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The Shift Approach to OCD Treatment

Obsessive-compulsive disorder (OCD) is a mental health issue impacting 1-2% of Canadians. According to the World Health Organization, it is the fourth most common mental illness. Depending on how severe the obsessions and compulsions are, it can result in serious impacts on day to day functioning. In a mild case, you may lose an hour a day to your symptoms. In a more serious case, you may spend an entire day consumed by obsessive thoughts and compulsive rituals. Because of its time-consuming nature, OCD will often interfere with jobs and schooling. Similarly, social relationships can become strained as significant people in your life become concerned with your symptoms.

The idea of an obsession in pop culture differs from the definition of an obsession you might experience if you were diagnosed with OCD. In pop culture, being “obsessed” with something usually means spending a lot of time engaging in or thinking about something that you get pleasure from. For example, being obsessed with video games, a favorite food, a new song you heard, or rock climbing. Even though you are obsessing over these things in an everyday sense, you can still meet up with friends for a drink, get to bed on time, be an attentive partner, and be productive at work. What we mean when we talk about an obsession as an OCD symptom is quite different — it is something unwanted that happens repeatedly and feels like it is outside of your control. An obsession as a symptom of OCD would be unwanted thoughts that stop you from being able to pay attention to other things that are important to you, like your family members. Common obsessions include:

Contamination from: body fluids (urine, feces), germs or diseases (bacteria, herpes, HIV), environmental contaminants (asbestos, radiation), household chemicals (cleaners, solvents), dirt.

Unwanted sexual thoughts: forbidden or perverse sexual thoughts or images, forbidden or perverse sexual impulses about others, obsessions about sexual orientation (own or of others), sexual obsessions that involve children or incest, obsessions about aggressive sexual behavior toward others.

Losing control: fear of acting on impulse to harm oneself, fear of acting on impulse to harm others, fear of violent or horrific images in one’s mind, fear of blurting out obscenities or insults, fear of stealing things.

Harm: fear of being responsible for something terrible happening (fire, burglary), fear of harming other people by not being careful enough (dropping something on the ground that might cause someone to trip and fall and hurt themselves)

Obsessions related to perfectionism: concern about evenness or exactness, concern with a need to know or remember, fear of losing or forgetting important things when throwing things out, inability to decide whether to keep or discard things, fear of losing things.

Religious obsessions: concern with offending a religious figure or blaspheming, excessive concern with right/wrong or morality.

Other obsessions: concern with getting a physical illness or disease, not through contamination (cancer), superstitious ideas about lucky/unlucky numbers or certain colours.

The obsessions people experience in OCD are unwanted and intrusive thoughts, images or urges that trigger an intense level of distress.

A compulsion is also something that we don’t always represent accurately. Often we think about rituals people have or any repetitive behavior as being a compulsion. Yet, everyone engages in these sorts of things — having a bedtime routine is a ritual. Lifting weights is repetitive behavior. We need to look at what someone is trying to do (the function of the behavior) and when, where and how the behavior happens (the context). If your job is housekeeping at a hotel, spending 8 hours a day cleaning is normal. On the other hand, needing to clean your home for 8 hours a day after a friend comes over, the behavior is problematic. You might have “compulsive” behaviors that you engage in because you are a stickler for details — in this case, it’s a personality trait that you might actually like. The major difference for people with OCD is that they feel driven to do compulsive behavior and would rather not have to do those very time consuming and sometimes embarrassing things. A classic example is hand washing: for someone with OCD who has an obsession with being contaminated, handwashing might take hours out of the day and result in pain, damaged hands and burns from prolonged exposure to hot water. For someone with OCD, they engage in behavior that seems out of context and seemingly without a function. However, they must do these things to escape or reduce the distress and anxiety their obsessions cause.

