OCPD emphasize perfectionism above all else and become anxious when they perceive that things are not “right.” People with OCPD may be putting money into the future, have their home perfectly tidy, or be anxious about delegating tasks to others for fear that things won’t be done right. In general, there are four primary areas that cause OCPD anxiety: time, relationships, impurity, and money. For them, there are only a few moral grey areas; Actions and beliefs are either completely correct or completely wrong for them. Interpersonal relationships are thus quite difficult, mainly due to the excessive demands they place on friends, partners and children.

Features of obsessive-compulsive personality disorder

Obsessive-compulsive personality disorder is reflected in different contexts, indicated by at least four (or more) of the following symptoms:

• preoccupation with details, rules, lists, order, organization or schedules (schedules) to the point where the essence of the activity (action) is lost;

• perfectionism that hinders the performance of tasks (so that he or she is unable to perform a task because his or her strict standards are not met);

• excessive dedication to work and productivity, exclusion of leisure activities and friendships;

• excessive care, precision and inflexibility in terms of morals, ethics or values;

• Reluctance to delegate tasks or work with others (teamwork) if the latter do not bow down and work in his or her own way;

• A stingy consumer style towards both one and others; he views money as something that needs to be invested in future catastrophes;

• rigidity and stubbornness (intransigence);

• Inability to throw away used or unworthy items, even if they have no sentimental value.

Characteristic of this disorder is dichotomous thinking, a tendency to see things in an all-or-nothing manner and in strictly black and white tones. This is what makes obsessive the basis for stiffness, procrastination, and perfectionism. Another characteristic is exaggeration or catastrophism, an exaggeration of the importance or consequences of an imperfection or error.

It is also a characteristic of many people with OCPD that they think in a “should” and “should” way. This style of thinking leads them in the direction of doing what they think they have to do; given their strict internalized standards; instead of doing what they want. And if they don’t do the ‘right thing’, they feel guilty and self-critical. And if others don’t do ‘what they’re supposed to do’, they deserve anger and reprimand.

Possible causes of the development of the disorder

There is very little definitive research on OCPD. Thus, there is very little evidence that OCPD originates from improper toilet training, as psychoanalytic theory assumes (Pollack, 1979 in Beck and Freeman, 1990). However, it was found that parents of obsessive children themselves had a number of obsessive traits, including being strict and overly controlling of their children, overly conformist, non-empathetic, and disapproving of spontaneous expression of emotions. Modest evidence points in the direction of the inheritance of this disorder.

The following hypotheses are known as possible causes for the development of OCPD:

1. There was an unrelenting insistence that it was necessary to do things right and follow the rules at all costs. There was very little warmth in the environment and a great emphasis on perfectionism and order. This excessive control was exercised in toilet training, play, etc. The consequence of introjections in adulthood, due to the relentless forcing of parents to do the right thing, is an unbalanced commitment to perfectionism in oneself and others. An individual thus stops at his mistakes and constantly strives to improve things and meet them according to high standards. To do this, he is willing to submit excessively to authority or principle or principle. He identifies with the parent and insists that the other person does the same. If the family does not approve of anger, such an individual will control the anger. On the other hand, if an individual with OCPD identifies with an angry, morally justifiable parent, then he or she may also become justifiably angry (outraged). A less rigid and more adapted form of obsessive includes skills particularly relevant to certain professions such as law, the military, and computer programming.

2. The 2nd individual with OCPD was punished for failures and was not praised for successes. The best that such an individual could do was to avoid criticism or punishment. For example, if such a child washed the dishes, there was no comment about it, unless some unclean speck was found. Thus, there was an intense focus on mistakes, and there was not even a temporary acknowledgment of success. Such parents believed that the full execution of duties could compensate for the “given” character deficits. To avoid destruction, the child learned that everything was in order and right. This, in turn, necessarily means constant control over oneself and others. A focus on mistakes and self-criticism are adult consequences of a lack of rewards for successes and a lot of punishment for imperfections. Uncertainty, indecision, and inability to move forward are the consequences of the need to be perfect, while mistakes are expected, no matter what. Checking, re-checking, planning, re-planning, the obsessive individual is always preparing and worried. Since success has never been recognized, such an individual has no boundaries. For them, there is no rest, there is no feeling of satisfaction in a job well done.

3. There was very little warmth in such a family. Hugs, laughter, etc. were very rare. Affection and love were not exemplary and could be dangerous. Emotions can’t be controlled. Because of the connection between rationality and control, such an individual is very likely to value them highly and ‘try not to feel’.​

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Psychotherapy and other forms of help

Treatment for OCPD includes mainly psychotherapy and self-help. Most people with OCPD have a hard time recognizing the problems. Thus, they usually do not want any psychological or medical treatment for their condition. As a result, they often continue to suffer from this disorder, which can also overwhelm them over time.

