Obsessive Compulsive Personality Disorder is still a fascinating topic in the field of psychology with constant research being done on treatment and possible cures. Obsessive Compulsive Personality Disorder is noted for intrusive thoughts and repetitive behaviors that cause significant functional impairment and distress (Thiel, Hertenstein, Nissen, Herbst, Külz & Voderholzer, 2013). There have been countless studies on the treatment outcomes as well as the symptoms of this disorder. This literature serves to provide a synthesis of research on treatment methods as well as understand the classification of personality disorder. The selected literature are all scholarly and rely on current findings.
It is important to note that OCD is classified into sub-classifications, with Personality Disorder being one of them. OCDP ranks high on the taboo symptoms of OCD and low on conscientious. The treatment options for this classification are a bit different from others due to its ‘taboo’ nature (Nestadt, Di, Riddle, Grados, Greenberg, & Fyer, 2009). However, these authors do believe that forecasts for treatments of this disorder bring promise that eventually something will work out.
In a study performed by researchers, it is believed that phenotypic stability in OCPD is moderate. However, in the study the writers wanted to explore concerns of genetic and structural environment when it comes to the disease’s instability (Gjerde, Czajkowski, Røysamb, Ystrom, Tambs, & Aggen, 2015). This disorder is a classification cluster C in the DSM. This disorder is characterized by anxiousness and fearfulness (Gjerde et al., 2015). One of the questions explored in the research is whether or not thedisorder is genetic. The research has proven this to be true. Phenotypic instability is a trait that is connected to the disorder, and is how the researchers were able to reassert the findings. According to Gjerde et al (2015) twins were used in the study to compare and contrast the genetic traits of OCPD. The research concluded that environmental factors made a small contribution of comparison in the disorder. The study ultimately found that genetics contributed more than unique environmental factors to the stability both within and across phenotypes (Gjerde et al., 2015, p. 3539).
Other researchers have focused on the effect of personality disorder on treatment outcomes. According to Thiel, Hertenstein, Nissen, Herbst, Külz & Voderholzer (2013) the outcomes are unclear for this type of disorder. The researchers opted to review 23 articles that focused on PD interviews used for this study. They looked for articles published between 1960 and 2011. They were able to filter through the articles based on their research question of outcomes. They only reviewed studies with adults. Adolescents were excluded from the findings. The research found that very few therapeutic treatments were effective for this disorder. The literature does suggests that the clusters play a major role in the treatment outcomes. Cluster A was explored mostly in this study. The combination of OCD and PD is what the researchers are exploring. Cluster A includes Schizotypal and Narcissism. Having two or more PDs negatively impacted the treatment outcomes (Thiel et al., 2013).
One form of PD is Schizotypal. There have been studies done on this particular Personality Disorder when it comes to which treatment options would work. Poyurovsky (2008) suggests that “Clozapine monotherapy is beneficial in treatment-resistant schizophrenia, but not OCD” (p. 219). The study discussed two treatment refractories in two patients. One patient who was 54 years old, met DSM-IV criteria for OCD and SP in her twenties. Under a 12 week trial she was offered different anti-psychotic medications including, fluvoxamine, paroxetine, and clomipramine combined with perphenazine, or risperidone. She was given proper dosage for each medication. The medication was ineffective and resulted in Tardive Dyskinesia (Poyurovsky, 2008). Clozapine was administered to the patient, and the only side effect was a little sedation. The TD disappeared as well (Poyurovsky, 2008).
In another case a 36 year old patient was given the same kind of initial medication as the other patient. The patient eventually refused due to TD and severe exacerbation of Obsessive Compulsion. The patient was then given Clozapine 150 to 250 mg dosages a day. The side effects for this patient included drowsiness and hypersalivation. Like the first patient, this patient’s TD disappeared and condition improved (Poyurovsky, 2008). Poyurovsky’s suggestion of Clozapine is continuously explored in his article. He argues that even relatively low dosages of the medication can have a great positive impact on patients.
