The Obsessive-Compulsive Personality

Excerpt from:  WHY YOU DO THAT, by John B. Evans, PhD, LCSW

This description covers multiple levels of obsessive-compulsive patterns of thought, emotion, and behavior. Those with fewer or milder traits as well as those with the symptoms of a serious disorder may readily identify some of their thinking, as well as emotional and behavioral tendencies. A more comprehensive understanding of self usually requires an ongoing self-observation and self-reflection over time. These traits are found in both men and women. 

     There are two distinct obsessive-compulsive personalities. One personality is called obsessive-compulsive personality disorder, or OCPD, and the other is called obsessive-compulsive disorder, or OCD. Both of these personalities show up in varying degrees of severity from a minor nuisance through a serious disorder. The two personalities do have some of the same traits and symptoms, such as rituals and hoarding, but the differences between these two personalities are much greater than the similarities. 

     For the OCPD, the emphasis is on perfectionism, orderliness, the need for control, the need to be right, avoiding humiliation, and they may be quick to anger. For the OCD, the emphasis is on obsessive thoughts that produce anxiety, which are then followed by mental or behavioral rituals designed to alleviate the anxiety. One major difference between OCPD and OCD is in the level of suffering.⁶⁵ Individuals with a more serious level of OCD experience considerable suffering and distress from a disorder they find unacceptable, and they struggle to make it go away. Individuals with a more serious level of OCPD may not even realize they have a problem because, in their struggle to be perfect, it never occurs to them that they could have a serious problem or need treatment. It is common for people discussing OCPD to mistakenly use the term OCD. I will first discuss the behaviors and symptoms related to the much more common OCPD. 

Obsessive-Compulsive Personality Disorder (OCPD) 

The thoughts, feelings, and behaviors related to OCPD are quite common¹⁹ and are found in varying degrees of severity. They include: 

• * Perfectionism: Checks and rechecks for mistakes 
• * Orderliness: Objects must be neatly arranged or in perfect order
• * Attention to minute details 
• * Recurring doubt, both causing and caused by attention to minute details 
• * They must be right—others are wrong 
• * Issues are black and white—no gray areas 
• * Ignores new information that contradicts their opinion 
• * Control—both self-control and interpersonal; they must have their way 
• * Rigidity—in thinking, emotions, and behavior 
• * Rigidity—in values, morality, and religion
• * Liberal use of “shoulds†and “musts†on self and others 
• * Angers quickly and easily 
• * Stubborn—refuses to listen or compromise 
• * Stingy with money and possessions—even with family 
• * Easily humiliated 
• * Humiliates others 
• * Follows strict rules and schedules
• * Enforces strict rules and schedules on others 
• * Procrastination 
• * Indecisiveness 
• * Avoids taking risks—overly careful 
• * Hoarding/collecting things 
• * Rituals: Repeating behaviors or thoughts. May not know why they perform the ritual 
• * Holds grudges
• * Depression
• * Impulsive: May act without thinking it through
• * Overly focused on details: Misses the big picture
• * Unable to relax: Continuous effort toward something Clueless that others are unhappy with his or her behavior 

VIGNETTE: Perfection, Order, Control, Righteousness, Criticism, and Anger 

     Todd’s wife, Elise, described Todd as a control freak who orchestrated their family life in every way. Todd would become irritated if there was any clutter anywhere in the house, and as a stay-at-home mother, it was Elise’s job to keep the house spotless. Elise said Todd had always pushed himself to finish one project so he could get to the next project on his list. Since Todd always seemed to be working at something, Elise suggested Todd hire outside help for repairs around the house to give him more free time, but Todd always insisted on doing the work himself because he did not trust anyone else to do a good job. 

     In most areas of life, Todd always wanted things done his way and would sometimes lose his temper if his instructions were not followed. Unfortunately, this attitude was applied to his children as well. The creative thinking that many parents would want to instill in their young children was thwarted in deference to doing things the right way, that is, Todd’s way. The children’s protestations were not tolerated unless his wife intervened. What the children usually heard from Todd was, “Because I said so.†

     While almost never offering compliments, Todd was very critical of the mistakes of others, including Elise and their children. Even the family’s religious orientation was designed to meet the rigid views that had evolved in Todd’s thinking. Elise also talked about the lack of family vacations over the years because Todd did not want to spend the money or there was some urgent project he had to finish. Elise also talked about having to “beg†Todd for enough money to run the household, and she was tired of putting up with Todd’s “inquisitions†when he thought she was not being frugal enough. When Elise finally refused to postpone one family camping trip, Todd drove the family to the campsite, helped set everything up, drove back home and worked for two days, and then drove back to the campsite to retrieve his family. On other trips, Todd would stay with the family but worked out of his briefcase most of the time. 

     According to Elise, the weekly dinner parties held at the homes of friends were the only social event she could get her husband to go to because he always had too much work to do. Todd only attended these dinner parties because Elise forcefully insisted he go. Elise described one dinner party where Todd exploded in anger at another guest over some political discussion and berated and humiliated the surprised victim for several minutes in front of the other guests. Elise pointed out that political discussions were routine and an accepted part of these weekly get-togethers. So why Todd’s extreme outburst? 

After exploring the subject further, Elise thought Todd’s rage may have been sparked by a previous discussion with the same guest the week before. Todd’s compulsive eating had kept him obese for most of his life, and he had always been sensitive about his weight. This dinner guest may have unwittingly humiliated Todd at the previous dinner party with his story of successful weight loss, which only served to highlight Todd’s inability to lose weight. Todd’s attempt to humiliate his political rival in front of so many other people may have been retaliation for the humiliation Todd had experienced during the weight-loss discussion a week earlier, although Todd was probably not aware of the connection. 

