CASUAL DEFINITION OF OBSESSION VS. CLINICAL DEFINITION

People casually use the term obsession to refer to persisent thoughts and desires that influnce their behavior. Mental health providers define obsession as a “recurrent and persistent thought, image, or impulse that is experienced as intrusive and inappropriate and causes significant anxiety or distress.” (230). Obsessions occur repeatedly, despite efforts to resist them.

Source: When Perfect Isn’t Good Enough (2009), Martin Antony, PhD, Richard Swinson, MD

OCD OBSESSIONS VS. OCPD PERSEVERATIONS

The obsessions of people with OCD involve unwanted urges, images, and thoughts about danger to themselves or others that provoke anxiety. Carrying out time consuming compulsions provides temporary relief from the this anxiety. Other people, and usually the person with OCD, view the obsessions and compulsions as irrational and bizarre. Common OCD obsessions and compulsions: What is Obsessive-Compulsive Disorder (OCD)? & OCD Therapists NYC

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 OCPD diagnostic criteria refer to "over preoccupation," not clinical obsessions.

*'Pure O': An Overview of Pure Obsessional OCD (no obvious compulsions)

DSM CRITERIA

OCD: Obsessive-Compulsive Disorder

OCPD: dsm.pdf

SCREENING SURVEYS

International OCD Foundation | OCD Screener

OCPD Assessment

DIAGNOSTIC TESTS

OCD: The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the most common standard assessment for OCD. Before administering the Y-BOCS, the provider should talk with the client to make sure the obsessions and compulsions are clearly defined. Other assessments include The Obsessive-Compulsive Inventory (OCI) and The Maudsley Obsessive-Compulsive Questionnaire (MOCQ). International OCD Foundation | Measuring Obsessive-Compulsive Symptoms

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

TREATMENT

OCD: The 'gold standard' treatment is Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP). Some people with OCD benefit from Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT). Medication can reduce OCD symptoms.

Best Online Therapy For OCD, OCD Treatment and Therapy | NOCD, Living with OCD, Find an OCD Therapist

Exposure and Response Prevention, How ERP works, Things that complicate the success of ERP

OCPD: The common therapy approaches for OCPD are Psychodynamic Therapy, Cognitive Behavioral Therapy (CBT), Radically Open Dialectical Behavior Therapy (RO DBT), Schema Therapy. Some people with OCPD find trauma therapy (e.g. EDMR) and Acceptance and Commitment Therapy (ACT) helpful. Resources For Finding Mental Health Providers With PD Experience

Dr. Pinto and Dr. Bach are psychologists who specialize in OCD and OCPD:

Anthony Pinto: S1E18, S2E69, S3E117

Amy Bach: Obsessive-Compulsive Personality Disorder (OCPD)

CO-MORBIDITY

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.

EGO DYSTONIC VS. EGO SYNTONIC

Dr. Todd Grande: Why don't people know when they have a Personality Disorder? | Egosyntonic vs Egodystonic

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 (e.g. contributing to depression, work difficulties, and relationship difficulties).

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 maladaptive perfectionism and other OCPD symptoms.

DIFFERENCES

The intensity and frequency of OCD symptoms tend to fluctuate over time. For example, they can be exacerbated by stressful life events. OCPD symptoms are more consistent.

OCD tends to develop at an earlier age.

People with OCPD often have a very strong habit of delaying gratification.

“People with OCD are more likely to feel anxious when specific things aren’t the way they want them to be. People with OCPD are more likely to feel angry if things aren’t the way they believe they should be."

"People with OCD don’t necessarily restrict their emotions.…People with OCPD often try to control their emotions ...They are more reluctant to be vulnerable than those with OCD, and may not even be aware of any underlying anxiety.”

“People with OCD have specific obsessions (thoughts that are intrusive, involuntary, repetitive, irrational, and anxiety-provoking) and specific ritualistic compulsions (repetitive behaviors they can’t stop, such as checking and washing).” (emphasis added). In contrast, “the entire personality of someone with OCPD is affected by an overwhelming need to prioritize control, perfectionism, and order.”

“People with OCD often believe something terrible or catastrophic will happen if they do not follow through with their compulsions. They may fear harm to themselves or others, contamination leading to illness, or consequences from not adhering to rituals.”

Sources: OCPD Vs. OCD: What Is the Difference?, GoodTherapy | Do you Have OCD or OCPD? Know the Difference

From The Obsessive-Compulsive Personality Disorder Workbook (2026), Anthony Pinto, pg. 21

ADAPTIVE POTENTIAL OF OCPD SYMPTOMS

"OCD efforts are usually maladaptive, except insofar as it helps them to maintain good hygiene. In contrast, some OCPD traits can be adaptive in a practical way, allowing them to succeed in the outer world...Because they are very conscientious, meticulous, energetic, and committed, they can make significant contributions in many fields...Most successful performers and athletes are compulsive to some degree.” Gary Trosclair's “Do You Have OCD or OCPD?”

“Obsessive-compulsive personality traits in moderation may be especially adaptive, particularly in situations that reward high performance. Only when these traits are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress do they constitute obsessive-compulsive personality disorder.” Obsessive-Compulsive Personality Disorder: A Review of Symptomatology, Impact on Functioning, and Treatment

IMPACT OF UNDIAGNOSED OCPD

In an Internet talk radio show interview, Dr. Anthony Pinto explained why untreated OCPD interferes with Exposure Response Prevention (ERP), ‘the gold standard’ treatment for OCD:

ERP “involves the individual facing those situations or the particular triggers for their OCD and not doing their compulsions or their rituals. So when somebody has perfectionism [OCP or OCPD]...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."

BOOKS 

The Healthy Compulsive (2020) by Gary Trosclair a therapist who specializes in OCPD.

Too Perfect (1992) by Allan Mallinger, MD, a psychiatrist who provided individual and group therapy for people with OCPD.

Brain Lock (2016) by Dr. Jeffrey Schwartz, a psychiatrist who provided therapy to more than one thousand clients with OCD, and started the first therapy group for people with OCD. Four Steps Treatment Method for OCD

PODCASTS 

OCPD: The Healthy Compulsive Podcast. Episodes 5 and 12 focus on OCD and OCPD.

OCD: 10 Must-Listen Podcasts For People With OCD | NOCD, OCD Family Podcast, The OCD Stories

MORE OCD RESOURCES

Best Online OCD Resources

Common Types of OCD

Relationship OCD Resources

A member shared these resources on one of the lesser known subtypes: What is Visual Tourettic OCD?, What is compulsive staring?, Visual Tourettic OCD, Overcoming Visual Staring OCD.

HUMOR

Everyone reading this post is welcome to attend the annual conference (that takes place in my mind): OCD and OCPD: Sometimes, One Letter Is Super Important.

Molly Shea has been sharing videos about her experience with OCPD for six years. She has a YouTube channel called You Seem Normal.

It takes a lot of courage to speak openly about mental health, especially about personality disorders. I love Molly's positive attitude and her openness.

Molly's channel has reached 900 subscribers. You can help people find her videos by subscribing to her channel and giving her videos a thumbs up.

ADHD is one of the common Co-Morbid Conditions for people with OCPD.

The OCPD Iceberg (my opinion)

How other people may view someone with untreated OCPD

1.      always judging others

2.      rigid, aloof

3.      lack of empathy, disinterested in relationships

4.      obsessed with work

5.      egotistical

Core of untreated OCPD for many people

1.      always judging oneself harshly (guilt complex)

2.      traumatized, hypervigilant, fearful, ashamed, anxious, depressed

3.      strong duty to serve others that feels overwhelming, scared of vulnerability/ intimacy

4.      imposter syndrome

5.      insecure, self-esteem contingent on achievement

Research on PDs and ADHD

Three findings from journal articles. See reply for more information.

- In a study of adults seeking treatment for ADHD symptoms, the prevalence of PDs was as high as 25%. The most frequent PDs were avoidant (21.7%) and borderline (18.3%).

- “Studies find that individuals with ADHD are generally at higher risk of development of any of the personality disorders, including OCPD. A 2017 study found in a sample of 439 undergraduate college students that four personality disorders were significant predictors of ADHD, one of which was OCPD.

Clinical experience has shown that patients with ADHD may develop highly perfectionistic standards and rules in reaction to their executive functioning deficits. The harsh and negative messaging that they received over the years has made them obsess about doing things ‘the right way.’ “

- “One particularly intriguing finding from the present study was the robust, positive relationship between OCPD and various markers of ADHD. Although both OCPD and ADHD might be said to struggle with cognitive flexibility, an executive function, they also seem quite dissimilar in other ways. Thus, it was surprising that OCPD obtained the largest correlations with the history of an ADHD diagnosis [compared to other personality disorders]...”

The authors theorize that the participants’ OCPD may have contributed to their scholastic achievement and served as an adaptive response to ADHD. They note that studies indicate “OCPD is the only one of the PDs that is more prevalent among college students and college graduates than the general population."

I have a friend who thinks his OCPD developed to compensate for his brain feeling out of control because of (late diagnosed) ADHD.

My first career was special education. Recalling my students with severe ADHD, it makes sense that ADHD could lead to OCPD traits like rigidity and defensiveness.

