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OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
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[Music]
Hi everyone, Dr. Peter Serno here. I am
a retired licensed psychotherapist,
personality disorder specialist, trauma
specialist, and I'm featured in a docue
series on Hulu and Disney Plus called
Ted Bundy: Dialogue with the Devil. I
get a lot of questions um saying, "Why
are you retired? Why did you retire? So,
I want to clarify what retirement means.
Retirement doesn't mean that I no longer
work. Retiring a license means that
you're changing the status from actively
practicing psychotherapy to no longer
practicing in a clinical setting. I'm no
longer operating from the position of
running a private practice. I still
write. I still teach. I still instruct
and train therapists. I offer
consultation in a non-clinical format
for people who want to gain an
understanding of the relationships that
they're dealing with. So, it's not to
say that I'm not working. It's just the
retirement status is how they officially
refer to the license no longer being active.
active.
And I just wanted to clarify that cuz I
get a lot of comments and emails and
questions about when did you retire? Why
did you retire so young? It's not that I
retired from working. It's just that
I've chosen to no longer be active in my
therapy practice. And down the road, if
I choose to unretire my license, I'm
able to do that. So, at this point in my
career, I'm just focusing more on
research and writing and education. So,
before we dive in, I like to give this
disclaimer and I like to ask this
respectfully. Please keep the comments
respectful. In the past, when I did not
say this in the beginning of a video, I
was pretty much assaulted with harsh
criticism, devaluing
harsh critical comments that were
somehow justified by the commenters
saying that they were offended by the
material or or that I was using
stigmatizing or pjorative language. And
the reality is if you specialize in the
treatment of personality disorders and
you attend required trainings, this is
how people talk in these clinical
settings. This is how they talk in the
trainings. They don't have to offer
disclaimers because they understand that
the people who are attending the
trainings know, look, we know that
you're professionals. You're coming here
because you want to learn about this.
And we use clinical language because it
helps with the descriptive and
explanatory pathology. So, nobody has
this idea that people's feelings are
going to get hurt. I understand this is
a different forum because this is a
social media platform. And I did oftent
times in my first videos make the
assumption that people were going to
understand that when you share science,
you don't necessarily need to offer
disclaimers, but I learned the hard way
that you do. So comments that are
disrespectful to me or disrespectful to
other commenters who have suffered
immeasurable harm and abuse, they're
just not tolerated. So they're going to
either be deleted or if they are
threatening or harassing, they're going
to be reported. So I just want to
clarify. If you want to stick out like a
sore thumb and be the person who for no
reason other than you want to is going
to insult the other commenters on this
post or you're going to insult me
because you're misinterpreting what I'm
saying. It's going to be dealt with in a
way where it won't be tolerated. These
videos are opportunities for
understanding, not grounds for cyber
abuse or assault. So today we are going
to discuss obsessivecompulsive
personality disorder. Much different
than OCD. They are not related except by
name. I'm going to start with the
distinction between obsessivecompulsive
disorder and obsessivecompulsive
personality disorder. Just to get that
out of the way because a lot of people
say things like, "I'm so OCD or that
person is so OCD." And often what they
mean is they're referring to this type A
characteristic personality, not the
intrusive thoughts and compulsive
behaviors that alleviate the anxiety in
somebody who is afflicted with
obsessivecompulsive disorder. So
obsessivecompulsive disorder, the one
that is not related to personality, is a
condition where there are intrusive
thoughts and compulsive behaviors that
are meant to alleviate the anxiety that
results from those intrusive thoughts.
This is when you see things like ritual
handwashing and other things where
people have to do something repetitively
because they're trying to alleviate the
anxiety that they're feeling. And this
is an egoistonic
condition. What that means is the person
who is going through this understands
that something is fundamentally wrong
inside and that they're not okay with it
and they don't justify it. It's
afflicting them. Whereas people with a
personality disorder, they have an
egoinonic experience, which means they
don't think that there's something
wrong. They justify their distorted or
disordered lens. And if you watched my
video on avoidant PD, I confessed in
that video that I've suffered from
avoidant personality disorder my entire
life. Somebody with an anxiety related
avoidance knows that the way that
they're thinking is wrong, that there's
there's something wrong about it, that
it's irrational. They don't justify it
and say, "No, this is the truth." They
say, "I understand this is problematic
and I want to do something about it. I
just don't know how to turn it off."