Whether at home, work, or social gatherings, Todd would rarely show emotion. Except when someone would say something that irritated Todd and drew his ire, he would just sit there with a blank expression on his face. Lacking outward emotional expression, Todd rarely expressed affection toward Elise in private, and never in public. Gradually, over time, the emotional connection between Todd and Elise had dissipated almost completely, to be replaced by a regimented lifestyle based on Todd’s need for organized certainty in all things. For years, attempts by Elise at romance, or any emotional connection with Todd, had been awkward, and Todd would become uncomfortable and stilted. Even sex became a mechanical routine designed to meet certain requirements. The emotional coldness in their home had become unbearable for Elise, and she finally began to pull away emotionally herself, and now describes her home life as simply “numb.†

Perfectionism 

OCPD sufferers’ need for a sense of control over themselves and their life may lead to some level of perfectionism. Common by-products of a perfectionistic attitude include excessive carefulness and procrastination. Perfectionism typically involves continuous self- criticism and anxiety about making mistakes, and it can be difficult for OCPDs to finish projects because of their relentless need to make sure every detail is exactly right. They may spend so much time reading and rereading material, writing yet another draft of a report, or rechecking yet again for mistakes that they never actually complete the project. They become so lost in the minute details of a project that they seem to lose sight of the overall goal. 

     Once they are happy with the minutia, they may still be unhappy with the overall final product and immediately commence revising the minor details again—and another deadline is missed. The forest may be missed as they concentrate on trees, branches, twigs, leaves, and seeds. Some projects may never even get started because of their extreme focus on the most trivial details of the basic preparations. Some OCPDs may also have poor time-management skills, and they may fail to complete a project because they did not leave enough time. 

     In work environments, if the OCPD is allowed to work independently, their intense concentration on details, along with a work ethic that emphasizes work over all other aspects of life, may get them rave reviews and promotions^.57 Otherwise the OCPD’s behavior at work may be dysfunctional on several fronts. Their perfectionistic attitude may rarely offer compliments to other employees for their exceptional work. When the OCPD has no choice but to delegate work to others, intimidation may be the technique of choice to be certain the work will be done according to the OCPD’s own strict guidelines. 

Decisions Decisions 

     Uncomfortable with decision-making, OCPDs may try to find some guiding principle or rule that helps them make the “correct†decision.²⁸ In this way, decisions that for most people involve a mere preference or have an emotional element are turned into a technical problem with external rules of logic or principles of tradition or morality to guide and ensure the “logical†choice. This approach may be applied to minor or inconsequential decisions with the same seriousness applied to major life decisions. Once the OCPD does finally make a decision, the decision may be written in stone with a rigid indifference to any new information that may come along. 

     One obvious and logical offshoot of the OCPD’s perfectionism is indecisiveness.²⁸ In milder cases, indecisiveness may be no more than a minor irritation for the OCPD and those around him. In more serious cases, the OCPD may vacillate endlessly between two or more choices, and the indecisiveness may be incapacitating and sabotage the OCPD’s efforts to lead a normal and productive life. The closer the OCPD gets to deciding on one thing, the more the alternative begins to look like the better choice—back and forth, over and over. The OCPD seems unaware that both choices might be equally suitable. The OCPD may spend a considerable amount of time just deciding what clothes to wear, only to change his mind an hour later and change clothes again. And once the OCPD has actually decided which used car to buy, and bought it, he may watch the car ads for months afterward to make sure he made the right choice. 

     The OCPD seems to operate on two extremes. He either has excessive doubt about something, or he has a rigid and unyielding certainty with little room for compromise.²⁸ It is the OCPD’s inflexible emphasis on the technical or minute details that results in these two extremes. Insignificant, or even irrelevant, information may create seemingly endless doubts about the right choice, but once the required rules or principles have been met and the decision is made, then he is right, and new information may be ignored. In business and employment, the effects of indecisiveness and dysfunctional decision- making may short-circuit the OCPD’s career goals. 

Rigidity / Doesn’t Listen / Blames Others 

     The OCPD may have a very rigid belief system that he believes is the right belief system for everyone at all times. These individuals may see their way of thinking and functioning as the right way, and everything and everyone is evaluated according to their strict standards. OCPDs do not like to be disagreed with. Completely certain of the rightness of their own opinion, the OCPD’s responses to alternative viewpoints or suggestions may range from increasing righteous indignation and criticism through extreme anger, although the anger may not be expressed in a direct manner. 

     Even trivial issues may be fought for and may escalate into a heated exchange, which the victim may find very difficult to gently bring to a close. The art of listening and compromise may appear foreign to the OCPD. You have the sense that he just does not hear anything you say as he simply restates his position. The OCPD does appear to be concentrating, but not on what you are saying.²⁸ Your views are just unacceptable interruptions. Further, this righteousness may be applied to anyone, including those the OCPD hardly knows. It’s as if the small talk that new acquaintances customarily use to become comfortable with each other does not exist for the OCPD. Compromise is ruled out, as it seems to imply not only some degree of wrongness on his part, but implies some loss of control as well. Unfortunately, OCPDs are sometimes promoted to management positions by businesses and bureaucracies⁵⁷ because of the very perfectionism that makes them dictatorial bullies who will criticize and humiliate those below them. Still, the OCPD may rigidly conform to rules issued by a recognized authority or an authority they respect. At the same time, the OCPD may ignore rules issued by an authority they do not respect. 

     The OCPD’s righteous style of discourse may cause some people to be very nice and polite in an attempt to close the conversation, which may infuriate the OCPD if the other individual has not yet conceded the correctness of the OCPD’s perspective.⁵⁷ If the OCPD recognizes that you are allowing him to win a few points to settle him down because you are less serious about the topic, or just do not want to talk to him, you may be on the receiving end of the very stern lecture you were trying so delicately to avoid. On those few occasions when the OCPD does give in and change his position on some vital issue, expect his new position to be taken with the same seriousness as his previous position and defended in the same rigid manner. The OCPD’s need to be right is frequently welded to his moral and ethical code. The OCPD may take his views on religion or politics very seriously, and “shoulds†and “musts†may predominate when these topics are discussed. In keeping with this attitude, the OCPD tends to blame other people or external circumstances for his problems. 

     Over time, the OCPD’s way of responding can be very destructive to his emotions, social relationships, and employment opportunities. Unfortunately, the OCPD’s rigidity, perfectionism, need to be right, and refusal to really listen to what others have to say may give them an enduring social incompetence with little opportunity for improvement. Even if they do begin to recognize their righteous or hostile communication style, the isolation they endure after driving away potential friends and acquaintances offers OCPDs fewer opportunities to practice appropriate communication. 

Sense of Effort 

     OCPDs may feel uncomfortable when they do not have some duty or obligation they must deal with, and they may remain uncomfortable until they find some new responsibility or endeavor that requires their attention or that they can at least worry about. It is common for the OCPD to take his work with him on a vacation and avoid the idle mind so coveted by most vacationers. The OCPD may be unable to experience the freedom of thought that most people have in their thinking and decisions. 

     In his extraordinary book, “Neurotic Styles,′⁸ David Shapiro points out that the detailed concentration of OCPDs may miss a whole range of sensual and emotional experiences as the bigger picture and spontaneity are lost to them. Allowing the mind to become spontaneously caught up in the beauty of nature, or to really hear a lyrical melody, requires a relaxation of attention that allows the mind to be available for new or unexpected stimuli. For OCPDs, unexpected or unplanned stimuli may just be irritating and distracting nuisances to be ignored, and they may lose the emotional and perceptual experiences available to a relaxed mind that can be seized by spontaneous events, thoughts, conversations, tastes, feelings, etc. Since there is always something OCPDs are concentrating on or worrying about, they rarely experience the surprise of something they just happen to notice. As Shapiro puts it, “It is not that they do not look or listen, but they are looking or listening too hard for something else.†Endeavors that relax the mind, such as yoga or meditation, may be difficult for OCPDs but are exceedingly rewarding if they can stick with the process without succumbing to the sense that they are wasting time. 

     Shapiro also points out that the sheer effort and tension involved in the focused attention on some project may seem to be more important to OCPDs than the goal of actually completing the project. OCPDs are always “trying†to do something. This serious level of effort may be applied to all activities, including activities they have little real interest in. The continuous and intense pressure to concentrate and focus on something is a self-inflicted pressure, which OCPDs may sometimes view as a positive trait while at other times complaining about the pressure that they believe stems from outside themselves. OCPDs are not aware that it is they who require themselves to work intensely on one project and then quickly concentrate just as intensely on something else. They feel they are merely “reminding†themselves of some important necessity, especially where ethics and morals are involved. 

     The OCPD’s emphasis on intellectual logic, with tiresome details and exact descriptions, may carry over into casual conversations with other people. The OCPD’s concentration on technicalities and detailed descriptions may become time-consuming, boring, and sometimes exhausting for the listener-victim. In an electronics store I frequent, there is an extremely knowledgeable employee who always goes into an OCPD level of technical detail that is way beyond what I can possibly understand or need to know. This seems to be the only modus operandi available to her, and she never seems to notice the bewildered stares customers offer in return. 

Humiliation 

     To understand the behavior of OCPDs, it is important to recognize that many OCPDs do not experience being “wrong†the way most people do. For most of us, being wrong implies a mistake to be reconsidered and corrected. Not so for some OCPDs. I have been struck by the extent to which many OCPDs experience being wrong about something, or even receiving constructive criticism, as a humiliating experience. For some OCPDs, avoiding humiliation is one of the paramount struggles in their lives and may be one of the main causes of their rigidity and intense need to be right. It is here that the need to be right, perfectionism, a rigid belief system, etc., work together, causing considerable and sometimes incapacitating procrastination and indecisiveness as OCPDs struggle to avoid the humiliating experience of being wrong. Since it is critical for OCPDs to avoid the humiliating experience of being wrong, just a suggestion or an offer of assistance by another employee may be interpreted as criticism worthy of direct or indirect retaliation. It is here that those who must deal with an OCPD may pay a high price. OCPDs may unconsciously react to their fear of being humiliated by occasionally humiliating others,⁵⁷ including their employees, their partner, and even their children. They seem to have a need to dish out that which they themselves most fear and want to avoid. 

Hides Emotions / Angers Easily / Holds Grudges 

     Many OCPDs are unemotional most of the time. A restriction of emotional expression is central to OCPD’s sense of self-control.^5,28,57 When the OCPD sense of willful effort is not maintained, they may feel like they are losing control of themselves. This sense of a loss of control may occur when OCPDs allow themselves to release their controlled demeanor to spontaneous excitement and laughter or to grieve over some loss. It is extremely important to OCPDs that they not risk ridicule and humiliation from mistakes, so they strive for complete control over their emotions at all times. Connecting with OCPDs on an emotional 121 level can be awkward at best. When they do attempt to show emotion, such as affection for a spouse or children, happiness at a family reunion, or sadness for someone’s loss, the expressed emotion may appear stiff and self-conscious as they struggle to maintain some sense of control. Even in brief or casual conversations, OCPDs may seem stilted and uneasy from fear they will say the wrong thing. OCPDs may also become very uncomfortable when other people freely express their emotions, possibly because OCPDs then feel an uncomfortable and self- inflicted pressure to loosen up as well. It may be easier for OCPDs to feel displeasure at the free spirits around them than to join them. Most of the time, OCPDs may remain essentially expressionless, with little in the way of positive or negative emotions. They are just there. 