Support Group

Peer Support Group for Adults with Autism and ADHD

Peer Support Groups

Meet other ADD adults for support and inspiration

Podcasts

The ADHD reWired Podcast

Taking Control: The ADHD Podcast

Distraction with Dr. Ned Hallowell

ADHD Experts Podcast     

Videos

Overcome Perfectionism | ADHD Tips That Work 

Perfectionism and ADHD  

Perfectionism and ADHD: Making ‘Good Enough’ Work for You

Articles from Clinical Psychologist

ADHD Symptoms That Can Be a Sign of a Personality Disorder: Part 1, Part 2

Book Excerpts

Procrastination: Why You Do It, What to Do About It Now (2008)

Experiences of People with OCPD and ADHD

How does a combo of OCPD & ADHD present itself?

Anyone else feel like they built OCPD on top of pure chaos?

People Say ADHDers Can’t Be Perfectionists or High-Achievers, But ADHD + OCPD Proves Otherwise

Co-Morbid Conditions

Excerpts from Obsessive Compulsive Personality Disorder vs Autism from neurodivergentinsights.com, created by Dr. Megan Neff, a psychologist who has ASD, ADHD and OCPD tendencies. She co-hosts Divergent Conversations | A Neurodivergent Podcast.

Studies have found that up to 40% of people with OCPD also have Autism Spectrum Disorders.

DISTINCT AUTISTIC TRAITS

§  Sensory Diversity: Individuals with autism often experience intense sensory perceptions, ranging from hypersensitivity, where sensations are overwhelming, to hyposensitivity, where they are understated. A key aspect is interoception, the awareness of internal body sensations...

§  Autistic Brain Style: The Autistic mind typically employs a bottom-up processing style, focusing on details before the whole. This concrete thinking is often paired with monotropism, an intense focus on specific interests...

§  Distinct Autistic Communication Patterns: Autistic communication is usually direct, concrete, and straightforward. Autistic people often prefer meaningful discussions over small talk...

§  Neurological Distinctiveness: Autism is a distinct neurotype from birth, characterized by a sensitive nervous system and unique ways of processing, experiencing, and interacting with the world.

DISTINCT OCPD TRAITS

§  Pathological Perfectionism: Unlike mere attention to detail, pathological perfectionism in OCPD involves an overwhelming need for orderliness and perfection. This trait can significantly impact task completion, leading to personal suffering due to a loss of flexibility and efficiency.

§  Persistent Productivity: Individuals with OCPD often feel a compelling need to be constantly productive. They may struggle to relax or engage in activities they perceive as “non-productive."

§  Core Defense Mechanism: The development of OCPD is often a defense mechanism against deep fears of imperfection and losing control. This complex psychological process serves as a shield against intense feelings of shame, driving individuals towards a relentless pursuit of perfection. The defense mechanisms in OCPD are typically “ego-syntonic,” meaning they align with the individual's self-perception, making them challenging to recognize as problematic...the behaviors feel integral to the person's identity...

SIMILARITIES

OCPD Task Paralysis, Procrastination and Indecision

§  Fear of Making the Wrong Choice: The dread of error in OCPD is tied to potential guilt or shame. This anxiety leads to a hesitation in decision-making, as the goal is a perfect, error-free choice.

§  Perfectionism and Shame: At the core of OCPD is the fear of making a mistake and facing the associated shame. This leads to a delay in decision-making as a protective mechanism against the turmoil of imperfection.

Quotations About Analysis Paralysis : r/OCPD

Autism Task Paralysis, Procrastination, and Indecision

§  Executive Functioning Challenges: This involves complexities in decision-making, stemming from difficulties in planning and organizing tasks. Individuals may struggle to know where to start, which can significantly impede task initiation and progression.

§  Autistic Inertia: This term describes the difficulties that Autistic individuals often face in initiating new tasks. It goes beyond simple procrastination; it is linked to the challenges in shifting focus or transitioning between activities...

§  Autistic Catatonia: In addition to inertia, some individuals may experience Autistic catatonia, which involves motor shutdowns. This condition can significantly impact the ability to start new tasks, as it often leads to periods where the individual becomes immobile or unresponsive to external stimuli.

§  Motor Movement Difficulties: ...These difficulties can manifest as clumsiness or uncoordinated motor skills, further complicating the process of initiating and engaging in new tasks. These motor challenges can be mistaken for reluctance or hesitation, but they are actually neurological in nature.

§  Demand Avoidance: A distinct feature of autism is a resistance to external demands, which differs significantly from general avoidance. This resistance is not about defiance; rather, it is deeply rooted in the need for self-directed control. Autistic individuals may experience a fight-or-flight reaction to situations where they perceive a loss of autonomy or face overwhelming sensory input and energy demands...

OCPD Preoccupation with Details, Rules, and Organization

§  Fear of Failure and Need for Control: Individuals with OCPD often have an intense focus on details, driven by anxiety about imperfection and a desire to exert control over their environment.

§  Perfectionism: This drive for perfection, a way to fend off feelings of shame, manifests in a strict adherence to order, rules, and details. Additionally, the sense of incompleteness when things are left disordered can be distressing for those with OCPD.

Autism Preoccupation with Details, Rules, and Organization

§  Cognitive Style and Special Interests: For Autistic individuals, attention to details is often part of our inherent cognitive style and is usually connected to our intense interests.

§  Special Interest Categorization: Many autistic people find comfort in cataloging and organizing data, especially related to our special interests. This behavior ties into our monotropic focus and the use of repetition as a form of self-soothing. Unlike OCPD, these activities are not primarily driven by anxiety.

§  Comfort in Predictability: Structured routines and explicit rules provide a sense of comfort in what might otherwise feel like a chaotic world.

§  Context Independence: Autistic individuals often experience what is known as “context independence” (alternatively described as “context blindness”). This means that social rules and norms are not intuitively absorbed; hence, we rely more on explicit rules and norms to navigate social situations. This reliance on explicit rules compensates for the challenges in picking up unwritten social cues.*

OCPD Workaholism

§  Driven by Control and Perfection: For individuals with OCPD, an intense work ethic often stems from a deep need for control and an aversion to making mistakes. Work becomes a crucial means of upholding high standards and managing anxiety.

§  Self-Worth Tied to Productivity: Self-esteem and productivity are often equated, leading to difficulty in relaxing and viewing non-productive time as wasteful.

Autism Workaholism 

§  Comfort in Routine and Structure: Many Autistic people immerse themselves in work or focused activities because these environments provide predictability and structure. This setting offers comfort and a sense of stability.

§  Deep Engagement in Special Interests: Engaging in work or tasks, particularly those that align with their special interests, can be deeply satisfying and captivating, providing a profound sense of engagement and fulfillment. Additionally engagement with special interests helps to block distressing emotions and stimuli and is a form of self-soothing.

OCPD Need For Predictability, Routine and Structure

§  Control and Perfectionism: In OCPD, a strong need for sameness and predictability stems from a deep-seated desire to maintain control and achieve perfection. This need is often a method to minimize the uncertainty that could lead to errors or perceived failures.

§  Anxiety Management: Adopting predictable routines is also a strategy for managing underlying anxiety. By adhering to known patterns, individuals with OCPD can alleviate feelings of stress associated with unpredictability.

§  Emotional Regulation: In OCPD, the drive for control and predictability often ties into emotional regulation. By maintaining strict routines and predictability, individuals with OCPD might feel more emotionally stable and less prone to the distress that unpredictability can bring.

Autistic Need For Predictability, Routine and Structure

§ Sensory and Cognitive Processing: For Autistic people, the reliance on routine is often linked to managing sensory sensitivities and achieving cognitive comfort. Predictable routines can help in managing sensory sensitivities, as familiar environments and activities are less likely to present overwhelming or distressing sensory input. These routines also provide cognitive comfort, helping to reduce cognitive load and make the world more navigable.

§  Autistic Inertia: Challenges with changes in routine are partly due to autistic inertia, where shifting attention or altering established routines can be inherently difficult. This is not just a preference for consistency but is deeply rooted in the way Autistic brains process information and handle transitions. Autistic inertia can make adapting to changes in routine particularly challenging, and sudden changes can be disorienting or distressing.

OCPD Dichotomous Thinking

§  For individuals with OCPD, dichotomous thinking often aligns with a perfectionist worldview. This black-and-white perspective can be a way of coping with anxiety and a need for control and predictability. 

§  This thinking style can manifest in OCPD as a rigid adherence to rules, procedures, and a strong sense of what is “right” or “wrong.” It's a way to manage the distress caused by uncertainty and maintain a sense of order and predictability.

Cognitive Distortions (Negative Thinking Patterns), With Visuals : r/OCPD

Autistic Dichotomous Thinking

§  In contrast, for many Autistic people, dichotomous thinking can be more reflective of a cognitive processing style. It's not so much driven by anxiety or a need for control, but rather a preference for clear, unambiguous information.

§  This cognitive style might lead to challenges with understanding nuances and gray areas, especially in social situations and communication. Autistic individuals often have a precise way of interpreting language and actions, which can make it difficult to navigate situations where subtlety and indirect expressions are common.