Individuals with OCPD very rarely ask for help. The most common problem is anxiety. Their way of functioning predisposes them to chronic, mild anxiety, which is characteristic of generalized anxiety disorder. Many residents with OCPD are constantly thinking about whether they have done something right and whether it is good enough. This usually leads to the development of traits such as indecision and procrastination, which are also common problems presented. For certain people, if they find themselves in a severe conflict between their obsessiveness and external pressures, their chronic anxiety can escalate to panic disorder.

Another common problem people with OCPD have is depression. These individuals tend to have very uninteresting, empty, boring, and unsatisfying lives, and thus suffer from chronic mild depression. People with OCPD often also experience various psychosomatic disorders. They have a predisposition to the development of these disorders due to the physical effects of their constant heightened arousal and anxiety. Often suffer from headache (pressure in the head), pain in the spine, constipation, stomach ulcer. They can also have type A personalities and are at increased risk of cardiovascular disease as a result, especially if they are often angry and hostile.

Some clients with OCPD complain of sexual dysfunction. Their discomfort with emotions, lack of spontaneity, excessive control and rigidity are not conducive to the free and satisfactory expression of their own sexuality. Sexual dysfunctions that they often experience is decreased desire for sexuality, inability to experience orgasm, premature ejaculation, etc. Individuals with OCPD, however, may also come to therapy with the encouragement of others, because of the problems others have in their relationship with them. It is most often referred to her by her partner mainly due to the lack of emotional availability of the partner with OCPD or his/her workaholism and spending very little time with their family, so they most often engage in partner therapy together. Families with an obsessive parent may come to therapy because of their rigid and strict way of upbringing, which can lead to chronic quarrels between parent and children. However, these individuals may also be sent to therapy by their employer because of their constant procrastination or their inability to function effectively in interpersonal relationships at work.

The way psychotherapeutic treatment is carried out

The main goal of psychotherapy with clients with OCPD is to help change or reinterpret basic assumptions that behavior and emotions will change. Therapy begins by focusing on the problem presented. From the perspective of a cognitive-behavioral approach, it is about looking at ways to change compulsions into healthier and more productive actions. In doing so, enumerating the strengths and weaknesses of a particular behavior or belief can be used to address such problems. We help clients understand how they learned the scheme. Typically, this has evolved from interaction with parents or other significant ones, although sometimes schemas are based on cultural norms or develop in more specific (typical) ways. Therapy in this case consists of helping such an individual to identify and understand the negative consequences of these assumptions or schemes and then to develop ways to challenge (refute) them, so that they can no longer control the client’s emotions and behavior and lead them to the problems that brought him/her to therapy. As with many personality disorders, treatment focuses on short-term symptom relief and supporting existing coping mechanisms while learning new ones. A real and radical change in personality requires long-term in-depth psychotherapeutic work. OCPD is particularly resistant to such changes due to the underlying structure of the disorder, which consequently requires time for in-depth work.

Therapy is especially useful for determining the client’s current defense system and coping abilities. These abilities, which are not working now, can be enhanced with additional abilities. The client’s social relationships are identified, and strong, positive relationships are reinforced, while at the same time the client examines negative and harmful relationships. It is important to work on finding and fully identifying one’s emotional states, rather than over-intellectualizing and distancing oneself from one’s emotions. Correctly identifying and expressing emotions can bring about a lot of change inside and outside of yourself. Due to the common problems of these clients with anxiety and psychosomatic symptoms, relaxation techniques and meditation are often helpful. Group therapy can be a very effective option in working with this disorder, but for most people with OCPD, it is a very difficult form of work because it is quite difficult to cope with the minimally necessary social contact to achieve healthy group dynamics. Most people with OCPD (as well as OCD) can live fairly normal lives, have families, friends, and go to work regularly. Medications are generally not used for this personality disorder unless the individual is also suffering from an Axis I diagnosis.

Hospitalization​

Hospitalization is rarely necessary for people with OCPD, except in exceptions where extreme pressure (burden) or a stressful life event occurs that increases compulsive behavior to the point where daily activities stop or a risk arises that would harm the client. Hospitalization can be so necessary when obsessive thoughts do not allow the individual to continue with daily activities, paralyzing them and forcing them to stay in bed or with their compulsive behaviors.

Self-help

– Educating family and friends about this condition will help manage behavioral problems with greater compassion and understanding and teach them to recognize warning signs.

– Self-help groups can be helpful in accepting and changing obsessive-compulsive behaviors. They can be a good helper in continuing medical check-ups once a month and a way to gain or improve emotional and social support in the community, helping the individual by sharing everyday experiences and emotions. These groups also support the client’s independence and stability.

– Relaxation, meditation, physical activity, regular sleep, and a balanced diet are all important factors in maintaining this focus.

– Consultation with a doctor for sleep problems and/or problems that prevent regular activity.

– Journaling can help an individual identify stressful situations that trigger compulsive reactions that prevent them from focusing on more constructive activities.

dr. Tamara Trobentar, psihoterapevtka