We talk about obsessive-compulsive personality disorder when the affected individuals show rigid as well as perfectionistic thinking and acting. In doing so, they suffer from strong doubts and indecisiveness.
What is obsessive-compulsive personality disorder?
In medicine, obsessive-compulsive personality disorder is also known as obsessive-compulsive personality disorder or anancastic personality disorder. The term comes from the ancient Greek word ananke, meaning “compulsion” or “compulsiveness.” Typical features of obsessive-compulsive personality disorder are perfectionism, compulsion to control, mental inflexibility, anxious caution, and strong doubts. However, obsessive-compulsive personality disorder is quite different from the usual obsessive-compulsive disorders. Thus, obsessive-compulsive disorder represents an axis I disorder, in which primarily an ego-dystonic pattern of complaints occurs. The reason for this is disturbances in brain metabolism. Obsessive-compulsive personality disorder, on the other hand, is an axis II mental disorder. It is predominantly characterized by ego-syntonic complaints. Overall, approximately two to five percent of the population suffers from obsessive-compulsive personality disorder. It is twice as common in males as in females. It is not uncommon for anancastic personality disorder to be associated with depression. In addition, other obsessive-compulsive disorders may be present at the same time.
Causes
The exact causes of obsessive-compulsive personality disorder are not yet adequately known. They are not caused by other psychiatric disorders or direct brain damage. From a psychoanalytic perspective, strict and punitive cleanliness education is suspected. This resulted in a strongly developed so-called “superego” in the affected persons. Thus the patients make extremely high demands on order and cleanliness. At the same time, a strong inhibition prevails in them. Numerous psychoanalysts suspect that there were considerable power struggles with the parents for control in the patients’ childhood. These led to aggressive impulses which were suppressed by the patients. In this process, patients gain control over their behavior by stubbornly adhering to their habits and rules. However, scientific evidence for this theory hardly existed. Cognitive therapy assumes that specific thought processes are important in maintaining obsessive-compulsive personality disorder. For example, patients often exhibit marked black-and-white thinking. Furthermore, they exaggeratedly fear negative repercussions if they make mistakes themselves. This in turn results in perfectionistic, rigid, inflexible, and at the same time strongly procrastinatory behavior.
Symptoms, complaints and signs
The typical symptoms of obsessive-compulsive personality disorder are the conspicuous behaviors of the patients. Thus, they basically doubt themselves a lot, but also other people. A characteristic feature of anancastic personality disorder is that those affected take on a large number of tasks that are to be performed to perfection. In doing so, however, they often lose track of what is going on. Furthermore, the patients feel a permanent sense of control. Whether the tasks they complete are important or not is irrelevant. Those affected do not set certain priorities. While unimportant tasks are given priority, important things are neglected and pushed to the back. People suffering from obsessive-compulsive personality disorder often act reasonable and logical. However, they do not tolerate other people’s feelings. Moreover, they fail to show warmth towards their fellow human beings. Work and productivity take precedence over pleasure and social contacts. Leisure activities are carefully planned and never changed. Another characteristic of obsessive-compulsive personality disorder is stubbornness and selfishness. Thus, other people are required to be subordinate to the patient.
Diagnosis and course of the disease
To diagnose obsessive-compulsive personality disorder, clinical psychological examinations are required. In this process, the therapist looks at the patient’s medical history, makes psychopathological findings, and performs psychological tests.Crucial for the diagnosis is the presence of at least four typical characteristics or behaviors. These include the patient’s permanent preoccupation with order, rules, planning and details, excessive doubt and caution, perfectionism, which has an impeding effect on the completion of tasks, and excessive conscientiousness, which neglects interpersonal relationships and pleasure. Other possible criteria are obstinacy, rigidity, excessive pedantry as well as imposing unwanted thoughts. A cure for obsessive-compulsive personality disorder is not yet possible. Thus, neither pharmacologic nor psychotherapeutic treatment approaches have been adequately studied.