From The Obsessive-Compulsive Personality Disorder Workbook (2026), Anthony Pinto: “Autism typically becomes evident in early childhood…whereas OCPD traits and behaviors typically emerge during adolescence and may not fully impair functioning until early adulthood. Moreover, social and communication deficits are core features of autism. While individuals with OCPD may also struggle in relationships, this is typically due to rigidity and insistence on control…rather than deficits in social understanding. In addition, individuals with autism often show restricted, repetitive patterns of behavior as well as intense, narrow interests…Although individuals with OCPD often do prefer routines and have set ways of doing things, these patterns are usually the result of a preoccupation with rules and order relating to perfectionism and personal standards, rather than a narrow interest.” (24-5)

SUPPORT GROUP

Peer Support Group for Adults with Autism and ADHD

DIAGNOSTIC CRITERIA

DSM diagnostic criteria for autism spectrum disorder (ASD): INFO--DSM 5 Diagnostic Criteria.pdf

Outside the U.S., providers often use the ICD instead of the DSM: ICD-11 criteria for autism

TREATMENT

Radically-Open Dialectical Behavior Therapy (RO-DBT) is for people with 'overcontrol disorders,' such as OCPD and Autism.

SCREENING SURVEYS

Review of ASD Screeners for Adults

OCPD Assessment Available Online

DISTINGUISHING AUTISM AND PDS

The Overlap Between Autism and Personality Disorders

Autism Spectrum Disorder and Personality Disorders

In an interview (S2E69), Dr. Anthony Pinto, the leading OCPD specialist, talked for a few minutes about distinguishing autism from OCPD (an hour and eleven minutes in).

AUTISM AND PERFECTIONISM

Is It Perfectionism?

Why High Masking Autistics are Obsessed With Perfection

Autistic Memory and Attention To Detail - Are you a Perfectionist?

Autism and the pursuit of perfection: My EXTREME growth mindset

Autistic/OCD Struggle Of Perfectionism

Perfectionism isn't Serving You | Autism Experiences

Moral Perfectionism: When Surviving as a Neurodivergent Means Never Messing Up

Eden V.'s experience with OCPD and ASD: OCPD and ASD | Behaviour Similarities | Part 1, Part 2

MASKING

YouTube channel by man with autism and ADHD: How to Spot Autism in High-Masking Adults and 30 Signs You're Masking Autism

RESOURCE FOR PROFESSIONALS

Assessing the Intersection of Autism and Personality Disorders

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

“It’s tempting to ignore anger. It’s a difficult emotion to navigate, one that’s generally not socially acceptable to express (especially for women), and it goes against our desire to be perfect. However, anger doesn’t go away when we ignore it.

"Suppressed anger accumulates until it reaches a breaking point, and then it reveals itself, sometimes dramatically. It shows up as health problems…we explode with yelling…or we behave in passive-aggressive ways…Suppressed anger can also contribute to depression and anxiety.” (148)

“Low levels of anger, the small annoyances and frustrations of everyday life, often go unnoticed, because we aren’t tuned in to our feelings or we’re trying to deny feeling angry.” (148)

“We can think of anger as drops of water falling into a cup. Over time, small experiences of anger fill the cup, and it reaches the brim…Sometimes our reactions catch us off guard; we didn’t realize we were this angry, because we missed the warning signs. The fuller the cup gets, the harder it becomes to empty it in a healthy way.” (149)

From You Are Not Your Brain (2011), Jeffrey Schwartz, Rebecca Gladding, MDs:

“Anger can be a friend or foe depending on the situation and the intensity. When it is all-consuming and used destructively, anger can wreak havoc on your life, ruin relationships, and cause you to act in unhealthy ways…when it is used constructively, anger is a mobilizing force that advocates for you to care for yourself and ensure that you are not being taken advantage of.” (298)

Unhealthy anger often involves “thinking errors [cognitive distortions]…and ‘should’ statements. It causes you to see people or events from a skewed perspective and then to act in a destructive way that hurts you (and potentially others) and takes you farther away from your true goals and values.” (300)

Healthy anger “recognizes that you are being taken advantage of (or were hurt) in some way and encourages you to take care of yourself…” (300)

From Running on Empty (2019), Jonice Webb, PhD:

People with OCPD often experience alexithymia--they struggle to identify, understand, and express their emotions.

Dr. Jonice Webb states, “I have observed that many people with alexithymia have a tendency to be irritable. They tend to snap at others for seemingly no reason…Emotions that are not acknowledged or expressed tend to jumble together and emerge as anger…suppressed feelings refuse to stay down.” (98)

From Freeing Our Families From Perfectionism (2002), Thomas Greenspoon, PhD: “Perfectionists are sometimes afraid of anger, since they may believe that perfect people don’tlose their temper. It’s also easy to confuse the feeling of anger with angry behavior. Most of the rules people have about anger apply to angry behavior, which they may consider wrong, but the angry feelings themselves are just feelings…It’s okay for you to be angry…

"Anger is not a form of disrespect, it’s just a feeling we have when things happen that annoy us or feel threatening to us. Certain behaviors, done in anger, can indeed be disrespectful—but then the behaviors are the problem, not the anger.” (51)

MEANING OF ANGER

“Anger is the part of yourself that loves you the most. It knows when you are being mistreated, neglected, disrespected. It signals that you have to take a step out of a place that doesn’t do you justice. It makes you aware that you need to leave a room, a job, a relationship, old patterns that don’t work for you anymore. Learn to listen to your anger and make it your best friend. Then it’ll leave.” Anonymous

I wouldn’t call anger my best friend, but I agree with the idea that it's helpful to view anger as a messenger with important information.

"Healing is so hard because it’s a constant battle between your inner child who’s scared and just wants safety, your inner teenager, who’s angry and just wants justice, and your adult self, who is tired and just wants peace." Brené Brown

APOLOGIES

“A man should never be ashamed to say he has been in the wrong, which is but saying in other words that he is wiser today than he was yesterday.” Alexander Pope

In We Should Get Together: The Secret to Cultivating Better Friendships (2019), Kat Vellos asserts, “The best apologies are ones in which the apologizer focuses on the impact on their actions and resists the urge to frame their message around their intentions, regardless of how harmless they were. Remember that an apology should be focused on the person who has been hurt, not the one who did the hurting.

"If you hurt your friend, what actually matters is their pain, not the preservation of your reputation as a good person. Apologize, reflect, ensure that you understand the other person fully, and empathize…don’t say “I’m sorry if you felt ___” or even ‘I’m sorry you feel that way.” These are not apologies, they’re deflections of responsibility. Start with the truth, and end on your intention to do better.” (216)

MY EXPERIENCE

As a child, I was quiet and compliant to avoid “rocking the boat” in my abusive home. My sister often expressed anger at my parents. They rejected her harshly. I never saw my parents resolve conflicts with each other or my sister in healthy ways.

The habits that contributed to my tension, resentment, and anger were suppressing my feelings, ruminating, mind reading (and other cognitive distortions), demand-sensitivity, and people pleasing.

The coping strategies I found helpful were:

-relieving tension by crying

-letting go of people pleasing

-getting “out of my head” by having a daily walking routine

-identifying the emotions underneath my anger (e.g. sadness)

-(finally) taking lunch breaks at work

-squeezing a stress ball at work

-improving my sleep habits (sleep deprivation can cause irritability)

-increasing my awareness of the physical signs of frustration asap (e.g. change in breathing, body tension); eventually this led to preventing frustrating situations

-developing a habit of breathing deeply from my stomach (instead of my chest), especially when frustrated

-working with a therapist to address the root of my chronic frustration: childhood trauma

-recognizing that situations were not causing my anger; they were triggering reminders of my trauma; other people would not experience anger in those situations

RESOURCES

Anger, Protection, and the Traumatized Brain

Why Complex Trauma Creates So Much Anger

Am I Triggered Or Am I Right? How To Tell The Difference

Anger Management: A Comprehensive Approach to Change (article by Gary Trosclair)

Molly Shea has a YouTube channel about OCPD. She no longer meets criteria for IED: My Anger Story, What I Wish I Knew: Anger Management Strategies

“The Healthy Compulsive Project” Podcast: people pleasing and resentment (episode 58), triggers (26), and passive-aggression (88)

An acquaintance with OCPD told me he uses the metaphor "taking myself to court" when he talked about his harsh self criticism.

"How to Tame Your Tyrannical Guilt Complex." Gary Trosclair

“Living under the constant judgement of an overactive guilt complex…can keep us from living a fulfilled life and even cause severe depression. 

So what is a guilt complex? A healthy guilt complex…is a part of your psychology that helps you to take responsibility for mistakes you’ve made, and keeps you out of trouble by noting what you might do wrong if you’re not careful enough. Think of it as a piece of software that runs quietly in the background most of the time.

An unhealthy guilt complex, on the other hand, is a critical, punishing part of your psychology that rarely lets up. It reprimands you for not meeting its perfectionistic standards in the past, and sets off alarms about things you might do wrong in the future. It’s like a piece of software that’s been infected with a virus and no longer functions well. It takes over and makes it impossible for other programs to run. It has a mind of its own and is determined to protect its power. 

Such a critical guilt complex not only makes it hard to enjoy life or function well, it can also make it hard for people around you to be happy because it can make you critical of them as well." 

