According to the Deconstructing Anxiety model, anxiety–aka “fear”–is at the heart of literally every problem we face in life. That might sound like a sweeping statement, but in the model, this idea is easily demonstrated by a simple process. Using what we call the “digging for gold” exercise, you can trace any issue back to a single core fear. Whether it’s relationship struggles, depression, procrastination, or even unhealthy habits like overeating, one’s core fear lies at the root. Anyone can discover this for themselves by picking a problem and following the steps of the “digging for gold” process, to uncover their core fear. Do it with multiple problems, and you’ll see that the same fear is behind all of them. 

This approach simplifies things in a rather extraordinary way. Many of us feel overwhelmed by the complexity of our issues, but recognizing that there’s a single underlying fear changes the game. Once you identify it, you know where to focus your efforts. Unfortunately, fear is tricky—it hides itself behind layers of defenses and distractions. This is what makes it so hard to overcome. But by applying the principles of the Deconstructing Anxiety method, we can cut through these defenses and find a clarity that is transformative. 

Let’s take a closer look at how this applies to relationship anxiety. 

What Is Relationship Anxiety? 

Relationship anxiety is, simply put, the stress or fear we feel in connection with others. This could mean worrying about rejection, feeling insecure in a relationship, or struggling with jealousy. Relationship anxiety isn’t limited to romantic partnerships; it can show up in friendships, family dynamics, or workplace interactions. 

Some common signs of relationship anxiety include: 

• Fear of being abandoned or rejected 

• A tendency to people-please and/or avoid conflict 

• Jealousy or possessiveness 

• Feeling overly dependent on others for your well-being 

• Loneliness, even when surrounded by people 

These feelings arise only because of the deeper core fear that is driving them. To truly address relationship anxiety, we need to uncover this core fear hidden beneath the surface. 

The Core Fears Behind Relationship Anxiety 

In the Deconstructing Anxiety model, all anxiety is linked to one of five core fears: 

1. Fear of losing love 

1. Fear of losing identity 

1. Fear of losing meaning 

1. Fear of losing purpose 

1. Fear of death 

Each of these fears plays a major role in our relationships, shaping how we connect with others and respond to challenges. Let’s break them down. 

Fear of Losing Love 

This fear is often at the heart of relationship anxiety. People with this fear might worry about being abandoned, rejected, or unloved. They may seek constant reassurance or feel devastated by even small signs of disapproval. At its root, this fear stems from the belief that our happiness and self-worth depend on being loved by others. 

Fear of Losing Identity 

Our sense of self is closely tied to how others respond to us. From a young age, we learn who we are through feedback from caregivers, friends, and our environment. When this feedback is positive, it reinforces our identity. But if others criticize, reject, or try to control us, it can feel like our sense of self is under attack. This fear often shows up in relationships where one partner feels “lost” or overly influenced by the other. 

Fear of Losing Meaning 

Meaning refers to the sense that life—and our relationships—has value and importance. When relationships are fulfilling, they bring deep meaning to our lives. But when conflicts arise or connections break down, it can feel like life loses some of its richness. This fear may also appear when we feel responsible for the well-being of those we care about. If loved ones are suffering, we may question the meaning of our own happiness. 

Fear of Losing Purpose 

Purpose is about having goals that create a better future. In relationships, this often means striving to improve love, trust, and connection. When we lose sight of these goals—or feel that achieving them is impossible—we may experience a sense of hopelessness. This fear can leave us feeling stuck, unsure of how to move forward or make things better. 

Fear of Death 

This might seem unrelated to relationships at first, but on a most basic level, humans rely on social connections for survival. From forming families to building societies, relationships help protect us from threats and provide resources. When relationships feel unstable, it can trigger a primal fear of being left vulnerable or unsafe. 

How to Address Relationship Anxiety 

If all relationship anxiety is rooted in a core fear, the solution is to uncover and challenge that fear. The Deconstructing Anxiety model provides tools for doing exactly that. Through techniques like the “digging for gold” exercise, you can trace your feelings back to their source and expose the fear for what it truly is—an illusion. 

Here’s why this matters: much of our behavior in relationships is automatic. We react out of habit, often without understanding why. But when you recognize your core fear, you gain the ability to step back and respond differently. Instead of being driven by fear, you can choose actions that align with your true values and goals. 

A Proven Approach for Couples 

For those struggling with relationship anxiety in a partnership, there’s a program called Deconstructing Relationships, based on the Deconstructing Anxiety model. One of its key techniques is a communication method that helps couples uncover the fears behind their conflicts. 

Here’s how it works: instead of focusing on surface-level issues like arguments or misunderstandings, couples explore the deeper anxieties driving their behavior. Often, they realize that both partners are acting out of fear—whether it’s fear of rejection, fear of being controlled, or something else entirely. This realization creates empathy, helping partners see each other in a new light. 