     So determining what emotion OCPDs are actually experiencing at any given moment may be difficult, and so it is that OCPDs may catch people by surprise with any real emotional sentiment or angry outburst. When a spontaneous show of emotion does occur, it is usually anger.⁵⁷ OCPDs get angry very quickly and easily, although they may bury their anger at someone for long periods of time, only to unload the anger on them later over some trivial or completely unrelated issue. 

Orderliness 

     Sometimes OCPD’s need for excessive control over their life is expressed through a need for everything to always be in its designated place or displayed in perfect order, and all in a perfectly clean house. Whenever things are not exactly right, OCPD’s feelings may range from a mild uneasiness through considerable distress, so they remain constantly vigilant for that which is out of place or just not quite right. Some OCPDs keep the clothes in their closet color-coded and all facing the same direction. Other sufferers feel compelled to repeatedly swipe their finger across their furniture to check for dust, and some may check for dust on the furniture in other people’s homes. 

Rituals 

     Some OCPDs feel compelled to perform mental or behavioral rituals, such as frequent housecleaning, checking something repeatedly, mentally counting backward, reciting a prayer, never stepping on cracks in sidewalks, etc. OCPD sufferers may not be aware of any anxiety or fear of disaster that compels them to perform a ritual, whereas the OCD sufferers discussed later may experience severe anxiety or fear some disaster occurring if they do not perform some ritual.⁵⁷ 

     The compulsive rituals of some OCPDs may become wrapped up in a self-image that is largely based on the role or roles they play in life.²⁸ Performing rituals that live up to the image that OCPDs believe is expected of a certain role, such as banker, doctor, lawyer, parent, minister, etc., may become a major preoccupation. The need to act according to their “role†may give these OPCDs a demeanor that seems overly formal, forced, or contrived and may give their behavior an unnatural wooden appearance. I know a doctor who puts on a coat and tie to drive to his clinic, where he changes into scrubs for work and then changes back into a coat and tie to drive home. 

Hoarding / Stingy 

     Some OCPDs find they are unable to throw things away because they think they may eventually find a need for them. The basements, attics, hallways, and garages of some OCPDs may simply fill up with old, useless stuff. If someone else attempts to dispose of the treasured possessions, there may be an immediate display of the OCPD trait of being quick to anger. OCPDs are also known to be very thrifty and are frequently described as “cheap.†The miserly aspect of OCPDs is simply a special case of hoarding,⁵ where they excessively hoard money, thinking they may need the money for some future event or disaster. OCPD misers may leave their spouse begging for money to care for the family as their savings account continues to grow. 

Depression / Low Self-Esteem 

     Depression and low self-esteem are common among OCPDs. Not only are other people unable to live up to the rigid standards and high expectations of OCPDs, but OCPDs may be extremely self-critical when they fail to meet their own inflexible requirements. With an almost delusional self-concept of living up to the highest standards, OCPDs will inevitably and repeatedly experience their own failures, including feelings of anger when their failures involve an apparent loss of control over self or others. At the same time, OCPDs may also deal with the frequent negative reactions of other people to their behavior. 

     As with many personality patterns, OCPDs may experience some degree of isolation as their personality drives away friends and acquaintances. This may create a vicious circle in the lives of OCPDs where isolation invariably leads to an increase in low self-esteem and depression, accompanied by ever-increasing odd or eccentric behavior that may result in even more isolation. While isolation may be the product of an individual’s personality, isolation may also create the conditions that exacerbate his eccentricities, while offering fewer opportunities for the individual to practice modifying the dysfunctional behaviors. Depression and loneliness are common complaints of OCPDs who seek professional help, although they are usually not aware of the underlying problem. Individual therapy at first, with group therapy later, can be very effective at helping isolated individuals, whether they are OCPD or not, to learn to understand themselves and develop the coping and interpersonal skills they need to better relate to other struggling souls on their own journey. 

The OCPD in Relationships 

     Although OCPDs typically have greater success staying married than individuals suffering from other personality problems, it is common for OCPDs to live alone³⁹ or have a history of short relationships. Even with the many OCPD characteristics that contribute to dysfunctional or failed relationships, including perfectionism, control, anger, criticism, few compliments, etc., it is frequently indecisiveness that prevents the formation of long-term relationships. 

     Typically, when we first meet someone and enter the honeymoon stage of a relationship, everything about our potential mate is just wonderful. The new potential mate can do no wrong when viewed through the lens of a chemically induced infatuation. But with time, from just a few weeks up to a year or more later, the honeymoon stage ends, and we begin to notice minor irritants about the other person, although not necessarily about ourselves. When the OCPD begins the essentially normal process of becoming a little more realistic about the characteristics of his love interest, his tendency to have overly high expectations of others may play itself out in his relationship. Some minor flaw in the potential mate may become the only thing the OCPD notices when they are together, and other potential mates less well known to the OCPD are starting to look just so awesome. Greener grass may always grow elsewhere for some OCPDs. 

     If the relationship does become a long-term commitment, it may be highly dysfunctional and quite miserable for the victim/mate and children, as the OCPD’s critical nature rules the house. In the home, the OCPD may want to take care of things himself because only he can do it right. The partner’s attempts to help may be rejected out of hand as the OCPD emphasizes the importance of his work while negating the value of his partner’s efforts. An OCPD may even disparage the efforts and desires of his children, and the compliments that a child’s self- esteem thrives on may be rare or nonexistent. 

