Obsessive Compulsive Personality Disorder - Part 2

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Definition – Obsessive-Compulsive Personality Disorder (OCPD) is a pervasive characterological disturbance involving one’s generalized style and beliefs in the way one relates to themselves and the world. Persons with OCPD are typically deeply entrenched in their dysfunctional philosophy and genuinely see their way of functioning as the “correct” way. Their overall style of relating to the world around them is processed through their own strict standards. While generally their daily experience is such that “all is not well,” they tend to be deeply committed to their own beliefs and patterns. The depth of ones belief that “my way is the correct way” makes them resistant to accepting the premise that it is in their best interest to let go of “truth owning.” Yet letting go of truth is paramount in their recovery.

Submitted: August 13, 2010

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Submitted: August 13, 2010

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In a conflict with someone who has OCPD, the non-OCPD person might be motivated to desperately seek closure. In the process of attempting conflict resolution, the non-OCPD might discover that every minute the quagmire becomes deeper and deeper. It is almost as if the mere effort to find resolution is a punishable offense. In a close relationship, encountering this zone of contempt is bewildering and frightening. All one wants to do is to bring this controversy to an end, and then, you are punished for not being willing to deal with the issue at hand. Within this zone, the person with OCPD feels a great need to bring about absolute clarity for the issue to be resolved. Once again this need for the perfect resolution creates a seemingly never ending tweaking of the issues. Agreeing to disagree is rarely a reasonable solution and often not in the scope of the OCPD’s world.

Interpersonal Relationships - For many who have close contact with an OCPD sufferer there can be a pervasive experience of being ill at ease, while in the company of someone with OCPD. Often, being with persons who evidence this diagnosis, feels like walking in a field of land mines. One never knows when you’re going to step on one and pay a heavy emotional price for crossing the rigid standards. This ever-present threat creates a tremendous amount of trepidation, resentment, and tension.

Within marital or familial relationships the divisiveness of this condition is most felt. Since ideology and correctness is placed before love and loyalty, divisiveness can break familial ties. Spouses can be subjected to daily scrutiny and given repeated feedback in a non-loving or supportive manner. The standard bearer must run his or her house like a tight ship—from the children being kept in line (seen but not heard) to the outside appearance of the house, well manicured and tidy. The expression, both physically and emotionally, of tender feelings for “loved ones” is often painfully absent. Corporal punishment is not unusual since the mentality of “spare the rod and spoil the child” is even endorsed in the Bible. Wreaking humiliation seems to be just punishment since it closely approximates the inner experience of the OCPD sufferer’s reaction to being wronged.

In interpersonal relationships we all tend to hope for a little leeway in being given feedback for mistakes that we make. Persons with OCPD tend not to find it within themselves to provide a nurturing environment where being human and fallible is expected. Instead they feel put upon by others’ mistakes and take license in extracting a heavy toll for even an initial infraction—“Person’s should know better and mistakes are just not to be tolerated.” Often others in the presence of an OCPD sufferer find themselves embroiled in heated conflict over issues, which pertain to seemingly trivial topics. It is not uncommon to become convinced that the OCPD sufferer actually takes delight in the heated nature of conflict. For those familiar with the OCPD’s style, bailing out of a conversation and avoiding future areas of debate, is a pervasive response pattern. Not surprisingly this style of interaction has devastating effects on the great majority of relationships persons with OCPD have. Faultfinding is the tendency for OCPD’s to chronically pick out the flaws in others, especially those close enough to them to mention it. It seems as if through criticism the receiver of the feedback will be inspired to get their act together.

For the OCPD sufferer, it is not uncommon for him to seek out the company of a significant other where his partner’s personal disposition is that of being passive and non-conflictual. For a long-term significant relationship to survive with this diagnosis, it is almost essential for the partner to have great depths of resilience or dependency. Many OCPD relationships involve a clear distinction between the domineering and controlling spouse and the passive-dependent spouse.

Aspirations for perfection can play themselves out in interpersonal relationships as well. Since all humans carry a significant amount of emotional baggage it typically doesn’t take long in a dating or marital situation to discover our partners’ flaws. For someone with OCPD choosing a partner who lives up to there unreasonably high standards is very difficult, if not impossible. Remaining invested in a relationship without bouts of volatility over the long haul is highly unlikely. For those who do remain in long term relationships chronic discord tends to be pervasive.

Isolation due to rigidly held high standards is also a common result of OCPD. When perfectionistic standards are applied toward a partner’s minute bodily defects or quirky personal style, the devastation wreaked within intimacy is astounding. When this aspect of OCPD is manifested there is typically a pattern of failed relationships. The sufferer tends to consistently withdraw from a relationship soon after the development of intimacy. The awareness of the defect in one’s partner as time goes on becomes so magnified, that after a while, the slight flaw which was not even noticed initially, becomes the only feature which is seen.

