The RIGHT Stuff
Obsessive Compulsive Personality Disorder: A Defect of Philosophy, not Anxiety
by Steven Phillipson, Ph.D.
Clinical Director, Center for Cognitive Behavioral Psychotherapy
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 beliefs 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. For the purposes of this article "truth" is defined as a person's rigidly held belief which s/he feels is universally applicable. Most often, blame for ones internal strife, is placed on external circumstances or the environment.
OCPD and Obsessive Compulsive Disorder (OCD) are often confused as they are thought of as being similar. There is, however, a great difference between the two conditions. Persons with OCD experience tremendous anxiety related to specific preoccupations, which are perceived as threatening. Within the condition of OCPD it is one's dysfunctional philosophy which produces anxiety, anguish and frustration. It has been well established that OCD is a condition in which people perform elaborate rituals to avoid or escape anxiety. Repetitive rituals are performed to undo the threat. Their overall genuine nature tends not to be affected by the condition and in the vast majority of the cases they recognize that the concerns are irrational. A person with washing rituals due to fears about contracting aids from a public door knob might still be very willing to sky dive or go white water rafting. This suggests that a person's inclination toward risk taking is not affected by their anxiety about germs.
This paper will attempt to convey a personality style that has devastating effects on one's emotional wellbeing, work productivity and interpersonal relationships. Although there is a moderate overlap between OCPD and OCD in regard to similarity of rituals, the pervasive differences might justify a relabeling (such as perfectionistic personality disorder) of this condition. OCPD wreaks havoc within a person's life due to a dysfunctional perspective. The movie "As Good as It Gets" unfortunately portrays a muddled combination of these two conditions, although it was touted as the OCD movie. The main character engages in a variety of OCD rituals, yet his overall demeanor is that of an angry, belligerent, intolerant loner who clearly has an exaggerated form of OCPD as his main handicap.
For those who have OCD, reading this paper will be very provocative. Not only are some of the characteristics similar to the population at large but there is going to be an unsettling degree of similarity between OCD and OCPD. If you have OCD, please do not read this paper and attempt to diagnosis yourself. It is not in the surface similarities that the distinction is made between the two conditions. Instead the distinction lies within the underlying rationale of these key elements. It requires vast training and clinical experience to distinguish the subtle but drastic contrast between the two conditions. Making an accurate diagnosis is therefore best left up to a qualified specialist. The purpose of this paper is to qualify aspects of this condition so that those who see glaring similarities to themselves or significant others may be better informed and possibly seek treatment. OCPD is a pervasive condition involving ones life philosophy where the characteristics are vast and complicated. To qualify for a diagnosis of OCPD one need not possess all of the following manifestations nor is one or two similarities sufficient.
A combination of the following dispositions in an extreme form is generally grounds for a diagnosis.
Generally two hallmark thinking styles are pervasive for persons who suffer this condition. The primary manifestations of OCPD entail either a bent toward perfectionistic standards or righteous indignation. Along with perfectionism comes relentless anxiety about not getting things perfect. Getting things correct and avoiding at all costs the possibilities of making an error is of paramount importance. This perspective produces procrastination and indecisiveness. The second factor entails the rigid ownership of truth. This feature produces anger and conflict. Persons with OCPD generally lean toward one of these perspectives or another. In some cases both perspectives are of equal magnitude. Rituals, on the other hand, often play a relatively small part in this complex syndrome of perfectionistic mannerisms, intense anger and strict standards. Their way is the correct way and all other options are "WRONG". Anger and contempt are rarely held at bay for those who disagree.
The Diagnostic and Statistical Manual of Mental Disorders (DSM III-R, the bible for persons in the mental health profession)suggests that persons with OCPD display a pervasive pattern of orderliness, perfectionism, and/or mental and interpersonal control, at the expense of flexibility, openness, and efficiency. It is further suggested that persons with this condition tend to resist the authority of others while simultaneously demanding that others conform to their way of doing things. The DSM III-R's pervasive focus relates to the person's inability to attain completion of tasks due to the inordinately high standards, which are placed on almost all aspects of living.
