u/FalsePay5737

Studies have found that people with OCPD and BPD have a higher rate of medical problems than people with other PDs. ("The economic burden of personality disorders in mental health care." Journal of Clinical Psychiatry, 2008).

Sharon Martin, the author of The CBT Workbook for Perfectionism (2019), explains that “Self-care doesn’t fit our image of perfection; we think perfect people are self-sacrificing, low-maintenance, don’t-need-anything types who can run on fumes and still get the job done. Because we have such unrealistic expectations for ourselves, we tend to underestimate our need for self-care and feel guilty about needing to rest, set boundaries, nurture our relationships, or have fun.” (177)

“Self-care is the practice of consistently taking care of our physical, emotional, or spiritual needs…Self-care is often confused with leisure, self-indulgence, or anything that’s enjoyable.” (178)

Self-care is “not a reward that we have to earn—nor is it selfish…Resting when you’re tired is no different than eating when you’re hungry, and yet we tend to judge ourselves negatively for resting…” (179)

Gary Trosclair, an OCPD specialist, explains that “The danger for the driven person is that the body becomes a mere vehicle; its pleasures and wisdom are untapped, and it may be treated so badly that it breaks down. Because you have a great capacity to delay gratification and tolerate pain, you may not give your body the attention it needs. Many compulsives, with their predilection for planning, have their center of gravity in their head, not in their body.” (89) The Healthy Compulsive (2020)

Ep. 76: The Need to Control: A Compulsive Recipe for Poor Health - The Healthy Compulsive Project Podcast

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GAS TANK METAPHOR

When Dr. Anthony Pinto starts working with a client who has OCPD, he shares the metaphor that people have “a gas tank or a wallet of mental resources…We only have so much that we can be spending each day or exhausting out of our tank.” The “rules” of people with untreated OCPD are “taxing and very draining.” In order for clients to make progress in managing OCPD, they need to have a foundation of basic self-care.

Dr. Pinto asks them about their eating and sleeping habits, leisure skills, and their social connections. He assists them in gradually improving these areas—“filling up the tank”—so that they have the capacity to make meaningful changes in their life. When clients are “depleted” (lacking a foundation of self-care), trying to change habits leads to overwhelm. S1E18: Part V

DIMMER SWITCH METAPHOR

Dr. Pinto helps his clients adjust the amount of effort they give to a task based on its importance. He has observed that individuals with OCPD tend to give 100% effort when completing low priority tasks—giving them far more time and energy than they require. This can lead to burnout, where they are not initiating tasks. He compares this all-or-nothing approach to a light-switch.

Dr. Pinto compares an alternative approach to a dimmer switch. His clients conserve their energy for important tasks. They learn how to adjust their effort so that they are making more progress on high priority tasks (e.g. ones that relate to their core values), and “dialing down” their effort for low priority tasks (e.g. washing dishes).

A light switch is either on or off—"that tends to be the way that a lot of people with OCPD approach the effort that they put into a task…It's all or nothing. I'm either going to put maximum effort or not at all. The problem with the light switch is that it doesn't allow for any modulation or gradations of effort for things that don't really require 100% effort…Let's imagine that you could dial up or down the amount of effort you put into a task à la a dimmer switch based on how important that particular task or decision is.”

Dr. Pinto’s clients with OCPD find the “dimmer switch” approach to effort empowering.

I love this metaphor. Having the mindset of 'pace yourself, conserve energy' was very helpful and fueled improvement in all of my OCPD symptoms.

SELF-CARE MANTRAS

Self-care is the best investment.

Put your own oxygen mask on first.

You can't pour from an empty cup.

Self-care is not self-indulgence, it’s self-preservation. 

Taking care of yourself doesn’t mean ‘me first’: it means ‘me too.’  

Rest is not a reward. You do not need to earn the right to rest.

RESOURCES

Self-Care Books That Helped Me Manage OCPD Traits - The resources I used to improve my sleep and lose 100 lbs.

This is an article from Gary Trosclair, a therapist who specializes in OCPD, the most severe type of perfectionism. From thehealthycompulsive.com. You can listen to this article on The Healthy Compulsive Podcast, episode 69.

The Beginnings of Self Control

Self control is the ability to restrain yourself from acting on emotions or physical urges. Self control is essential to getting along with others and reaching goals. We naturally learn early on that doing whatever we please doesn’t always work so well.

But this capacity to exercise self control may become exaggerated during childhood if our emotions and physical urges lead to us to do things that our caretakers don’t like. Finger painting on the wall, tantrums in the grocery store, justified counter-attacks on uncivilized siblings, and peeing in that fancy new outfit Mom just bought can all lead to punishment that makes us become tight and hold back.