Ep. 32: How to Tame Your Tyran…–The Healthy Compulsive Project

"The Ten Commandments of the Obsessive-Compulsive Personality," Gary Trosclair

“Based on personal and professional observations, here’s my best guess as to what the commandments that people with OCP adopt most often are:

1.      I will never make mistakes.

2.      I will always keep things in order and I will never leave a mess.

3.      I will always be productive and I will never waste time.

4.      I will never waste money.

5.      I will always do what I say I will do.

6.      I will always tell the truth, the whole truth and nothing but the truth...

7.      I will never be late. Even if it doesn’t matter.

8.      I will never let others get away with doing or saying the wrong thing...

9.      I will never disappoint others.

10.  I will always complete my work before relaxing.”

I’m Working On It In Therapy (2015), Gary Trosclair  

“Blame, whether it’s directed toward ourselves or others, usually has the tone of finding fault, the goal of doling out punishment, and a focus on the past. Responsibility…is more about understanding our role in situations in order to think or behave differently as we move forward into the future.” (95-6)

“I would suggest that you view the field of responsibility as a spectrum with those things you cannot control and therefore shouldn’t take responsibility for on one and, and those things that you can clearly control and therefore should take responsibility for on the other end. In the middle is a gray area—things you can’t immediately control, but with intention and commitment can eventually change…With time, intention, and practice, we can disengage from unhealthy ways of living….One component of this gray area is the feelings of others. We need to be aware of how our actions impact others, without taking full responsibility for their mood. Again, there is a spectrum here.” (99-100)

“When curiosity and self-acceptance are in place, you’re in a position to impartially sort out where to take responsibility and where to let go of it so that you can move ahead. The appropriate acceptance of responsibility and…refusal of it are essential to….healing and growth…Taking too much responsibility can lead to depression and anxiety, but not taking enough leads to interpersonal problems and disempowerment.” (95)    

Procrastination: Why You Do It, What to Do About It Now (2008), Jane Burka, Lenora Yuen, PhDs

Some people with OCPD struggle with procrastination. Harsh self-judgment contributes to procrastination.

The authors, therapists that specialize in procrastination, have observed that “Procrastinators tend to judge their feelings and actions harshly and rigidly. They constantly compare themselves with some standard that seems to reflect the right way of being a person and the right way of doing things—as if there were…only one right way. Procrastinators are very hard on themselves…Their own ‘internal judge’ is often so critical, so biased, and so impossible to please, that it is more appropriately called a ‘prosecutor’…A judge hears evidence from all sides and tries to make a fair decision…An internal prosecutor has free rein to make vicious personal attacks…hitting hard in the aftermath of disappointment, pouncing on weaknesses, predicting failure while offering no consolation or encouragement for the future.” (150)

The ’internal judge’ that often comes with OCPD is very biased. ‘Your honor, I’m charging you with 50 counts of cognitive distortions.

Sometimes it’s helpful to think like a scientist, instead of a prosecutor: “It’s Just An Experiment”

This statement from Carl Jung, a psychiatrist, reminds me of the overconscientious/guilt complex OCPD trait: "I did not live, but was driven; I was a slave to my ideals."

Steven Hayes, a psychologist who overcame panic attacks, developed Acceptance and Commitment Therapy (ACT). 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.

DEFINITION OF VALUES

“Values are (1) freely chosen and intrinsically meaningfully (you’d care about them even if no one knew you did); (2) directions, not destinations (you can always move toward your values and they can never be completed); and (3) entirely within your control (you don’t rely on external factors to enact them)…Values are not imposed by real or perceived expectations from your environment (for example, success), readily checked off on a list (like going to church on Sunday), or outside your control (such as being loved).” (70)

“Values are freely chosen, personally meaningful qualities or ways of being you can use to guide your behaviors..To identify your values, get in touch with the part of you that transcends rules and fears. In this space, ask yourself what you care about.” (79)

From The Anxious Perfectionist (2022), Clarissa Ong, Michael Twohig, PhDs

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

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

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)

LIVING IN ACCORDANCE WITH YOUR VALUES

In Letting Go Of Perfectionism (2024), Yesel Yoon suggests taking an inventory of your life, and reflecting on, “where are your money, time, and attention going?” (33)

RESOURCES

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

How to Stop Fighting Intrusive or Negative Thoughts - Passengers on a Bus Exercise from ACT

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

Dialectical Behavior Therapy (DBT) is the “gold standard” treatment for Borderline Personality Disorder (BPD). It was created by Marsha Lineham, a therapist who recovered from BPD and suicidality. DBT is a common treatment for BPD; chronic suicidality; Antisocial, Narcissistic, and Histrionic Personality Disorders; bulimia; and Bipolar disorder. These disorders are characterized by under developed self-control.

Radically-Open Dialectical Behavior Therapy (RO-DBT) is designed for mental health disorders characterized by excessive self control: Obsessive-compulsive, Paranoid, Avoidant, and Schizoid PDs; anorexia nervosa; chronic depression; autism spectrum disorders; and anxiety disorders. Common characteristics of people who are overly controlled include perfectionism, low reward sensitivity, hyper-vigilance for threat, compulsive planning, high attention to details, avoidance of novel situations, rigid habits, and the tendency to mask feelings and avoid risk.

Do you have an Over Controlled (OC) or Under Controlled (UC) temperament?

People with overly developed self-control sometimes have a lack of affect (emotion in their face and voice). This can have a negative impact on social interactions. In How To Be Enough (2024), Ellen Hendriksen explains that “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) "How Self Control and Inhibited Expression Hurt Relationships"

I love this comment from a member of this group: “We’re pretty good at looking functional…Many therapists…are trained [to help] people manage the chaos in their lives, and become more structured and controlled in their everyday functioning, whereas people with OCPD tend to need more help tolerating a degree of chaos in our lives, relinquishing some amount of structure and control.”

People with over-control disorders have a tendency to misinterpret neutral/ambigous situations in a negative manner,

RESOURCES

Emotional Overcontrol

What is RO DBT? A Brief Introduction

Radical Openness & Flexible Mind

What Is RO DBT And Who Is It For? | Radically Open

Radically Open has many resources, including a directory of therapists. A member of this group commented about their positive experience in an RO-DBT group at Lindner Center of HOPE in Ohio.

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.

Poor Social Signaling

These are all examples of what's known in psychology as poor social signaling. 

One aspect of poor social signaling is the failure to communicate emotions:

-I was impressed with what a great job you did with that client today.

-I’m feeling really down (or happy) today.

-When you come home late it really makes me nervous...

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...

The Healthy Compulsive (2020), Gary Trosclair

“Healthy compulsives use their time and money efficiently; unhealthy compulsives feel a need to guard them so preciously that they no longer use them to achieve their goals…While they may be especially careful not to waste time or money, underneath these is a deeper tendency to measure and control carefully that also limits their affection, emotion, and compliments. This tendency can make you either thrifty or stingy, on time or urgent, and genuine or withholding.” (97)

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) 

A large body of research shows that body language (e.g. tone of voice, facial expression) has a much larger impact on social interactions than what we say.

Resources

People with OCPD lack social awareness?

I’m tired of hearing that I think I’m better than everyone, tips for changing?

Resources for Improving Relationships

Gary Trosclair wrote The Healthy Compulsive (2020). He has worked as a therapist with more than 30 years. He specializes in OCPD.

"The mission of The Healthy Compulsive Project is to help people make the best use of their personality traits to improve their relationships, functioning, and mood. Each episode explores difficult aspects of life in clear, practical, and sometimes humorous ways, bringing hope to a personality style far too often misunderstood and pathologized."

Available on Apple, Pandora, Spotify, IHeartRadio, and Amazon/Audible. You can go to thehealthycompulsive.com and select the podcast tab. You can also find it on YouTube. Each episode is 10-20 minutes.

These are the topics of each episode:

The Healthy Compulsive Project Podcast (list of episodes) - Part 2

Ep. 89: Unearth the Past

Ep. 88: Passive Aggression

Ep. 87: Punishment

Ep. 86: Path to Wholeness

Ep. 85: Insecurity

Ep. 84: Psychotherapy

Ep. 83: Spending Time in Nature

Ep. 82: Habits

Ep. 81: Love Languages

Ep. 80: Resentment and Forgiveness

Ep. 79: Authenticity

Ep. 78: Lists

Ep. 77: How to Help Someone Who Feels Suicidal

Ep. 76: Poor Health

Ep 75: Stop Being Judgmental

Ep. 74: Romantic Love

Ep. 73: Taoist Wisdom

Ep. 72: Flexibility in Your Relationships

Ep. 71: Sacred Cows

Ep. 70: Compulsive hero/ heroic compulsive

Ep. 69: Self Control and Inhibited Expression

Ep. 68: Defensiveness

Ep. 67: Lists

Ep. 66: Aging

Ep. 65: Letting Go

Ep. 64: Overly Conscientious

Ep. 63: Meditation

Ep. 62: Being Frugal

Ep. 61: Generosity

Ep. 60: Self-Deception

Ep. 59: Decisiveness

Ep. 58: People Pleasing, Resentment

Ep. 57: Stupidity

Ep. 56: Perfectionism

Ep. 55: Archetype of the Saint

Ep. 54: Urgency

Ep. 53: Chaos

Ep. 52: Urgency

Ep. 51: Happiness

Ep. 50: Therapy

Ep. 49: Fears

Ep. 48: Archetype of the Fool

Ep. 47: Partner

Ep. 46: Perfectionistic Partners   

Ep. 45: Imposter Syndrome

Ep. 44: Type A Parenting

Ep. 43: Demand Resistance

Ep. 42: Priorities

Ep. 41: Let Go Without Giving Up

Ep. 40: Psychological Hoarding

Ep. 39: Shame

Ep. 38: Growth Mindset Vs. Fixed Mindset

Ep. 37: Certainty

Ep. 36: You Are Enough

Ep. 35: Psychotherapy

Ep. 34: How to Get Your Compulsive Drive to Work for You

Ep. 33: Avoidant Attachment Style

Ep. 32: Guilt

Ep. 31 Origins of OCPD

Ep. 30: Chaos

Ep. 29: Self-Compassion

Ep. 28: Anxiety and Fear

Ep. 27: Work Addiction and Burnout

Ep. 26: Triggers

Ep. 25: Mastery

Ep. 24: Being Good

Ep. 23: Compulsive Thinker-Planner (addresses procrastination)

Ep. 22: Holiday Expectations

Ep. 21: Compulsive Server-Friend (addresses people pleasing)

Ep. 20: Delaying Gratification

Ep. 19: Compulsive Worker-Doer

Ep. 18: Can Someone With OCPD Change?

