There are a variety of ways to treat OCPD symptoms, however the most common treatments often include a combination of medication, psychotherapy, and relaxation/mindfulness skills. While treating a personality disorder can be difficult, an individual with OCPD’s often rigid adherence to rules and firm dedication to tasks can paradoxically be helpful when applied to the following treatments recommended by providers and clinicians.1
Therapy for OCPD
When choosing a therapy modality for OCPD, there are several factors to consider:
- Is it evidence-based, meaning is it supported by research findings?
- Is it available to me where I live?
- Is it affordable and feasible for my lifestyle and schedule?
It is important to note that there is limited research on the best treatments for OCPD.2 It may be more beneficial to identify the most important goals for treatment (symptom reduction, improving relationships, improving insight) to help select the treatment when multiple modalities are available:
- Psychodynamic therapy may be best if there are attachment and insight issues
- Cognitive Therapies (CT) or Cognitive Behavioral Therapies (CBT) may be best for treating maladaptive behavioral and cognitive issues
- Family-based therapy could be a good option if OCPD is affecting parent-child relationships, or other interpersonal problems between family members
- Couples therapy may be more beneficial if the ways OCPD is impacting your relationship is the primary motivator for bringing you to therapy
The efficacy and evidence for these may vary, however treatment quality and the motivation of the individual will often be more important than the treatment modality itself.1,2
Cognitive Behavioral Therapy
There is no therapy created specifically to treat OCPD; however, Cognitive Behavioral Therapy is the most common form of treatment for OCPD and the most widely studied.1,2 CBT targets maladaptive thoughts, feelings and behaviors and promotes self-awareness and agency. It may do this through sessions and homework that focus on building coping skills, emotion regulation, and cognitive reframing (thinking about one’s thoughts differently).
The therapist will determine length of treatment based on clinical severity and willingness to engage in treatment planning, however most individuals should expect a minimum of 10 one-hour sessions. Treatment for OCPD is typically longer than treatment for Obsessive Compulsive-Disorder (OCD) due to the persistent nature of disordered personality versus the primarily behavioral aspects of OCD.1,2,3
Dialectical Behavioral Therapy (DBT), or Radically Open DBT
Dialectical Behavioral Therapy (DBT) was developed to improve upon CBT by equally emphasizing the concepts of acceptance and change.4 A specific type of DBT called Radically Open DBT (RO DBT) has been found to be effective in treating OCPD. Traditional DBT targets under-controlled symptoms like excessive dysregulated emotions and behaviors (like substance use issues or overeating), whereas RO DBT best targets over-controlled behaviors and disorders such as anorexia and OCPD.
RO DBT is characterized by promoting flexibility (in thoughts and behaviors), openness, and improving interpersonal relationships and social signalling (showing true emotions to engender better relationships).5 While the amount of scientific research is limited so far, there is one study that found RO DBT was effective in treating symptoms of OCPD, making it an exciting option for future research and clinical intervention. RO DBT treatments typically consist of weekly individual and group sessions lasting for 30 weeks.5,6
Psychodynamic Therapy
Psychoanalytic or psychodynamic therapies emphasize developing increased insight into one’s thoughts, motivations and unresolved conflicts. This may be beneficial for those with OCPD that often struggle with insight into their disorder.1 This may be done by resolving childhood or past issues to help improve current functioning.7
This can be done through traditional analytic psychotherapy, which focuses more on bringing unconscious material to the conscious mind, or a more transference-focused psychotherapy where special attention is paid to the self in relation to others including the therapist.8 There is also brief psychodynamic therapy which has a considerably shorter treatment time and is more goal-oriented than standard psychodynamic therapy.1,9
There is limited research assessing the efficacy of dynamic psychotherapies specifically for obsessive-compulsive personality disorder. However, there is evidence that psychodynamic therapies can show similar clinical improvement when compared to other treatment modalities, indicating that the type of therapy someone receives may be less important than the quality of care and the client-therapist relationship.10
Other Therapy Options
Other types of therapy that you may encounter when seeking treatment for OCPD include:
- Schema Therapy has been found to be an effective treatment for many personality disorders
- Interpersonal Therapy (ITS)—a time-limited and structured approach that focuses on resolving interpersonal conflict
- Family therapy and/or couples counseling may improve relationship dynamics
- Nidotherapy seeks to change one’s environment to ease distress as opposed to changing the person internally
- Relaxation and mindfulness practices may be incorporated into an existing treatment, or can be practiced on their own
Questions to Ask About Therapy for OCPD
There are many factors to consider before selecting a therapist to start treatment for OCPD. Before beginning treatment with someone new, you might want to ask the therapist what their experience is with OCPD.
It may also be helpful to find a therapist that offers online therapy sessions if resources are limited where you live. It is also important to remember that when you start with a new clinician they will complete an intake and may come to different conclusions about your diagnosis, so it’s important to discuss your concerns with your therapist and to be open to their clinical expertise.
These questions may be helpful to ask before beginning therapy with a mental health professional:
- What are your areas of expertise?
- Have you worked with OCPD before?
- What is your therapeutic orientation?
- Do you bill insurance? If so, what insurance do you take?
- Do you offer sliding scale payment plans?
Finding a Therapist & Insurance Options
For rural and suburban areas, treatment options and clinician availability are often limited and may be the deciding factors when selecting treatment. To see if a clinician or provider is covered by your insurance, you may contact them directly to find out what insurance they are accepting and then contact your insurance company to determine coverage specifics such as percentage covered, co-pay, and number of sessions covered.
