The Obsessive-Compulsive Personality Disorder

Basic Information

Though the DMS-3 (Diagnostic and Statistical Manual of Mental Disorders) published by the American Psychiatric Association calls this disorder "compulsive personality" this does not describe an "obsessive-compulsive" anxiety syndrome that is quite separate from compulsive personality disorder. Thus the designation "compulsive personality disorder" may be confusing as patients do not usually show signs either of compulsions or obsessions.

What DMS-3 describes as compulsive personality disorder includes such personality traits as:

• a stifling perfectionism that restricts the patient from seeing the "big picture"
• indecisiveness
• a devotion to work at the exclusion of pleasure
• a preoccupation with triviality, procedures or form that interferes with the ability to take in the bigger picture and often results in a poor allocation of time, leaving tasks unfinished at the last moment
• difficulty in expressing tender or warm feelings towards others
• extreme sensitivity to social criticism especially if it comes from an authority figure
• decision-making is protracted and avoided for fear of making a mistake
• painfully aware of his or her status in dominant/submissive relationships, the patient seeks the approval of dominant figures in authority while secretly resenting it and at the same time making subordinates feel they should be towing the line and doing things his or her way
• excessively moralistic and judgmental of self or others
• a stinginess with emotions, time and material possessions
• considerable distress brought on by circumstantial, ruminative thinking

The compulsive personality is considered an ambivalent personality and the disorder is thought to be of moderate severity, unlike the narcissistic personality disorder which is considered to be of mild severity because the narcissist is comfortable with himself or herself and sees the world clearly and resolutely, going to his or her self rather than others for comfort and rewards. The ambivalent personality or compulsive personality constantly struggles between obedience and defiance, always in a state of turmoil and confusion, unable to see himself or herself and the world comfortably because of the internal conflicts he or she can never escape from since they are part of his or her self. The compulsive personality wants nothing more than to discover how to fit into society so that others will see him or her as responsible, productive and successful but inside the more he or she adapts to this conforming pattern the more he or she resents it and feels great anger. Thus it is as if he or she is sitting on a minefield, always aware of the inner turmoil and deeply imbedded ambivalence that he or she fears will explode and reveal to the world his or her anger and resentment at the conformist values he or she has been so careful to present to the world.

Two types of compulsive personalities have been identified:

• The active-ambivalent or passive-aggressive personality who constantly swings between obedience and conformity and defiance and rebelliousness, creating a turmoil and whirlwind of indecision on a daily basis.
• The passive-ambivalent personality appears rigid, showing consistency and uniformity by stifling any desire for independence but this mantle of conformity only cloaks his or her burning resentment.

Not only does the compulsive personality conform to societal customs but he or she insistently defends them in a self-righteous and moralistic way. By this rigidity he or she is keeping his or her antagonisms under control. Methods of control include a rigidity, a superego (sensitive to himself or herself but insensitive to others), stinginess, obstinacy, orderliness, often a compulsive cleanliness (to keep the outside world from coming in) and an unwavering compliance to rules and authority.

Symptoms

Often it is not readily apparent to the health care provider or therapist or psychiatrist to recognize immediate symptoms of this compulsive personality disorder as the compulsives themselves go to great lengths to avoid seeing the glaring differences between their unconscious feelings and the behavior they present to the world. They themselves avoid self-exploration and are terrified at looking at their motives for the rigid mold into which they have cast their lives. A key is to listen for the harsh judgments of others as frivolous or irresponsible since by judging others harshly, deep down they hope to restrain their own rebellious behaviors. They use more defensive mechanisms than do any of the other patients with personality disorders. Another key to understanding is realizing their great fear of disapproval and that they will somehow be published for their actions. Main symptoms of this disorder have been described in the bulleted sections under Basic Information.

Diagnosis/Treatment

Besides observing the behavior, rigid thinking and personality traits of the compulsive patient, the health care provider or counselor in tandem with a therapist and psychiatrist will look at the family history of the patient. In all likelihood the compulsive personality will have had overly perfectionistic and condemnatory parents. The patient will have been over controlled as a child and will have a history of having been punished for misbehavior. This does not describe parents who are hostile in general, but overly controlling parents who mete out punishment selectively. Thus the child is reacting to punishment more than positive reinforcements. The child learns what he or she must do to escape condemnation and punishment. The parameters of disapproval are set in stone, the punishments setting constricts upon the child's behavior so that the child knows what not to do. Unfortunately the child does not know what to do that the parents will praise or give positive reactions to, thus the child learns to stay within the constricts of parental boundaries and will not go outside of them. The child accepts dependency not for its comforts but from guilt, shame and the fear of punishment. The child cannot think for himself or herself so he or she thinks along the conventional lines of his or her parents. The child's great fear of making mistakes, his or her fear of taking risks, his or her ever-present internal conscience all work together to prevent the world's disapproval. The child will find great difficulty in trying to make changes or trying out new directions.

Thus treatment is a difficult and a long process since the patient's defenses are so great that even as he or she hopes to relieve their uncomfortable feelings he or she avoids at any cost any exploration or awareness of the self. The patient experiences psychosomatic episodes because he or she cannot release his or her repressed tension and emotion. Patients often have terrible fatigue, terrible anxiety attacks, periods of immobilization. They do not generally respond well to therapy initially because of the protective armor they have built around themselves.

While there are no physical characteristics indicative of the compulsive personality some patients may show a lack of energy and an emotional rigidity.

Long term psychiatric care is usually indicated to deal with any phobic, anxiety, psychosomatic or affective disorders. Medication to alleviate anxiety may be recommended. The greatest benefit seems to be the long term relationship with a trusted therapist or psychiatrist (group therapy has not proven particularly effective) in which trust is established, the patient's autonomy is improved and behavior modification and cognitive reorientation methods help the patient see his or her issues and difficulties in a real rather than abstract way.

If you feel you may have this personality disorder or have a friend or loved one who may have this disorder please discuss this with an experienced health care provider, counselor or therapist.