Obsessive-Compulsive Personality Disorder And Perfectionism: How To Cope
Obsessive-compulsive personality disorder (OCPD) often first shows symptoms in late adolescence or early adulthood. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the condition is characterized by a pervasive preoccupation with perfection, order, rules, and control.
Symptoms of OCPD can overlap with the symptoms of obsessive-compulsive disorder (OCD). However, as a personality disorder, the symptoms of OCPD are long-term patterns that are seen as a part of a person’s character that negatively affects relationships. People with OCD may have intrusive thoughts and co-occurring anxiety disorders or other underlying mental health conditions, whereas people with OCPD may not think that their behavior is problematic.
Because people with OCPD can be high-achieving, it may be difficult for some people with the condition to understand why their desire for perfectionism is a problem, which can affect various areas of their lives and make treatment challenging.
Obsessive-compulsive personality disorder and perfectionism
Below are several ways perfectionism can appear in OCPD.
Inflexibility and rigidity
People with OCPD are often fixated on their own ideas of how tasks “should” be done and unwilling to compromise. Their inability to change their views can affect their relationships and professional or personal development. They may be willing to risk everything to get their way.
Black-and-white thinking
People with OCPD may find it challenging to accept any gray areas or leave any situation up to chance. They can experience tunnel vision and struggle to see past their own views. When challenged, they may respond with frustration and anger. Seeing all situations as black and white may make them believe they are in control. For them, experiences may either fit into one category or the other, and those that don’t can cause them inner turmoil.
Following their own rules
In OCPD, people are often compelled to complete tasks a certain way. They believe this way is the best and only way to complete tasks, big or small, even though there may be little or no evidence or logic to prove it is. Any push-back can result in long arguments, as the person with OCPD may maintain their beliefs, even though they may struggle to justify why they believe what they do. This insistence can affect relationships as the desire of people with OCPD to maintain their perspective may be prioritized over compromise.
Low tolerance for criticism
For people with OCPD, any criticism can be seen as an attack on what they perceive to be perfect, which can lead them to believe they’ve lost control. To avoid the perception that they’ve failed, they may spend extended time trying to determine the “right” decision, exercise extreme caution, or remain indecisive to avoid failure. These thoughts can lead to common obsessive-compulsive symptoms, like fixation and rumination, as well as anger or sadness.
Holding everyone to the same standard
People with OCPD may immediately judge people against their high standards, which may be difficult or impossible for anyone to achieve. They may also quickly recognize the flaws of others and scrutinize their character. Everyone has flaws, but for someone with OCPD, the flaws they find in other people can outweigh any positive qualities, earning their disapproval. They may focus only on the flaw.
This trait can cause friction in relationships. People with OCPD may ruminate about their partner’s perceived flaw and continue to push the other person to try to change the behavior to the point that they become fixated on it. Because there is no room for reasoning with someone who has OCPD, this constant pressure can lead to the end of the relationship.
Treating OCPD
Three types of therapy are recommended to treat OCPD: psychodynamic therapy, cognitive-behavioral therapy (CBT), and radically open dialectical behavior therapy (RO-DBT).
Psychodynamic therapy
Psychodynamic treatment uses an insight-oriented approach that helps clients work to change their patterns of behavior and let go of their demand for perfection by attempting to reveal how these demands protect them against insecurity and uncertainty.
Cognitive-behavioral therapy
Another type of therapy used to treat OCPD is cognitive behavioral therapy. CBT to treat OCPD focuses on identifying and restructuring the dysfunctional thoughts underlying their persistent pattern or maladaptive behaviors. For example, they may learn to challenge their all-or-nothing thinking by considering other possibilities that could occur or to learn to recognize the realistic significance of minor mistakes.
Someone with OCPD may fear that treatment will change them into someone with lower standards or change the core of who they are. The therapist may remind them that therapy is meant to help them relax their internal rigidity and replace thoughts with more flexible guidelines that allow for a “good enough” performance instead of aiming for perfection. They may learn self-compassion to challenge self-critical beliefs.
RO-DBT
Radically open dialectical behavior therapy is a more modern form of treatment developed specifically to treat OCPD. The modality involves a workbook clients use to work through various skills and modules. The modules of RO-DBT include the following:
- Mindfulness
- Interpersonal effectiveness
- Emotion regulation
- Distress tolerance
- Radical openness
Taking skills from traditional DBT, RO-DBT also helps clients work through the following challenges:
- Masking feelings
- Neglect of self-care
- Low empathy or validation of others’ needs
- Difficulty taking risks
- Aloofness
- Fear of vulnerability
- Social comparison
- Rigidity and rule adherence
- High distrust
Skills like self-inquiry, non-judgmental stances, mindful awareness, social signaling, taking positive risks, embracing uncertainty, and identifying core values may help individuals reduce symptoms of OCPD and move forward healthily. These sessions are often held in groups but can also be held individually. After completing the worksheets, skills training, and lessons in the workbook, individuals graduate from RO-DBT and celebrate their progress with the therapist.
How to help someone with OCPD
Having a relationship with someone who has OCPD can be challenging. However, it may be helpful to consider that individuals with OCPD are trying to do what they think is right, and high anxiety may be driving their desire for perfection.
When you have a relationship with someone who has OCPD, it may seem easier to allow them to do most of the work because it’s easier than trying to meet their high expectations. However, if they believe they are responsible for every situation, they may feel resentful or angry.
Setting boundaries can be beneficial in these situations. For example, if they try to tell you how to complete a particular chore, let them know you can handle it on your own. Telling them you appreciate their interest in helping you may reduce the chances of conflict. Reassure them that they don’t have to be perfect and consider suggesting therapy with mental health professionals as an option to support them.
Support options
Having a relationship with someone with a mental health condition like OCPD can be challenging. People with this condition can also struggle. For couples, couples therapy may improve your relationship, and one-on-one therapy can help people work through the various challenges they face as a result of OCPD.
If you face barriers to in-person therapy, talking to an online therapist through a platform like BetterHelp may help you learn to cope with the challenges of being in a relationship with someone with a personality disorder or living with the condition. Through an online platform, you can meet with a licensed mental health professional from the comfort of your home at a time that suits your schedule. In addition, you may be able to access other tools like support groups and worksheets.
In addition to being convenient and flexible, research shows that online treatment is also effective. One review found that online CBT leads to significant decreases in symptoms of depression and anxiety, which are common comorbid conditions with OCPD.
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