Some insurance plans will limit the number of sessions depending on diagnosis and prognosis, so often treatment duration may not be determined until after the first intake session. Many clinicians are open to working with future patients on to minimize treatment barriers and can offer sliding scale fees or referrals to other providers. Most mental health providers do not require a referral, but confirm with your insurance if they require one for ideal coverage rates. Often, an initial appointment with a primary care provider for a referral is recommended. Consulting with your insurance carrier and primary care provider about your concerns is a great place to start.
Medication for OCPD
Medications are commonly prescribed to individuals with OCPD. While there is no medication established to specifically treat OCPD, medications often alleviate symptoms of the disorder and comorbid disorders such as depression and anxiety.1,10,11 These medications require prescriptions by a medical provider and are typically covered by most insurances. Contact your insurance company to determine cost and copays if applicable.
SSRIs
SSRIs are a class of antidepressant medication that work to reduce the uptake of the neurotransmitter serotonin in an aim to increase the availability of this “feel good” neurotransmitter in the brain. This may be helpful with anxiety and depression comorbidity in those with OCPD and in helping with rigidity and over-attention to detail.11,12
Some studies have shown that SSRIs are the most effective medication treatment, and in conjunction with CBT, can be the most effective treatment protocol. However, it is important to remember that research on OCPD is limited and the findings in favor of certain treatments are typically based on uncontrolled studies, literature reviews, and case studies where causality cannot be completely confirmed.2,11 Commonly prescribed SSRIs for OCPD include: fluoxetine (Prozac), and paroxetine (Paxil).11
Benzodiazepines
Benzodiazepines are a class of drugs that are usually used to treat anxiety disorders but can also be used to treat other conditions such as insomnia and seizures. Benzodiazepines work to reduce activity in the nervous system by impacting neurotransmitters in the brain. While the full mechanism of the drug is not fully understood, one neurotransmitter that it enhances is GABA which works to suppress nervous system activity.13
In recent years, benzodiazepines have fallen out of favor with providers due to its addictive properties and withdrawal symptoms. However, they are effective in reducing symptoms of anxiety in 70-80% of individuals.13 For people with OCPD that also experience anxiety, this medication is effective in alleviating symptoms and may also reduce desire to over-control situations and agitation by increasing relaxation.11,13
Anticonvulsants
Anticonvulsants are also commonly prescribed to individuals with OCPD, especially those that are prone to irritability, hostility, and anger.14 It is well known that some anti-convulsant medications have mood stabilizing effects.15 This negative emotion state can occur when they are unable to sustain control over a situation or their environment, or when others do not meet their high standards.3
Anticonvulsants and antidepressant medications are the most effective medications for treating OCPD within the limited research we have so far.1,11 Other anticonvulsants with evidence for efficacy in treating OCPD besides carbamazepine include sodium valproate and divalproex sodium.11 Ask your physician about anti-convulsant treatment benefits and side-effects to see if it may be the ideal choice of medication for your symptoms of OCPD.
Other Medications
Other less commonly prescribed medications for the treatment of OCPD include:
- Antipsychotic medications such as risperidone, haloperidol, or olanzapine may be used to augment SSRIs in those for whom an anti-depressant has shown little to no improvement.16
- Lithium may be prescribed to treat OCPD along with bipolar disorder or to help stabilize an individual’s mood when other medications have not shown effectiveness.11
- Stimulant medications can treat comorbid ADHD symptoms and have been shown in limited research to reduce symptoms of OCPD.17
Questions to Ask About Medication
It is best to be informed about your options prior to starting a new medication regimen. Being prepared with questions will help you and your provider work collaboratively towards treatment goals.
These questions may be helpful to ask your doctor/prescriber before beginning a new medication:
- What are the common side-effects from this medication?
- How long before it starts to work?
- Are there foods or drinks I should avoid while taking this medication?
- Will I have to take this medication forever or can I stop whenever I start feeling better?
- Can I contact you or someone on your staff if medication side effects begin?
- How do I end the use of this medication if the side effects become too problematic?
OCPD Treatment Self Help
Making certain lifestyle changes can often have a large impact on mental health and functioning. Changes in exercise and diet, and increasing resilience and adaptive coping skills, will help an individual feel better and enjoy life more. Additionally, being self-motivated and knowing you need support is a fundamental step in getting help for OCPD.
There are strategies to help your disorder at home that can be done regularly that will minimize symptoms and distress. These can be done on their own or in conjunction with an existing treatment regimen. It is always advisable to discuss self-help strategies with your provider before implementing them on your own.
Lifestyle changes and self-help techniques that may help alleviate OCPD symptoms and promote overall wellness include:
- Getting proper sleep
- Eating a healthy diet
- Getting exercise regularly
- Following medical and mental health treatments
- Building a support network
- Practicing relaxation & mindfulness techniques
- Identifying values and goals for treatment
Questions to Ask About Lifestyle & Self Help
Ask your care team (primary care physician, mental health professional, etc.) these questions when considering implementing self-help strategies:
- What are some books or podcasts you recommend?
- Do you know of any online or in-person self-help groups?
- Will these strategies be enough for me or should I also seek professional help?
- How can I get my family on board with these changes?
Final Thoughts on Treatment for OCPD
What you or your loved one is dealing with may feel challenging, but you’re not alone. Talking to a therapist and finding the right treatments can make a big difference in how you or your loved one feels.
For Further Reading
Websites:
- The Healthy Compulsive Project
- Mental Health America
- National Alliance on Mental Health
- MentalHealth.gov
Support Groups and Forums:
