Obsessive-Compulsive Personality Disorder Treatment
Obsessive-compulsive personality disorder (OCPD) is one of the most common personality disorders in the general population. Individuals with OCPD are preoccupied with order, perfection, and control—which tends to make them inefficient and to alienate others.
For instance, individuals with OCPD might be unable to complete a project because their own rigid standards haven’t been met. They might be excessively devoted to work to the detriment of their relationships. They might be unable to get rid of worn-out or worthless objects (even when they have zero sentimental value). They might hoard money. They might hesitate to delegate tasks or collaborate with individuals unless they do things their way.
OCPD commonly co-occurs with anxiety disorders, including panic disorder, generalized anxiety disorder, and social phobia; mood disorders; and substance-related disorders. OCPD appears to frequently co-occur with paranoid and schizotypal personality disorders. It’s also common in individuals with medical conditions, such as joint hypermobility syndrome/Ehlers-Danlos syndrome hypermobility type and Parkinson’s disease.
In addition, there’s overlap between OCDP and obsessive-compulsive disorder in some individuals.
Even though OCPD is so prevalent, the research on it is scant. What we do know is that psychotherapy is critical and forms the foundation of treatment. Also, preliminary research suggests that some medications may be helpful in reducing OCPD traits.
While psychotherapy is the mainstay treatment for obsessive-compulsive personality disorder (OCPD), there’s little information on which treatment is best. Most of the literature on treatment comes from case studies and uncontrolled trials.
According to a 2015 review, recent research suggests that cognitive therapy and cognitive behavioral therapy are helpful.
Cognitive therapy (CT) focuses on challenging and changing core beliefs or schemas that impair individuals’ functioning, cause distress, and hinder their relationships. These core beliefs include: “I must avoid mistakes at all costs,” “There is one right path, answer, or behavior in each situation,” and “Mistakes are intolerable.” Individuals with OCPD need complete control over themselves and their environment. They typically avoid emotions and ambiguous situations, which creates relationship problems. They also believe that disasters and mistakes can be prevented by worrying about them.
In CT, therapists and clients identify specific treatment goals, and the underlying thoughts and beliefs associated with these goals. Individuals learn the significant role perfectionism plays in producing and perpetuating their symptoms. They learn to evaluate the underlying assumptions and core beliefs that maintain perfectionism and rigidity. They learn relaxation techniques and mindfulness practices.
Also, instead of disputing certain beliefs, therapists help clients to conduct behavioral experiments to test them. For instance, individuals might compare their productivity levels on the days they use relaxation techniques with the days they don’t.
Several older case studies have provided some evidence for metacognitive interpersonal therapy (MIT) for individuals with OCPD. MIT consists of two main parts: stage setting and change promoting. In the first part, clients discuss the details of different autobiographical episodes and try to pinpoint cause and effect, such as how an emotion triggered a certain behavior. More episodes are discussed, so hypotheses can be formulated about underlying interpersonal patterns. In the second part, clients are encouraged to find different ways to think about their problems and identify creative solutions to conflict.
Some research suggests that psychodynamic psychotherapy is effective in treating OCPD. For example, in supportive-expressive therapy, the clinician creates a core conflictual relationship theme (CCRT). This includes the person’s main wishes, how they view or anticipate others to respond to them, and how the person feels, thinks, or behaves. The therapist uncovers this information by f0cusing on the person’s narratives about their present and past relationships.
Dialectical behavior therapy (DBT), which was originally developed to treat borderline personality disorder, has been investigated for OCPD. In 2013, researchers tested DBT’s effectiveness in four individuals with a cluster C personality disorder. They found “significant improvement in depression, anger, perceived anxiety control, and global functioning.”
A 2014 study found schema therapy (ST) to be effective for individuals with cluster C personality disorders, including OCPD. ST includes cognitive, experiential, behavioral, and interpersonal techniques. For example, individuals may process negative childhood experiences and see how they connect to their present problems. The therapist uses a technique called “limited re-parenting,” where they partly meet client’s unmet childhood needs while maintaining healthy therapy boundaries.
In a different case study, two forms of cognitive behavioral therapy (CBT) were combined to effectively treat a graduate student with OCPD.