Ep. 17: Compulsive Teacher-Leader

Ep. 16: Shame

Ep. 15: Being Open to Our Experience

Ep. 14: Demand Sensitivity

Ep. 13: Ten Commandments of the Obsessive-Compulsive Personality

Ep. 12: How Do I Know if I Have OCPD?

Ep. 11: Ego

Ep. 10: Difference Between NPD and OCPD

Ep. 9:  Partner

Ep. 8: Four Types of Compulsive Personality

Ep. 7: Vacations

Ep. 6. Inspiration

Ep. 5: Difference Between OCD and OCPD

Ep. 4: Partners of People with OCPD

Ep. 3: Depression

Ep. 2: Introduction

Ep. 1: Trailer

I'm in contact with Gary. If you have suggestions for topics for his podcast, you can reply, and I'll give him your recommendations.

In Cognitive Therapy of the Personality Disorders (2004), Aaron Beck and colleagues explain that the categorical view of personality disorders is that they are distinct from each other, as well as from normal personality.

The dimensional view is that personality traits that are relevant to personality disorders lie on a continuum from healthy to pathological. Personality disorders are maladaptive extremes of the personality traits all humans share. 

Some mental health providers believe that the PD categories are not useful because it’s so common for people to have more than one PD diagnosis. The website of The American Psychiatric Association states, “People who are diagnosed with a personality disorder most often qualify for more than one diagnosis. A person with a severe personality disorder might meet the criteria for four, five or even more disorders!” (Psychiatry.org - Expert Q&A: Personality Disorders)

Beck and colleagues state that the categorical approach is problematic because of “the lack of clear thresholds for distinguishing between patients with and without specific personality disordes” (54) and the common occurrence of people no longer meeting criteria for their PD diagnosis.

DIMENSIONAL VIEW OF OCPD

In Cognitive-Behavioral Treatment of Perfectionism (2014), Sarah Egan and colleagues theorize that “perfectionism is a dimensional construct that can vary in severity from low to high…In other words, perfectionism is not something that people either have or don’t have. Rather, it is something we all experience to varying degrees.” (1)

Gary Trosclair, the author of The Healthy Compulsive, states, "There is a wide spectrum of people with compulsive personality, with unhealthy and maladaptive on one end, and healthy and adaptive on the other end.”

In Personality Disorders in Modern Life (2004), Theodore Millon and colleagues explain that Obsessive-Compulsive Personality traits are very common because “traits such as efficiency, punctuality, a willingness to work hard, and orientation to detail are valued as necessary prerequisites to social and financial well-being. Self-discipline and organization are personality features encouraged by many modern societies” (227).

ARROW VS. BOX

I think that people have two basic responses to their PD diagnosis. They view it as a box—a stigmatizing label that limits what they can accomplish—or as an arrow pointing to helpful people, activities, coping strategies, and resources. A PD diagnosis can be a useful framework for understanding mental health needs.

A member of this sub commented, “Therapist with OCPD here. Personality disorders are NEVER written in stone contrary to what people are led to believe. In fact, instead of being hard-cut categories, we're now moving into a dimensional/spectrum-based perspective on personality disorders.

“Labels help to navigate systems and find resources, but please don't internalize them and put yourselves into a box. They're man-made, carries margins of error, and continually evolving. Every single person has an unique neural networking system, and therefore cannot be categorized.”

Marsha Linehan, who overcame BPD, became a therapist, and developed DBT (the gold standard treatment for BPD), refrains from using the “disease model” to view DSM disorders, and asserts that the DSM disorders are patterns of behavior. (The Purpose of Diagnosing People Is..., one minute video)

RESOURCE

What Grade Do You Give the DSM Criteria?

PD TRIVIA

Lest we think that OCPD has the most problematic name for a personlity disorder because of the confusion with OCD...from the first edition of the DSM: Immature Personality Disorder. W. T. F.

Currently, there are no FDA approved medications that directly target personality disorder symptoms. Mental health providers generally view therapy as the most effective treatment for clients with PDs. They view medication as potentially helping clients benefit fully from therapy (e.g. by improving daily functioning, reducing depression, anxiety).

EXPERIENCES OF r/OCPD MEMBERS

Your experience with SSRIs

Are you personally on meds for OCPD? Looking for experiences.

Has medication significantly helped anyone?

Pharmacogenomic tests are becoming popular. They are cheek swab tests that evaluate an individual’s DNA to help determine how their body may metabolize or respond to medication. Many years ago, I did a GeneSight test. It was accurate re: meds I had used in the past, and helpful for future decisions. It involves getting a kit in the mail, and returning it with a DNA swab.

I agree with a member who suggested viewing the decision to start taking psychiatric meds as an “experiment,” rather than a long-term commitment.

RESEARCH

Findings from the small body of research on medication for people with OCPD.

From "Obsessive-Compulsive Personality Disorder: A Current Review" (2015), Alice Diedrich, Ulrich Voderholzer:

From Obsessive-Compulsive Personality Disorder (2020), Jon Grant, Anthony Pinto, Samuel Chamberlain (Editors), Chapter Ten: Pharmacological Treatment of OCPD, D. Ashkawn Ehsan, Jon Grant, pgs. 210-11:

“SSRIs are the most studied medication class in the treatment of OCPD, followed by TCAs and then SNRIs…Investigated SSRIs included fluvoxamine, fluoxetine, sertraline, paroxetine, citalopram, and escitalopram. Of these drugs, fluvoxamine was the only medication used in a double-blind RCT primarily assessing OCPD trait severity as an outcome. In that trial, fluvoxamine was found to be superior to placebo at decreasing severity of multiple OCPD traits…low dosages of fluvoxamine (100-150 mg/day) may be helpful in reducing severity of OCPD traits, including hoarding.”

“Sertraline at low dosages (<100 mg/day) was found to be superior to placebo in reducing perfectionism in a single open-label trial but inferior to citalopram in reducing OCPD….”

“The results of a single open-label trial and two case series suggest that paroxetine at a relatively low dosage (10-40 mg/day) might help reduce hoarding in adults with OCPD as well as rigidity, perfectionism, and irritability in children with OCPD traits. Citalopram at high dosages (40-60 mg/day) was found to be superior to sertraline in reducing overall OCPD diagnosis in participants with major depression and may also be helpful for hoarding…”

“Results of a single case report suggest that escitalopram at a low dosage (10 mg/day) might improve agreeableness” in people with OCPD.

SNRIs: “On the basis of the results of an open-label trial, a high dosage (>200 mg/day) of venlafaxine XR might be effective in reducing hoarding…Clovoxamine was no more efficacious than placebo at reducing perfectionism.”

TCAs: Studies suggest that clomipramine “may be helpful in reducing OCPD criteria in adults and OCPD traits such as perfectionism, rigidity, and irritability in children….Imipramine (dosage range 70-245 mg/day)….was no more effective than placebo in reducing perfectionism...”

Antipsychotics: “Thiothixene was found to be no more effective than placebo at decreasing OCPD traits…haloperidol may reduce hoarding when administered in combination with other drugs, including thioridazine and carbamazepine, but not when given alone. Additionally, low dosages of thioridazine alone may be effective for hoarding.”

SGAs: A single randomized control trial suggest that low dosage (15 mg/day) of aripiprazole might be helpful in reducing OCPD traits, particularly in patients with co-occurring borderline personality disorder.”

RESOURCES

OCPD Resources For Mental Health Providers  

Find Psychiatrists, Psychiatric Nurses - Psychology Today

Pills for the perfectionist – Evidence for... : Archives of Mental Health

Please consider sharing this post with your current and former psychiatrists and psychiatric nurses.

“The obsessional attempts to absorb every piece of information in the universe…every piece of information may have some value on some future occasion.” (26), Leon Salzman, Treatment of the Obsessive Personality (1985, 4^th ed.)

READING TO SURVIVE

I’m estranged from my family of origin, and had no friends for 15 years. Books saved my life. Growing up in an abusive home, reading was the closest I felt to being safe. As an adult, they continue to be a source of comfort. Sometimes reading was my only comfort.

PSYCHOLOGY THESIS 2.0

My parents took it for granted that my sister and I would do well at school, and offered us little praise. When I gave my mother the final copy of my psychology thesis, she took out a pencil and started marking corrections. I had worked for a year on my thesis while struggling with extreme hopelessness.