Worse, if feelings of affection or need are rebuffed, we begin to feel that our most basic emotional self makes us too vulnerable. We not only turn down needs and feelings so that others don’t hear them, we might even turn them down so low we can’t hear them ourselves.

Obsessive and Compulsive Defenses Against Feelings

This has happened to many people who have obsessive and compulsive traits. While they’re usually aware of discontent, anxiety and anger, they may not be aware of affection, appreciation, and connection—feelings which might make them feel too vulnerable or out of control.

And whether they are of aware of these feelings or not, they tend to restrict their expression.

They can recite their to-do list, express anger at the imperfections they see in others, and share their endless internal debates about whether to buy the green shirt or the teal shirt, but they often have difficulty acknowledging feelings that would allow them to be more connected with others. 

When you aren’t aware of these feelings, or you don’t allow yourself to express them, you starve your relationships of the emotional exchange they need to thrive.

What Self Control Can Look Like to Others

We can also come across in ways that we don’t intend. For instance, as a result of their restraint, compulsives may come across as:

-Rigid and cold

-Serious

-Judgmental and critical

-Stiff and formal

-Socially detached or aloof

-Withholding of affection and compliments

To the degree that you inhibit or control your self-expression, you may unwittingly get people to experience you this way. Imagine, for a moment, what it’s like to be on the other end of that.

The problems caused by this presentation are magnified by the lack of awareness about how you might come across. You might assume people know how you feel when they don’t...

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Compulsives tend to be concerned mostly with fixing problems and getting things done. Communicating about anything that doesn’t immediately push those projects forward is considered superfluous, and therefore a waste of energy. Compulsives can become so distracted that they only communicate about what they’re trying to correct or accomplish.

And this isn’t just about how many words you speak, or even the choice of words, but also the expression you put into them. Too much self control and others might hear your words but not the music, the tone that’s needed to communicate what you really feel.

Non-verbal aspects figure into this as well: facial expression, eye contact, and body posture communicate far more than we’re usually aware of. Too much self control makes us appear wooden...

The less people see of the real you, the less safe they feel trusting you or getting close. If your self control keeps you from expressing how you really feel, others will sense that and will trust you less. This leads to distancing on their part, and then, naturally, you express yourself even less because you’ve become more anxious since they’ve distanced themselves...

FACIAL EXPRESSION

From How To Be Enough (2024), Ellen Hendriksen:

“Research shows that hanging out with someone whose expression doesn’t vary—whether they’re all smiles or all business—makes us anxious and uncomfortable. It literally increases our blood pressure. And because it’s stressful to interact with someone we can’t read, we’re more likely to avoid them in the future.” (245) 

Gordon Flett, one of the leading researchers on perfectionism, stated that “perfectionism is essentially antithetical to mindfulness.”

Practicing mindfulness was one of my most helpful strategies for overcoming the cycle of maladaptive perfectionism.

DESCRIPTIONS OF MINDFULNESS

From You Are Not Your Brain, Jeffrey Schwartz, Rebecca Gladding (Dr. Schwartz pioneered the treatment of OCD by developing mindfulness-based CBT techniques).

“Most people think of mindfulness as a state of mind, as being analogous to being ‘in the zone.’ This is a common misunderstanding that can lead to frustration because mindfulness isn't something you can just switch on like a TV and expect that it will remain in that state indefinitely…The best way to conceptualize mindfulness is as an activity, not a state of mind or way of being…Mindfulness, like any activity, requires effort…the more you practice, the better your abilities become.” (147)

From The Perfectionism Workbook, Taylor Newendorp:

“The basic concept of mindfulness is for you to take on the role of observer…learn how to watch your thoughts come and go through your mind without placing judgment on what kinds of thoughts they are and without judging yourself for any thoughts you have…You are not trying to stop having thoughts (that’s impossible) or to have only good thoughts; you are not trying to analyze what you are thinking about or figure anything out.” (37)

From The CBT Workbook For Perfectionism, Sharon Martin:

“Mindfulness means being focused on the present…focusing on the here and now, rather than being preoccupied with the past or present. Sometimes, as perfectionists, we get so wrapped up in the daily grind…that we’re not fully present in our own lives…[The author helps her clients learn how to] do one thing at a time. Use your five senses to fully appreciate all aspects of the present. Notice how your body feels. If your thoughts wander, refocus on the present.” (120) 

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“We perfectionists tend to be so busy and distracted or so goal-focused that we don’t even notice our feelings [or suppress uncomfortable feelings]…But feelings provide valuable information…” (121). 

