CBT/ERP for Obsessive-Compulsive Personality Disorder (OCPD)

Cognitive-behavioral therapy (CBT) is a research-backed treatment that can be applied to Obsessive-Compulsive Personality Disorder (OCPD).

CBT involves learning how thoughts, behaviors, and emotions are linked:

Exposure therapy is a type of CBT that involves gradually facing one's fears in order to tackle unhelpful anxiety. Gaining exposure to the fear trigger helps someone to challenge unhelpful thoughts and behaviors. This is how they get back into life and keep the fear from disrupting school/work, family/home life, their social life, health, or other important areas of functioning. Read my previous post for more detail.

OCPD at its core is excessive perfectionism that negatively impacts the person’s life. Someone with OCPD might get so caught up in living up to an ideal that they never actually get to enjoy the present moment. For example, they might be a “workaholic” but never feel a sense of accomplishment when they have a major work-related achievement. People with OCPD also tend to be more rigid in their thinking and inflexible in their behavior. For example, they might think their method of loading the dishwasher is flawless and anyone who does it differently is wrong. You can see how this leads to the inherent interpersonal difficulties of the disorder... Control and order are essential, and other symptoms might include hoarding, being extremely conservative with spending money, and taking a hard line on morality. OCPD is not a rare condition (estimates are that it affects at least 8% of the population), yet it is under-represented in the research.

At the simplest, having a personality disorder means that someone’s mental health symptoms are pervasive to all areas of their life: work, romantic relationships, friendships, caregiving, etc. Their symptoms are more stable and not dependent on moods or emotions. In fact, it might be better to refer to them as “traits” that lead to symptoms that cause distress in themselves or others.

There is a lot of stigma and misunderstanding surrounding personality disorders. Having a personality disorder does not mean that someone has a “bad” personality. And, although it means that all areas of life are likely impacted, someone with a personality disorder might not be functioning worse than someone with a more situation-dependent disorder such as depression or panic disorder.

People with OCPD often do not seek treatment for themselves because their symptoms are what we call “ego syntonic.” This is a fancy way of saying that they only feel distress when their rules of living are broken by others, and so they would not assume that their way of thinking and behaving is the core issue. Usually, people with OCPD only start to realize they might have issues to work on in therapy when they experience a major stressor such as a breakup or job loss.

Because of the productivity, high conscientiousness, and high achievement of many with OCPD, it might not sound all bad or even like a disorder at all. In fact, these are traits on a spectrum and can be positive, when applied correctly. The problem with OCPD is that these traits are so rigid, and the perfectionism is so pervasive that it ends up corroding the person’s life. In addition to the problems interacting with other people OCPD can cause, it is also highly associated with other mental health conditions that would warrant treatment as well.

In CBT treatment, people with OCPD learn things like how to evaluate their own standards and whether they are helpful or hurtful to their life (and emotions), how to get along with other people when those people are not meeting their standards, and how to decrease unhelpful perfectionism while still achieving and getting work done. For example, someone with OCPD who was extremely careful with money might learn that they actually really enjoy sailing, and it’s so worth it to them to have the joy of sailing in their life that they are willing to spend money on it and de-prioritize having the “perfect” amount of money in their savings account. But they might still be more careful with their money with other people after treatment, and that’s totally fine! They don’t need to become a shopaholic or go into debt.

My favorite thing is teaching people to loosen up while still maintaining who they are as a person. Usually people with OCPD find treatment to be freeing!