Session 14: OCPD (Obsessive-Compulsive)

Dr Zamel's slides, need to add presentation

Essential Features

Preoccupation with O,
P & C

orderliness, perfectionism, control

Prominent Features


-rigid C

-argumentative & C
-self-R; moralistic
-severely self-C
-constricted; excessively D
-cool and D
-stubborn & U

conformity, controlling, righteous, critical, disciplined, distant, uncompromising

Self-Image

-“Right” (ego S)
-R
-relentless self- criticism for I

syntonic, responsible, imperfection

View of Others
-I

-self-I

-I

irresponsible, indulgent, incompetent

Relationships
-Control = O principle
-Likely to be D and D

organizing, domineering, disrespectful

Issues with Authority
-looking for others’ S
-spectrum between D at the lowest and C at highest

status, Deferential, Condemnatory

Behavior

-Aligns with HP
-Abdicates R
-I
-Physically T (in constant state of tension between C and desire to R)
-Devoted to work & P
-Eat well, exercise, take vitamins (H minded)
-Careful & prone to R
-Hoard & protect B (miserly)
-A preoccupation

higher power, responsibility, Indecisive, tense, compliance, rebel, productivity, health, repetition, belongings, Aging

Affect
-Subject to frequent feelings of S & overwhelm
-Prone to D and other A disorders
- R (at being controlled) & F (of being punished)
-Angry, frustrated, I

stress, depression, affective, RAGE, FEAR, irritable

Defense
-I (relate to feelings in a purely intellectual manner)
-Isolation of A (think the feeling but don’t really feel it)
-U (try to reverse your feeling by doing something that indicates the opposite feeling)
–RF (turn the feeling into the opposite)
–D (redirect feelings to another target)
-R (revert to old, less mature behavior to vent feeling)

Intellectualization, affect, Undoing, Reaction formation, Displacement, Regression

The need that is most common across PDs

need for safety

SELF-CREATED WORLD (ALTERED REALITY)
Security & C > A, Spontaneity or C
-”Being in control is a means to manage an U F”
-“ People should do things M way”

Control, Authenticity, Connection, unsafe future, my

Protective Factors to Substances
-Desire for P and focus
-Desire for C

productivity, control

Risk Factors to Substances
-C behavior entailed in addiction = desirable
-Relentless Internal Tension/A
-R work, energy and focus demands
-S difficulties resulting from intensely demanding schedule
-Attraction to skills and challenges of drug dealing W
-R prone yet so S sensitive returning to tx after (returning to tx after =
U)
-need for high level of S
-Propensity for P pattern (alcohol, mj, heroin, cocaine)

Compulsive, anxiety, Rigorous, Sleep, world, Relapse, shame, unlikely, stimulation, polydrug

Drugs of Choice:
-S to manipulate energy and
ability to focus (from C for ability to focus to C)
-S to calm, soothe, promote
S (alcohol, prescription sleep meds)

Stimulants, caffeine, cocaine, Sedatives, sleep

TREATMENT ISSUES FOR
INDIVIDUALS WITH OCPD

Recommendations:
– K, P & T
– Be aware of client’s becoming over-conscientious or T-oriented in therapy
–Monitor C, Feelings of
B, I, impatience, or anger
- Remember that coping defenses (self-righteousness and argumentativeness can make them seem “stronger or T” than they are internally
–Watchful eye for R (likely to H due to
shame & perfectionism demands)
–Encourage recovery as a P rather than a single event
- Develop tolerance for emotional V,
powerlessness over people & certain events,
presence of chance, uncertainty & impermanence
-Do utilize propensity to W on & complete written activities (wellness recovery plan)
-Encourage 12 step or other P support group
(with ongoing monitoring and support)

Kind, patient, tolerant, task, countertransference, boredom, irritation, tougher, relapse, hide, process, vulnerability, work, peer

TREATMENT ISSUES FOR
INDIVIDUALS WITH OCPD

Don’ts:
- Do not accept and M client’s own stereotyped self-presentation
- Do not adopt a R, uncreative way of
relating
- Do not pressure client to prematurely focus on and experience E

mirror, routinized, emotions

Obsessive-Compulsive PD--
Part of OC spectrum?
(Fineberg et al)

OCPD differences:
-no other C behaviors
-R personality traits
-less D
-Justifying

compulsive, rigid, distress

Obsessive-Compulsive PD--
Part of OC spectrum?
(Fineberg et al)

OCD differences:
-chronic, intrusive, O
-anxiety-driven D
-showing symptoms in C

obsessions, distress, childhood

Obsessive-Compulsive PD--
Part of OC spectrum?
(Fineberg et al)

Similarities:
-P
-need for C
-compulsive H
-D

perfectionism, control, hoarding, doubt

Obsessive-Compulsive PD--
Part of OC spectrum?
(Fineberg et al)

● Criteria is not fully M for diagnosis of OCPD for people with OCD
● Two disorders can exist at S time
● Many different disorders can be C with OCPD, not just OCD
● H based disorder in case of O
● N component in OCD (specifically atypical brain C)

met, same, comorbid, hereditary, OCD, Neurobiological, circuitry