u/ChappyDev

So, I have both OCD and OCPD. I've had OCD since childhood, and it going untreated (combined with trauma I won't get into) led to OCPD developing. I'm formally diagnosed with both and I am undergoing DBT for my OCPD, but my OCD is relatively untreated.

For one thing, my OCD these days can be fairly mild. Visualization and meditation is usually enough to handle the compulsions and obsessive thoughts. Keyword, however, is usually. If things are going poorly in my life, or if my OCPD is spiralling out of control, the OCD symptoms can severely worsen. People often imagine that the ego syntonic nature of OCPD means you can't have both, but in reality it simply means the thoughts are different. The fact I need to be perfect is not distressing to me (other than when I fail to live up to that standard, inevitably, which is the main cause of distress in OCPD aside from interpersonal issues). Meanwhile, my OCD obsessions are very much dystonic, and related to completely different things (if I don't snort, I'll say a slur being a common obsession, obviously dystonic, obviously distressing)

Here comes the issue, though

The most effective treatment for OCD is ERP as you know. But some studies have suggested that ERP is specifically ineffective in Comorbid OCD/OCPD cases; worse, even when it does help with the OCD, it will simultaneously make the OCPD worse.

So at the moment my treatment is using DBT (dialectical behavioral therapy, common in treating pretty much all personality disorders) to treat my OCPD. because my OCD improves when my OCPD is under control, my therapist and I have decided to focus on treating the OCPD and only mitigate the symptoms of OCD as they come up.

But I don't know if this is working anymore. It did for about a year, but stress in my life is getting worse. And while I am doing DBT, and it's greatly helping with my perfectionism and anger issues, my OCD symptoms are remaining constant -- if not worsening again.

Does anyone have any advice? Am I mistaken on ERP being ineffective in Comorbid cases?

Also. In advance, I don't want to see any negativity wrt OCPD here. I've seen some posts and comments on this subreddit more or less demonizing OCPD as "OCD but you harm others instead of yourself" which is extremely reductive and a harmful belief. I am asking a question; please don't project your experiences with other people with OCPD onto me. Focus on the question please.

Just wanted to vent about a lot of OCD discussion focusing around cases that are responsive to ERP. To be fair, this is the vast majority of cases. But I have, in addition to OCD, OCPD. And in comorbidity cases like mine, the OCD is caused in part by OCPD that went untreated for a very long time, resulting in compulsions to cope with imperfections. OCPD is quite responsive to DBT and CBT, but ERP has very little effect on it. Worse, if you have both OCD and OCPD, the OCD is treatment-resistant to ERP (instead, treating the OCPD makes the OCD more managable).

This presents a problem, because personality disorders can never be cured. It's not like OCD, which can go in full remission. PDs are part of who you are, they can be mitigated and you can learn to live with them and that's it. And because my OCD stems from my OCPD, and is so connected to my co-morbidity, I will be living with this my entire life, to different degrees. ERP is completely ineffective; instead, I have to do DBT which is its own can of worms to treat the OCPD.

And when I'm doing bad or struggling in life, my OCD re-emerges to cope with the self-hatred that follows from OCPD. Relapse is inevitable; and that's terrifying. It makes me jealous when I read posts about people who have fully overcome their OCD. To be clear, I know this is a bad instinct; I should be happy for people who have overcome their disability. But I know I will never have that.