“When we’re mindful, we’re aware of what we’re doing, thinking, and feeling…we’re just ‘being’…Most of us do a lot of things on autopilot—we do them because we’ve always done them, without giving a lot of thought to how or what we’re doing…Mindfulness helps us to pause before making a decision or taking action, so we can make choices that align with our values and bring us the most satisfaction.” (119-20)

Martin helps her perfectionistic clients gradually reduce multitasking because it is the “opposite” of mindfulness and only gives "the illusion of efficiency." Multitasking “doesn’t actually help us get more done. Our brains can only focus on one thing at a time, so when we multitask…the quality of our attention and work declines." (126)

From ACT Made Simple, Russ Harris

Mindfulness “involves paying attention with openness, curiosity, kindness, and flexibility…mindfulness is an attention process, not a thinking process...” (40)

Mindfulness is different from “positive thinking, relaxation...distraction...[and getting] rid of unwanted thoughts and feelings.” (42)

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“We can plan for or predict the future, but that planning and predicting happens here and now. We can reflect on and learn from the past, but that reflection happens in the present. This moment is all we ever have.” (190) Russ Harris, ACT Made Simple (2019)

MY EXPERIENCE

These strategies gave me a lot of relief form perfectionism:

-slowly reducing multi-tasking

-slowly increasing the amount of time I spent outside

-getting out of my head and into my body by developing a walking routine (started with a few minutes and gradually increased)

-working through issues relating to my false sense of urgency

-increasing awareness of my body (e.g. tension, breathing), especially during difficult situations

-developing a habit of focusing on information from my five senses to accurately view my environment instead of creating unhelpful narratives

-adopting 'be here now' and 'one day at a time' as mantras

A study from Harvard found that participants were happier when they focused on the activity they were engaged in, rather than thinking about something else. This finding applied to all kinds of activities (e.g. working overtime or sitting in traffic). This has been my experience for 2 ½ years. ("A Wandering Mind is an Unhappy Mind," Matthew Kilingsworth, Daniel Gilbert).

RESOURCE

Meditation is the formal practice of mindfulness. Popular meditation apps: Calm, Headspace, Insight Timer, UCLA Mindful App

Dr. Allan Mallinger is a psychiatrist who shared his experiences providing individual and group therapy to clients with OCPD in Too Perfect: When Being in Control Gets Out of Control (1996, 3rd ed.). You can listen to Too Perfect with a free trial of Amazon Audible. 

Dr. Mallinger’s clients with OCPD "seem to sense a constant, ever-lurking threat of embarrassment or humiliation, and they will go to great lengths to avoid it” (39).

The most common theme in his client’s statements is “the desire to eliminate feelings of vulnerability and risk, and to gain instead a sense of safety and security…Trust is a leap of faith that makes us vulnerable—to betrayal, exploitation, incompetence, chance, and the unexpected—a leap that flies in the face of guaranteed fail-safe passage." (112)

People with OCPD tend to "doubt people’s motives, honesty, and reliability. They doubt that others care for them as much as they say they do, and that these people will still care tomorrow.” (112)

Dr. Mallinger explains why intimacy can cause anxiety in people with OCPD: “The closer you are to someone, the more likely he or she is to see all aspects of your personality—both the ‘good’ traits and those you feel are unattractive or even shameful.” (108-9)

“Becoming less guarded is not something that can be ‘worked on’ all alone…such change must take place within living, breathing relationships. Remind yourself that no one and nothing can be one-hundred-percent dependable. [People without OCPD] understand this and still manage to trust and depend upon one another...It’s not that these people don’t see the risks of opening themselves to others. Instead they know that many of the best things in life—such as a sense of connection and closeness with other people—are worth the risks…

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“Try to be conscious of the fact that your guarded behavior is likely to cause the very rejection and isolation…that you fear. Realize that other people are very apt to misinterpret your guardedness, taking it as a hurtful indication that something in them is causing you to hold yourself at a distance.” (124-5)

"It takes determination and patience to become less guarded…changes occur slowly…Over time, the guarded person gradually is able to reveal more and more of the real self beneath the façade—the spontaneously experienced feelings and thoughts. And often, for the first time, he or she begins to experience what it’s like to feel truly understood and still cared for—something that never seemed possible.” (124-5)

My Experience

Taking small social risks every day made a huge difference in reducing my OCPD traits. My thoughts about my ‘wall’ of guardedness:

-This wall protected me from my abusive parents (hypervigilance).

-Now that I’m safe, most of this wall has outlived its usefulness. As an adult, this wall often prevented me from taking even small risks that can enrich my life.

