Obsessive-compulsive personality disorder: psychotherapy, medication

Personality disorders are a group of ten disorders grouped into three groups (also called “clusters”) on the basis of descriptive similarities.

Obsessive-compulsive disorder is included in group C

It encompasses three personality disorders characterized by low self-esteem and/or high anxiety and in which people often seem anxious or fearful.

  • Avoidant personality disorder: sufferers tend to completely avoid social situations for fear of negative judgments from others, thus exhibiting marked shyness;
  • dependent personality disorder: sufferers have a strong need to be cared for and cared for by others, thus delegating all their decisions;
  • obsessive-compulsive personality disorder: the patient shows a marked tendency to perfectionism and precision, a strong concern for order and control over what is happening.

Obsessive-compulsive personality disorder

Obsessive-compulsive personality disorder (also called ananchastic personality disorder or obsessive personality disorder) is characterized by a set of rigid personality responses, behaviors, and feelings that manifest in multiple domains.

The subject tends to excessively and inflexibly conform to procedures, habits or rules, and also has repetitive thoughts or behaviors, the latter being doomed to constant control of the situation and to a perfectionism which, s If it is not reached and maintained, can transmit a strong feeling of anxiety in the patient.

Anxiety manifests itself particularly when

  • the subject’s usual and repetitive procedures are altered, for example by an unexpected situation or by other people;
  • the standards tending to perfectionism are not respected, even with minimal deviations between the expected objective and the achieved objective.

The general attitude of the patient is that of an iron inflexibility of judgment (sometimes tending to moralism), a desire for order and fidelity to routine, an anxiety in the face of a world that surrounds that often appear messy and uncontrollable.

Defense mechanisms typical of the obsessive personality are avoidance, withdrawal, reactive drive, isolation from affection, and intellectualization.

Obsessive-compulsive personality disorder should be distinguished from obsessive-compulsive (neurotic) disorder

Obsessive-compulsive disorder is an anxiety disorder dominated by recurrent thoughts with unpleasant content and is characterized by the establishment of ritual behaviors that the subject is compelled to perform: these symptomatic manifestations are egodystonic, in the sense that the patient recognizes them as problematic and wishes to get rid of them, but he is unable to do so.

On the contrary, the traits that constitute the particularity of the obsessive-compulsive personality disorder, described above, are egosyntonic and do not cause discomfort: on the contrary, the subject sees his disorder positively and often does not even know that he has it, considering his actions as a positive trait of his personality and not as a disease.

Obsessive-compulsive disorder and obsessive-compulsive personality disorder can, however, coexist in the same subject.

Psychotherapy

Psychodynamic approaches focus primarily on the interpretation of repressed and repressed elements, from which the symptoms exhibited by the patient are thought to derive.

They use the therapeutic relationship as a starting point to explore prior relationships that may have determined the development of symptoms.

Early traumas are studied.

Recognition of 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, they can be dealt with productively.

Dreamwork and free associations are used to overcome the patient’s defenses against deep-seated feelings and fears.

In cognitive behavioral therapy for obsessive-compulsive personality disorder, treatment goals are collaboratively agreed between patient and therapist; therefore, they differ from patient to patient.

In general, the therapy is aimed at relieving the patient’s discomfort, making the necessary changes to allow him to live a more satisfying life.

More specifically, the fundamental objectives to be achieved with the patient are to

  • promote awareness and acceptance of one’s moods and emotions
  • learn effective strategies for dealing with problematic situations;
  • encourage flexibility on questions of morality and ethics;
  • lower 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 behaviors on the one hand, dominant behaviors on the other.

The method used to achieve these objectives includes:

  • the identification, questioning and subsequent modification of fundamental beliefs about oneself and the world;
  • identifying and breaking vicious circles between emotions, thoughts and behavior;
  • using the therapeutic relationship as a context in which to be yourself and experience unconditional acceptance by the therapist, which encourages and fosters self-acceptance;
  • the use of relaxation techniques;
  • progressive exposure to feared situations.

Obsessive-compulsive personality disorder: drug treatment

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 case of productive symptoms.

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