     OCPDs may come across as type A personalities with their preoccupation with work, details, competitiveness, and a sense of urgency to get things done. Other areas of the OCPD’s life, such as their spouse, children, vacations, home or auto maintenance, etc., may get neglected. Vacation time, so coveted by most people, may be largely ignored, postponed again and again, because of the pressure the OCPD puts on himself to get more work done. Of course, when the OCPD does not take the vacation, the spouse and children usually miss out as well. When the OCPD finally does take his family on a vacation, he may take his work with him to avoid wasting time. The OCPD works while the spouse and children play without him. The OCPD might as well not be there. If the OCPD tries to have quality time with his family during the vacation, he may still have work on his mind the whole time and soon return to his urgent duties. And the family may actually be glad he is again leaving them alone, since the OCPD typically approaches play with the same serious intensity he approaches work and dictatorially removes the element of fun for both himself and his family. For example, if the OCPD does spend time with his children, the child who just loves to throw gutter balls is ordered to “throw in a straight line.†Another example is the small child who is having a blast using crayons to draw all over the pages of a coloring book but is ordered to draw only within the lines and possibly ridiculed or scolded—that is, humiliated— for any failures to do so. The real issue behind the OCPD’s distaste for relaxation is that, for the OCPD, relaxation feels like a loss of control.^28,57 

     The OCPD may be completely unaware of his symptoms or their impact on other people, including his family.⁶⁵ As a result of this lack of awareness, the OCPD will probably be happier in the relationship than his partner or the children. The OCPD is quite happy with his emphasis on work, dominance, and control, while the family’s needs for an emotional connection, empathy, intimacy, affection, warmth, compliments, spontaneity, and fun get neglected. In some cases, the OCPD’s overly strict, dictatorial approach to family life may legitimately be described as abusive. As with most abusive behavior, it is in the home, hidden from public scrutiny, that OCPD symptoms are most likely to be expressed in abusive behavior. The criticism, humiliation, and punishments the OCPD uses to control his partner and children may be severe behind the closed doors of a home.        Hidden away from public scrutiny, it is control, humiliation, and severe punishment that may replace both rational explanations for decisions and logical consequences⁴⁵ for discipline. The extremely dedicated hard worker the partner knew during the early parts of their relationship may have become a controlling and punitive workaholic. In a tension-filled environment, the abusive OCPD may hold other family members responsible for most family problems. With irritation or anger quickly and easily displayed, the rest of the family may find themselves feeling uneasy when they are around the OCPD, fearing they will say or do something that sets him off. Unaware of the OCPD’s underlying problem, the partner may try to figure out what it is he or she is doing that upsets the OCPD. 

     The partner of an OCPD may blame herself for the OCPD’s emotional distance and lack of involvement in family life. The partner may also wonder why the OCPD rejects her attempts to work with him on their problems. The partner fails to recognize that the OCPD is very content with the status quo as long as he is in control. If the OCPD has rigidly held religious beliefs, the fear of God may be used as a technique of control, and rigid adherence to religious rituals, readings, etc. may be punitively enforced.⁵⁷ This, along with a lack of positive attention, encouragement, or compliments offered to children as positive reinforcements, may be severely damaging to children’s self-esteem. Depression may dwell in every room of the abusive OCPD’s house. An abusive personality, whether he suffers OCPD or not, desires the power, control, dominance, and privileges he experiences from being abusive to his family, employees, etc. An abusive personality combined with the symptoms of OCPD creates an extremely controlling abuser who cannot change without a willingness to commit to considerable work with a knowledgeable therapist. 

Change 

     Since OCPDs typically are not aware of the underlying cause of their problems, they may seek treatment for related complaints such as anxiety, fatigue, depression, or sexual dysfunction. Many OCPDs seek treatment only after their spouse or employer insists they do so.¹⁹ It is frequently the spouse who brings an OCPD to my office after years of chronic marital discord, possibly threatening divorce if he does not seek help. 

     Even when OCPDs are aware of specific dysfunctional behaviors, such as rituals or anger outbursts, they may not have connected any dots involving their own responsibility. Whether we call it rationalization, denial, or something else, the OCPD will frequently find fault elsewhere for that which stems from within. It is the therapist’s job to help OCPDs connect the dots, and to enlighten them about their personality-related symptoms. With a comprehensive understanding of their personality, OCPDs can begin to work on choosing new responses and behaviors. 

     Unfortunately, it is common for OCPD clients to find some reason for not continuing in therapy, such as the expense or a therapist who is clearly “wrong.†But those committed to the therapeutic process can learn to recognize their problematic attitudes, emotions, and behaviors and learn to respond in a way that leads to a productive life. Medications can be effective in treating OCPD.¹⁹ 

     A number of problems may co-occur with OCPD, including anxiety, shyness, depression, and eating disorders, especially anorexia nervosa. Personalities found to commonly co-occur with OCPD include the paranoid, avoidant, borderline, and schizoid personalities.¹⁹ 

Similarities and Differences 

     As with the OCPD, the narcissist also seeks perfection and does not trust others to do things right, but there is one big difference. The narcissist believes he is already perfect and merely seeks affirmations to support this conviction. The OCPD does not believe he is perfect at all and may flood his brain with critical self-talk as he pushes himself toward that perfection which cannot be achieved. 

