The OCPD Coming Into Treatment

Individuals with OCPD often come in for treatment because their productivity or cognitive skills are slipping. They complain of depression and an inability to be productive. These individuals appear to be particularly sensitive to natural changes in cognitive skills due to normal aging (Turkat, 1990, p. 85). Another reason individuals with OCPD come in for treatment has to do with psychophysiological difficulties. They frequently experience psychosomatic disorders due to the problems they have with discharging tension. They may also experience severe anxiety, immobilization, impotence, and excessive fatigue (Millon, 1981, pp. 242-243). A third reason these individuals come in for treatment is a result of someone else's concern about their behavior. For example, they may have received a negative performance evaluation on the job because they are having difficulty getting along with others. Interpersonal difficulties for people with OCPD are related to their failure to grasp the impact of their own behavior. They are quite inept at reading other people's emotions and at experiencing and understanding their own. They usually deny they are having problems with others on the job and see the supervisor as having made false accusations (Turkat, 1990, p. 85).

Initially, clients with OCPD appear to be cooperative. They are polite, unemotional, rational, and detail oriented (Turkat, 1990, p. 84). These individuals will want to defer to their service providers and be perfect clients (Benjamin, 1993, p. 260). They will be serious, conscientious, honest, motivated, and hard-working. Over time, however, it will become apparent that they are inclined to be consciously compliant and unconsciously oppositional (McWilliams, 1994, p. 292). They are likely to replicate their conflicts with obedience and defiance within the treatment setting as in other areas of their lives.

Medication Issues

Generally, OCPD symptoms are not responsive to medication (McCullough & Maltsberger, Gabbard & Atkinson, editors, 1996, pp. 999-1000). Thus far, only medication for concurrent Axis I symptoms have been reported (Sperry, 1995, p. 152). Medication helpful to obsessive-compulsive disorder, e.g., clomipramine, is unlikely to benefit individuals with OCPD (Janicak, et.al, 1993, p. 519). Even if medication is tried, individuals with OCPD may have some difficulty with compliance because of their fear of loss of control. Alternatively, they may develop unrealistic expectations of medication (Ellison & Adler, ed., 1990, p. 59). Overall, therapy is the treatment of choice for OCPD (McCullough & Maltsberger, Gabbard & Atkinson, editors, 1996, pp. 999-1000) (Sperry, 1995, p. 152).

However, if the unremitting struggle with tension, interpersonal difficulties, and chronic dread of the future have resulted in depressive symptoms, antidepressant medication may make a difference. If individuals with OCPD can be less physically and psychologically strained, they may be able to focus with greater clarity on treatment issues.

continue: Guidelines for Psychotherapy with the OCPD Patient

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Reviewed: 04/2006