So… you’ve been diagnosed with OCPD
You started reading about it and you conclude that you must be a “massive jerk.” Or at least that’s the experience that I hear from most of my clients with OCPD. They feel attacked when they learn that their cluster of experiences might be best described with this label.
You are not a jerk. You are not a bad person. You probably had some difficult experiences earlier in life that taught you that YOU must be in control of everyone’s safety (NO MISTAKES) and that’s an impossible job. You’ve been working really hard on keeping the promise you made to yourself to NEVER let anything slip but since you’re (probably) not God, this impossible goal is making you miserable. Let’s talk about what OCPD really is and how to gain some freedom without compromising your values.
I believe that OCPD is simply a lot of great characteristics that are a bit too intense and pointed in some wrong (or at least incomplete) directions. Let me show you what I mean.
DSM-5 description of OCPD: A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following…
My reframe of this description: You were probably rewarded over the course of your life for being orderly, careful, controlled, non-disruptive, pro-social, and efficient. You took these lessons to heart and haven’t had the opportunity to see yourself as valuable when you make mistakes. You’re very good at safety, structure, and getting things done but you always feel like you have to do it alone. Since not everyone sees the world this way, you often feel alone. Emotional loneliness is a hallmark of OCPD, and it causes suffering.
The DSM-5 goes on to describe symptoms, four of which must be present for a diagnosis. Here are each of those (in italics) and my reframe of each symptom/criteria (in bold).
Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
You are probably valued for your ability to handle complex and difficult projects. However, you get so focused on the trees that the beauty of the forest is lost in everything you do.
Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
If you can’t get things done anymore, it’s probably because you’ve set such impossible standards that you cannot tolerate the anxiety of releasing anything other than perfection. When they say “perfect is the enemy of good” this is what that means but you simply can’t take that advice to heart. It’s too scary.
Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
You’re always stuck at work because you don’t believe you will be valued for anything less than perfection. You might even judge colleagues or other students who can’t meet your standards but you also probably covet their freedom and fun. We have to somehow help you believe that you will be valuable and excellent, even when you can’t be perfect and that perfection might be making your work quality worse.
Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
You’re trustworthy and extremely ethical but to the detriment of other important values like flexibility and contextual interpretation. Whether you know it or not, folks probably are threatened by your extreme adherence to rules and won’t open up to you about their difficulties meeting the same standards, thus making you feel lonely and disconnected. How can you be EXCELLENTLY ethical without being lonely?
Is unable to discard worn-out or worthless objects even when they have no sentimental value.
You never want to say that you threw out something that you ended up needing, but this tendency to never err and never regret means you’re saddled with physical or digital junk. In the end, this actually is counter-productive and will lead you to exactly the outcomes you fear - being messy/sloppy and making mistakes. So we can use that risk as a motivator for you to let go and risk throwing away something you eventually need.
Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
It’s true that no one is likely to do as good of a job as you do. But they’ll also never learn to do a better job if you don’t give them space and permission to try and fail. This is another self-fulfilling prophecy in which you believe no one can do what you can do, so no one learns to do it. In the service of being a GREAT mentor, could you be willing to be more flexible in how things are done?
Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
You’ll have a great retirement, if you make it that far. Or will you? If you have no practice making strategic spending decisions on things that provide good value in increasing your happiness, how will you know how to do that later?
Shows rigidity and stubbornness.
Standing up for what you believe in can really help others reflect on their own behavior but chances are, even as competent as you are, you are not the best in the world at everything you feel rigid and stubborn about. What would you gain if you could be just a millimeter more open about how things should be done? How can you try on the idea of opening up a bit without feeling completely unsafe and exposed?
In contrast to OCD, OCPD is not confined to a few feared outcomes with rigid coping only in those areas. OCPD is pervasive across most things in a sufferer’s life. For this reason, the process of treating OCPD like OCD, creating a fear hierarchy and structured exposures, is never-ending and likely not very effective. We have to match the global nature of OCPD with interventions that target the underlying processes. We have to counter core beliefs and then use Exposure and Response Prevention as a framework to develop habits of flexibility across all life domains.
Think of it like this: OCD treatment is like going to the gym to train for a specific goal. OCPD treatment is like office ergonomics and how to move your body on a daily basis to develop new habits and prevent injury.
Values work
First, we have to understand what you’ve lost to OCPD and what types of flexibility would be valuable for you to build the type of life you want. It is such difficult work, to change habits that have worked seemingly well for much of your life. We need really good reasons as to why you’d be willing to try different approaches.
Self Compassion
Folks with OCPD are highly self-critical so I’m going to guess that your inner voice isn’t very nice to you. Maybe it’s not very nice to others either but I’m guessing your self-critical voice is the bigger problem. Since you might not find inherent value in being nice to yourself, we may have to identify the cost of self-criticism on goals that do matter to you. We can find specific ways that self-compassion might improve your performance in moving yourself towards larger valued goals. Hopefully once you see some benefits, you may be able to practice self-compassion more for its own sake.
Willingness
We may have to spend awhile using values and self-compassion skills to build willingness to try new approaches to things you feel very tied to. This is similar to values work but more tied on your willingness to participate in uncomfortable and awkward processes to ultimately (but perhaps after a lot of hard work) feel better. Having OCPD isn’t easy but neither is the treatment for it. Willingness will be key.
Targeted Exposure Therapy
We can use the principles of exposure therapy to help you try on new behaviors and ways of thinking of things, while working to prevent your old, destructive coping habits. Example: You’ve always wanted to ice skate but you can’t endure the embarrassment and discomfort of barely being able to stand on skates from the start.
We try to understand why you wanted to skate, what was fun about the idea, and how it would fit into your life in the future.
We work to understand all of the ways you’ve been stopped from skating in the past - thoughts, feelings, and behaviors. We would develop a plan for coping with each barrier so when it comes up, you can keep moving forward with your practice.
We identify self-critical language and practices and develop alternatives to employ consciously when you feel the impulse to criticize yourself.
Once we believe you’re fully convinced that this skating journey is worth it and that you have some tools for forgiving yourself for mistakes, we build up your willingness to look awful on the ice, to fall the experience the cold and pain inherent in learning, and realistic expectations about how fast you’ll learn skills. We may have to practice together, the idea of making a fool of yourself and staying on track anyway.
We start practicing skating, while employing all of the tactics above.
This is like ERP for OCD but with more emphasis on the ancillary parts of ERP rather than the exposures alone. The exposures without a really good base understand of values, self-worth, and willingness, won’t work if you have OCPD.
So if you know or suspect that you have OCPD, don’t listen to the descriptions of your world that make you sound like a jerk! There is a good reason that you are like this and now, we need to give you some more flexibility so that you can feel more connected with your life and people around you.