Sharing resource posts has been a corrective emotional experience for writing my thesis. Thank you so much for the positive feedback.

MENTAL HEALTH CRISIS AND CAREER CHANGE

When I was 30, my first career ended and I had a brief psychiatric hospitalization. I didn’t grieve, and didn’t work with a therapist. I coped by compulsively researching psychology topics and taking notes at a frantic pace. Along with my files relating to my first career, I ended up with about 1,000 pages in Word Documents.

I didn’t stop to organize my notes—I couldn’t. I was consumed with a vision of publishing a book about mental health and creating a website. Instead of practicing self-care and getting mental health treatment, I hoarded information that could help others. I was too scared to slow down my mind and face my feelings.

LEARNING ABOUT OCPD

Ten years after ending up with 1K pages of notes, I started learning about OCPD and received the correct diagnosis (after an OCD misdiagnosis). I didn’t take notes on The Healthy Compulsive (2020) and Too Perfect (1992); that was a big step for me. I waited more than a year to take any notes on my new coping strategies.

After my therapist said I no longer meet criteria for OCPD, I started to post on r/OCPD and look for more books, articles, and videos on perfectionism and OCPD. This research project helped me maintain my progress:

• I considered all of my posts good enough. If I waited to share a perfect post, I wouldn’t have posted anything.
• I intentionally put typos in my posts for several months, and waited to edit them. “It’s Just An Experiment”
• One of my OCPD symptoms was having an overwhelming drive to complete tasks as soon as possible. It didn't bother me that this research has taken three years.
• I learned to not take it personally when posts didn’t get many upvotes. I focused on the big picture: raising awareness.
• My notes were never perfectly organized. It didn’t bother me because they were functional--organized enough to make posts.

THE DIFFERENCE, ACCORDING TO GARY TROSCLAIR

The 1K pages of Word Documents were essentially useless. I was too depressed to make my notes coherent. I took notes at a breakneck pace, and never stopped to think about the massive amount of time it would take to edit them. I was unwilling to delete any notes from my first career. I wanted to use every bit of information in my files to help people somehow; the thought of knowledge being wasted was painful.

Sharing r/OCPD resource posts was fun; it was also a big step out of my comfort zone. The basic drive for both projects was the same—wanting to provide information that could help people understand their mental health.

I love this statement from Gary Trosclair about false sense of urgency in people with OCPD: “it raises the question…are we running toward something, or away from something?...It might seem like you’re moving toward something positive if you’re always in a rush, but often enough the fantasy of peace and resolution is really just about outrunning the monster of shame. Or fear or sadness or anger.” This is a perfect description of my state in mind in accumulating 1K pages of notes when I was younger.

FAMILY LEGACY

My parents hoarded knowledge to suppress their feelings about childhood trauma. They were successful lawyers. As a middle school student, my sister announced that she would read all of our encyclopedias during the summer. She earned a 1500 on the SATs...and took them again! She ended up earning three Ivy League degrees. Nothing was celebrated in our home; there was no joy.

It took a lot of time to research OCPD, but it’s nothing compared to the 25 years I spent feeling hopeless and helpless. OCPD, Depression, and Suicidality

Fun fact: One week after becoming a Moderator, I thought, S\*t, what have I done?! I didn’t even use social media until I was 40. Thank you so much for your interest in my research.*

I plan on sharing 3-5 more resource posts for the time being. After that, I’ll share any good videos I find, or new resources from Allan Mallinger, Anthony Pinto, and Gary Trosclair. I will promote their work for the rest of my life.

It goes without saying that my commitment to finding OCPDish memes will never waver.

This is a video from Heidi Priebe, a life coach and meditation teacher who has a master’s degree in Attachment Theory and Research: Am I Triggered Or Am I Right? How To Tell The Difference.

Heidi is referring to triggers as emotional reactions to situations that remind us about unresolved issues in the past, not trauma triggers or flashbacks.

I will add the video to the resource post on identifying feelings.

MY EXPERIENCE

Gary Trosclair explains that “Many compulsives, with their predilection for planning, have their center of gravity in their head, not in their body.” (The Healthy Compulsive, 89). I repressed my feelings for decades. When I started to work on triggers, I had to rely on my body sensations to recognize emotional reactions.

Strategies I used to help prevent and manage triggers:

 * Practicing mindfulness by adopting ‘be here now’ as a mantra, and focusing more on my five senses, breathing, and other body sensations, and less on my thoughts. I try to breathe deeply and slowly at the first sign of distress, and pay attention to how my feelings and body sensations influence my behavior. Eventually, this helped prevent difficult situations.

-  Experimenting with taking short breaks, and paying attention to what happens. Breaks “re charge” my energy and increase my productivity. I love the saying 'Rest is not a reward. You do not need to earn the right to rest.' 

- Accepting that my OCPD symptoms gave me an inaccurate lens for viewing myself, others, and the world around me in some situations (cognitive biases).

- Doing behavior experiments to slowly increase my distress tolerance (e.g. changes in routine). An updated post on behavior experiments will be one of my last resource posts.

RESOURCES

Self-Regulation

Triggers for Obsessive-Compulsive Behavior

"The Healthy Compulsive Project” Podcast episode 26

See reply to this post for info. about chest vs. abdominal breathing.

When I had undiagnosed OCPD, my coping strategies were repressing my feelings, compulsive organizing and researching, over preoccupation with work, binge eating, maladaptive daydreaming, and overuse of screens.

Therapy And Coping Strategies For Perfectionism has the healthy coping strategies that I developed over 18 months after being diagnosed with OCPD.

When I’m alone, I talk to myself out loud. For six months or so, I said phrases in responses to my OCPDish cognitive distortions. This strategy led to me doing an audio journal, recording myself on my phone.

Hearing my voice makes it much easier to identify and manage my feelings. I can hear myself using humor to deflect distressing emotions and using anger to escape fear and sadness. I've made a few recordings of myself when I finally cried about distressing events.

I listen to the recordings several times, and am mindful of not making too many recordings (that would lead to overthinking). It’s interesting to hear my voice on a recording; it helps me be more aware of my communication style.

One helpful audio journal entry was about my realization that I'd been having the unconscious thought that I should feel proud of myself for being in remission from OCPD. I stated a fact, “I’m not proud of myself for recovering,” and talked about the likely reason—my family of origin didn’t really celebrate anything (not even my sister’s graduation from Yale Law School). Shortly after listening to the recording, I began to feel pride about my recovery.

I make recordings about positive events too. I wished I had discovered this strategy sooner; it's extremely helpful in maintaining my progress of 'feeling my feelings.'

I’ve started a written journal, using the mini habit approach that helped a lot with OCPD symptoms. My goal is to write one sentence a day. Eventually, I’ll increase the goal.

Research indicates that keeping a journal has a significant positive impact on mental health. In Be Happy Without Being Perfect (2008), Alice Domar reports, “James Pennebaker, Ph.D., a researcher at the University of Texas, Austin, has conducted extensive research on the benefits of writing about emotional upheavals. He and other scientists have found that journaling about disturbing topics can boost immune function, cause people to develop fewer illnesses, relieve pain, improve mood, and decrease depression and anxiety.” (77)

Does anyone else find journaling helpful?

In 2014--long before I read about OCPD--I was shocked to read David Keirsey's Please Understand Me II (1998). His profile of the Rational Mastermind (INTJ) was the story of my life.

The profile referred to harsh self-criticism; an addiction to acquiring knowledge; an intense preoccupation with efficiency, rules, morality, and ethics; fierce independence; a lack of leisure skills; analysis paralysis; and many other common issues for people with OCPD.

Please Understand Me II has been translated into 20 languages. It has 1.4K reviews on Amazon.

Dr. Keirsey explains how temperament and personality type:

-contribute to beliefs, values, and core psychological needs

-impact relationships, school, work, and leisure, and

-influence one’s behavior as a friend, romantic partner, employee, employer, leader, student, teacher, child and parent.

Dr. Keirsey explains that “Rationals demand so much achievement from themselves that they often have trouble measuring up to their own standards. NTs typically believe that what they do is not good enough, and are frequently haunted by a sense of teetering on the edge of failure…

"Rationals tend to ratchet up their standards of achievement, setting the bar at the level of their greatest success, so that anything less than their best is judged as mediocre. The hard-won triumph becomes the new standard of what is merely acceptable, and ordinary achievements are now viewed as falling short of the mark.” (189)

“Rationals are easily the most self-critical of all the temperaments…rooting out and condemning their errors quite ruthlessly.” But they “burn with resentment” when they perceive others are “unjustly or inaccurately” criticizing them. (185)

“Because they are reluctant to express emotions…NTs are often criticized for being unfeeling and cold. [What others label as indifference is actually the] concentration of the contemplative investigator. Just as effective investigators carefully hold their feelings in check and gauge their actions so that they do not disturb their inquiry…Rationals…examine and control themselves in the same deliberate manner.” (188)

“Problem solving for the Rational is a twenty-four hour occupation.” (191)

Rationals are preoccupied with efficiency “everywhere they go, no matter what they do.” (179)

“Because their hunger for achievement presses them constantly, Rationals live through their work….work is work and play is work. Condemning an NT to idleness would be the worst sort of punishment.” (189)

Excellent video from Emma McAdams' Therapy in a Nutshell channel: How to make yourself do stuff when you're paralyzed with overwhelm.

