I recently finished therapeutic work with a man whom I’ll call Fred. His story addresses the question, “Can someone with OCPD change?” and it illustrates the challenges involved.
I was certain that Fred would ruin his marriage with his rigidity and control. “Yup,” I thought, “this is just what all the discouraged and angry partners of people with OCPD talk about online and in support groups.”
Anger and dominance felt morally justified to Fred. At first, little I said seemed to get past his assumptions about how the world should be. Anyone observing him would have concluded that being “right,” frugal, efficient and in charge was what was most important to him. This led him to be offensive at times.
I told him twice that I wasn’t sure I could help him. That’s rare for me to say, and shows just how intractable things seemed at the time. But he assured me that I was helping him, and he insisted that we persevere.
Fred’s OCPD Change
I continued to acknowledge his good intentions while also pointing out to him that he was failing at those intentions. By being so stubborn he was having a very negative effect on the very people he said he cared about. I also pointed out to him when he was offensive toward his wife. And toward me in session.
He was motivated to save his family. And his underlying anxiety wasn’t so debilitating that he couldn’t let go of his defenses long enough to try new attitudes and behaviors. Eventually he was able to take in my comments and change how he felt, thought and acted. He came to view doing the “right” thing differently.
He came to see the discrepancy between what he said was important–his family–and what he actually treated as important—control. Over time this discrepancy narrowed and his behavior changed substantially. He honored his love for his family with what he actually did, not just what he said.
How is OCPD Change Possible and To What Degree?
While the process is not easy, most people with OCPD can change–to some degree. It would be unrealistic to think that the entire personality would transform into something totally different.
But characteristics of OCPD such as conscientiousness[i] and the capacity to delay gratification[ii] can actually enhance their capacity to use their personality traits in a healthier way. Given motivation and proper support, many, though not all, can turn their determination onto their stubbornness, and come to value flexibility.
Over the last 25 years the concept of neuroplasticity has emerged as one of the guiding principles of psychological science. Previously understood as a potential that ends with childhood, we now know that the capacity to change the brain endures well into adulthood[iii] . And that experience actually leads to measurable changes in the brain and subsequent changes in behavior.[iv]
We now also have good reason to believe that this applies to personality disorders as well.
Obsessive-Compulsive Personality Disorder and Change
While personality disorders are usually considered to be consistent over time, there is research which indicates that many people who meet the criteria for OCPD no longer meet those criteria 12 months later—even without treatment. As the authors of this study state, “Personality disorders may be characterized by stable trait constellations that fluctuate in degree of maladaptive expression.”[v][vi] [vii]
No-one doubts that obsessive-compulsive personality is persistent. These attributes are inborn, hard-wired. But how they are expressed–the soft-wiring–can change. Obsessive-compulsive personality does not necessarily become, or remain, disordered.
One might express determination, for instance, through rigidity and control at first, but eventually learn to be politely resolute. One can be determined without demeaning or dominating others.
Like water, compulsive personality traits can be rigid and frozen like ice, or they can flow flexibly.
Psychotherapeutic Treatment Can Help to Achieve Change
While the research into the treatment of OCPD is limited, many studies have documented its effectiveness in promoting change. [viii] [ix] [x] [xi] [xii] [xiii] Psychotherapy creates conditions for a different sort of experience. Ideally, the client feels safe enough to lower their defenses and consider other ways of thinking and behaving that honor their values.
This safety may best be achieved by working with the traits of OCPD to affect change, acknowledging their potential benefits, rather than rejecting them all outright.
Intractable Cases and Co-existing Conditions
Certainly there are people who don’t change. We hear about them from partners who suffer mightily for decades, hoping for change and never see it. These are painful stories and are not to be doubted.
Most of these cases are found among what psychologist Anthony Pinto describes as the hostile-dominant subtype.[xiv] Well-channeled, the energies of these individuals could just as well have led them to be fine leaders and teachers. But too often they become controlling and critical to the point that others around them find intolerable.
There are at least three other subtypes, including workaholics, people pleasers and procrastinators—each with positive and negative potential.
Many of these intractable cases probably also have co-morbid conditions, not just OCPD alone. Research has indicated that patients with OCPD also often meet diagnostic criteria for:
- major depressive disorder
- generalized anxiety disorder
- alcohol abuse/dependence
- drug abuse/dependence
- obsessive-compulsive disorder (OCD)
Some individuals with OCPD could also have symptoms of other personality disorders, such as narcissistic or antisocial personality disorder.
When there is a second or even third diagnosis, symptoms may become magnified and less tolerable for partners. Treatment and change become more difficult, though not impossible.
Conditions for OCPD Change
Three main factors determine the capacity for change:
Core psychological stability versus underlying fragility and anxiety
Another client in the same situation as Fred might be too anxious and fragile to be able to change, despite being motivated to keep his or her family together. This level of anxiety is determined somewhat by genes, but at least as much by family history and any trauma and abuse they may have experienced.
The inability for someone with OCPD to change should not necessarily be taken personally by the partner. Despite appearances, beneath the bravado is an absolute terror of what it would feel like to let go of their rigid defenses of righteousness and control. But they themselves are rarely aware of the underlying fear.
In my experience, individuals who are aware of their anxiety are more able to change than those who cover their anxiety with defenses.