Poor social skills are often a consequence of a life-long pattern of rigid thinking. Being motivated to attend to subtle cues within one’s social environment is lost due to the overriding perspective that “my way is the right way.” Taking liberty to disclose radical opinions or facts, which are of an extreme nature, in the presence of a novel relationship or non-intimate acquaintances is a common characteristic. Whereas in a novel social setting, decorum pressures persons to withhold extreme positions, the OCPD sufferer feels that a lack of genuineness is wrong and being totally open, no matter what the consequence, is the only option. “If others are offended by what I say, too bad for them.”

Friendships (how ever long lasting they may be) are often tenuous at best. Persons with OCPD, at the more extreme end of the continuum, project an air of consternation and rigidity. The eventual breakdown of casual relationships comes as a consequence of chronic tension and failed expectations. The internal schema (style of viewing life circumstances) of the sufferer is incapable of learning from these repeated failures due to the dogged conviction that the other person was at fault, and therefore the termination of the relation was justified.

Strict Moral Standards - Moral righteousness and preaching morality as a dogmatic necessity is not an uncommon expression of OCPD. The avoidance of discussing religion or politics is certainly wise in the presence of the OCPD sufferer. Both of these realms are steeped in the potential for the OCPD sufferer’s truth to override consideration and respect.

Excessive religious observance as in, strict adherence to ritualistic aspects of daily or weekly routines, is a potential component of OCPD. Often persons with this form of OCPD, believe in literal interpretations of the Bible or Koran. Adamantly endorsing the idea that the world was created some 5864 years ago, despite the existence of rocks carbon dated to over a million years ago, would not be unexpected. Using the Wrath of God as a means of modifying behavior is often an unfortunate component of OCPD. Of course, religious intolerance is not surprisingly a derivative of this style of thinking. Finding fault with different views or creating fractions within divergent religious sects is not uncommon.

Treatment

The treatment of OCPD is incredibly complex and lengthy. Generally speaking the focus of Cognitive-Behavioral treatment for OCPD entails helping these individuals develop a greater tolerance to the notion that the world is exclusively made up of gray, not the clearly defined black and white lines of rigidly held beliefs. As is the case with all treatments there is an utmost emphasis on developing rapport and trust within the therapeutic relationship. Educating the client about the diverse nature of this condition offers the sufferer the option to identify those aspects of OCPD, which are most salient to their own lives. Having the client identify that these dispositions are a handicap at all is a monumental achievement. The treatment would most likely focus on breaking down and intervening on specific individual aspects within the spectrum of OCPD. A standard cognitive-behavioral intervention might deal with the hoarding (using exposure and response prevention methods), while social skills training and role-playing might help facilitate a more effective style in relationships. Assertiveness training would facilitate one’s ability to make requests or provide feedback such that the receiver of the information not is alienated. Overriding all of the specific interventions would be an achieved sensitivity to helping the sufferer relinquish their dogmatic belief system. Letting go of “truth owning” and relating to one’s world without needing to be “right” is a tremendous ambition. The dividend it pays is incomprehensible.

As has been previously stated, the existence of OCPD has devastating effects on relationships. The therapeutic relationship is unfortunately not excluded. Therapists may well be advised to forewarn all persons with OCPD that at some point in the course of therapy the clinician will inadvertently behave in a manner, which will violate the client’s perfectionistic standards. Rather than responding by terminating the relationships, this juncture provides the client with an opportunity to learn how to manage the conflict. Playing out conflict resolution in the course of therapy can be a powerful therapeutic tool. Being real and available to the client is critical. Once rapport has been established, giving honest and immediate feedback about the dynamics within the therapeutic relationship is imperative. Keeping the channels of communication open so that at the point where the client most desires ending the relationship, becomes the point where effective communication can take place to strengthen the foundation of the partnership. In all honesty, approximately 50% of OCPD clients remain on board for the long haul. Rather than seeing the actual conflict within the therapeutic relationship as the unavoidable manifestation of why they came into therapy in the first place, many bail prematurely due to the overwhelming sense of outrage that the doctor has made a mistake.

Personality disorders are typically some of the most challenging mental disorders to treat, since they are, by definition, an integral part of what defines an individual and their self-perceptions. Treatment most often focuses on increasing coping skills and interpersonal relationship skills through psychotherapy. The overwhelming preoccupation with orderliness, perfectionism and control of their lives and relationships means that most types of treatment are going to be, at best, difficult. Treatment options that do not fit within the client’s cognitive schema will likely be quickly rejected rather than attempted.

Psychotherapy - As with most personality disorders, individuals seek treatment for items in their life that have become overwhelming to their existing coping skills. These skills may be somewhat limited, in the first place, because of their disorder. While they may be generally effective enough in most instances to shield the client from stress and emotional difficulties, during times of increased stress, work pressure, family problems, etc. the underlying disorder will become more evident in day-to-day behaviors. As with most personality disorders, treatment is often focused on short-term symptom relief and the support of existing coping mechanisms while teaching new ones. Long-term or substantive work on personality change is usually beyond most clinician’s skill levels, and patient’s budgets. Obsessive-compulsive personality disorder is especially resistant to such changes, because of the basic makeup of this disorder.