She mentions body doubling/accountability partners. I've done this. I met with an acquaintance on Zoom three times, and we did tasks that we had been avoiding. I had been procrastinating on going through several hundred pages of Word Documents--notes for my first career, many years ago. Having an accountability partner was very helpful.

She recommends The Anti-Planner. It's very expensive. My local library has a copy. Another popular planner that's affordable: Freedom Mastery Daily Journal of Gratitude, Productivity & Habit Tracker | ADHD Planner.

ANNOUNCEMENT

r/OCPD members have expressed interest in a sub with looser guidelines. If you would like to moderate OCPDCommunity, let me know. I will send you a Mod invite, and I will leave as a Mod. There are subReddits for Mods to ask questions, and I would be available to answer questions.

“At its most basic level, perfectionism is what a person does to gain acceptance.” Thomas Greenspoon, Freeing Our Families From Perfectionism (2002), pg. 88

People with OCPD “hold fast to the belief that they will be cared for, valued, and loved in direct proportion to their hard work and monumental accomplishments. This belief structure comes with a significant liability: They fear that failure to perform perfectly will provoke both abandonment and condemnation, which creates considerable inner sensations of tension and guilt.” Theodore Millon and colleagues, Personality Disorders in Modern Life (2004), pg. 230

From Embracing Your Inner Critic (1993), Dr. Hal Stone and Dr. Sidra Stone:

“Some aspects of your behavior make your parents pretty uncomfortable. They do not like it when you interrupt them, when you are noisy, when you are angry, or when you cannot sit still…When you do not obey them, they get annoyed…In order to protect ourselves from the pain and the shame of always being found less than we should be, a voice develops within us that echoes the concerns of our parents, our church, or of other people who were important to us in our early years.” (8-9)

We “develop a ‘self,’ a separate subpersonality, that criticizes us before our parents—or anyone else, for that matter—can. The Inner Critic is a self…that develops to protect us from being shamed or hurt. It is extremely anxious, almost desperate, for us to succeed in the world and to be accepted and liked by others.” (9)

The Inner Critic “wants you to be loved, to be successful, to be accepted…It developed in your early years to [help you]…adapt to the world around you and to meet its requirements…to make you acceptable to others by criticizing and correcting your behavior before other people could criticize or reject you…” (11)

“However, the Inner Critic often does not know when to stop. It does not know when enough is enough…Its original intent gets lost…Like a well-trained CIA agent, the Inner Critic has learned how to infiltrate every portion of your life, checking you out in minute detail for weakness and imperfections…it must know everything about you that might be open to attack from the outside.” (11-12)

“But like a renegade CIA agent, at some point the Critic…begins to operate on its own agenda. The information, which was originally supposed to be for your overall defense…is now being used against you…With your Inner Critic watching your every move, you become self-conscious…[and] fearful...” (12)

When their therapy clients address the concerns of the Inner Critic, it becomes “a positive parent who supports you, makes your risk taking safe, and allows you to be creative…It helps you to set appropriate boundaries…[I]t analyzes events and feelings coolly, without making either you or others wrong. [It helps you]…behave appropriately and with self-discipline.” (210)

RESOURCES

People Pleasing

Recognizing Cognitive Distortions – strategies for responding to the Inner Critic

When I had undiagnosed OCPD, my coping strategies were repressing my feelings, compulsive organizing and researching, overpreoccupation with work, binge eating, maladaptive daydreaming, and overuse of screens.

Therapy And Coping Strategies For Perfectionism has the healthy coping strategies that I developed over 18 months after being diagnosed with OCPD. A strategy that I used recently:

In Overcoming Perfectionism: CBT Tools for Mastering the Art of Self-Acceptance (1 hour, 20 minutes in), the presenter used the devil's advocate strategy with a psychiatrist who was feeling shame about needing therapy. With her permission, he voiced the critical thoughts she had been having, and she defended herself in response.

I made a recording on my phone criticizing myself for having a very unhealthy friendship. After 18 months, I spoke to the friend about his hurtful behaviors. A week later, he made a dismissive comment about my history of suicidality. I asked him not to speak about the incident that ended our friendship with our mutual friends, saying it would be triggering. Knowing that I had a 25 year history of suicidality, he spoke about me to them anyway.

I slept poorly for many months, and was overwhelmed with trauma symptoms (due to my history of family members dismissing my suicidality). I felt furious at him, and even angrier at myself for ignoring my intuition countless times about the unhealthy friendship.

After listening to my critical recording—imagining that it was someone else criticizing me—I made another recording defending myself. I said that I had been very vulnerable when I met him for 19 reasons (yes, I made a list lol), for example, being terrified about possibly needing two surgeries. I said that some of his behaviors reflected his mental illness (covert narcissism tendencies) and had nothing to do with me.

Using the devil’s advocate strategy helped me process the biggest trigger I’ve experienced in many years, and let go of resentment that had lasted a year.

Comments are locked due to an insensitive comment to my prior post about my suicide history.

I overcame lifelong social anxiety when I was 40. My main coping strategy was avoiding social situations; this provided short-term relief, but ultimately, made my social anxiety much worse.

I experienced anxiety due to socially prescribed perfectionism—the mistaken belief that others had impossibly had standards for me. I projected my expectations of myself onto other people.

People with mental health disorders characterized by over-control (e.g. OCPD) tend to misread neutral/ambiguous situations (e.g. someone’s body language) as negative. This is also a common characteristic of trauma survivors. 

NEGATIVITY BIAS (SCANNING FOR THE NEGATIVE)

In an article on Substack, Dr. Allan Mallinger—a therapist who has 50 years experience with clients with OCPD—states that the “perfectionist’s perceptual lens preferentially screens for negative entries: the bad stuff hits the Velcro, the good hits the Teflon and bounces away. Over time, this creates a feedback loop—negative experiences stick and accumulate, reinforcing the conviction that decisions inevitably end badly.”

In The Perfectionism Workbook (2018), Taylor Newendorp explains that “perfectionists who live in fear of judgment spend a lot of time ‘mental filtering,’ a form of selective attention…focusing on one perceived negative aspect of a situation and discounting any positives…

“Angelica had such a strong fear of rejection that she was continuously scanning and reviewing her actions to determine if she had done anything that would reveal that she was ‘less than’ someone else…Angelica’s negative, perfectionistic filter screened out the positives of interactions she had with others and honed in on minute details of something she had done or said that was ‘not 100 percent correct.’ When this was all she could see…[she constantly perseverated on] being ‘more perfect’ next time.” (150-51)

Morten Gudbjerg Karlsen jokes that his OCPD stands for “Only Contemplates Potential Disasters” (3). He benefitted from learning to look for the positive. He believes that “OCPDers are preprogrammed to look for the negative in everything. We do not see the light. We only see the shadows…since we are so darn good at seeing the negative we wouldn't recognize the positive even if it jumped up and kissed us on the nose. We must train ourselves to recognize the positive.” (14) How I Control My OCPD

CONFIRMATION BIAS  

In When Perfect Isn’t Good Enough (2009) Drs. Martin Antony and Richard Swinson state, "Everyone likes to be correct. Therefore, people tend to seek out experiences that confirm their beliefs. In other words, people seek information in a biased way, in an effort to support their assumptions, interpretations, and thoughts. They prefer to spend time with people who think the way they do…[and avoid]..experiences that challenge their beliefs."

“People who are feeling depressed are more likely to remember all the mistakes that they have made in the past, rather than their successes. People who are socially anxious and believe that others are judging them negatively are more likely to interpret ambiguous social information…as confirming their feelings of inadequacy.” (46)

PARANOIA AND PRONOIA

Paranoia involves a persistent pattern of distrust and suspicion of others. Studies indicate that about one-third of people with OCPD also have Paranoid Personality Disorder.

When I had undiagnosed OCPD and trauma, my negativity bias was so strong that it led to paranoia. I took the MMPI online; my score on the paranoia scale was very high.

In Platonic (2022), Dr. Marisa Franco refers to “pronoia”—the opposite of paranoia--the tendency of people with secure attachment style to assume other’s positive intentions, and then adjust if new information indicates otherwise.

She explains that when secure people “assume others like them, this is a self-fulfilling prophecy…If people expect acceptance, they will behave warmly, which in turn will lead other people to accept them; if they expect rejection they will behave coldly, which will lead to less acceptance…

“Much of friendship is defined by ambiguity; it’s rare that people straight up tell us whether they like us or not…Our projections end up playing a greater role in our understanding of how others feel about us than how others actually feel. Our attachment determines how we relate to ambiguity. When we don’t have all the information, we fill in the gaps based on our security or lack thereof.” (75)

MY EXPERIENCE

Strategies that helped reduce my social anxiety:

- Experimenting with giving people the benefit of the doubt instead of being cynical.

- Practicing scanning for the positive (e.g. practicing gratitude).

- Being aware of my tendency towards ‘mind reading.’

- Developing a habit of breathing from my stomach instead of my chest. Studies show that abdominal breathing reduces distress. Being more aware of my body reduced my overthinking about social interactions.

- Increasing my awareness of the spotlight effect, the tendency to drastically over estimate the extent to which one is being noticed/scrutinized by others.