People with OCPD tend to be energetic, goal-driven and ambitious, though their perfectionism may prevent productivity. If this energy can be channeled to preserve a family, prevent self-destructive tendencies from ruining a career, or diminish a painful depression, the potential for change is great.
These motivations can be triggered by hitting rock bottom. But some may get glimpses of how unsatisfying their lifestyle is without hitting bottom. They may become motivated to achieve psychological growth, greater happiness and fulfillment by enlisting their energy into change.
I have not met people who were motivated to become healthier but were unable to change at all.
Support (family, friends, support groups, professionals)
Change requires an environment that allows the person with OCPD to feel safe and respected, while at the same time helping them to question how they’ve been living. Acknowledging their efforts while communicating their actual impact is central to their change.
Supportive family and friends are necessary but not sufficient for significant change. Because people with OCPD are convinced that they are right, it usually takes an outside party to interrupt their patterns so the individual can begin to consider other ways of living.
While the symptoms of OCPD can be difficult to change, characteristics of the condition such as conscientiousness, determination, and the capacity to delay gratification can be enlisted to achieve change. If you or a loved one suffers from OCPD, professional help is the first step. See my post about How Psychotherapy Can Help With OCPD.
For a complete guide to changing OCPD see my book: The Healthy Compulsive: Healing Obsessive-Compulsive Personality Disorder and Taking the Wheel of the Driven Personality.
[i] Samuel, D. B., and T.A. Widiger. (2011). Conscientiousness and obsessive-compulsive personality disorder. Personality Disorders: Theory, Research, and Treatment, 2(3), 161-174. doi:10.1037/a0021216
[ii] Pinto, A., J.E Steinglass, A.L Greene, E.U. Weber, and H.B. Simpson. (2014). Capacity to delay reward differentiates obsessive-compulsive disorder and obsessive-compulsive personality disorder. Biol Psychiatry, 75(8), 653-659. doi:10.1016/j.biopsych.2013.09.007
[v] Tracie Shea, et al. (2002). Short-Term Diagnostic Stability of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders. American Journal of Psychiatry. 159:12, pgs. 2036-2041.
[vi] Burkauskas, J. F., Naomi. (2020). History and Epidemiology of OCPD. In J. E. Grant, Anthony Pinto, Samuel Chamberlain (Ed.), Obsessive-Compulsive Personality Disorder (pp. 1-16). Washington, D.C.: American Psychiatric Association Publishing.
[vii] Grilo, C. M., Sanislow, C. A., Gunderson, J. G., Pagano, M. E., Yen, S., Zanarini, M. C., Shea, M. T., Skodol, A. E., Stout, R. L., Morey, L. C., & McGlashan, T. H. (2004). Two-Year Stability and Change of Schizotypal, Borderline, Avoidant, and Obsessive-Compulsive Personality Disorders. Journal of Consulting and Clinical Psychology, 72(5), 767–775. https://doi.org/10.1037/0022-006X.72.5.767
[ix] Abbass, A., Sheldon, A., Gyra, J., & Kalpin, A. (2008). Intensive short-term dynamic psychotherapy for DSM-IV personality disorders: a randomized controlled trial. J Nerv Ment Dis, 196(3), 211-216. doi:10.1097/NMD.0b013e3181662ff0
[x] Winston, A., Laikin, M., Pollack, J., Samstag, L. W., McCullough, L., & Muran, J. C. (1994). Short-term psychotherapy of personality disorders. Am J Psychiatry, 151(2), 190-194. doi:10.1176/ajp.151.2.190
[xi] Ng, R. M. K. (2005). Cognitive therapy for obsessive-compulsive personality disorder–a pilot study in Hong Kong Chinese patients. Hong Kong Journal of Psychiatry, 15(2), 50+. https://link.gale.com/apps/doc/A170196134/HRCA?u=nysl_oweb&sid=googleScholar&xid=39d24e16
[xii] Strauss, J. L., Hayes, A. M., Johnson, S. L., Newman, C. F., Brown, G. K., Barber, J. P., Laurenceau, J.-P., & Beck, A. T. (2006). Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. Journal of Consulting and Clinical Psychology, 74(2), 337–345. https://doi.org/10.1037/0022-006X.74.2.337
[xiii] Martin Svartberg, M.D., Ph.D. ,, Tore C. Stiles, Ph.D. , and, & Michael H. Seltzer, Ph.D. (2004). Randomized, Controlled Trial of the Effectiveness of Short-Term Dynamic Psychotherapy and Cognitive Therapy for Cluster C Personality Disorders. American Journal of Psychiatry, 161(5), 810-817. doi:10.1176/appi.ajp.161.5.810
[xiv] Pinto, A. (2020). Psychotherapy for OCPD. In A. P. Grant JE, Samuel R. Chamberlain (Ed.), Obsessive-Compulsive Personality Disorder (pp. 143-178). Washington, D.C.: American Psychiatric Publishing.
[xv] Enero, C., Soler, A., Ramos, I., Cardona, S., Guillamat, R., & Valles, V. (2013). 2783 – Distress Level and Treatment Outcome in Obsessive-Compulsive Personality Disorder (OCPD). European Psychiatry, 28(S1), 1-1. doi:10.1016/S0924-9338(13)77373-5