Clients tend not to enter therapy for the express purpose of being treated for OCPD. Typically a diagnosis will be made by the clinician after other topics have been explored. Why seek out the help of others when one possesses ultimate knowledge. Perhaps this trend will now change due to an increasing awareness of the manifestations of this condition. Three pervasive rationales for entering therapy have entailed: seeking treatment for OCD rituals, which are becoming burdensome; a generalized dysphoric experience thought to be related to depression or social isolation; and/or marital discord where they have received an ultimatum from their spouse to "get help or get out."
Associated features, according to the DSM III-R, often entail, distress related to a tremendous amount of indecisiveness, difficulty expressing tender feelings and a depressed mood. From my own clinical observations it seems that emotional and cognitive rigidity are the hallmark indices suggesting the existence of OCPD. When events stray from what a person's sense of how things "should be," bouts of intense anger and emotional discord are characteristic.
Indecisiveness: When almost all decisions seem to take on the same paramount importance and being correct is imperative, making even simple choices can become a nightmare. Persons with OCPD can become stymied in life due to an inability to establish with certainty which choice is the correct one. Not unusual would be for someone to spend over ten minutes attempting to choose the correct pair of socks which best matches their tie. They tend to place a great deal of pressure on themselves and on others to not make mistakes. Within OCPD the driving force is to avoid being wrong. In contrast, the underlying rational for someone with OCD would typically be to make the correct decision so that nothing superstitiously bad would happen. Since continuously making the correct choices in life, seems to be an impossible task for us humans, there is a regular source of discontent available for OCPD sufferers.
This indecisiveness can have devastating effects on academic, professional and interpersonal relationships. From early adolescence, through college, perfectionism can take an otherwise straight "A" student and bring him to the brink of failure due to incomplete assignments. Having to get the term paper exactly correct makes for an almost impossible task. An extremely difficult time making decisions (always looking for the correct choice) contributes to procrastination. Frequently even starting a task seems impossible, due to a need to sort out the priorities correctly. If it takes an hour to complete the first paragraph of a report, because revision after revision never seems to get it perfect, imagine the anguish experienced when contemplating the completion of a two thousand word essay. The time it could take to complete a ten page report might be multiplied by five due to checking or rewording so that it is just so.
Imagine a college student who has to choose a major and in doing so be convinced that she is completely correct in her choice. The expression of this, "need", to have a perfect academic fit is seen in some students having multiple majors during their four year stint. Changing colleges, due to emerging complications and disillusionment, is also a possible manifestation of OCPD.
The need for an occupational exact fit, can also bring long term investment in a career choice to a screaming halt. Many aspects of any career can seem very appealing in their conceptualization. Things can always look great from afar. As one becomes more thoroughly educated about any school, career or person, through experience, the pitfalls become more apparent. Since perfection is often sought, the emerging defects of any career choice often deter a prolonged investment in any specific area of focus. Making a definitive choice and changing jobs can become stymied due to the endless pursuit of figuring out which of the available options is best.
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 their 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.
Emotional Rigidity: In a world where being in control is of paramount importance, dealing effectively with the volatility of emotions is extremely difficult. Since emotionality is associated with spontaneity and upheaval (i.e. loss of control), responding to emotions effectively and appropriately places an abundance of pressure on the OCPD to keep them constricted. Exerting effort to contain "out-bursts" of emotion is an everyday phenomenon. It seems however that there is one emotion which exists in abundance. The expression of anger tends to come out naturally and in excess. Anger, as an emotion, is one of the most basic and easily triggered of human reactions. Anger is only seconded by anxiety in its primitive nature. Vulnerability, (one of the most advanced of human emotions), as seen through the eyes of the OCPD sufferer, compels people to act in silly ways and expose themselves to the possibility of rejection. Emotional constraint is exerted to prevent the possibility that one may act in a regrettable way. The result of this emotional constraint is that all displays of emotion sometimes becomes compressed into an expression of flat affect. Anxiety and happiness can be perceived as the same on the receiving end. It is not uncommon for persons with OCPD to have their humor often mistaken for seriousness. Jokes or sarcasm (seen by the deliverer as obvious) are mistaken for insults and political incorrectness.
