Treating Obsessive-Compulsive Personality Disorder

cont. from

Psychotherapy for OCPD (cont.)

Individuals suffering from obsessive-compulsive personality disorder often are not in touch with their emotional states as much as their thoughts. Leading the client away from describing situations, events, and daily happenings and to talking about how such situations, events and daily happenings made them feel may be helpful. Sometimes the patient may complain he or she doesn't remember or know how he or she felt at the time; the journal becomes a useful tool at this point.

Therapy with people who have this disorder can sometimes be trying, since they can see the world in a very "all-or-nothing" manner. Beck's cognitive therapy doesn't seem to be all that effective in treatment, and cognitive approaches in general probably aren't useful in this case. Clinicians must be willing to undergo verbal attacks on their professionalism and knowledge, as such skepticism about a therapist's treatment approach from the client with this disorder can be expected. Clinicians should also be careful about engaging the client within these verbal attacks or intellectual discussions, as they continue to distance the patient from his or her feelings. And take the focus off of the client and onto unrelated matters (e.g., a therapist's professional training).

Most people who suffer from this personality disorder (and the different, but related, obsessive-compulsive disorder) lead relatively normal lives, may have a family, friends, and work regularly. Clinicians should be careful not to overgeneralize psychopathology and look to change aspects of the patient's personality he or she is not ready or willing to change. This means, in effect, that if the way they relate to others in their environment (which a clinician might characterize as a personality disorder) is working for them, a clinician should not seek to change it 180 degrees without the client's purposeful consent. Therapy will most often be most effective when it focuses on correcting short-term difficulties currently being experienced. It will become increasingly less effective when the goal of therapy is complex, long-term personality change.

Although a group therapy modality may be helpful and an effective treatment option, most people who suffer from this disorder will not be able to withstand the minimum social contact necessary to gain a healthy group dynamic. They may quickly become ostracized by the group for pointing out other people's deficits and "wrong-headed" ways of doing things.

Hospitalization

Hospitalization is rarely needed for people who suffer from this disorder, unless an extreme or severe stressor or stressful life event occurs which increases the compulsive behaviors to an extent where regular daily activites are halted or present possible risks of harm to the patient. Hospitalization may also be needed when the obsessive thoughts do not allow the individual to conduct any usual activities, paralyzing them in bed or with their accompanying compulsive behaviors.

Medications

In most cases, medication for Obsessive-Compulsive Personality Disorder is not indictated unless the individual is also suffering from a clearly delineated Axis I diagnosis (ie, depression, anxiety) as well. However, newer medications such as Prozac, an SRRI, have been approved for the treatment of obsessive-compulsive disorder and may provide some relief to individuals with the personality disorder. Long-term use, though, is rarely indicated, appropriate, or beneficial.

Self-Help

Self-help methods for the treatment of Obsessive-Compulsive Personality Disorder are often overlooked by the medical profession because very few professionals are involved in them. Support groups, though, offer an excellent adjunct to continuing medication check-ups once a month, and a way to gain emotional and social support through the community. These groups also allow others to ensure the client is doing well and promotes the client's independence and stability. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.

Such support groups are recommended to individuals suffering from Obsessive-Compulsive Personality Disorder, especially if they have found therapy unhelpful or too expensive.

Expectations (Prognosis)

The outlook for people with obsessive-compulsive personality disorder tends to be better than that of other personality disorders. The self-imposed rigidness and control of people with obsessive-compulsive personality disorder may prevent many of the complications -- such as drug abuse -- that are common to the other personality disorders. However, the social isolation common with this illness may eventually lead to feelings of depression later in life.

next: Therapy and Medication Issues

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Reviewed: 04/2006