Obsessive-Compulsive Personality Disorder

Treatment Summary: There have been some different treatment options that have been tried for the disorder of obsessive compulsive disorder. The pharmaceutical approach was one of the included approach using serotonin reuptake inhibitors, such as clomipramine, and some selective serotonin reuptake inhibitors. One of the down falls for these medications were it was only effective on some patients. However, most treatment individuals showed lasting symptoms after an adequate trial of medical treatment but the relapse after medication discontinuation is another issue. Relapse rates varied from 24% after stopping the use of serotonin to 31-89% after discontinuation of clomipramine. Many people with obsessive-compulsive disorder have a good response to medication, but this is usually only a partial response. (Baxter, Schwartz, Bergman, Szuba, Guze, Mazziotta, et al. 1992 Caudate glucose metabolic rate changes with both drugs and behavior therapy for obsessive compulsive disorder. Archives of General Psychology, 49, 681-689)There were also attempts to use psychological treatment for obsessive-compulsive disorder by the use of cognitive-behavioral therapy. This therapy involved exposure and response, repeated, and prolonged confrontation with stimuli that provoke anxiety and the urge to perform compulsive rituals. The individuals who are affected with the disease believe they may hurt some innocent people if they discontinue their behavior. In order to convince a positive response from the individual a person who feared the number 13 was instructed to write the number 13 and imagine something that is positive. The individuals who performed any rituals to reduce anxiety or the chances of bad luck by saying prayers, checking for reassurance were assured that these behaviors did not assist in avoidance behavior and compulsive rituals are unnecessary for averting harm. Overall, the findings from randomized controlled trials suggest that exposure and response prevention-whether delivered in daily or weekly sessions-substantially improve obsessive-compulsive symptoms, and its effect is more than that produced by pharmacotherapy.

• Reference: (Rast, Johnson Drum (1984). Journal of the Experimental Analysis of Behavior, 41, 125-134.)
• Submitter: N/A

Cognitive or behavioral therapy

Treatment Summary: Cognitive therapy identifies beliefs, assumptions and strategies that perpetuate conduct and attitudes related to the disorder. Individuals with obsessive-compulsive personality disorders have extreme desires to complete tasks without making any mistakes. Cognitive therapy combats intrusive thoughts by engaging the client in role playing that recreates a scene to evoke the intrusive thoughts. The client can become aware of these thoughts and replace them with more positive and rational thoughts with help from a therapist they can trust. Practicing behaviors that were suggested by a therapist during a counseling session may not be easily accepted by the client because they believe their ideas are the only ones that will work. It helps the client to cooperate with plans from therapeutic sessions if they can help construct it and if the plan has a succinct and sequential outline. When the plan has order and certain steps take precedence over others it gives the client the structure they are comfortable working with.

• Reference: Bienenfeld, D. (2007). Cognitive therapy of patients with personality disorders. Psychiatric Annals, 37(2), 133-139. doi: 1230624671 Eskedal, G.A., & Demitri, J.M. (2006). Etiology and treatment of cluster c personality disorders. Journal of Mental Health Counseling, 28(1), 1-17. doi: 975605981
• Submitter: N/A

Psychodynamic therapy

Treatment Summary: Freud described obsessive behaviors as stagnation in the anal stage. Strict rules and verbal punishment during this stage transfers to strict self-imposed rules and standards when the child becomes an adult. The psychodynamic approach is modified to apply structure to free association and introspection. Goals related to character change are established and the therapist and client work toward those goal. Psychodynamic therapy that is structured and goal oriented helps reduce the impairments of OCPD in in-patient, out-patient, and day hospital care settings.

• Reference: Eskedal, G.A., & Demitri, J.M. (2006). Etiology and treatment of cluster personality disorders. Journal of Mental Health Counseling, 28(1), 1-17. doi: 975605981 Verheul, R., & Herbrink, M. (2007). The efficacy of various modalities of psychotherapy for personality disorders: A systematic review of the evidence and clinical recommendations. International Review of Psychiatry, 19(1), 25-38. doi: 1250727381
• Submitter: N/A

Group therapy

Treatment Summary: Individuals with severe OCPD refrain from attending group sessions until they can be classified as presenting with milder symptoms. Group therapy can become an intense emotional experience. Strong emotions may cause individuals to lose their sense of self control. When they recognize this possibility they may become manipulative and attempt to control the direction of the group's conversation or they may not share any experiences. Long-term group therapy is a beneficial treatment after a client completes an in-patient program or even if they only use the group out-patient program.

• Reference: Eskedal, G.A., & Demitri, J.M. (2006). Etiology and treatment of cluster c personality disorders. Journal of Mental Health Counseling, 28(1), 1-17. doi: 975605981 Verheul, R., & Herbrink, M. (2007). The efficacy of various modalities of psychotherapy for personality disorders: A systematic review of the evidence and clinical recommendations. International Review of Psychiatry, 19(1), 25-38. doi: 1250727381
• Submitter: N/A

Drug therapy

Treatment Summary: Researchers added medication along with therapy to observe any further improvements in quality of life. When a treatment plan is tailor made to fit a client's specific needs there are major improvements. Miller and Kraus (2007) conducted a case study involving a client who voluntarily requested help to cope with OCPD, as it affected his performance at work. These researchers decided to temporarily implement anxiety medication. During the interview process, evaluators could address more issues and symptoms than if they were conducting a multiple participant design. Since OCPD does not have a specific medication tailored to reduce all symptoms, the researchers addressed the client's anxiety. The medication relieved some stress related to the anxiety issues and this allowed the client to focus on other aspects of the psychotherapeutic process.

