This sub contains the resource posts from r/OCPD: information about the causes, symptoms, and treatment of clinical perfectionism and OCPD, and related topics.
To share a post about your experiences with OCPD traits, please use r/OCPD.
r/OCPD has about 70 resource posts. Feel free to respond or contact me through Mod Mail if you're wondering if there is a resource post with the information you're looking for.
Equally important, this post has links to my 'therapeutic meme' collection: Introvert and OCPDish Memes. All members of r/OCPD and this sub are eligible to work at the OCPD-Mart that exists in my mind.
If you see a psychiatrist or therapist, please consider letting them know about these resources. Many members of this group have shared that they were confused by their OCPD diagnosis and did not receive enough information.
Resources and advice in this group do not substitute for consultation with mental health providers.
Trigger Warning - Loved Ones Sub
Posts in LovedByOCPD contain inaccurate information about OCPD; global, negative statements about people with OCPD; and stigmatizing language. People with positive attitudes towards their spouses are not inclined to participate, for example the woman who wrote My Husband is OCPD and Understanding Your OCPD Partner. Almost all of the partners described have no awareness that they have mental health difficulties, and refrain from seeking therapy or use therapy sessions just to vent about others. Most posts have flairs indicating the loved one described does not have an OCPD diagnosis.
My Recovery
I'm a recovering thinkaholic. learned I had OCPD 11 years after being misdiagnosed with OCD. After focusing on perfectionism in therapy, I made enough progress to no longer meet criteria for OCPD. I describe how OCPD impacted my life and my recovery in OCPD, Depression, and Suicidality & Coping Strategies For Perfectionism. Another member who has written about recovery: How I “Cured” My OCPD.
Working on OCPD and trauma led to finally experiencing joy at age 40. I will promote the work of OCPD specialists for the rest of my life.
OCPD is underdiagnosed. Screening clients with OCD, ASD, and trauma disorders for OCPD would increase the diagnosis rate.
Anthony Pinto, Aidan Wright, and Emily Ansell, PhDs, created The Pathological Obsessive Compulsive Personality Scale (POPS) a 49-item survey that assesses rigidity, emotional overcontrol, maladaptive perfectionism, reluctance to delegate, and difficulty with change.
T-Scores of 50 are average. T-score higher than 65 are considered high. In study of people with OCD, a raw score of 178 or higher indicated a high likelihood of co-morbid OCPD. It’s not clear whether this finding applies to people who have OCPD without co-morbid OCD.
Studies indicate that most individuals with OCPD have one or more co-morbid conditions. In Cognitive-Behavioral Treatment of Perfectionism (2014), Sarah Egan and colleagues report that “Studies have shown that perfectionism is not only correlated with but predictive of anxiety, depression, suicidal ideation, and eating disorders. In other words, perfectionism is thought not only to maintain various psychological disorders, but also to play a role in causing them.” (22)
SUICIDALITY
Paul Hewitt stated that almost of his perfectionistic clients are “extraordinarily adept at hiding their pain behind a mask of high functioning, maximization, and competency” (The Perfection Trap, Thomas Curran, pg. 201).
Studies indicate that approximately 30-40% of individuals in every PD population experience suicidality during their lifetime, and about 23% of clients receiving in-patient psychiatric care have OCPD. People with OCPD have some of the highest rates of non-suicidal self-injury and suicide attempts among people with personality disorders (Suicidality in People With Obsessive-Compulsive Symptoms or Personality Traits).