Short-term therapy will most likely be beneficial when the patient’s current support system and coping skills are examined. Those skills that are not currently working could be reinforced with additional skill sets. Social relationships can also be examined, reinforcing strong, positive relationships while having the client re-examine negative or harmful relationships. One important aspect is to try and have the individual examine and properly identify their feeling states, rather than just intellectualizing or distancing themselves from their emotions. This can be accomplished through a variety of techniques, such as feeling identification at the onset of every therapy session. Homework might include writing feelings down in a journal, especially as they notice them. Proper identification and realization of feelings can bring about much change in and of itself.

Individuals suffering from OCPD often are not in touch with their emotional states as much as their thoughts. Leading the client away from describing situations, events, and daily happenings and to talking about how such situations, events and daily happenings made them feel may be helpful. Sometimes the patient may complain he or she doesn’t remember or know how he or she felt at the time; the journal becomes a useful tool at this point.

Therapy with people who have this disorder can sometimes be trying, since they can see the world in a very “all-or-nothing” manner. Beck’s cognitive therapy doesn’t seem to be all that effective in treatment, and cognitive approaches in general probably aren’t useful in this case. Clinicians must be willing to undergo verbal attacks on their professionalism and knowledge, as such skepticism about a therapist’s treatment approach from the client with this disorder can be expected. Clinicians should also be careful about engaging the client within these verbal attacks or intellectual discussions, as they continue to distance the patient from his or her feelings, and take the focus off of the client and onto unrelated matters (e.g., a therapist’s professional training).

Most people who suffer from this personality disorder (and the different, but related, obsessive-compulsive disorder) lead relatively normal lives, may have a family, friends, and work regularly. Clinicians should be careful not to over generalize psychopathology and look to change aspects of the patient’s personality he or she is not ready or willing to change. This means, in effect, that if the way they relate to others in their environment (which a clinician might characterize as a personality disorder) is working for them, a clinician should not seek to change it 180 degrees without the client’s purposeful consent. Therapy will most often be most effective when it focuses on correcting short-term difficulties currently being experienced. It will become increasingly less effective when the goal of therapy is complex, long-term personality change.

Although a group therapy modality may be helpful and an effective treatment option, most people who suffer from this disorder will not be able to withstand the minimum social contact necessary to gain a healthy group dynamic. They may quickly become ostracized by the group for pointing out other people’s deficits and “wrong-headed” ways of doing things.Medications such as selective serotonin reuptake inhibitors (for example, Prozac) may help reduce obsessions and compulsions.

Medications in combination with talk therapy may be more effective than either treatment alone.

The Demensional Perspective - Here is a hypothetical profile, in terms of the personality, for sufferers of OCPD:

High Neuroticism

Chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame; difficulty in inhibiting impulses: for example, to eat, drink, or spend money; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self, unwarranted pessimism; unfounded somatic concerns; helplessness and dependence on others for emotional support and decision making.

High Extraversion

Excessive talking, leading to inappropriate self-disclosure and social friction; inability to spend time alone; attention seeking and overly dramatic expression of emotions; reckless excitement seeking; inappropriate attempts to dominate and control others.

High Openness

Preoccupation with fantasy and daydreaming; lack of practicality; eccentric thinking (e.g., belief in ghosts, reincarnation, UFOs); diffuse identity and changing goals: for example, joining religious cult; susceptibility to nightmares and states of altered consciousness; social rebelliousness and nonconformity that can interfere with social or vocational advancement.

High Agreeableness

Gullibility: Indiscriminate trust of others; excessive candor and generosity, to detriment of self-interest; inability to stand up to others and fight back; easilty taken advantage of.

High Conscientiousness

Overachievement: workaholic absorption in job or cause to the exclusion of family, social, and personal interests; compulsiveness, including excessive cleanliness, tidiness, and attention to detail; rigid self-discipline and an inability to set tasks aside and relax; lack of spontaneity; over-scrupulousness in moral behavior.

Conclusion

My intentions to further advance the knowledge of OCPD I feel I have accomplished. It is with heartfelt admiration for my friend that I have done so. And I completely accept the idea that this ‘condition’ is an illness and not necessarily a behavior that is purposely expressed.

Among other resources used, most of the credit must be given to Steven Phillipson, Ph. D., Center for Cognitive-Behavioral Therapy, for his article titled The RIGHT Stuff – Obsessive-Compulsive Personality Disorder: A Defect of Philosophy not Anxiety. His paper thoroughly examines causes and affects not only of the sufferer but also how a sufferer can affect other individuals who are close to them. Such knowledge was imperative for me to understand why my friend behaves lots of times in an abrasive manner. Steven Phillipson’s complete article is at http://www.ocdonline.com/articlephillipson6.php.

Other resources are:

PSYwebb.com http://psyweb.com/Mdisord/jsp/ocpd.jsp

MentalHelp.net http://mentalhelp.net/poc/view_doc.php?type=doc&id=480&cn=8 The End


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