-This wall makes it hard to see opportunities for social connection.

-When my wall is up, it’s hard to recognize my feelings.

-My wall impairs my ability to perceive myself, other people, and the world accurately.

-This wall can be misperceived by other people as rudeness and arrogance.

-This wall takes a lot of time and energy to keep up. If I spent a little less time and energy on this wall, I can use that time and energy in healthier ways.

-My wall is usually very effective in keeping dangerous people away. The problem is that it’s keeping the kind people away too. Does it need to be so high? Does it need to be up in all situations?

CO-MORBIDITY

About 40% of people with Paranoid Personality Disorder also have OCPD.

Many years ago, I took an assessment called the MMPI online. My score on the paranoia scale was very high. I didn't know what to make of that. Later, I realized that my untreated OCPD and childhood trauma led to paranoid tendencies and hypervigilance.

RESOURCES

Spotlight Effect

How Self Control and Inhibited Expression Hurt Relationships

These are excerpts from Gary Trosclair's I'm Working On It In Therapy (2015). This is the book that helped me the most in reducing OCPD symptoms. It's available on Kindle and with a free trial of Amazon Audible. Trosclair has worked as a therapist and for 35 years, and specializes in OCPD.

Therapy sessions can serve "as a microcosm of your life that fosters insight: the way that you relate [to your therapist may] mirror what happens in your larger world. [A therapy session] allows you to see more clearly what you do and don’t do that works for you or against you," (63)

"Therapy creates a unique and safe environment that allows us to slow down and pay close attention to ourselves…so that we can live more consciously in our everyday life. It’s a bit like playing a video in slow motion so that we can observe our thinking, feeling, and behavior more clearly. We can see and learn from what is usually pass over in everyday life…When you speak about disturbing emotional issues in the presence of someone you feel you can trust…[the] experience is coded differently in the brain and becomes less disturbing.” (63)

“Work outside of session includes observing the patterns in your life and thinking about what meaning they have…Deep change also requires moving beyond thinking to action—applying the insights you’ve had in session by doing things you haven't done before." (135)

Taking Off The Mask

"We all need to use masks in certain areas of our lives…to get along with others and to feel safe…Working hard in therapy includes taking off the mask and bringing in as many different parts of your personality as possible…Acknowledging these hidden parts….may feel like a wound to our idealized sense of whom we want to be, but it’s also how we move toward growth and wholeness…” (2-3)

“Trying too hard to be a good client, or trying too hard to please the therapist, could be a repetition of what you’ve been doing for years, and it may hide the parts of you that you need to bring into the process. When you notice what you want to hold back from your therapist (your angry, childish, vulnerable, or strong parts, for instance), you get clues as to what you have excluded from your personality.” (4)

"Bring your mask in, show what it looks like, but then take it off and study it to see how it works and what it’s covering up. This part that we want to cover up, deny, or get rid of, is known as the shadow…[it] causes problems only to the degree that it’s hidden or unconscious; once we begin to integrate it more consciously, it actually enriches our personality.” (4-5)

“Some clients feel more comfortable being abstract and intellectual in therapy, focusing on why they are the way they are, leaving out the actual experience of feelings…staying in intellectual mode is often a defense against feeling.” (21)

"It's helpful to say whatever comes into your mind during your sessions “even if you think it unimportant or irrelevant or nonsensical or embarrassing…When your therapist asks you a question, don’t censor or think about it too much…This approach opens the possibility for the many different aspects of your personality to come to the surface.” (4)

Paul Hewitt stated that almost of his perfectionistic clients are “extraordinarily adept at hiding their pain behind a mask of high functioning, maximization, and competency.” (The Perfection Trap, Thomas Curran, pg. 201).

Corrective Emotional Experiences

Many of the benefits of therapy relate to corrective emotional experiences, defined by Deborah Fried as the “reexposure of the patient, under more favorable circumstances, to the emotional situations which he could not handle in the past.” 

From I'm Working On It In Therapy (2015): “When you speak about disturbing emotional issues in the presence of someone you feel you can trust…[the] experience is coded differently in the brain and becomes less disturbing.” (63)

Island of Time

From Allan Mallinger's Too Perfect (1992):

A therapy session is an "island of time for honest communication, reflection, clarification, and encouragement, a starting point. In the end, each person must use his or her…insights, creativity, courage, and motivation as a springboard for his or her own trial solutions.” (xv)

Relationships Between Therapists and Clients

It's important for someone with OCPD to find an experienced therapist that they trust. At the same time, it's also helpful to be aware that compulsive perfectionism can lead to having unrealistically high standards for therapists. One of the biggest 'lies' (cognitive distortions) of OCPD is 'I need the perfect therapist to help me with perfectionism.'