Some articles in the review focused on how to treat OCPD and other Obsessive compulsive disorders with other psychotic disorders. Each disorder has its own method and medication of treatment. Therefore, what happens for patients who suffer with more than one classified DSM illness? One treatment suggestion is CBT ( Cognitive-Behavioral Therapy). The study pointed out how years ago it was argued that OCPD and other OCDs were untreatable. However with research and advances in psychological and pharmacological interventions this has proven to be false (Rector, Cassin, & Richter, 2009). The CBT treatment is an efficacy option for depressed patients who suffer from a personality disorder. However, there is a high treatment dropout rate with this option. The researchers believe due to this other strategies need to be explored that can work well with CBT.
According to Langner, Laws, Röper, Zaudig, Hauke, & Piesbergen, (2009) subtyping OCD is being considered for newer treatment options as a result of the different profiles of the disorders. The study acknowledges that there are plenty of studies looking into the treatment options of OCD, but they are not subtyping the different types like personality disorder. The writers discuss the predicting outcomes after CBT for 191 patients. In the outcomes there were a couple of factors that worked against some of the treatment. Some of those factors included age, the long duration of treatment before the assessment, and social behavior (Langer et al., 2009). Nonetheless thee wee some positives from the study. Patients who were in stable living environments, incurred high motivation and longer duration of inpatient care experienced favorable outcomes (Langer et al., 2009). Overall, the role of subtyping proves to be promising for researchers, and more are taking this into consideration for treatment.
Another treatment option suggested for personality disorder is psychopharmacological for affective stability. Affective instability is what is believed to be the underlining cause of mood changes and other factors in personality disorders. Nica & Links (2011) examine this treatment option in their article. Of course psychotherapy is the standard way to treat, but as the researchers point out, some patients are treated with psychotropic medication. This is especially true for patients who suffer from BPD (Nica & Links, 2011). As of recently there are no up-to-date guidelines for the drugs used to treat patients with personality disorder. Yet, there is an advisement against the use of treating patients with BPD with medication. The guidelines also advise against, “antipsychotics for the moderate or long-term management of patients with BPD” (Nica & Links, 2011, para. 20). Yet, the experts do not see any harm in using drugs for short term treatment. Overall, the article’s findings support the guidelines, but believe that out of all the disorders treating this one is challenging.
de Groot, Verheul, Trijsburg, (2008) provides further insight into the treatment options out there for personality disorder. They provide a theoretical psychotherapeutic review on treatment for this disorder. The writers believe that optimism has risen for treatment options of PD in recent years. They acknowledge the treatment models: Dialectical Behavioral Therapy, Schema- Focused Therapy, and Mentalisation Based Treatment. These options date back to 1999, but are starting to prove to be effective for PD (de Groot et al., 2008).
As with other literature this one also discusses the role of psychotherapy as the main form of treatment for PD (Biskin, & Paris, 2012). They provide two other forms of therapy that can be beneficial to patients who suffer from PD. The authors believe that dialectical behavior therapy and mentalization-based are good treatment options to explore. They have been around for quite some time, but not all researchers focus on these as effective methods. These therapies are also not always available to patients. This is due to making sure there is a team of therapists who have specialized training in these treatments. Furthermore these treatments can be costly, and lots of times the patients need to be in treatment for a year or longer for it to effectively generate outcomes (Biskin, & Paris, 2012). Dialectical behavior therapy was one if the first forms of therapy that was proven to be effective for Personality disorders. It is a bit complex in its approach because it combines philosophy with numerous others of components in order to be administered. Psychiatrists have to be highly specialized in order for this treatment to work. As discussed, the length of treatment is the biggest problem for this form of therapy.
Mentalization-based treatment is the other treatment discussed in the Biskin article. This is the second type of treatment that was specifically designed to treat PD. This therapy has a foundation in attachment theory. Part of the theory is weekly group therapy over a period of 18 months. It has the potential to offer shorter sessions. It was found to be effective in an outpatient type of setting. Overall, there are positive outcomes for this type of therapy. The gains may not be substantial as with the Dialectical behavior therapy, but it does prove to work over time (Biskin & Paris, 2012).