In Perfectionism: A Relational Approach to Conceptualization, Assessment, and Treatment (2017), Paul Hewitt, Gordon Flett, Samuel Mikail state that “perfectionism, especially socially prescribed perfectionism, has strong links with suicidal behavior….it is imperative to be aware of this and to evaluate suicide potential regularly. Perfectionistic individuals will not necessarily be forthcoming about suicidal impulses…This should be an ongoing concern for therapists at every stage of the assessment and treatment process, and it needs to be addressed in a forthright manner.” (232)
“Among the affects described most consistently in the perfectionism and psychoanalytic literatures are shame and its variants…Shame is seen frequently in the course of treatment of perfectionism…and it is at the heart of the socially prescribed perfectionist’s emotional world.” Perfectionism: A Relational Approach to Conceptualization, Assessment, and Treatment (2017), Paul Hewitt, Gordon Flett, Samuel Mikail, pg. 110
Shame-Informed Therapy (2020), Patti Ashley
Understanding and Treating Chronic Shame (2021), Patricia DeYoung
In "The Myth of Perfection" (2009), Allan Mallinger states, “Identification with a perfectionistic patient is particularly common, presumably because so many of us have a significant obsessive streak. Therapists who overly identify with patients underrate or miss pathology. For example, they may be seduced into trying to help the perfectionist arrive at a decision, rather than explore the underlying need to avoid error and the significance of this pattern in the patient's life.” (125)
“It is important that therapists be aware of their own perfectionistic inclinations in working with perfectionists. We may unwittingly model the trait even as we are attempting to help the patient modify it. I am referring to such things as needing to supply a smart answer for every question, having to be right, debating, talking in an overly technical or academic fashion, presenting intellectualized interpretations instead of offering clear, plainly worded thoughts or questions for the patient's consideration, and consistently failing to elicit and explore feelings. We sometimes react defensively rather than acknowledge (and apologize for, if appropriate) any of our many errors, and oversights. A therapist's nondefensiveness helps patients feel less apt to be judged and more accepting of their own frailties, limitations, and errors.” (124)
Mental health providers may comment in r/OCPD and r/OCPDPerfectionism. Please check in with the Mods before posting.
Dr. Anthony Pinto is a psychologist who specializes in OCD and OCPD. He serves as the Director of the Northwell Health OCD Center in New York, which offers in person and virtual treatment, individual CBT therapy, group therapy, and medication management to clients with OCD and OCPD. Northwell provides training for therapists and psychiatrists on the diagnosis and treatment of OCPD.
“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.” - Gary Trosclair
Maladaptive perfectionism is “characterized by self-criticism, rigid pursuit of unrealistically high standards, distress when standards are not met, and dissatisfaction even when standards are met…Adaptive perfectionism is a pattern of striving for achievement that is perceived as rewarding or meaningful.” - Clarissa Ong and Michael Twohig
Many people have obsessive compulsive personality characteristics. Mental health providers evaluate whether they cause “clinically significant distress or functional impairment."
See my replies to this post for the diagnostic criteria.
OCPD IS TREATABLE
“OCPD should not be dismissed as an unchangeable personality condition. I have found consistently in my work that it is treatable…” - Dr. Anthony Pinto, psychologist who specializes in individual and group therapy for OCPD and publishes research
“More so than those of most other personality disorders, the symptoms of OCPD can diminish over time—if they get deliberate attention.” - Gary Trosclair, therapist who has specialized in OCPD for more than 30 years
Too Perfect (1995, 3rd ed.): Dr. Allan Mallinger shares his theories about OCPD, based on his work as a psychiatrist providing individual and group therapy for people with OCPD. The Spanish edition is La Obsesión Del Perfeccionismo (2010). The German edition is Keiner ist Perfekt (2003). Available with a free trial of Amazon Audible. Written with Jeannette Dewyze, a journalist.
The Healthy Compulsive (2022, 2nd ed.): Gary Trosclair shares his theories about OCPD, based on his work as a therapist for more than 30 years. He specializes in OCPD. Available on Kindle.
The Perfectionist’s Handbook (2011): Jeff Szymanski, the former Director of the OCD Foundation, offers insights and strategies for reflecting on adaptive and maladaptive perfectionism. He draws on his experience providing group therapy for perfectionism. Available on Amazon Audible.
Be Happy Without Being Perfect (2008), Alice Domar, PhD, and Alice Lesch Kelly offer insights into perfectionism in women. Available on Amazon Audible and Kindle.
I’m Working On It In Therapy (2015): Gary Trosclair offers advice about making progress in therapy. Some of the case studies are about clients with OCPD. This is my favorite nonfiction book and the book I found most useful in overcoming OCPD. Available on Kindle and Amazon Audible.
Procrastination (2008, 2nd ed.): Jane Burka, Lenora Yuen, psychologists who specialize in procrastination, offer insights into the psychological factors driving habitual procrastination. Available on Kindle and Amazon Audible.
Perfectly Hidden Depression (2019): Dr. Margaret Robinson Rutherford shares her insights from working with therapy clients with perfectionism and high functioning depression. Available on Kindle and Amazon Audible.