Depressed Mood: Although rarely observed by others, the experience of inner turmoil within this syndrome is immense. As much as others are often victimized by OCPD's oppressive and demanding style, the high standards often apply two fold within the OCPD sufferers' expectations directed toward themselves. It is not uncommon for a person with OCPD to feel deeply entrenched in the belief that they are a "Good Person." This belief can paradoxically often lead to feelings of depression and disappointment. The high standards which a "Good Person" is expected to live up to are often far beyond the capacity for any human being to consistently fulfill. A belief such as "I know that I'm a good person, but I hate myself for doing so many wrong things" is not uncommon. This self-hatred along with tremendous disappointment can easily lead to feeling of depression. Since ones humanness prevents an OCPD sufferer from living according his own high standards, a tremendous amount of self-hatred is imposed. Recent research has documented that as much as seventy percent of depression can be attributed to feelings of low self-esteem and inadequacy. In my work with helping persons manage the challenges of self-esteem I have found it much more difficult to have persons who are "Good" come to find acceptance in being "human" than helping those with low self-worth rise up to the possibilities of self-acceptance.
Another contributor to depression within the OCPD population is a cognitive style characterized by dichotomous thinking. Dichotomous thinking is the tendency to categorize all aspects of life into one of two perspectives -- "All good" or "All bad." The world is viewed predominantly through clearly defined black and white realms. All that is pure and wholesome is valued. It can take only one stain or blemish to have the person completely find justification in discarding anything which evidences a flaw. Within their own being these rigid standards can be devastating to one's self image. Fault finding in one's own world produces a regular source of conflict in maintaining the high standards of life.
Common rituals, which accompany the OCP syndrome typically, involve (1) perfectionism, (2) hoarding, and (3)ordering.
Perfectionism: Perfectionism as expressed by the OCPD is not the admirable quality often sought by the world at large. As a ritualistic aspect of this condition the OCP perfectionism entails checking and rechecking "completed" tasks to be absolutely sure that there are no imperfections. It could literally take upwards of 10 to 20 minutes to fill out a check or mail an envelope due to a rigid need to ensure that there are absolutely no mistakes. It is as if, to make a mistake which might be noticed would ruin ones reputation for life. Perfectionism could also take the form of a need for over completeness -- reading and rereading material until a sense of absolute clarity exists. Not only is it extremely time consuming but the overall content of the story is lost. The forest is missed while examining each leaf, of each branch, of each tree. This disposition can also have an adverse impact on one's conversational style. In the course of a conversation sometimes information is sought which involves such minutiae that the questioned person becomes lost and frustrated. Slight inconsistencies or mistakes, within another's conversation, are often perceived by the OCPD sufferer. These details, no matter how peripheral to the conversation, must be brought out into the open and clarity must be achieved.
In some cases the corporate environment rewards a person's perfectionism. It is not uncommon for persons with OCPD to reach high levels on the corporate masthead because their productivity was not sufficiently impaired while their high standards seemed to reflect the company's dedication for quality. How often do we find subordinates complaining about the tyrant at the top? But more on this subject latter. Occasionally the OCPD sufferer may acknowledge that other ideas are also functionally correct, but then go off and spend a great deal of time and effort at coming up with an even more correct idea. This effort may produce a modicum of improvement at the expense of efficiency and productivity.
Hoarding: Hoarding involves the excessive saving or collecting of items (typically thought of as junk), such that it intrudes on the quality of life for the hoarder or those living with such a person. (Research at the Center for Cognitive-Behavioral Psychotherapy has begun to gain further insight into the relationship between hoarding and OCPD.) In a significant percentage of cases, people lack the insight that they are behaving in an unhealthy manner. When persons are not cognizant of the irrational nature of this condition it is referred to as overvalued ideation (ego-syntonic OCD). Typically this form of OCD involves a poor prognosis since the individual is rarely willing to confront the challenges offered by the treatment. This lack of willingness to see one's own culpability has a very adverse impact on the quality of life for those around her. Many hoarders, however, are well aware of the adverse impact of this condition and suffer tremendously as a consequence of seeing all free space within their living environment occupied. Renting extra storage space to pick up the overflow of ones own living environment is not uncommon.