Avoidant personality disorder, like
other personality disorders, the person
who has the disorder, they don't think
to themselves, there's something wrong
with the way I'm thinking. They think,
"See, I was right. I'm justified in
perceiving reality this way. The world
really is that scary and therefore I
have to avoid it. I really will be
humiliated and therefore I have to
isolate and avoid." So, I'm willing to
admit that about myself because I think
it helps and informs people understand
the difference between somebody who's
afflicted with something that they
really don't like and they understand
that there's something wrong with it and
somebody who justifies their perspective
even though the perspective is based on
a distortion. It's not based in truth
but for that person it is their truth.
And to use another example, when we talk
about narcissism, narcissists truly feel
entitled to mistreat people because
their disordered lens is grandiose. It's
I do have a special superior place in
the world. People just need to accept
that and then everyone will get along.
They don't think to themselves, I should
probably fix this within myself. It
doesn't occur to them that being
grandiose is problematic. What occurs to
them is when other people confront them,
that's the problem. It's happening out
there. It's not happening in here for
the narcissist. And although the
operating system is different for
somebody with obsessivempulsive
personality disorder or avoidant
personality disorder, that mechanism of
inflexibility is the same.
So the first recourse is not to look
inward and say, "I need to probably
self-correct this because it's not
working." The reason why it's considered
a personality
disorder rather than a mood disorder or
a trauma disorder is because with mood
and trauma disorders, the person is
aware that the symptoms that are
afflicting them are interfering with
their life and need to change. On the
contrary, when it comes to a personality
disorder, the personality
tells that person due to the perceptual
gaps and distortions, there's nothing
wrong with me. It really is happening
out there.
One of the reasons I think why cluster
B's are the ones who get the most
attention is because those are the ones
that cause the most significant
impairment in interpersonal
relationships because
of the traits that make up those
disorders. They're different than the
traits that make up the cluster C
disorders. So, cluster C disorders, I
will admit, can cause a lot of harm in
relationships. Especially
when we're talking about avoidant
personality. Because as I mentioned in
my other video, if you are in a
relationship with someone who's avoidant
or you're trying to be friends with
someone who's avoidant, their avoidance
eventually becomes so pervasive that
it's almost like you stop asking them to
participate in the relationship because
you're going to get let down by them
because they have convinced themselves
that they're going to receive harsh
ridicule and shame before anything even
happens. that they stop altogether even
trying to socialize with you. And so
that can be really painful for the
person on the receiving end of dealing
with someone with avoidant personality.
Um I mentioned in that video too that
the way that you treat avoidant
personality is you don't go down memory
lane as to all of the horrible things
that happened in their life because
that's actually not going to stop them
from being avoidant. What's going to
stop them from being avoidant is
installing the traits that are really
deficient or lacking in them and
strengthening them. Traits like
resilience, traits like courage, you
know, the ability to just do the thing
anyway, even though it terrifies them,
they typically stop at I've convinced
myself this is going to be so horrible
and humiliating that it's not even worth
trying. I can't do it. And what you need
to do is install that capacity of I can
do it in spite of the fear. And you have
them practice that over and over and
over again that eventually they have
enough evidence to realize they were
wrong that that the humiliation and the
criticism actually are survivable. When
they get to that point, they can start
functioning in social situations more
adaptively. It's not easy. And as I as I
mentioned in that video, these are
traits that I am always going to be
afflicted with. It's never going to be
something that I completely conquer. I'm
not sure if there are others out there
with avoidant traits at the severe end
of the continuum who have conquered
them. If there are and you're watching
this, please leave a comment so that
people can understand your journey and
see how you've overcome it. I think it's
something that's going to be a lifelong
struggle, but I think it can be much
more manageable if the right
interventions are implemented. Going
back to obsessivempulsive personality
disorder, OCPD is a rigid pervasive way
of being. It's the entire operating
system. It's not a symptomatic
condition. It's not hypervigilance
related to trauma or depression related
to a mood disorder. It is the entire
operating system which is why we call
them personality disorders because they
actually cause the entire person to
operate out of order hence disorder.