Obsessive-Compulsive Disorder (OCD) 

     The main symptoms of obsessive-compulsive disorder (OCD) involve repeating obsessions that are usually followed by compulsive rituals that are severe enough to interfere with the individual’s daily activities and relationships. OCD also occurs in children, and between one-third and one-half of OCD cases in adults can be traced back to childhood symptoms. OCD exists in every country in the world.⁶⁵ 

Obssessions 

     Obsessions are recurring and persistent thoughts, feelings, mental images, impulses, or ideas that intrude into an individual’s thinking, even though the individual considers them inappropriate and does not want them. Common obsessions include thoughts of contamination or being dirty, persistent doubts about something, thoughts of committing a violent act against another person or of possibly having harmed someone in the past, thoughts or images of inappropriate sex, thoughts of having offended God, etc. Individuals recognize the obsessions as originating in their own minds yet seeming to be outside of any voluntary mental process and, therefore, they are experienced as foreign to their actual selves.⁶⁵ 

Compulsive Rituals 

     Compulsive rituals involve the repeating performance of behaviors or mental exercises that are usually performed for any of three main purposes: 

      1. Reducing the anxiety or distress that accompanies an obsession. 131 

2. Preventing some terrible event or disaster. 
3. Relieving guilt feelings over the possibility that they may have harmed or insulted someone, and avoiding the sense that they are terrible people who are capable of doing harm to others.⁶¹ 

     Consider the case of writer-actor-director Woody Allen:⁶² Woody Allen cuts his banana for breakfast cereal into exactly seven equal pieces. He performs this ritual out of a fear—that is, an obsessional thought—that if he does not cut the banana into seven equal pieces, some disaster may befall his family, such as they may all die in a house fire. Like the great majority of OCD sufferers, Woody Allen knows very well that his thinking, and the accompanying anxiety, are completely irrational and that there is no actual connection between his cutting the banana and the possibility of some disaster. Yet, as Woody Allen points out, if he does not cut the banana into seven equal pieces, and something terrible does happen to his family, “The guilt would be too much for me to bear, so its easier for me to cut the stupid banana.†

     The varieties of compulsive rituals are endless, and they can be very strange indeed. Some rituals used by OCDs involve mental exercises that are not outwardly observable, such as silently reciting a phrase or prayer or mentally counting backward from 100 to zero for each unwanted thought. Concentration on mental rituals may give the individual the appearance of daydreaming.⁵⁶ Be careful not to confuse compulsive rituals with other behaviors, such as culturally based behaviors, addictions, compulsive gambling, etc. Eating disorders, however, do appear to have a strong connection to OCD.⁶⁶ All OCD sufferers have obsessions, and most OCDs will also have compulsive rituals.⁵⁶ These individuals, except for OCD children, usually recognize that their obsessive thoughts and compulsive rituals are completely irrational and may also recognize that the ritual may have no logical connection to the obsession that appears to cause it. Yet their compulsion to perform the rituals only seems to increase, taking up more and more of their time and making their lives increasingly stressful. OCD symptoms, unlike OCPD symptoms, may ebb and flow over time, which helps explain why the level of insight some OCDs have into the irrationality of their disorder may vary from time to time.⁵⁶ 

     While about 80 percent of OCDs recognize the irrationality of their ritualistic responses to an obsessive thought, up to half of those offer little resistance to the urge to perform rituals.⁵ The other half of those afflicted may attempt to resist the ritual but usually give in to their anxiety and distress and make some ritual a part of their everyday life. In simple cases like Woody Allen’s, giving in to the ritual is a reasonable accommodation. For other OCDs, their daily functioning may become seriously controlled and constricted as they perform rituals or attempt to avoid the situations that seem to trigger their OCD symptoms. The mega-wealthy aviator, industrialist, and film producer Howard Hughes became as famous for his extremely reclusive lifestyle, reportedly to avoid a germ-infested world, as for his considerable accomplishments. Obsessions, mental or behavioral rituals, or avoiding the perceived cause of an obsession may take over an OCD’s life. 

     Interestingly, rituals may have no effect in other areas of the OCD’s life.⁵⁷ The individual who washes his hands 50 times a day because he fears germs may love to race motorcycles, hang glide, skydive, climb Mt. Everest, etc. Many OCDs will have more than one symptom, and the symptoms may change over time. A fear of germs may disappear only to be replaced by a need for perfect order and symmetry.⁶⁵ 

Common Patterns of OCD 

     Symptoms of OCD typically show up in a gradual manner, although a sudden onset of symptoms may occur during a period of significant emotional stress, like leaving home for college, having a baby, divorce, etc. Symptoms usually present themselves in one or more of several common patterns involving obsessive thoughts and compulsive rituals.⁶⁵ Here are descriptions of the most common forms of OCD:⁵ 

Contamination OCD: The most common form of OCD involves an obsession with contamination by germs, dirt, viruses, etc. and is usually accompanied by rituals designed to eliminate or avoid the contamination. The obsessive thoughts may involve germ phobias such as a fear of dirty hands, a dirty body, or a dirty house. There may also be a fear of public restrooms or of the sufferer’s own bodily waste products, such as sweat, urine, or feces. Habitual housecleaning, frequent showers, or repeated hand washing are common rituals performed to reduce the anxiety caused by obsessive thoughts about germs and dirt. Other rituals may be designed to avoid the contamination in the first place, such as the refusal to shake hands during greetings, staying away from trash cans, keeping bathroom doors closed, etc. OCDs may also worry that they have contracted some disease. 

Doubt OCD: Having serious doubts about something is the second- most-common form of OCD. Examples of repeating thoughts involving doubt include: 

“Did I leave the water running?†

“Did I lock the door?â€
“Did I buy the right car?â€
“Did I hurt his or her feelings?â€Â 
“Have I offended God?â€Â 
“Am I gay?â€
“Did I turn the computer off?â€
 “Should I end my relationship?â€Â 

     The rituals that follow obsessive doubt may involve compulsive checking, such as checking letters or papers repeatedly for mistakes, returning to the house repeatedly to make sure all appliances and computers were turned off, doors locked, etc. 

     Steven Phillipson discusses a subtype of doubt OCD, referred to as “Responsibility OC.â€⁶¹ Responsibility OC involves feelings of guilt caused by (1) obsessive thoughts of possibly having harmed someone or (2) guilt experienced when some ritual designed to protect others from harm, such as giving warnings or removing a dangerous object, is not carried out. Phillipson points out that the ritual of hand washing, usually connected with a fear of contamination by germs, may also reflect an OCD’s sense of responsibility in not wanting to infect others when shaking hands. The fear that they may have harmed someone because of their negligence may cause OCDs to repeatedly seek assurances that they have not harmed anyone. This form of OCD has little to do with a normal sense of compassion. A Responsibility OC may take in so many stray animals that the animals and the sufferer live in unsanitary and unsafe conditions.⁶⁵ 

     Another element found in Responsibility OC is the low self-esteem that accompanies the guilt. In the Responsibility OC’s mind, the obsessive thought of having harmed someone, or the failure to perform a ritual to protect others, seems to imply a lack of caring about other people, and the OCD sufferer’s feelings of self-worth may start to crater. The protection of the sufferer’s own reputation and self-esteem may actually become the major motivation for performing a ritual or attempting to avoid the obsession in the first place. 

     Up to 20 percent of OCDs may suffer “Hyper-Responsibility Hit and Run OCD,†and must constantly deal with the obsession that they may have hit someone with their car. Rituals then follow this obsessive thought, such as driving back by the scene where an accident may have happened, or repeatedly checking police reports to see if an accident was reported.⁶⁵ 

     When doubt involves religious beliefs, the result may be a form of OCD referred to as “Scrupulosity OCD.â€^59,65 Scrupulosity OCD typically involves religious rituals, such as repeated prayers, prayers that must be spoken perfectly evenly, or frequent confessions. These rituals are designed to deal with the obsessive thought that the sufferer’s thinking or behavior may have offended God or shown disrespect to some religious institution or icon. Other scrupulous rituals may involve following a strict ethical or legal regimen or a strict code of conduct. Scrupulosity OCD will usually involve overvaluation, which is the exaggerated importance given to obsessions.⁵⁶ With religious scrupulosity, the emotional involvement makes it less likely that OCDs will be fully aware of the irrationality of their obsessional thoughts and compulsive rituals.⁵⁹ Contrary to basic common sense, Scrupulosity OCD is not caused by strong religious beliefs alone, but by the combination of strong religious beliefs and a genetic predisposition to develop OCD. Religious obsessions and rituals are just how the genetic tendency toward OCD gets played out in some people.⁶⁵ 

Obsessional Thoughts Only OCD (No Outward Ritual): This third- most-common form of OCD involves repeating thoughts that are not necessarily followed by a behavioral ritual. The obsessive thoughts in this form of OCD are usually about committing acts of a repulsive sexual nature or about committing a violent act, although OCDs never carry out their obsessions. 

     While these individuals do not respond to their obsessive thoughts with the usual behavioral performance of rituals, there may be a mental struggle within them to avoid the thought or find a solution.⁶⁰ Researchers now recognize that the internal struggle in this form of OCD may actually involve mental rituals such as the silent repetition of some prayer, phrase, counting backward, etc.^68,69 The fact that these OCDs virtually never carry out their abhorrent thoughts does not keep many of them from feeling like they could snap and do harm to another person.⁶⁵ Unfortunately, trying to resist the obsessive and unwanted thought only ensures that the thought will continue to reoccur even more frequently, and with increasing anxiety and distress. Thoughts of killing one’s newborn son, shouting obscenities in public, having inappropriate sex, or thoughts that question the sufferer’s sexual orientation may create extreme distress in the sufferer’s mind and seem totally foreign to the sufferer’s self-concept. The high level of distress then drives the obsessive thought to repeat itself. 

     It is important to recognize that OCDs may feel that just having the abhorrent thoughts implies that they are bad people. Believing they must be bad people, the struggle to escape the original obsessive thought and the struggle against the thought of being a bad person becomes the same struggle. Of course, everyone experiences unwanted or inappropriate thoughts from time to time, but individuals who do not suffer from OCD recognize the absurdity of the thoughts and easily shrug them off.⁷⁰ If the individual is uncertain whether a thought or idea is legitimate or stems from OCD, thoughts that are accompanied by feelings of anxiety, guilt, or a sense of urgency are probably the result of OCD.⁶⁰ 

Symmetry OCD: This fourth-most-common form of OCD involves the need for symmetry, which is the need for balance, uniformity, evenness, order, or precision in certain areas of life. For example, there may be a need for objects to be in a straight line, handwriting must be perfectly even, or if one’s body moves in one way—such as turning around—there is the feeling of being unbalanced unless the body is turned in the opposite direction to an equal degree. Anxiety may also occur if a daily routine is interrupted. Some OCDs may be obsessed with symmetry such that their daily showers become very slow, lasting two hours or more, as the OCD makes absolutely certain that all body parts are washed equally. Any sense of unevenness leads to the compulsion to begin the shower from scratch, yet again. Meals can become long, drawn-out ordeals for similar reasons of symmetry. 