The first phase of treatment used skills training in affective and interpersonal regulation (STAIR). STAIR helps individuals learn to experience their feelings without getting overwhelmed, such as becoming more aware of their feelings and learning to manage emotions that interfere with relationships. It also helps clients improve their interpersonal skills. The second phase used CBT for clinical perfectionism/rigidity. This treatment helps individuals understand what maintains their perfectionism; conduct behavioral experiments to learn alternate ways of living; and modify problematic personal standards and unhelpful cognitive biases.
Overall, more rigorous research—such as randomized controlled trials—is needed to confirm the treatments that are highly effective for OCPD.
There is no FDA-approved medication for obsessive-compulsive personality disorder (OCPD). Similar to psychotherapy for OCPD, the research on medication has been very limited.
A 2015 review noted that some preliminary research has shown that carbamazepine (Tegretol) and fluvoxamine (Luvox) may reduce OCPD traits in individuals who only have OCPD, and citalopram (Celexa) may help individuals with both OCPD and depressive symptoms.
Tegretol is an anticonvulsant that has these common side effects: nausea, vomiting, dizziness, drowsiness, swollen tongue, and a loss of balance or coordination.
Both Luvox and Celexa are selective serotonin reuptake inhibitors (SSRIs), whose side effects include: nausea, dizziness, drowsiness, sleep problems, and decreased sex drive.
Medication may be prescribed for co-occurring conditions. For example, a doctor might prescribe an SSRI to treat clinical depression or panic disorder.
Self-Help Strategies for OCPD
The best approach to managing obsessive-compulsive personality disorder (OCPD) is to work with a therapist. However, self-help strategies can complement your sessions. Here’s a selection of tips to try:
Become more aware of your thoughts. Often you don’t even realize when your automatic thoughts are unhelpful and perpetuating your rigid mindset. Take a look at these common cognitive distortions on a daily basis. When you notice that you’re thinking one of these distortions, try a different approach.
Target perfectionism. Because perfectionism can lead to inefficiency at work and other challenges, it can help to find a resource on reducing perfectionism that resonates with you. For instance, you might use The CBT Workbook for Perfectionism or The Perfectionism Workbook.
Practice relaxation techniques. Because you might struggle with rumination and worry, try relaxation techniques, such as deep breathing, progressive muscle relaxation, and guided meditation. These are also great ways to practice self-care in general. Make relaxation practices part of your routines, so they fit seamlessly into your days: Listen to a 5-minute guided meditation before breakfast, on your lunchbreak, and before bed.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Bamelis, L.L., Evers, S.M., Spinhoven, P., Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 3, 305-322. DOI: 10.1176/appi.ajp.2013.12040518.
Carrotte, E, and Blanchard, M. (2018, June). Understanding how best to respond to the needs of Australians living with personality disorder. Melbourne. Prepared by SANE Australia for the National Mental Health Commission. Retrieved from https://www.sane.org/images/NMHC_SANE_PD_Report.pdf.
Diedrich, A., Voderholzer, U. (2015). Obsessive-compulsive personality disorder: A current review. Current Psychiatry Reports, 17, 2. DOI: https://doi.org/10.1348/147608310X527240.
Dimaggio, G., Carcione, A., Salvatore, G., Nicolo, G., Sisto, A., Semerari, A. (2010). Progressively promoting metacognition in a case of obsessive-compulsive personality disorder treated with metacognitive interpersonal therapy. Psychology and Psychotherapy: Theory, Research, and Practice, 84, 70-83. DOI: 10.1348/147608310X527240.
Leichsenring, F., Leibing, E. (2007). Supportive-expressive (SE) psychotherapy: An update. Current Psychiatry Reviews, 3, 57-64.
Navarro Haro, M., Palacios, A.G., Moliner, R., Guillen, V., Botella, C. (2013). Dialectical behavior therapy in the treatment of cluster C personality disorders. Behavioral Psychology, 21, 2, 321-340.
Simon, Karen M. (2015). Obsessive-compulsive personality disorder. In Aaron T. Beck, Denise D. Davis & Arthur Freeman (Eds.), Cognitive therapy of personality disorders (3rd ed., pp. 203-222). New York, NY: Guilford Press.
Tartakovsky, M. (2020). Obsessive-Compulsive Personality Disorder Treatment. Psych Central. Retrieved on August 3, 2020, from https://psychcentral.com/disorders/obsessive-compulsive-personality-disorder/treatment/