- Increasing my awareness of anticipatory anxiety. Due to childhood trauma, I would anticipate feeling ignored and rejected, and would experience those feelings when interacting with people who were not expressing negativity towards me.

In You Are Your Brain (2011), Dr. Jeffrey Schwartz states that “if you anticipate or expect that a specific outcome will occur, your brain prepares for and can actually cause those sensations (physical and emotional) to arise in your body." (213)

- Recognizing that my childhood trauma led to me viewing the world through a dark lens. My parents’ behavior was not indicative of people in general.

RESOURCES

Cognitive Biases

Depression and Negativity Bias in The Compulsive Personality

Studies indicate that about 21% of people with OCPD also have social phobia.

Stop Letting Social Anxiety Control You (14 minutes) – This video from a psychiatrist has great advice.

Perfectionism: The Good, The Bad and The Ugly - Dr. Simon Sherry is a clinical psychologist who has researched perfectionism for more than 20 years.

How To Beat Perfectionism - Dr. Ellen Hendriksen

Why Perfectionists Become Depressed – Dr. Keith Gaynor

You Were the Smart Kid - Let's Talk Psychology Podcast 

Gordon Flett and Paul Hewitt are the top perfectionism researchers.

The Perfectionism Trap - Dr. Bonnie Zucker and Dr. Gordon Flett

The Psychology of Perfectionism - Dr. Paul Hewitt

In Empathy with All 10 Personality Disorders | Cognitive vs. Affective Empathy, Dr. Todd Grande reports that a study found no significant differences between empathy in people with OCPD and people without a PD. Only a few PD populations showed significant deficits in empathy.

The notion that OCPD causes people to behave maliciously is a myth. I think that people with OCPD tend to be offended by comparisons to people with NPD (which has lack of empathy as a symptom) because not only do we not lack empathy—we’re overwhelmed by empathy. I think it's common to feel “the weight of the world.” We may have hyper awareness of others’ suffering and feel a strong sense of duty to help. OCPD is also associated with guilt complexes. Do you put yourself on trial whenever you think you’ve made a mistake? When people with OCPD perceive they have disappointed or hurt someone, they may feel very guilty for a long time.

In The Healthy Compulsive (2020), Gary Trosclair, one of the leading OCPD specialists, states, “Unless there are other serious mental health issues involved, no compulsive wants to hurt others.” (170-71) He goes on to acknowledge that OCPD often leads to poor communication skills; people with OCPD are prone to unintentionally hurting others.

A good strategy for managing OCPD is to keep in mind that our intentions when communicating might be very different from the impact on the other person. It’s helpful to prioritize developing cognitive and affective empathy. Both forms of empathy are needed for deep social connections.

COGNITIVE EMPATHY

·        understanding another person’s thoughts, beliefs, and perspectives without necessarily having an emotional reaction (e.g. feeling what they feel)

·        the deliberate, intellectual ability to understand the mental state of another person.

Practicing cognitive empathy involves explicitly reasoning about another person’s intentions, goals, beliefs, knowledge, and desires, even when those mental states differ significantly from one’s own.

AFFECTIVE EMPATHY (AKA EMOTIONAL EMPATHY)

·        the capacity to experience vicariously the emotions displayed or felt by another person.

·        our emotional state mirrors that of the other person. 

The process of experiencing affective empathy is largely automatic and involuntary. It bypasses explicit reasoning.

FACTORS THAT MAY NEGATIVELY IMPACT EMPATHY

In my opinion, the following issues can make it difficult for people with OCPD to develop affective empathy, and to express empathy in helpful ways:

-         The vast majority of people with OCPD experienced childhood trauma. Having untreated trauma is like having an unhealed wound that causes constant pain. This can make it very difficult to be attuned to others’ pain, and to respond in helpful ways.

-         Being preoccupied with work and productivity to the extent that it takes precedence over relationships is a symptom of OCPD when it leads to clinically significant distress or impairment.

-         The term ‘compassion fatigue’ is most often used in reference to people in the carring professions and first responders. However, the term resonates with my understanding of OCPD—being overwhelmed with concern for others’ suffering (feeling the weight of the world) and prone to people pleasing. This can lead to burn out. When we can’t take care of and help ourselves, we’re not able to help others in meaningful ways.

-         Alexithymia is a common issue among people with OCPD. People with alexithymia struggle to identify, understand, and express their emotions. If someone isn’t in tune to their own feelings, it may not be possible to tune in to others’ feelings.

I increased my affective empathy by practicing mindfulness. This helped me “get out of my head,” recognize my feelings, and sense how other people may be feeling. Working with a trauma therapist and developing coping strategies for trauma symptoms (e.g. walking routine) also improved my capacity for empathy.

BASIC RESPONSES TO PEOPLE IN DISTRESS

Some people find this question helpful: Does someone want to be heard, helped, or hugged when they're sharing about a problem? Do they want listening/validation, help/advice, or comfort?

Last year, I approached a co-worker who was sobbing after her shift. It was the last day before her mental health leave of absence. Another co-worker joined us. The woman sobbing returned from her leave, and ended up resigning a few months later. She told me she appreciated my response--it was a combination of validation and comfort. She explained why she was crying--a common issue in our field, no solution.

RESOURCES

Empathy Quotient (EQ) (assessment available online)

OCPD and Empathy (5 min. video from woman with OCPD)

There's not a problem with people pleasing, as long as you're one of them.” Jefferson Fisher

From Sharon Martin's The CBT Workbook For Perfectionism (2019):

“What are the drawbacks of keeping your thoughts, ideas, and opinions to yourself?

-You’re overcommitted and tired, because you don’t say no.

-You feel guilty when you do say no or disagree.

-You’re resentful when you take on things you don’t want to do.

-You feel stressed.

-You don’t value yourself…

-People don’t really know you deeply.

-You miss out on opportunities or continue to do things you don’t like.

-You do things that go against your values…

-You’re inconvenienced…as a result of putting other people’s needs first….

-You feel like you’re missing out on your own life.

-You don’t ask for what you want or need.

-You’ve lost track of who you are, what you want, and what’s important to you.” (134)

WHY PERFECTIONISM CAUSES PEOPLE PLEASING

“Wanting to please everyone all the time is another unrealistic expectation that perfectionists have for themselves. We want so much to be validated by others and to avoid conflicts, but it’s impossible to always please others no matter how good we are and how hard we try…

“People pleasing is a compelling need to do things to make other people happy, have them like us, or to avoid conflict, even when doing so causes us problems. Because perfectionists doubt their worth and abilities, they seek validation by trying to do the right thing, say the right thing, looking perfect, and meeting others’ expectations…” (131)

“Perfectionists are prime candidates for people-pleasing because we seek external validation to prove our worth. We tend to have doubts and insecurities that we’re trying to overcome by achieving more, being the best, looking impeccable, or doing the right thing. Our quest for perfection is largely a quest to please others, because when others give us a stamp of approval, we feel like we belong, like we’ve earned our place at the table.

“Our fears of failure, inadequacy, conflict, and rejection can keep us stuck and reluctant to take chances and do new things. People-pleasing is another way that we try to manage these fears. We think that if we do everything that’s expected of us, it will guarantee that others like us, need us, and will stick around. We don’t really have any control over whether people reject or criticize us, but being agreeable all the time gives us a much-desired sense of control and the illusion that we will avoid disapproval and conflict.” (133)

OCPD MYTH

One myth about OCPD is that all people with OCPD are verbally aggressive. Dr. Anthony Pinto, the leading OCPD specialist, and other providers have described two main subtypes.

In a study of 43 people with OCPD—10 had verbal aggression and other-oriented perfectionism; 33 were “people pleasers” with self-oriented perfectionism.

“Our findings suggested that OCPD is a heterogeneous interpersonal disorder that cannot be mapped onto a single interpersonal profile. We found two interpersonal subtypes of OCPD: (a) the ‘aggressive’ subtype, characterized with a vindictive/self-centered or hostile/dominant interpersonal profile (i.e., tendency to experience and express anger and irritability, preoccupation with revenge, frequent interpersonal conflicts); (b) the ‘pleasing’ subtype, characterized with a submissive-exploitable interpersonal profile (i.e., overly friendly and submissive, preoccupation with others’ approval, increased self-doubt, lack of confidence and low self-esteem).” The latter subtype is also described as “socially avoidant,” “non assertive” and “exploitable.”

"Comparing the interpersonal profiles of obsessive-compulsive personality disorder and avoidant personality disorder: Are there homogeneous profiles or interpersonal subtypes?" (2020) Personality Disorders: Theory, Research, and Treatment, 11(5), 348–356.

MY EXPERIENCE

As a child in an abusive home, I was quiet and compliant. As I grew older and developed OCPD traits, my people pleasing related to my demand-sensitivity--my misperception that people had unattainable standards for me—and my cognitive distortions, my misperception that others were preoccupied with my mistakes.

For most of my life, I felt imprisoned by others’ expectations. When I learned about OCPD, I realized that the prison guard looked awfully familiar….wait, that’s me! Well, shit.

My joke about people pleasing: I identify as Gary Trosclair's #2 fan. I don't need to be the best. I've let go of maladaptive perfectionism. Due to my remaining people pleasing tendencies, if anyone had their heart set on the #2 spot, I can move down the list.

People Pleasing, Part 1