Obsessive-Compulsive Personality Disorder (OCPD)

The obsessive-compulsive personality disorder in the psychiatric population is the third most common personality disorder. It is characterized (DSM-5) based on some specific personality traits: concern for details, perfectionism, excessive devotion to work and productivity, extreme conscientiousness, difficulty in delegating tasks, difficulty in throw unnecessary objects, avarice, stubbornness, and rigidity.

This disorder is associated with difficulty in psychosocial functioning and reduced quality of life.

Traits of Obsessive-Compulsive Personality disorder patient:

Individuals with this disorder have a moderate level of difficulty in the functioning of the personality that manifests itself in the following areas i.e. identity, intimacy, empathy, ability to self-direction. Beyond a strict perfectionism, two or more of the following psychopathological personality traits may be present. It includes strict affectivity, avoidance of intimacy.

Individuals with obsessive-compulsive personality disorder always feel they obliged to achieve goals and struggle to dedicate themselves to moments of pleasure and relaxation. They control others, and if others escape control, they become hostile and may have occasional outbursts of anger both at home and at work.

Always considering the domain of interpersonal relationships, the quality of attachment is compromised in the obsessive-compulsive personality disorder. It emerges that often, a secure attachment has not been formed, and patients have received little care and excess protection during childhood with a subsequent failure in emotional and empathic development.

It is also important to also consider relatively recent circumstances that may have contributed to the crystallization of a pathogenic scheme. The pathogenic interpersonal scheme is an intra-psychic procedural structure consolidated over time through experiences, a subjective representation of destiny to which our desires will meet in the course of relations with others.

A subject with an obsessive-compulsive personality disorder may have the desire for autonomy and exploration but imagine that if he spontaneously shows his emotions and tendencies. The other will show himself to be critical, aggressive, punitive, and imposed; in response, the subject feels fear and awe and controls emotions (emotional inhibition) and behavior. 

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Treatment:

The strategies that the subject develops over time to adapt to the expectation of how the other will treat his desires elicit, in turn, in the other emotional and behavioral responses. Unconsciously, it confirm the initial negative beliefs of the person, generating, thus, a pathogenic interpersonal cycle that helps to maintain the disorder. Think, for example, of the common tendency in the obsessive-compulsive personality disorder to overload himself with commitments, tasks, with great difficulty in delegating or asking for help.

The other, on his part, not listening to the requests for help, and indeed facing the obligatory self-sufficiency of the patient with obsessive-compulsive personality, prefers to keep his distance, feeling his help useless and his interventions as inadequate and criticized. The patient, however, in some moments, overloaded with work and irritable due to fatigue, bursts out angrily at the sight of the other who does not support him and protests for the support that he has been denied immorally. The other, at this point, feel easily unfairly criticized and reacts to accusations in ways that diminish his willingness to give the help itself.

Consistent with the information gathered from clinical experience, it is possible to outline in the obsessive-compulsive personality disorder a series of interpersonal patterns that move from different motivations:

Dominant motivation: In this case, the strategy will lead the person to the desire to be seen, loved, appreciated, but the other is represented as cold, rejecting, inattentive. In response, the social rank system is activated. These people hope that they will be loved if their value is considered adequate by the reference figures. At that point, then, they engage, organize, plan, try to be always prepared, to give their best, to be impeccable, perfect, and adhering to the rules.

Motivation: self-esteem. The person wishes to be capable, adequate, but he represents the other as critical, debilitating; in response, the person feels anger, feels sad, fails, and develops the obsessive trait as a strategy to make up for the sense of personal ineffectiveness. This leads to states of overload, physical and mental fatigue that is often expressed through a series of rather relevant psychosomatic symptoms combined with hypochondriac concerns and which include, for example, gastritis, irritable bowel syndrome, abdominal and intercostal pain.

 Motivation: autonomy / exploration. The actions and choices of everyday life are not associated with the feeling of being internally generated. In fact, subjects with obsessive-compulsive personality disorder are guided, for the most part, by their high and inflexible standards of ethics and performance. But they difficulty recognizing that they have desires, intentions, goals that arise from their most intimate inclinations, and allow themselves to be guided by them without judging yourself. It follows inhibition of the exploratory system and a lack of agency.

A possible historical origin deduced from the stories of many patients with an obsessive-compulsive personality disorder is that when they tried to explore and pursue autonomous plans, they had to deal with disabling parenting figures, easily disappointed, critical, or harshly punitive. In response, they felt fear; they lost belief in desire, giving up exploration and blocking spontaneous self-generated plans.

The patients with an obsessive-compulsive personality disorder, also because of the difficulty in establishing priorities among its tasks, often feel as blocked, suspended, believing that time is never enough and committed enough and as a result, struggle to meet deadlines.

From an emotional point of view, subjects with obsessive-compulsive personality disorder are convinced that their feelings and emotions must always be controlled, basically because they are considered as intrinsically wrong, a sign of moral weakness.

The idea of ​​experiencing something that they deem unworthy exposes them, in their mind, to the risk of blame, accusations, and eventually, abandonment by others or punishment. On the whole, therefore, they try to control their affections and appear rigid, formal, and difficult to let go, so as to be called cold and not very expansive.

They often feel anger towards themselves when they do not respect standards or towards others when they do not behave with due zeal. Their anger is not explosive; it is more restrained, controlled; it appears on the face and tone of voice even more than in the language.

The understanding of one's thoughts, one's emotions, fluctuates in the same person as the quality of relationships varies. Recall that in patients with personality disorders, metacognition depends largely on the emotional context and the quality of the relationship.

In general, in patients with personality disorders, metacognition is dysfunctional: patients with obsessive-compulsive personality disorder correlate with rigid personality styles and adhere inflexibly to the rules.