Fear of Catastrophe: There may be a compulsion to perform some ritual by exact rules to avoid some catastrophe as described earlier in the Woody Allen example. Other rituals designed to avoid some catastrophe might include never stepping on cracks in sidewalks, always touching some object in a certain way or a certain number of times when passing it, always walking through a doorway a certain number of times, turning a light switch on and off a certain number of times, etc. 

Hoarding OCD: Compulsive hoarding is the extreme collecting or hoarding of useless possessions⁶⁵ to the point that it seriously affects the sufferer’s life or even becomes incapacitating. 

     I recall years ago when an old friend of mine, a true mountain man in the high mountains of North Carolina, took me across the mountain where he lived to meet his severely OCD sister, although none of us recognized her behavior as OCD at the time. His sister owned three shacks next to her house, and if you opened the door to any one of these shacks, there was stuff piled literally to the ceiling—not stacked, just piled higher and higher. The house she lived in also consisted of endless piles of clutter. It appeared she had never thrown away anything in her life, but just opened the door to one of those shacks and threw something else on top of the pile. She was known in the area as possibly having almost anything you might need, and she was showing a bow and arrow to someone when we drove up. Other OCDs may specialize and save clothes, junk mail, or worn- out appliances, or they may have saved every magazine they ever read. OCD hoarders may fill up so many rooms in their house that they find it difficult to live there, yet they must continue to hoard. Another example of hoarding involves money where the hoarder may become known as “cheap†or “thrifty.†Hoarders feel a strong emotional or sentimental attachment to their overvalued piles of stuff, in part because of the sense of control the hoarding offers them. While they usually recognize the irrationality of their hoarding behavior, this awareness does not seem to reduce their need to hoard. Any attempts by others to clean up the mess may be met with a very angry response. Since anything can be hoarded, variations on hoarding are endless.⁶⁵ 

Other Symptoms: Other symptoms that may be related to OCD include eating disorders, hair-pulling (trichotillomania), nail-biting, and excessive masturbation.⁵ 

Treatment of OCD 

     The majority of OCDs experience some shame over their problem and may keep it a secret for years. With so many OCDs hiding their problems, most sufferers remain unaware of how many other people also experience OCD symptoms, so they fail to recognize that they are not alone. At the more serious and diagnosable levels of OCD, about one in 40 people suffer from the disorder. Keeping their problem to themselves, OCDs do not seek treatment for an average of more than seven years after the onset of symptoms.⁶⁷ Children are less likely to recognize the irrationality of their symptoms, or they may hide their OCD symptoms for years because of the embarrassment. This is unfortunate, because the longer treatment is delayed, the more generalized the symptoms become and the more difficult they are to treat.⁷¹ With treatment, childhood OCD may go away or it may continue into adulthood, although the specific symptoms may change over time.⁶⁷ Keep in mind that superstitions or ritualistic behaviors are normal in 140 young children, and the opinion of a trained professional is recommended if OCD is suspected in a child. 

     The treatment of choice for OCD is a form of cognitive behavioral therapy (CBT) called Exposure and Response Prevention (ERP). Antidepressant medications can also be very effective in treating OCD symptoms, and for many sufferers, it is the combination of both ERP and medication that seems to get the best results.⁶⁵ 

Exposure and Response Prevention (ERP): The ERP technique, as described in “The OCD Workbookâ€⁷⁰ by Bruce M. Hyman, PhD, and Cherry Pedrick, RN, involves “habituationâ€, which is the process of becoming so accustomed to something through frequent exposure to it that it no longer holds the individual’s interest and becomes boring.⁶⁵ Sufferers are asked to repeatedly expose themselves to the anxiety- producing object, such as unwashed hands, a trash can, bathroom, etc., and to try to avoid, or at least postpone, performing the usual rituals. If the anxiety-producing thought or situation cannot be enacted, as is the case with thoughts of violent or sexually inappropriate behavior, frequently imagining or visualizing the thought while accepting the accompanying anxiety rather than fighting against it usually results in the desired habituation and eventual elimination of rituals. Medications may relieve the depression and anxiety, which may allow the OCD sufferer to better concentrate on the ERP exercises. 

     The goal in treatment is to have the OCD accept the obsessive thought and the anxiety that accompanies it without blaming himself and without responding to the obsession with mental or behavioral rituals. The idea is to get on with other aspects of daily life while allowing the obsessional thoughts and anxiety to just be there. The acceptance of the obsessive thoughts and the resulting anxiety essentially takes away the power the obsessive thoughts have over the OCD’s behavior, and only then will the obsessions occur with less frequency. 

     The process of acceptance may be especially difficult when obsessive thoughts involve violence toward loved ones, sexual orientation, whether to end a relationship, thoughts of having offended God, thoughts of being a bad person, or feelings of guilt. In cases where the obsessive thoughts involve religious beliefs, OCDs are less likely to even be aware of the irrational nature of the recurring thoughts or that the thoughts and religious rituals they perform may not even be related to their actual religious beliefs. The point is to “be with†the obsessions and the accompanying anxiety rather than attempting to escape them. To willingly accept the anxiety-producing thoughts rather than trying to escape them is, of course, the opposite response to what our brains are biologically designed to do when faced with anxiety and fear. The obsessional thought is not the problem. It is how the sufferer responds to the obsessional thought and the accompanying anxiety, guilt, fear, etc. that causes the problems that interrupt the individual’s life. 

     OCD may show up any time during a person’s life. About 67 percent of the more serious and diagnosable OCDs will experience major depression at some point during their lives, but effective treatments are available for depression as well.⁵ 

Suggested Reading 

“The OCD Workbook†by Bruce M. Hyman, PhD, and Cherry Pedrick, RN. This is an excellent source of information about OCD generally and includes a chapter about OCD in children.