Where hoarding is a component of OCPD, the justification for saving items typically involves one of the following rationales. In many instances there is a deep commitment related to the "sinfulness of waste." A father may say to his wife, "Why throw out the diapers when they're still in perfectly good shape," referring of course to their 15 year old daughter's leftover diapers. "Who knows? Maybe when she's a new parent the baby will be able to use these diapers." Another perspective which supports the hoarder's resistance to throwing out items is the possibility that the item may come in handy at some point in the future. Throwing away four year old TV guides would cause a tremendous upheaval since Mom may want to see which program was on NBC 9:00 pm Thursday 1994. Another determinant for hoarding involves the endless projects on the "to do list." Perfectionism often stymies the OCPD's ability to complete tasks. Rather than abandoning projects, they become piled up and the fantasy is maintained that some day they will be gotten to.
Ordering: A telltale sign of OCPD is ordering gone haywire. It would not be unusual for a person's cabinets or refrigerator to have the items placed in exactly their proper spot. The closet or drawers would tend to be aligned exactly as they "should be" while shirts and shoes pointed in the same direction. A client who had this manifestation of OCDP once mentioned that his wife often played the following game. She would go in the bedroom alone and move his shoelace an inch or adjust the angle of the phone an eight of an inch. When she would finally call him in, it would literally take him only 10 seconds to locate every item she had slightly adjusted.
For persons who are impaired by the ritual of ordering, there tends to be an overwhelming need to be in control of one's environment. If the items on one's desk are not put away exactly in their proper spot the world might be a much more threatening place. Imagine the unpredictable and threatening nature of the universe if things tended to not be just where they were left. With ordering as a manifestation of OCD and OCPD it is not uncommon to find a person placing and replacing items over and over again until they feel they have gotten it exactly right. Ordering also entails the placement of items in geometric symmetry. Parallel lines and even spacing seem to be of paramount importance. A client used to euphemistically refer to his stacks of items as "anal piles," amusingly recognizing his own need for obsessive structure. Symmetry can also be sought after in an obsessive way. Having to keep the world perfectly balanced can lead to rituals where items would need to be perfectly and evenly spaced. Touching both sides of an object or ones right and then left leg are also other examples of symmetry.
We all periodically have such confidence in what we are saying that statements such as "I'm sure of it" or "The fact of the matter is..." play a natural part of our everyday vocabulary. For persons with OCPD, facts and confidence are all too often turned into "I'm RIGHT and your WRONG." "The way I see it represents the way it is, end of story". For others, refusing to yield to the "correct perspective" often entails encountering tension and discord. This manifestation of OCPD entails one's adamantly guarding his dogmatic beliefs to such a degree that casual conversation often converts minor disagreements into heated debates. The relative importance of any topic (i.e. comparing the effects of regular gas vs. high test on a particular car's performance) rarely is of consequence in determining the degree of the intensity expressed in the midst of the debate.
Perhaps there are a few variables on this planet, which are beyond debate in their apparent universal truthfulness. "Humans are a living organism when there is a heart beat and/or brain activity" or "Rocks eventually tend to drop in a downward direction when released into the air." For the person who experiences OCPD, abstract ideals and moral standards become rigidly held truths. An example belief would be that "The Mormon's practice of marrying more than one woman is illegal and absolutely wrong." The ideology that all-religious practices are subject to interpretation and not a matter of right or wrong is often overlooked and rarely considered. It is not unheard of for someone with OCPD to feel that he is flexible due to an occasional shift in his beliefs. If one listens carefully, the shift in position can be dramatic and equally dramatic is the degree to which the new truth is held as fact. The knowledge that abortion is "murder" can be converted to the fact that the freedom to chose represents every woman's "God Given" right to make decisions about her own body. Most examples of this particular cognitive shift would tend to go in the opposite direction.
It would not be unusual for an OCPD sufferer to literally take delight in being wronged, since it affords them, what they perceive, as the justified opportunity to deliver a steep punishment. The term "righteous indignation" was probably conceived with this perspective in mind. Crossing a person with OCPD provides her the license to hold a grudge and forever hold your mistake over your head.
