Obsessive-compulsive personality disorder: psychotherapy, medication
Personality disorders a set of different habitual patterns of experience or behaviour that deviate considerably from the social and cultural context to which the individual belongs and are characterised by persistent patterns of thought, perception, reaction and ways of relating that cause the subject considerable suffering and/or impair his or her functional capacities
Personality disorders are a group of ten disorders collected into three groups (also called ‘clusters’) on the basis of descriptive similarities.
Obsessive-compulsive disorder is included in cluster C
It encompasses three personality disorders characterised by low self-esteem and/or high anxiety and in which people often appear anxious or fearful.
- Avoidant personality disorder: sufferers tend to avoid social situations altogether for fear of negative judgements from others, thus presenting a marked shyness;
- dependent personality disorder: sufferers have a marked need to be looked after and looked after by others, thus delegating all their decisions;
- obsessive-compulsive personality disorder: the sufferer presents a marked tendency towards perfectionism and precision, a strong preoccupation with order and control over what happens.
Obsessive-compulsive personality disorder
Obsessive Compulsive Personality Disorder (also called Ananchastic Personality Disorder or Obsessive Personality Disorder) is characterised by a complex of rigid personality responses, behaviours and feelings that manifest themselves in several areas.
The subject tends to conform to procedures, habits or rules in an excessive and inflexible manner, and also has repetitive thoughts or behaviour, the latter being devoted to constant control of the situation and perfectionism that, if not achieved and maintained, can transmit a strong feeling of anxiety to the patient.
Anxiety therefore manifests itself particularly when
- the subject’s habitual and repetitive procedures are altered, e.g. by an unexpected situation or by other people;
- standards tending towards perfectionism are not met, even with minimal discrepancies between the expected and the achieved goal.
The patient’s general attitude is one of iron inflexibility of judgement (sometimes tending towards moralism), a desire for order and fidelity to routine, anxiety about a surrounding world that often appears disordered and uncontrollable.
The typical defence mechanisms of the obsessive personality are avoidance, removal, reactive training, isolation from affection and intellectualisation.
Obsessive-compulsive personality disorder must be distinguished from (neurotic) obsessive-compulsive disorder
Obsessive-compulsive disorder is an anxiety disorder dominated by recurrent thoughts with unpleasant content and is characterised by the enactment of ritual behaviours that the subject is compelled to perform: these symptomatic manifestations are egodystonic, in the sense that the patient recognises them as problematic and wishes to get rid of them, but is unable to do so.
On the contrary, the traits that constitute the peculiarity of obsessive-compulsive personality disorder, described earlier, are egosyntonic and do not cause discomfort: on the contrary, the subject sees his disorder positively and often does not even know he has it, considering his actions as a positive trait of his personality and not as an illness.
Obsessive-compulsive disorder and obsessive-compulsive personality disorder can, however, coexist in the same subject.
Psychotherapy
Psychodynamic approaches focus mainly on the interpretation of repressed and repressed elements, from which the symptoms manifested by the patient are believed to derive.
They use the therapeutic relationship as a starting point to explore previous relationships that may have determined the development of symptoms.
Early traumas are investigated.
Recognition of the aspects that block the patient’s creativity and are ineffective in coping with life situations is stimulated.
When fears and feelings of discomfort become conscious, then they can be dealt with productively.
Dream work and free associations are used to overcome the patient’s defences against deeply rooted feelings and fears.
Within the framework of cognitive-behavioural therapy for obsessive-compulsive personality disorder, the treatment goals are agreed upon in collaboration between patient and therapist; consequently, they differ from patient to patient.
In general, the therapy aims to alleviate the patient’s discomfort, achieving the changes necessary to enable him/her to live a more satisfying life.
Specifically, the fundamental objectives to be achieved with the patient are to
- to foster awareness and acceptance of one’s moods and emotions
- learning effective strategies for managing problematic situations;
- encourage flexibility on issues of morality and ethics;
- lowering excessively high performance standards;
- increase the ability to relax in leisure activities;
- develop the ability to establish more relaxed, informal, and intimate relationships;
- abandoning complacent behaviour on the one hand, dominant behaviour on the other.
The method used to achieve these objectives includes:
- the identification, questioning and subsequent modification of basic beliefs about oneself and the world;
- the identification and interruption of vicious circles between emotions, thoughts and behaviour;
- the use of the therapeutic relationship as a context in which to be oneself and experience unconditional acceptance by the therapist, which encourages and fosters self-acceptance;
- the use of relaxation techniques;
- gradual exposure to feared situations.
Obsessive-compulsive personality disorder: drug therapy
Pharmacological therapy is currently used as a support to psychotherapy, to treat some of the patient’s symptoms, if present.
Depression and anxiety are often treated with selective serotonin reuptake inhibitors (SSRIs). Antipsychotic drugs are used in the event of any productive symptoms.
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