It's not an insult. Regarding prevalence
estimates, OCPD is considered to be the
most common or most prevalent of the 10
recognized personality disorders in the
DSM. So this is the most prevalent
disorder OCPD. The main feature, the
defining feature of obsessivecompulsive
personality disorder is rigidity. It's
that inflexibility. The trait that they
need that they are lacking that would
balance the rigidity is more
flexibility. So this causes people with OCPD
OCPD
to see themselves as the righteous one.
They are doing the best. They are doing
striving for perfection. They are doing
the most. Sadly, what that means for
people in their life is they see others
as lacks and not doing a good enough
job. They might even refer to others as
careless because they perceive them as
not trying hard enough when in reality
the person with OCPD is in fact trying
way too hard in ways that are just
unrealistic. They see the world as
contaminated or disordered. And the way
they cope with this is they feel that
they have no choice but to control
everything in their life. Regarding the
diagnostic themes, they are preoccupied
with details and lists to the point
where they actually lose sight of the
activity or the task. Their
perfectionism interferes with their
ability to complete tasks. They have an
excessive devotion to work and
productivity. So this is that
workcoholism that people often see in in
individuals with this disorder. They
have a rigid inflexibility about morals
and values. But the morals and values
that they are rigid and inflexible about
are their own. So they really don't have
the capacity for understanding other
people's values and morals. It really
comes down to theirs are right. So
everyone else's must be wrong. Some do
show hoarding behaviors, but hoarding
disorder doesn't have to be comorbid or
accompany OCPD. There's a reluctance to
delegate tasks because they have to be
in charge because they're the only ones
who know how to do things right. They
tend to be stingy with money or
resources which goes way beyond frugal.
And they have an overall general
rigidity and stubbornness in their
perspective. Something that's
interesting about OCPD is while they do
tend to externalize blame because they
think others aren't doing a good enough
job, they also are very very critical of
themselves because they believe that
they have to strive for perfection. So
if something goes wrong, they actually
often believe it's their fault. So
everything must be perfect. And that's
what differentiates OCPD from the
cluster B disorders. Because if you take
a cluster B disorder like narcissism,
they are not going to think anything is
their fault. The way that the
narcissistic world works is I'm right,
everyone else is wrong. End of story, no
questions, and they feel very confident
in that reality that everyone else is
wrong and they are right. With OCPD,
that rigidity can be really hard to deal
with in relationships and they feel very
closed off in a way. So, people can
often mistake it for narcissism. But
what it really is, they're holding
themselves to such a high standard. So
they are very controlling, doineering,
oftentimes critical, but that criticism
is also on themselves. It's their fault
if something's not perfect.
And so that's why we see the fear.
That's why this is in the cluster C
because it's more associated with fear
and anxiety than exploitation.
The person with OCPD must be in control
at all times. One of their recurring
themes in their mind is life is very
demanding and there is no room for
errors whatsoever. Their identity is
typically tied to work and productivity.
Things that they can see measurable
progress with that they are in charge
of. Emotions tend to be restricted,
controlled and rarely expressed in a
vulnerable way. So with these
individuals, goal direction and
self-direction sort of becomes a trap.
They are so moralistic and conscientious
to a fault that they can't complete many
of the tasks they start because
nothing's ever good enough. And empathy
can be a challenge. It's not the same
deficit you see in narcissism, which is
a lack of concern for others and an
indifference to the feelings and needs
of others. It's more about rigidity,
being so focused on a task that they
can't step away to attend to someone
else's needs. Doesn't feel good to be on
the receiving end of it, but I just want
to clarify the motivation is different.
And sadly when it comes to relationships
they come second to work. Productivity
is the priority and so personal
connections inevitably suffer. So the
traits that we see there that are
inherent in a obsessivempulsive
personality rigid perfectionism and
insistence that everything must be
flawless restricted emotional expression
and intimacy avoidance because tasks and
productivity and work have to come
first. Behaviors can look like speech
that goes off on tangents and
overexlains, procrastination because
it's never good enough to finish,
endless list making and scheduling,
workcoholism and micromanagement. And
here is where I differ from many of the
modern trends in psychology. OCPD is not
the result of childhood trauma. These
are human traits. Rigidity,
conscientiousness, morality taken to
extremes. Some of these tendencies can
be learned and adopted because of
environmental influence, but not
everybody who adopts and learns these
traits experience them or take them to
the extreme that somebody with a
personality disorder does. These traits
have been around as long as humans have.