• Reference: Miller, T.W., & Kraus, R.F. (2007). Modified dialectical behavior therapy and problem solving for obsessive-compulsive personality disorder. Journal of Contemporary Psychotherapy, 37(2), 79-85. doi: 1265264031
• Submitter: N/A

Cognitive Behavior Therapy

Treatment Summary: Cognitive behavior therapy was used with adolescents and children in a clinical setting. The sessions were one hour in length on a weekly basis. These sessions last approximately eight to twelve weeks depending upon the patient's progress. Cognitive Behavior Therapy helps the patient to become aware of inaccurate or negative thinking. This in turn allows the patient to view difficult situations in a different light and respond to them in a more effective way.

• Reference: Nakatani, E., Mataix-Cols, D., Micali, N., Turner, C., & Heyman, I. (2009). Outcomes of Cognitive Behavior Therapy for Obsessive Compulsive Disorder in a Clinical Setting: A 10-Year Experience from a Specialist OCD Service for Children and Adolescents. Child & Adolescent Mental Health, 14(3), 133-139. doi:10.1111/j.1475-3588.2008509.x.
• Submitter: Sarah Delozier

Deep brain stimulation (DBS)

Treatment Summary: DBS is a neurosurgical procedure involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses, through implanted electrodes, to specific parts of the brain (brain nucleus) for the treatment of movement and affective disorders"( Kringelbach, Jenkinson, Owen, Aziz , 2007).

• Reference: Kringelbach ML, Jenkinson N, Owen SLF, Aziz TZ (2007). "Translational principles of deep brain stimulation". Nature Reviews Neuroscience. 8:623-635. PMID 17637800. Khol, S., Schonherr, D., Luigjes, J., Denys, D., Mueller, U., Lenartz, D., & Visser-Vandewalle, V. (2014). Deep brain stimulation for treatment-refractory obsessive compulsive disorder: A systematic review. BMC Psychiatry, 14(214).
• Submitter: Jackelyn Ferrer

Metacognitive Interpersonal Therapy (MIT)

Treatment Summary: MIT involves two goals. One goal is to improve the client's understanding of their own mental state. The therapist helps identify unused emotions and facilitates the learning of their use. The second goal is to regulate troublesome attitudes and behaviors, especially those that involve interpersonal cycles, and develop helpful ones. The therapist is careful to establish a smooth, helpful relationship and avoid getting involved in negative interpersonal cycles. Group therapy is a useful addition to individual therapy as it offers peer feedback. Individual therapy can then reinforce the peer feedback received. The case study involved one year of weekly individual and group psychotherapy which reduced the criteria for the personality disorder.

• Reference: Fiore, D., Dimaggio, G., Nicolo, G., Semerari, A., & Carcione, A. (2008). Metacognitive Interpersonal Therapy in a case of Obsessive-Compulsive and Avoidant Personality Disorders. Journal of Clinical Psychology: In session, 64 (2), 168-180.
• Submitter: Martin

Cognitive Behavior Therapy (CBT) and Yoga

Treatment Summary: For patients who suffer with obsessive or compulsive disorders, most research focused on helping the patient improve their quality of life by learning to change or control their thoughts that brought on the limiting behavior. Most treatments were centered around cognitive and/or behavioral approaches that helped the patient face their fears of negative outcome and adjust their understanding or learn to help control their inaccurate thoughts or repeated behaviors. With CBT, the development of problem-solving skills helped them develop a higher quality of life. But a bit more untraditional approach was found for patients that suffered from OCPD but objected to the issue of having a mental disorder. The treatment was with the relaxation and concentration of yoga exercise. The use of meditation, controlled breathing, and gentle stretching worked with patients who had less severe interruptions to their life. The anxiety that these patients suffer was well addressed by a schedule of regular yoga exercise.

• Reference: Abramowitz, J., Taylor, S., & McKay, D. (2005). Potentials and Limitations of Cognitive Treatments for Obsessive-Compulsive Disorder. Cognitive Behavior Therapy, 34, 140-147. Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J., & Pilkington, K. (2005). Yoga for Anxiety: a Systematic Review of the Research Evidence. British Journal of Sports Medicine, 39, 884-889.
• Submitter: N/A

Treatment for Compulsive Hoarding

Treatment Summary: The typical treatment for hoarding is individual cognitive behavioral therapy. In an effort to increase motivation as well as cost effectiveness, a combination of group cognitive behavioral therapy as well as home visits were used. Group treatment was found useful as many hoarders are increasingly isolated. Each group met once a week for 2 hours for over 16 weeks. Each group member also received two home visits lasting 1.5 hours each. These home visits were conducted around week 3 and week 12. Group therapy concentrated on hoarding-specific areas including hoarding education, beliefs, emotional attachments, decision making, identifying barriers, and maintaining gains. The group cognitive behavioral therapy did have modest success in improving hoarding outcomes. This type of therapy was not only cost-effective, but it also created greater motivation among participants through the social networking of the group.

• Reference: Muroff, J., Steketee, G., Rasmusse, J., Gibson, A., Bratiotis, C., & Sorrentino, C. (2009). Group cognitive and behavioral treatment for compulsive hoarding: A preliminary trial. Depression and Anxiety, 26(7), 634-640. doi:10.1002/da.20591
• Submitter: Tracey Eddy