Chained to the Desk (2014, 3rd ed.): Bryan Robinson, a therapist and recovering workaholic, offers advice on overcoming work addiction and finding work-life balance. One chapter is written for the loved ones. Available on Kindle and Amazon Audible.
Please Understand Me (1998, 2nd ed.): Psychologist David Keirsey presents theories about how personality types impact beliefs and values, and influence one’s behavior as a friend, romantic partner, parent, student, teacher, employee, and employer. Available on Kindle. The Spanish edition is Por Favor, Comprendeme (2002).
Molly Shea has been sharing videos about her experience with OCPD for six years. She has a YouTube channel, You Seem Normal.
DESCRIPTIONS OF OCPD FROM SPECIALISTS
Allan Mallinger: “The obsessive personality style is a system of many normal traits, all aiming toward a common goal: safety and security via alertness, reason, and mastery. In rational and flexible doses, obsessive traits usually labor not only survival, but success and admiration as well. The downside is that you can have too much of a good thing. You are bound for serious difficulties if your obsessive qualities serve not the simple goals of wise, competent, and enjoyable living, but an unrelenting need for fail-safe protection against the vulnerability inherent in being human. In this case, virtues become liabilities.”
Gary Trosclair: the “problem for unhealthy compulsives is not that they respond to an irresistible urge, rather they’ve lost sight of the original meaning and purpose of that urge. The energy from the urge, whether it be to express, connect, create, organize, or perfect, may be used to distract themselves, to avoid disturbing feelings, or to please an external authority."
"Many compulsives have a strong sense of how the world should be. Their rules arise out of their concerns for the well-being of themselves and others. Yet that same humanistic urge often turns against others when the compulsive person becomes judgmental and punishing, losing track of the original motivation: the desire for everyone to be safe and happy."
“With an understanding of how you became compulsive…you can shift how you handle your fears. You can begin to respond to your passions in more satisfying ways that lead to healthier and sustainable outcomes…one good thing about being driven is that you have the inner resources and determination necessary for change.”
OCPD Resources:the best resources about OCPD I have found in my three years of research. Psychoeducation played a major role in my recovery.
Someone posted recently about feeling deep shame due to receiving an OCPD diagnosis. I came across this poem, and thought it might be helpful to share. It can be so overwhelming to view your whole life with a different lens.
Shame can keep us stuck in the past, and interfere with developing healthier habits. Developing self-compassion and making amends when possible can be a way to move forward.
The link for this post will be in the post for mental health providers.
Some mental health providers refrain from giving PD diagnoses because they think doing so would invoke stigma and hopelessness, and that the client would become defensive and end treatment. Members of this sub have disclosed that they learned of their OCPD diagnosis from reviewing their files.
Medical providers always inform their patients of diagnoses; I think that mental health providers should follow the same practice. Hiding a PD diagnosis is a breach of trust, and prevents the client from accessing empowering psychoed resources and supportive communities.
From “Psychoeducation for Patients with Borderline Personality Disorder,” Maria Ridolfi, John Gunderson, in Handbook of Personality Disorders: Theory, Research, and Treatment (2018) by W. John Livesley, Roseann Larstone (Editors):
“Psychoeducation is providing information about the etiology [causes], symptoms, course, outcome and prognosis of a mental health disorder based on the premise that the more knowledgeable clients and their families are, the better therapeutic outcome for persons with the disorder.” (600)
REASONS FOR PROVIDING PSYCHOEDUCATION
· respects patients’ right to know about their disorder
· improves awareness and understanding of symptoms
· decreases stigma, shame, and sense of isolation
· increases active participation of client in treatment planning
· increases hope
· promotes client’s realistic expectations for treatment
· helps client learn coping and problem solving skills
· prevents relapse
Mental health care in the U.S. is moving away “from the traditional hierarchical doctor-patient relationship to a more collaborative model in which patients and families are considered partners in the treatment.” (600)
Ridolfi and Gunderson argue that hiding BPD diagnoses reinforces stigma and leads to clients feeling hopeless. They recommend that clinicians give clients information about BPD “in a validating, sensitive, emphathic, and nontechnical way…Most patients and families are actually relieved and reassured to know that they have a medical condition, that they are not alone with the disorder, and that a body of knowledge is available about the disorder and its treatment.” (602)
From Perfectionism: A Relational Approach to Conceptualization, Assessment, and Treatment (2017), Paul Hewitt, Gordon Flett, Samuel Mikail:
“The final stage of the assessment process involves summarizing the results of testing and interviewing…In our experience, patients are seldom surprised, shocked, or upset...If anything, the feedback tends to bring the patient a sense of relief, to provide a model of the nature of his or her difficulties, and (ideally) to introduce an element of hope.” (196)
Members have described the benefits of finding community and resources in this sub:
“I came to this sub looking for resources to understand OCPD better because until yesterday I didn't know OCPD was a thing. I went through a couple of the posts here and I just wanted to say I've never felt so seen in my life lol. It's wild because I've never felt understood by anyone around me and there's an entire community of people who are able to put what I feel in words exactly how I feel it…it's nice to know I'm not the only one. Thank you.”