At Shift, we not only focus on the obsessive-compulsive disorder symptoms, but we uncover the root causes of the disorder. We use a two-pronged approach: First, we introduce cognitive behavioral therapy (CBT), which focuses on better managing symptoms and interrupting the link between the obsession and compulsive behavior. Second, we focus on reprocessing techniques, which create an environment in which we can help you work through not only the obsession itself but experiences over your life that may have reinforced the obsession. Studies of cognitive behavioral therapy (CBT) and reprocessing techniques for OCD show excellent outcomes. In addition to this, we work with all of our clients in a proactive, self-empowering and egalitarian manner. We want to get to the root of the issue as quickly as possible, and give you tools to work through it so you can get back to living your custom built reality! Give us a shout and book in today.

Amy Haggard | OCPD

Obsessive Compulsive Personality Disorder

Obsessive Compulsive Personality Disorder (OCPD) is one of the ten personality disorders outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. A personality disorder is an enduring pattern of inner experience and behavior. The ten types of personality disorders are divided into three subcategories, which share some defining features within the subcategory. Obsessive Compulsive Personality Disorder is a Cluster C personality disorder. Other Cluster C personality disorders are avoidant personality disorder and dependent personality disorder. All three of the Cluster C disorders share a common experience of intense anxiety.

In order to meet criteria for a personality disorder, someone needs to show at least two of the four core features. The four core features of personality disorders are (1) rigid, extreme and distorted thinking patterns; (2) problematic and excessively emotional responses; (3) impulse control problems, and/or; (4) significant interpersonal problems. Keep in mind that, when most people read about personality disorders, they identify with some or all of the traits that make up a disorder. It’s not as simple as sharing traits with someone who has a personality disorder — for personality traits to be a diagnosable clinical problem, they need to cause distress or disability. Also keep in mind that, even if you don’t meet the criteria for a mental illness related to personality, you might still want to address some traits that you are finding difficult for yourself or others and a psychologist can certainly help with that! I will be putting together another blog post in the near future that talks about personality in general, so keep an eye out if you are interested in learning more about how psychologists conceptualize personality.

A Note About OCD & OCPD

A significant amount of confusion exists between obsessive-compulsive disorder, and obsessive-compulsive personality disorder. Both can look similar, and make things more confusing, they have very similar names. The purpose of this blog post is not to discuss obsessive-compulsive disorder (OCD) at length. For an in-depth description, see my earlier blog post that examines obsessive-compulsive disorder.

Some differentiating features of the two issues include whether or not the person with the disorder is aware of the issue, and how a person is doing at work. People with OCD are aware that there is an issue and seek help. They often feel tortured by their symptoms — they recognize the obsessions and compulsions are unreasonable and interfere with their lives. On the other hand, people with OCPD often don’t believe there is anything wrong and don’t believe they need therapy — at least, not initially. Clients with OCPD often come to therapy because significant people in their lives are struggling with them or are feeling controlled by their behaviours and rigidity. As these close relationships suffer, those significant people, in turn, will ask the person with OCPD to consider seeking help, or the person with OCPD will attend therapy thinking there is something wrong with the people around them. Often people with OCPD believe their way is the “right and best way,” and feel comfortable with their self-imposed sets of rules and believe others should comply.

When it comes to work and school performance, people with OCD typically struggle in these areas. Compulsions often get people with OCD in trouble at work — taking long periods of time away from their work station, or detracting from a focus on projects to meet. For people with OCD, obsessions also infringe on the ability to focus or effectively do their work. It is also often the case for people with OCD to pick professions which allow them to hide their symptoms better from others to avoid embarrassment. Unlike OCD, work and school performance are typically quite high for people with OCPD. Many of the traits in OCPD, such as preoccupation with details and organization or the need for perfection, translate well in most work settings. It is often the case that individuals who are spending time at work outside of their regular schedule to review their work and make sure it is “perfect” are celebrated and the behavior is reinforced. However, their interpersonal relationships suffer a great deal. This may be due to work/life balance as in the example above, but also typically includes strained relationships with co-workers and managers due to the rigidly high standards people with OCPD hold for themselves and others. Another issue that is common for people with OCPD is an inability to “see the forest for the trees” — they become so caught up in the details that they lose sight of the bigger picture and may spend overtime hours or try to extend deadlines on projects consistently to avoid submitting subpar work.