A clinical psychologist wrote an excellent article on how therapy clients can advocate for themselves if they are upset with their therapist: What to Do in Therapy If You Want It to Work.

Therapy clients' feelings towards their therapists can give them insights about their relationships people from their past. Why Being Frustrated With Your Therapist is a Goldmine.

Short-Term Therapy

Therapy is not a lifetime sentence. Short-term therapy can be helpful too. Emma McAdams, the therapist who created the Therapy in a Nutshell YouTube channel, mentioned in a video that most people with PTSD no longer meet criteria after three months.

RESOURCES

Masking my true OCPD self

Trying to get an A in therapy

The Most Difficult Thing About Healing

These are excerpts from Gary Trosclair's I'm Working On It In Therapy: Getting the Most Out of Psychotherapy (2015). Trosclair has worked as a therapist and for 35 years, and specializes in OCPD. He is the author of The Healthy Compulsive book, blog, and podcast.

This is the book that helped me the most in reducing OCPD symptoms. It's available on Kindle and with a free trial of Amazon Audible.

Trosclair states that this book is not intended for people who are in therapy to get through crises. It’s for people who want to make significant changes. I think it's a great resource for all therapy clients and anyone interested in self-reflection.

Themes

Effective therapy involves “…connecting the dots to see what themes are consistent in your life…[for example, experiences that led to seeking therapy], what gets you annoyed, resentful, angry, or fearful, and what moves you, excites you, and gives you please. Observing your interactions with coworkers, family, and friends…and watching for patterns…will be very important.” (117)

“While we do need to discuss the individual events…if we don’t ask what larger themes recur, and which core issues consistently cause us trouble, we could spend a lifetime in therapy looking at individual events as if they were unrelated and not make progress toward a more satisfying future.” (108)

Stories

“We all create stories about our lives…to make sense of what’s happened in the past and what’s happening now. Our stories help the brain to organize and recall incredibly complex information, and they lead to the beliefs that help us navigate the world without having to reassess each new situation individually.” (109)

“Stories are powerful medicine [that] can help or harm, depending on whether we take the right one in the right dosage. They can either create or diminish energy. Whether we are aware of it or not, we’re always taking this medicine...We all tell ourselves stories about how we’ve come to be who we are and where we’re going. It is the default mode of the brain. Some of it’s true, some of it isn’t, and some of it we’ll never know for sure.” (110)

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The stories we create "lead to our fundamental beliefs about who we are, how the world operates, the nature of relationships, and what will make life fulfilling for us. These beliefs in turn lead to how we feel and how we behave.” (108)

“We usually create the first editions of our stories when we’re too young to do it consciously, so they often end up playing in the background, influencing us constantly without our being aware of it. [When they’re] inaccurate and unhelpful, they…put more emphasis on certain events and leave out others, creating a skewed sense of reality…we’re stuck, unable to take in the new information that could change how we live.” (111, 123)

“If the story you’ve told yourself is that the world is a dangerous place in which you have little control, self-protection and survival will become your supreme values. Fulfilling relationships, satisfying creativity, or the simple joy of being present…will all be left out. On the other hand, if your story is one in which resilience and perseverance lead to fulfillment, there’s much more room to pursue things that are valuable to you.” (117)

“Letting go of the old stories [is very challenging]. They may seem like they’ve been faithful companions…for much of our lives, and creating a new story may feel as though you’re betraying them." (127)

“Don’t worry if you can’t shake the old story right away. It takes time…More and more often you’ll notice when you are at a fork in the road…you can choose whether or not to operate out of old assumptions…You won’t get it right all the time, but each time you do, you strengthen the new narrative.” (132-33)

Dr. Brene Brown is a professor and research psychologist who has specialized in courage, vulnerability, shame, empathy for more than 20 years. Her qualitative research has involved interviewing more than 1,000 people. She is the author of six New York Times bestsellers. This post has quotations from The Gifts of Imperfection (2020).