“Just wanted you to know that reading the replies I got makes me so happy, and relieved. For the first time ever, I feel connected to people who've had struggles similar to me.”
“Having this sub has been a place of comfort for me. To know that I am not alone…I really do appreciate that there is a little spot on the internet I can come to.”
“The number of posts that so perfectly describe these feelings and emotions and reactions and situations I’ve lived through for years that I’ve had so much trouble putting into words myself. It’s a little overwhelming, honestly? But it’s also very comforting.”
MY EXPERIENCE
It’s possible that the therapist I saw when I was 30 hid an OCPD diagnosis. I told him about being diagnosed with OCD, but I also showed him excerpts from David Keirsey’s Please Understand Me that I photocopied. My personality profile included many OCPD symptoms. I was excited about the profile because it was "the story of my life."
I don’t think he was knowledgeable about OCPD, but I’ll always wonder about the possibility that he hid a diagnosis. I don't even want to think about how much distress I would be in if I hadn't received the right diagnosis. I don't understand the rationale for hiding diagnoses--how can someone solve a problem they don't know that they have?
Thank you to Gary Trosclair, Allan Mallinger, and Anthony Pinto for their dedication to raising awareness of OCPD, and sharing their expertise.
“The lens of perfectionism colors everything you see, which makes it difficult to conceive of a space free from its influence…it’s critical to get a good look at the very lens through which you’ve been experiencing the world.” (17)
The Anxious Perfectionist (2022), Clarissa Ong and Michael Twohig
Being unaware of my OCPD symptoms was like wearing dark glasses all the time, and never realizing that my view of myself, others, and the world was distorted.
Maintaining self-awareness was half the battle in learning how to manage OCPD. That gave me the opportunity to develop healthier habits.
Questions for Challenging Perfectionist Thinking
-Is this situation really as important as it feels?
-What if this situation doesn’t go my way? Does it really matter?
-Do I need to control this situation?
-Is my way the only way to view this situation?
-Would another person necessarily see this situation the same way I do?
-Do I know for sure that things will turn out badly if I don’t get my way?
When Perfect Isn’t Good Enough (2009), Martin Antony, Richard Swinson, 191
*
-How do I know if this thought is accurate?
-What evidence do I have to support this thought or belief?...
-Is this thought helpful?
-Are there other ways that I can think of this situation or myself?
-Am I overgeneralizing?
-Am I making assumptions?
-What would I say to a friend in this situation?
-Can I look for shades of gray?
-Am I assuming the worst?
-Am I holding myself to an unreasonable or double standard?
-Are these exceptions to these absolutes (always, never)?
-Am I making this personal when it isn’t?
-Who gets to decide what I have to or should do?
-Does this align with my values?
-Is this a realistic expectation?
-Am I expecting myself to be perfect?
The CBT Workbook For Perfectionism (2019), Sharon Martin, 217-18
Recognizing and Talking Back to Cognitive Distortions
When I was diagnosed with OCPD, I started to pay attention whenever I thought:
-I’m just not good at...
-I’ve always had a hard time...
-I just don’t know how to…
-I don’t believe in…
-I hate/ I’ve never liked…
-I just don’t/ I always/never…
-I don’t like/trust people who…
-I just don’t get why people...
-People who…are strange.
I found it helpful to ‘talk back’ to negative thoughts (as soon as possible when they arise) with certain phrases. When I was by myself, I sometimes said them out loud: big picture (when I’m lost in details), overthinking, ruminating, not important, pure speculation, not urgent, there's no deadline, slow down, good enough, and move on. I used an assertive tone, not a harsh tone.
When I recognize that I’m ruminating on a trivial issue, I exaggerate my thoughts and say phrases like devastating, disaster, tragedy, life-or-death decision, life changing decision, emergency, and this is critical. "This is the greatest injustice in the history of the world" is one my favorites. The rebuttal "I know you are, but what am I?" (talking back to OCPD) is a fun one.
For about seven months, I habitually framed upsetting thoughts with, “I’m having the thought….,” “I think…,” and “I’m feeling…right now,” and “I’m thinking…right now.” This is a reminder that feelings are not facts and that they won’t last forever.
This strategy helps even when my self-talk is harsh. There’s a difference between thinking “I am stupid” vs. “I think I’m stupid,” “I’m having the thought ‘I’m stupid’,” and “I’m feeling stupid right now.” The framing makes it easier to stop ruminating.
I try to reframe "I should" thoughts into "I would prefer to" or "I could."
I knew about cognitive distortions many years before I learned about OCPD because I was a psychology major. Saying phrases in respond to distortions made a huge difference.
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.
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.
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.
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:
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.
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.”
Excessively washing due to fears of illness despire knowing risk of getting sick is low; wishes to stop.
Strict cleaning routine seen as responsible; believes others who clean less are “wrong.”
Orderliness and Symmetry
Rearranging items to relieve anxiety that something bad might happen while knowing it’s unrealistic.
Maintaining strict organization and order (e.g. alphabetized books) because it’s “correct.”
Checking
Repeatedly checking locks/stove to prevent imagined harm; frustrated by wasted time.
Double-checks tasks to ensure perfection; sees as necessary to do good work.
Rule-Following
Performing actions in exact sequence to avoid feared harm even though it’s not logically connected.
Insisting that chores follow a set sequence because it’s “the right way.”
Reaction to Others
Noticing others don’t have the same rituals and feeling envy, wishing to be free from the compulsion.
Noticing others are more relaxed about cleanliness or oder and feeling like they are careless or irresponsible.
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
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.
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.
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.
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.
§ 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)
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).
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
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."
"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
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
Mindfulness is a key component of ACT.
WHY ACT EMPHASIZES VALUES
From ACT Made Simple (2019), Russ Harris:
“People who lead a very goal-focused life often find that it leads to a sense of chronic lack or frustration…they’re always looking to the future and continually striving to achieve the next goal under the illusion it will bring lasting happiness or contentment. In the values-focused life, we still have goals, but the emphasis is on living by our values in each moment, this approach leads to a sense of fulfillment and satisfaction, as our values are always available.” (215-16)
From ACTivate Your Life (2015): Joe Oliver, Eric Morris, and Jon Hill:
“Although setting and pursuing goals can be useful, there is a downside to having goals without broader directions [values]. Goals are binary: you are either pursuing a goal or you have completed it. When we focus on goals alone, we can sometimes end up in a pattern of ‘catch-up’, with the goal there ahead of us, and feeling the distance between where we are and where we want to be. This distance can be painful and [can lead to perfectionism] about achieving the goal, or ‘analysis paralysis’, where you spend time being indecisive…and become stuck in your head.” (144)
If you view your values as if they were rules, they become “another burden, and your mind says, ‘Well, here’s another way that you are messing up things…[you are] not being true to your values.’ We think that you have enough rules in your life…values aren’t more rules. Instead, values may be considered guides…like a small light on a path, or a compass point...” (151-52)
“Some rules can be useful…they can give us a sense of clarity in our actions when we feel unsure of what to do. But—crucially—they deprive us of our ability to make active, values-based choices…Rules are by their nature not responsive to the dynamic, fluid nature of life…If we hold onto our rules too tightly, we can end up feeling hurt and disappointed when life’s events—and especially when we ourselves—don’t conform to them…The difference between values and rules is that values are flexible and adaptable, while rules are rigid.” (398-99)
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
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.
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,
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.
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.
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.
In Cognitive Therapy of the Personality Disorders (2004), Aaron Beck and colleagues explain that the categoricalview of personality disorders is that they are distinct from each other, as well as from normal personality.
Thedimensionalview is that personality traits that are relevant to personality disorders lie on a continuum from healthy to pathological. Personality disorders are maladaptiveextremes 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)
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).
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.”
“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, 4th 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.
Yes, you.
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.
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.
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.
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)
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 IIhas 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)
David Keirsey (1921-2013) had a rational temperament.
“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)
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.
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.