What Obsessive-Compulsive Personality Disorder Looks Like

People with obsessive-compulsive personality disorder are persistently preoccupied with order, perfectionism, and control of self, others, and situations. This persistent pattern is shown by having four or more of the following:

  • Preoccupation with details, rules, schedules, organization, and lists
  • A striving to do something perfectly that interferes with completion of the task
  • Excessive devotion to work and productivity (not due to financial necessity) resulting in neglect of leisure activities and friends
  • Excessive conscientiousness, fastidiousness, and inflexibility regarding ethical and moral issues and values
  • Unwillingness to throw out worn-out or worthless objects, even those with no sentimental value
  • Reluctance to delegate or work with other people unless those people agree to do things exactly as you want
  • A miserly approach to spend for themselves and others because they see money as something to be saved for future disasters
  • Rigidity and stubbornness

Also, these patterns must have begun by early adulthood.

The preoccupation with rules, regulations, orderliness, and perfection sounds great in theory. However, in a person who has OCPD, it becomes so intense that they become very difficult people. These preoccupations come with a need for control which is at the expense of flexibility, openness, and efficiency. The need for control over themselves, others and the environment is driven by a preoccupation with order so behaviors, feelings, and thoughts are consistent with their sense of self. This is where the belief that everything would be fine if people just conformed to their way of doing things comes from. In contrast, someone with OCD will experience their symptoms as inconsistent with their sense of self, leading to a feeling that they are being tortured by their obsessions and compulsions.

What causes Obsessive Compulsive Personality Disorder?

Like most mental health issues, it is difficult to find one specific root cause that is common across all people who have OCPD. However, a number of theories do exist about the sorts of environments and personal characteristics that might predispose someone to develop OCPD. A specific form of the DRD3 gene has been implicated in OCPD, but environmental factors still need to trigger this gene for people who are genetically predisposed to developing OCPD. We subscribe to two theories at shift regarding environmental factors: the role of parenting styles and the role of childhood trauma in the development of OCPD.

A variety of researchers and theorists have drawn conclusions that people with overly controlling or overly protective parents often develop OCPD as a long term response to this parenting style. Additionally, research supports the theory that children who are consistently harshly punished by their parents can develop OCPD traits as a way to try and be perfect and obedient to avoid punishment. In regard to trauma, researchers have examined the development of OCPD traits as a means of coping with the experience of physical, emotional, sexual or other psychological abuse in childhood. One study in 2002 by Aycicegi, Harris, and Dinn identified experiences of psychological control (psychological manipulation and the use of guilt) as a theme in childhood as a unique predictor for the development of OCPD. A controlling parenting style, in the same study, was associated with OCPD as well but was also associated with the development of a broad range of depressive and anxiety issues. If you are interested in reading this study, the reference is attached at the end of this blog post.

How do we Treat Obsessive Compulsive Personality Disorder at Shift?

When we work with people who have OCPD here at Shift, we utilize the Shift Protocol. The Shift Protocol integrates aspects of Cognitive Behavioural Therapy (CBT) and Bi-Lateral Stimulation (BLS) which is the major component of Eye Movement Desensitization and Reprocessing (EMDR). Our goal is to explore with each of our clients the underlying experiences, early in life, which have resulted in specific beliefs about the self, others, and the world. Once we have explored and identified these beliefs, we then work to examine and reprocess these beliefs.

Through reprocessing the underlying beliefs which have been developed in early life and reinforced time and time again throughout life, we can build a better awareness of how an individual with OCPD is impacting the people around them and how the symptoms of OCPD are getting in the way of the person with OCPD creating their custom built and preferred reality. By getting to the root causes, whether they be linked to traumatic childhood experiences, parenting styles, or other causes, we believe that a person with OCPD can live a more intentional life — one less focused on control, perfectionism, and work.