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.
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 your 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. These land mines can present themselves in association with seemingly random topics.
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 1985 I was working in a university outpatient clinic with a child who's academic performance had lapsed far behind his intellectual capacity. Near the end our successful treatment I brought in the father of my client. My objective was to see if I might transfer the positive changes, which had occurred in the course of treatment, to the home. Near the end of the session I asked the father whether he was proud of his son for bringing up his grades so dramatically. I'll never forget the father's response in front of this child. "There's nothing to celebrate, these are the grades he SHOULD have gotten all along!"
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. Fault finding is the tendency for OCPD's to chronically pick out the flaws in others, especially those close enough to them to mention it. "You always misuse the word affect in stead of saying effect!" "Your hair is always so messy; don't you have any self respect?" 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. Mail order brides have sometimes provided an outlet for otherwise frustrated men who have found it difficult to cope with the ever-evolving power structure of women within today's western society.
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. I have all too often worked with clients who have legitimized ending relationships due to such minutiae as a significant others bad breath, small shoe size, or eyebrow thickness. An article written in New York Magazine, a few years ago, portrayed a satirical conversation which went something like this: "She's a Ph.D., expert skier, loves children and animals, and encourages me to spend as much time out with the guys as possible... it's just a shame she speaks French with a southern dialect". 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."
In professional relationships, subordinates of many OCPD's are often intimidated and frequently berated. Staff may experience tremendous inhibition in speaking freely about topics where there is not absolute certainty regarding the correctness of the statements. This environment facilitates the stifling of creativity and risk taking. Often the chain of command from above reinforces or ignores this style, since it appears that the manager is just being vigilant and instilling the company's commitment to excellence.
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
"Premarital sex is wrong and it means that persons are tainted if they have ever engaged in it." "Girls who wear make up are loose and promiscuous." "Men who allow their wives to work are inadequate providers."
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. In 1986 I flew with a client to Boston to aid him in his fear of flying. While at the airport in Boston we walked past a booth representing some very conservative organization (Linden LaRouch I believe). Out of nowhere, my 6'4" male client reached over the booth and grabbed the innocent fellow by the collar. My client proceeded to yell about the toxic ideology that this booth represented. In that moment this client graduated from fear of flying and commenced with a long year of work related to helping him let go of truth and anger. One of our agreed upon goals was for him to become more available to his friends, who had expressed that they were afraid to discuss any topic which he disagreed with. Our successful outcome boiled down to my client's willingness to replace "truth" with expressing his opinion in terms of degrees of confidence.
Excessive religious observance as in, strict adherence to ritualistic aspects of daily or weekly routines, is a potential component of OCPD. If a child would ask for rationales for following through with certain age old traditions the OCPD parent may respond with "You just do it and never question the relevance". 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. The existence of hundreds of subsets amongst the Baptists and the ever-fractionalizing Hasidic (ultra-orthodox Jewish) community is evidence of religious leaders owning their interpretation of the Bible too rigidly. One of my favorite recollections of a female OCPD in discussing her spirituality was her reassurance that her observance of Eastern philosophy was the "True Buddhist" expression. The paradoxical humor is that letting go of truth is a spiritual goal of Buddhism (as I understand it).
The treatment of OCPD is incredibly complex and lengthy. Therefore, any depth in relaying the specifics of this treatment go well beyond the scope of this paper. 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 be alienated. Overriding all of the specific interventions would be a 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.
This paper represents a radical departure from the style of most of my previous writings. I am aware that there is an emphasis on the aftermath within oneself and on others, rather than a primary focus on understanding and compassion. I strongly believe that through being informed about this condition's manifestations, people can better seek appropriate treatment. Living out the patterns of OCPD for oneself and for others around you is devastating. If you are at the end of your rope and these characteristics are relevant, I strongly suggest you seek new paths.
For more on OCPD, Please refer to Dr. Phillipson's speech at the 2000 OC Foundation, ocdonline"Let's Get One Thing Perfectly Clear."