Complications
Many personality disorders co-occur with one or more forms. This is also true of obsessive-compulsive personality disorder. Anxious-avoidant personality disorder is most common in addition to obsessive-compulsive personality disorder. Three percent of those affected suffer from this additional personality disorder. Anxious-avoidant personality disorder may develop as a direct consequence of obsessive-compulsive personality disorder, as sufferers often fear not meeting their own (very high) standards. Obsessive-compulsive disorder can also occur as a complication of obsessive-compulsive personality disorder. These are characterized by obsessive thoughts or compulsive actions, whereby the affected person usually knows that the compulsion itself is senseless or excessive. Another possible complication of obsessive-compulsive personality disorder is affective disorders. Depressive disorder, in particular, occurs frequently. The spectrum ranges from mild depressive moods to chronic depressive mood (dysthymia) and major depression. Suicidality is possible as a complication of depression or depressed mood. In addition, obsessive-compulsive personality disorder can occur together with an eating disorder. Especially for anorexics, an excessive perfectionism is typical, which is also found in obsessive-compulsive personality disorder. However, other eating disorders are also possible. Other complications can occur as a result of an eating disorder, including severe physical consequences of the disease. Examples include electrolyte imbalances, neurological disorders, and osteoporosis.
When should you see a doctor?
People who exhibit behavior that can be described as off the norm should be evaluated by a physician. If there is deliberate injury of an emotional or physical nature to others or recurrent disturbances in social behavior, consultation with a physician is advised. Compulsive actions, severe self-doubt, and violation of social rules are cause for concern. If the execution of assigned duties is done to a constantly perfectionistic extent, this should be interpreted as a warning signal. People from the close social environment should point out the conspicuousness to the affected person. If the urge for perfectionism is continuously intensified, the affected person needs help. An addiction to control, the loss of a sense of reality and the assumption of innumerable tasks are further signs of a health irregularity. A creeping increase in behavioral abnormalities is characteristic. In some cases, the peculiarities appear after a fall, accident or violent impact on the head. In case of sudden as well as continuous conspicuities in appearance, there is a need for action. If there is a lack of tolerance, empathy and consideration towards other people, the procedure should be considered more closely. Part of the appearance of obsessive-compulsive personality disorder is the lack of insight on the part of the person affected. Therefore, the cooperation of a relative is often necessary. Only if there is a good relationship of trust with another person, the affected person seeks the advice of a doctor.
Treatment and therapy
Since a cure for anancastic personality disorder cannot be achieved, the focus of therapy is on improving the patient’s social skills. This also focuses on structuring his environment and applying what he has learned to everyday life. Sociotherapy and psychotherapy are considered the most important therapy concepts for this purpose.In most cases, however, patients do not go to a therapist on their own initiative, but because they are under strong social pressure from their partner or family. Of particular importance for the success of treatment is a sustainable relationship between therapist and patient, which should be strengthened right at the beginning of therapy. However, building this relationship can be a major challenge. Failure to successfully establish a good relationship usually results in the end of therapy. If there is a comorbidity such as depression, medications such as antidepressants can be administered. In the case of concomitant anxiety disorders, the patient is often given neuroleptics. Lithium as well as carbamazepine are considered other helpful medications.
Prevention
Preventing obsessive-compulsive personality disorder is unfortunately not possible. For example, the triggering causes of the mental disorder have not yet been fully researched.
What you can do yourself
If the affected person has recognized that he / she suffers from Obsessive-Compulsive Personality Disorder, the first step towards improvement has already been taken. However, there is now a long road ahead of the affected person until improvement occurs. Psychotherapy and sociotherapy are the measures that most often accompany this path. Insight is the first step. But it is important that sufferers become aware of their illness every day anew in order to recognize and break through patterns. Sufferers often withdraw from their social environment, if they are involved in one at all. This withdrawal is very destructive. If those affected know this about themselves, they have the chance to act against it and consciously seek contact with loving fellow human beings. The same applies to perfectionism and the need to control, from which most sufferers suffer. Once the sufferer is aware of this, he or she can take the necessary steps against it. It is a significant step to recognize that this behavior is detrimental to one’s own health. It is important to be aware of one’s own needs again and again in everyday life in order to sense limits to exhaustion in time. Self-help can only play a supporting role to therapy.