Livesley (2012) believe that the recent focus of specialized treatment for PD needs to be reevaluated. He believes that it should be replaced with evidence that supports combing all methods that have proven to help patients who suffer from this illness. He believes that due to PD being left out of so many research studies because of its heterogeneous and complexity, it is unfair to use a one-treatment fits all approach to the issue. Livesley (2012) argues that an integrated approach needs to be taken into consideration in future studies. Livesley (2012) wants “A two-component framework is proposed for organizing integrated treatment”. While it may not be a popular choice among others in the field of psychology, it does offer a promising alternative. What is probably most important argues (Livesley (2012) is that a working alliance is vital in positive treatment options of personality disorder. Patients need to be able to know that they are able to trust all who are involved in getting them the best outcomes possible. He does gives recognition to the progress in treatment options for personality disorder. He recognizes that there are now an array of treatment options that have been tried and tested in the past 20 years that have added to the progression of positive outcomes. He believes what will be most powerful is to move beyond the specialized options and integrate the treatments with the ingredients that work well in all of the options. By using this method, then Livesley (2012) believes that there will be significant progress in treating this mental illness.
Overall, the insight provided in all of these articles offer important perspectives in treating Obesessive Compulsive Personality Disorder. The good thing will all of the literature is that there is hope and promise that eventually an ultimate effective treatment that works beyond measure will soon be available for patients who suffer from this order. As of now, it is best to continue using the treatments that are minimizing the instability of this disorder. Consequently as Livesley (2012) suggest, it would be a great show in solidarity and growth to integrate the best ingredients form all the methods to come up with the best treatment yet.
References
Biskin, R. S., M.D., & Paris, J., M.D. (2012). Management of borderline personality disorder. Canadian Medical Association.Journal, 184(17), 1897-902. Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/1314695485?accountid=34899
de Groot, Erik R, MSc, Verheul, R., PhD., & Trijsburg, R. W. (2008). An integrative Perspective on psychotherapeutic treatments for borderline personality disorder. Journal of Personality Disorders, 22(4), 332-52. Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/195243514?accountid=34899
Gjerde, L. C., Czajkowski, N., Røysamb, E., Ystrom, E., Tambs, K., Aggen, S. H., . . . Knudsen, G. P. (2015). A longitudinal, population-based twin study of avoidant and obsessive-compulsive personality disorder traits from early to middle adulthood. Psychological Medicine, 45(16), 3539-3548. doi:http://dx.doi.org/10.1017/S0033291715001440
Langner, J., Laws, M., Röper, G., Zaudig, M., Hauke, W., & Piesbergen, C. (2009). Predicting therapy outcome in patients with early and late obsessive-compulsive disorder (EOCD and LOCD). Behavioural and Cognitive Psychotherapy, 37(5), 485-96. doi:http://dx.doi.org/10.1017/S1352465809990294
Livesley, W. J. (2012). Moving beyond specialized therapies for borderline personality disorder: The importance of integrated domain-focused treatment. Psychodynamic Psychiatry, 40(1), 47-74. doi:http://dx.doi.org/101521pdps201240147
Nestadt, G., Di, C. Z., Riddle, M. A., Grados, M. A., Greenberg, B. D., Fyer, A. J., . . . Roche, K. B. (2009). Obsessive-compulsive disorder: Subclassification based on co-morbidity. Psychological Medicine, 39(9), 1491-501. doi:http://dx.doi.org/10.1017/S0033291708004753
Nica, E. I., & Links, P. S. (2011). Psychopharmacological treatments for emotion dysregulation in borderline personality disorder. Mind & Brain, 2(1) Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/881276389?accountid=34899
Poyurovsky, M., M.D. (2008). Clozapine in treatment-refractory obsessive-compulsive disorder with comorbid schizotypal personality disorder. The Israel Journal of Psychiatry and Related Sciences, 45(3), 219-20. Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/236927737?accountid=34899
Rector, N. A., Cassin, S. E., & Richter, M. A. (2009). Psychological treatment of obsessive-compulsive disorder in patients with major depression: A pilot randomized controlled trial. Canadian Journal of Psychiatry, 54(12), 846-51. Retrieved from https://login.libproxy.edmc.edu/login?url=http://search.proquest.com/docview/222842086?accountid=34899
Thiel, N., Hertenstein, E., Nissen, C., Herbst, N., Külz, A. K., & Voderholzer, U. (2013). The
effect of personality disorders on treatment outcomes in patients with obsessive-compulsive disorders. Journal of Personality Disorders, 27(6), 697-715. doi:http://dx.doi.org/101521pedi201327104