Perfectionism

“Perfectionism is a twenty-ton shield that we lug around thinking it will protect us when, in fact, it’s the thing that’s really preventing us from taking flight.” (75)

“Perfectionism is not self-improvement. Perfectionism is, at its core, about trying to earn approval and acceptance. Most perfectionists were raised being praised for achievement and performance (grades, manners, rule-following, people-pleasing, appearance, sports). Somewhere along the way, we adopt this dangerous and debilitating belief system: I am what I accomplish…Healthy striving is self-focused—How can I improve? Perfectionism is other-focused—What will they think?...” (75-6)

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Shame

“We’re all afraid to talk about shame…The less we talk about shame, the more control it has over our lives. Shame is basically the fear of being unlovable…the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love, belonging, and connection.” (53)

“Shame is all about fear. We’re afraid that people won’t like us if they know the truth about who we are, where we come from, what we believe, how much we’re struggling.” (53-4)

Perfectionism and Shame

“Perfectionism is a self-destructive and addictive belief system that fuels this primary [unconscious] thought: If I look perfect, live perfect, work perfect, and do everything perfectly, I can avoid or minimize the painful feelings of shame, judgment, and blame…” (77)

“Perfectionism is addictive because when we invariably do experience shame, judgment, and blame, we often believe it’s because we weren’t perfect enough. So rather than questioning the faulty logic of perfectionism [recognizing it’s impossible to be perfect], we become even more entrenched in our quest to live, look, and do everything just right.” (77)

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Guilt vs. Shame

“The majority of shame researchers and clinicians agree that the difference between shame and guilt is best understood as the differences between ‘I am bad’ and ‘I did something bad’…Shame is about who we are, and guilt is about our behaviors. [Guilt is] an uncomfortable feeling, but one that’s helpful. When we apologize for something we’ve done, make amends to others, or change a behavior that we don’t feel good about, guilt is most often the motivator. Guilt is just as powerful as shame, but its effect is often positive while shame often is destructive…shame corrodes the part of us that believes we can change and do better.” (56-7)

“Along with many other professionals, I’ve come to the conclusion that shame is much more likely to lead to destructive and hurtful behavior than it is to be the solution…it is human nature to want to feel worthy of love and belonging. When we experience shame, we feel disconnected and desperate for worthiness. Full of shame or the fear of shame, we are more likely to engage in self-destructive behaviors and to attack or shame others.” (57)

Please stop shaming yourself for not knowing things no one taught you. Anonymous

Self-Acceptance

Brene Brown has conducted more than 1,000 interviews, searching for themes that indicate how people can make progress in reducing shame and improving their lives by connecting with their courage, vulnerability, and empathy. She identifies self-compassion as the key to shame and perfectionism. 

Tewelve years ago, I was misdiagnosed with OCD. When I learned about Obsessive Compulsive Personality Disorder (OCPD) (age 40), I went back to individual therapy. I also did a 3 month trauma therapy group that was very helpful. I don’t meet the OCPD diagnostic criteria anymore.

There is a lot of confusion about OCD and OCPD, distinct disorders that have some similarities on the surface.

Research indicates that about 25-33% of people with OCD also have OCPD. Some people meet the criteria for one disorder and just have tendencies of the other disorder.

DSM CRITERIA

Obsessive Compulsive Personality Disorder [also called Anankastic Personality Disorder] is a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

• Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.

• Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).

• Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).

• Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).

• Is unable to discard worn-out or worthless objects even when they have no sentimental value. [least common symptom]

• Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.

• Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.

• Shows rigidity and stubbornness.

The essential feature of obsessive-compulsive personality disorder is a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. This pattern begins by early adulthood and is present in a variety of contexts.

Outside the U.S., mental health providers often use the International Classification of Diseases (ICD-10) instead of the DSM as their reference manual. The ICD refers to OCPD as Anankastic Personality Disorder.

The general diagnostic criteria for personality disorders is in a reply to this post.

OBSESSIONS VS. PERSEVERATION

Obsessions are not an OCPD symptom. People with OCPD perseverate and hyperfocus on issues and tasks they value (e.g. work, organizing). They have a tendency to ruminate, worry, and overthink. Their compulsions are rigid habits and routines driven by moral and ethical beliefs and a strong need for order, perfection, and control over themselves, others, and/or their environment. People may receive praise for behaviors stemming from OCPD (e.g. diligence at work). The diagnostic criteria refer to "over preoccupation," rather than obsessions.

EGO DYSTONIC VS. EGO SYNTONIC

People with OCD usually view their obsessions and compulsions as separate from themselves—intrusive, distressing, and not aligned with their beliefs and desires (ego dystonic).

OCPD is usually 'ego syntonic.' Individuals with OCPD tend to view their habits as rational, logical, justified, and as expressions of their values and beliefs. They often don’t realize that these behaviors impact them negatively. There are exceptions to this pattern.

People with OCD are more likely to seek therapy to find relief from their symptoms. When people with OCPD seek therapy, it's often due to depression, anxiety and/or difficulties with work or relationships, rather than OCPD symptoms.

IMPACT OF UNDIAGNOSED OCPD

In an interview, Dr. Anthony Pinto explained why untreated OCPD interferes with Exposure Response Prevention Therapy for OCD: “when somebody has perfectionism...they tend to perseverate over details of therapy instructions and they become really worked up about whether they are doing the treatment correctly.

"They can also sometimes be argumentative about the rationale for the treatment, and feel like it is wrong not to do rituals, and so that can impact their compliance or their adherence with the treatment...Sometimes individuals with perfectionism...might avoid doing the exposures on their own for fear that they're not doing them correctly....[They] might be more sensitive to feeling like a failure if the progress in treatment is moving slowly."

DIAGNOSTIC TESTS

There are many assessments for evaluating personality disorders, e.g. Millon Clinical Multiaxial Inventory (MCMI), Personality Assessment Inventory (PAI), and The Personality Diagnostic Questionnaire (PDQ).

Dr. Anthony Pinto created The Pathological Obsessive-Compulsive Personality Scale (POPS). It's available on the website of the OCPD Foundation. He suggests that people show concerning results to a mental health provider and that they retake the POPS to monitor their progress in treatment. In a study of people with OCD, a raw score of 178 or higher indicated co-morbid OCPD.

Steven Hayes, a psychologist who overcame panic attacks, developed Acceptance and Commitment Therapy (ACT), a subtype of Cognitive Behavioral Therapy (CBT). Studies show the effectiveness of ACT in treating anxiety disorders, depression, OCD, OCPD, eating disorders, chronic pain, and substance use disorders. A Meta-Analysis of The Efficacy of Acceptance and Commitment Therapy

I agree with Gary Trosclair's statement that OCPD is "a disorder of priorities." When he starts to work with clients who have OCPD, they often cannot identify what is most important to them.

Learning about ACT helped me make decisions that align with my values and priorities, and focus on “the big picture” (my values) instead of “getting lost in the details”—overthinking and ruminating about upsetting experiences. ACT coping strategies helped me feel less overwhelmed by thoughts and feelings, improved my flexibility, and made it easier to make decisions.

HOW VALUES ARE DIFFERENT FROM GOALS

From The Perfectionism Workbook (2018), Taylor Newendorp:

“Goals are things you can put on your ‘to-do list’ and check off once you have accomplished them. Goals lead to measurable achievements. Values are broader, overarching principles that provide you with a sense of purpose in life. Values are constant. They are ongoing, underlying guidelines by which we live. Values can instill in you a positive sense of motivation and fulfillment. Values are what are most important to you, separate from what anyone else in your life says or does.” (182).

From ACT Made Simple (2019), Russ Harris:

“Values are our heart’s deepest desires for how we want to behave; how we want to treat ourselves, other people, and the world around us. They describe what we want to stand for in life, how we want to act, what sort of person we want to be, what sort of strengths and qualities we want to develop.” (213)

“Goals are things you are aiming for in the future: things you want to get, have, or achieve. In contrast, values are how you want to behave right now and on an ongoing basis for the rest of your life, and how you want to behave every step of the way toward achieving your goals--whether you achieve them or not." (214)

"Values are directions, not endpoints, and they make better guides than 'shoulds' do." mentalhealthathome.org

EXAMPLES OF VALUES

independence, family, education, patience, spirituality, creativity, health, compassion, financial security, honesty, perseverance, service to others, self-care, gratitude, community, friendships, flexibility, self-acceptance, authenticity, assertiveness, generoisty, creativity, fairness, gratitude, fun and humor, mindfulness, order, persistence

How To Identify Your Core Values

Mindfulness is a key component of ACT.

WHY ACT EMPHASIZES VALUES

From ACT Made Simple (2019), Russ Harris:

“People who lead a very goal-focused life often find that it leads to a sense of chronic lack or frustration…they’re always looking to the future and continually striving to achieve the next goal under the illusion it will bring lasting happiness or contentment. In the values-focused life, we still have goals, but the emphasis is on living by our values in each moment, this approach leads to a sense of fulfillment and satisfaction, as our values are always available.” (215-16)

From ACTivate Your Life (2015): Joe Oliver, Eric Morris, and Jon Hill:

“Although setting and pursuing goals can be useful, there is a downside to having goals without broader directions [values]. Goals are binary: you are either pursuing a goal or you have completed it. When we focus on goals alone, we can sometimes end up in a pattern of ‘catch-up’, with the goal there ahead of us, and feeling the distance between where we are and where we want to be. This distance can be painful and [can lead to perfectionism] about achieving the goal, or ‘analysis paralysis’, where you spend time being indecisive…and become stuck in your head.” (144)

If you view your values as if they were rules, they become “another burden, and your mind says, ‘Well, here’s another way that you are messing up things…[you are] not being true to your values.’ We think that you have enough rules in your life…values aren’t more rules. Instead, values may be considered guides…like a small light on a path, or a compass point...” (151-52)

“Some rules can be useful…they can give us a sense of clarity in our actions when we feel unsure of what to do. But—crucially—they deprive us of our ability to make active, values-based choices…Rules are by their nature not responsive to the dynamic, fluid nature of life…If we hold onto our rules too tightly, we can end up feeling hurt and disappointed when life’s events—and especially when we ourselves—don’t conform to them…The difference between values and rules is that values are flexible and adaptable, while rules are rigid.” (398-99)

RESOURCE

ACTivate Your Life (2015), Joe Oliver, Eric Morris, Jon Hill

What are your goals and values, and how are they influenced by your OCPD traits?

Questions for Challenging Perfectionist Thinking

-Is this situation really as important as it feels?

-What if this situation doesn’t go my way? Does it really matter?

-Do I need to control this situation?

-Is my way the only way to view this situation?

-Would another person necessarily see this situation the same way I do?

-Do I know for sure that things will turn out badly if I don’t get my way?

The CBT Workbook For Perfectionism (2019), Sharon Martin, 217-18

*

How do I know if this thought is accurate?

What evidence do I have to support this thought or belief?...

-Is this thought helpful?

-Are there other ways that I can think of this situation or myself?

-Am I overgeneralizing?

-Am I making assumptions?...

-Can I look for shades of gray?

-Am I assuming the worst?

-Am I holding myself to an unreasonable or double standard?

-Are these exceptions to these absolutes (always, never)?

-Am I making this personal when it isn’t?

-Is this a realistic expectation?

-Am I expecting myself to be perfect?

When Perfect Isn’t Good Enough (2009), Martin Antony, Richard Swinson, 191

Self Talk and Motivation

“Most perfectionists mistakenly believe that self-criticism will motivate them to excel or change and that meeting an error with compassion will only lead to poorer performance and more mistakes…Self-criticism might temporarily motivate you out of fear and shame…Ultimately, self-criticism makes us feel worse about ourselves, and it’s hard to do better…Self-compassion isn’t self-indulgent. It’s not giving ourselves a free pass when we screw up. We don’t have to choose between accountability or compassion." (68)

"Self-compassion allows us to give ourselves both the accountability and the understanding that we need to accept and improve ourselves…Self-compassionate people...[learn] from their mistakes. They can move on more quickly after a setback and set new goals instead of getting stuck in disappointment and self-reproach." (68)

From The CBT Workbook For Perfectionism (2019), Sharon Martin

“What we often hear [from many of our clients] are comments such as: ‘I don’t deserve to go easy on myself,’ ‘I’m lazy, I’ve brought this on myself’, ‘If I stop giving myself a hard time, I’ll never get out of this mess!’ We would like you to pause for a moment and ask yourself how well does this approach work? When your mind is engaging in a solid twelve rounds of ‘beating yourself up’, do you feel invigorated, creative, ready to tackle new challenges? Or do you feel drained, exhausted, guilty and defeated?...Imagine you were talking to a dear friend [in great distress]…How would you respond to them? Compare this to how [you talk to yourself during your] lowest, most vulnerable points.” (235)

From ACTivate Your Life (2015), Joe Oliver, Eric Morris, and Jon Hill

My Experience

I found it helpful to ‘talk back’ to negative self-talk and cognitive distortions (as soon as possible when they arise) with certain phrases. When I was by myself, I sometimes said them out loud: big picture (when I’m lost in details), overthinking, ruminating, not important, pure speculation, not urgent, slow down, good enough, and move on. I used an assertive tone, not a harsh tone.

When I recognize that I’m ruminating on a trivial issue, I exaggerate my thoughts and say phrases like devastating, disaster, tragedy, life-or-death decision, life changing decision, emergency, and this is critical. "This is the greatest injustice in the history of the world" is one my favorites.

For about seven months, I habitually framed upsetting thoughts with, “I’m having the thought….,” “I think…,” and “I’m feeling…right now,” and “I’m thinking…right now.” This is a reminder that feelings are not facts and that they won’t last forever.

This strategy helps even when my self-talk is harsh. There’s a difference between thinking “I am stupid” vs. “I think I’m stupid,” “I’m having the thought ‘I’m stupid’,” and “I’m feeling stupid right now.” The framing makes it easier to stop ruminating.

I try to reframe "I should" thoughts into "I would prefer to" or "I could."

It's helpful for me to identify what feelings are contributing to self-critical and ruminating thoughts.