And historically, people were described
by their character, their virtue, and
their flaws. Writers and philosophers
debated for thousands of years how to
balance out these traits for the good of
the community. It's only a recent
occurrence that trauma stories are
embedded in the thinking structure of
everyone to explain every single
behavior. And even if trauma has
occurred, which often times it does
occur. People with OCPD, many of them
have been abused, many also have not.
But those who do have trauma, the
present traits that are impairing life
still need to be balanced out. And you
don't balance rigidity with endless
trips down memory lane in therapy. It
will not make somebody with OCPD any
less rigid. If you go down memory lane
with them and have them gain insight
into their history, it really will not
make them any less rigid. Behavior
change in the here and now and
practicing a new way of being is what is
going to work. So other people react to
individuals with OCPD seeing them as
rigid, stingy, cold, demanding,
sarcastic. Some people feel compelled to
try and please them and meet their
standards. Other people feel provoked or
triggered by them, and other people feel
controlled by them. Treatment is about
balancing out these excessive and
deficient traits. So turning
perfectionism into flexible reasonable
standards. Replacing my way or the
highway with perspective taking.
Shifting workcoholism to incorporating
leisure and rest and fun. Moving from
indecisiveness to healthy
decision-making. Expanding restricted
affect into genuine affection.
Transforming stinginess into frugality
or even generosity. And learning to let
things go. So to sum it up, OCPD, rigid,
controlling, emotionally constricted,
rarely satisfied with their own level of
order or with anyone else's. Cluster C
disorders don't get as much public
attention as cluster B disorders, but
they really can cause deep suffering in
others. I am a perfect example of that
because, as I mentioned, I have lived
with these avoidant personality traits.
I can guarantee you these traits were
not embedded in me or instilled in me
through trauma or adversity. I know
there's going to be some analysts out
there who say, "Well, you just repressed
it so much that you don't even remember
and you're in denial." Okay, that's a
perfect theory because you can't test
it. Point is from personal experience,
these are not quirky personality styles.
I also get comments, "Why are you
pathizing everybody's personality? These
are just differences." Okay. Well, I'm
the first to admit somebody who has
cluster C pathology, differences to this
extreme cause immense suffering in the
individual and in the people in their
lives. And so, it is the person's
responsibility to do something about
balancing out those traits and reliving
your history in therapy for 10 years and
blaming your mom and dad and your
teachers and your upbringing and all of
that. even if they didn't do a great
job, still will not make you flexible.
So, the interventions still need to be
geared around changing the behavior, not
processing the trauma. Trauma
interventions can deal with the trauma.
But even if you heal all of your trauma
with evidence-based trauma
interventions, you will still have the
fullblown personality disorder because
the personality disorder doesn't go away
once the trauma symptoms go away. And
they've done replicated studies to prove
this and longitudinal studies to measure
this. These are pervasive ways that are
rigid and inflexible and shape someone's
entire life and affect all important
areas of life. It's not a reaction to
adversity. Trust me, if you recognize
these patterns in yourself or someone
else, remember it is never about blame.
Whether we're talking about the
heritability, the genetic influence, the
biological underpinnings, or the
environment that exacerbated or
amplified it, it's never about blame.
That doesn't get you anywhere. It's
about understanding, compassion, and
when possible, effective treatment.
Thank you for watching. I'm Dr. Peter
Serno. If you found this helpful, please
feel free to view my other videos.
Subscribe to this channel for more
videos to come. I also encourage you to
read my book, The Nature and Nurture of
Narcissism and Traumatic Cognitive
Dissonance. There's a lot of commenters
out there that that refer to me as a
reductionist and a biological
determinist. I know for a fact they
haven't read my book because if they had
read it and they did their due
diligence, they would know that that is
categorically untrue. I don't believe in
environmental determinism and I don't
believe in biological determinism.
Again, please leave comments and please
make sure that they are respectful to me
and to everyone else. I want this to be
a community where people feel safe to
disagree or to be curious, but it
doesn't necessarily have to involve
antagonism or insults or belittling or
devaluing in any way, shape, or form.
Until next time, take care and I will
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