I’ve seen this technique transform relationships time and again. Couples who once felt stuck in patterns of blame and frustration discover a renewed sense of compassion and love. By addressing the root causes of their struggles, they create space for healing and growth. 

The Path Forward 

Relationship anxiety can feel overwhelming, but it doesn’t have to control your life. By understanding the role of core fears and using the tools of the Deconstructing Anxiety method, you can build healthier, more fulfilling relationships. Whether you’re addressing your own fears or working through challenges with a partner, the key is to approach the process with honesty, curiosity, and compassion. 

To learn more about Dr. Pressman’s approach to creating healthy, vibrant relationships, visit www.makemarriagebetter.com or see his profile on Goodtherapy.org. 

Masks Off, Anxiety Up: Dealing with No-Mask Anxiety

After over a year of covering their faces, Americans across the country were told they could breathe freely earlier this year as mask mandates were lifted. 

Unfortunately, the return to “normal” life hasn’t been smooth sailing for everyone. In fact, nearly half of Americans admit they have concerns about resuming in-person interactions, according to the American Psychological Association.  

It appears as though the mental health issues brought about by the pandemic aren’t going away anytime soon. 

Indeed, “no-mask anxiety” is real, and folks all over America are worried about life returning to the way it was before the pandemic. 

What Is No-Mask Anxiety? 

Like the name suggests, no-mask anxiety is a condition where people are scared about the prospect of taking off their masks in public.  

Those affected by no-mask anxiety feel uneasy when they themselves don’t wear a face covering, and they can also be uncomfortable around others who are not wearing masks. 

People of all ages can suffer from no-mask anxiety, including kids who are not yet vaccinated. 

Worried you might be suffering from no-mask anxiety? Don’t be. Doctors say it’s completely normal — and will likely be an increasingly common diagnosis as we move further into the post-pandemic world.  

The Why Behind No-Mask Anxiety  

On top of general uncertainty about the future, there are a few reasons why folks might develop no-mask anxiety: 

It’s become a habit.  

Imagine Henry, a 45-year-old father of two.  

For the first 44 years of his life, Henry never wore a mask. All of a sudden, in 2020, he wore a mask every day, each time he stepped out of his house.  

Since research says it takes an average of 66 days to develop a new habit, it comes as no surprise that Henry now feels more or less “naked” without a mask on. 

It feels like a security blanket. 

Throughout the pandemic, masks have served as our front line of protection against the virus. While vaccinations are helping the world safely move past the pandemic, many still feel comforted by wearing a mask and were planning on wearing them for the foreseeable future. 

Then, suddenly, the CDC updated its guidelines and said that folks who were fully vaccinated could return to pre-pandemic life. Expecting to wear a mask for some time and being told it was no longer required has been a difficult adjustment for many people. 

“The only time I don’t have mine up is when I’m at home or driving my car,” Jenny Krislov, a resident of Madison, Wisconsin, told Spectrum News 1. “It almost feels like my security blanket.”  

Krislov doesn’t only wear the mask to protect herself. She also wears it to protect her loved ones. 

Unmasking can exacerbate social anxiety. 

Those who have social anxiety live in fear that their peers will judge them for awkward or abnormal behavior in social settings. Simply put, people with social anxiety do everything they can to act “normal” and fit in with the crowd. 

As the pandemic began, these individuals might have been hesitant to put their masks on in the first place out of concern they’d get weird looks. However, ever since masks were mandated and the vast majority of people complied, they were happy to mask up.  

Now, as we transition to a post-pandemic world, social anxiety may be a bit higher than normal, according to David Moscovitch, a professor at the University of Waterloo. People who were nervous to be in public might have felt some comfort in being able to hide their faces. But in order to fit in now, they need to reveal their faces — which is causing some people to develop no-mask anxiety.  

“Many people who didn’t struggle with social anxiety before the pandemic may find themselves feeling more anxious than usual as we emerge out of the pandemic and into a more uncertain future — especially within social situations where our social skills are rusty and the new rules for social engagement are yet to be written,” Moscovitch wrote in a recent paper. 

Social anxiety got you shut down and isolated, hyper-vigilant and self-critical, or any other way that is blocking your path to a peaceful, full life? Don’t let anxiety define you. Reach out to a therapist near you today for help.

Resilience and Growing Through Change: How to Conquer No-Mask Anxiety 

If you’re impacted by no-mask anxiety, you need to remember there’s nothing to be ashamed about. None of us have ever lived through a pandemic at the scale of COVID-19 before, so we will all need to adapt to varying degrees. 

If you’re looking to conquer your no-mask anxiety, here are a few tips to keep in mind:

1. Take your time.

Just because other people aren’t wearing masks doesn’t mean you have to take yours off, too. 

Doctors say there’s nothing wrong with taking your time to ease back into a more open world. 

“You can pick a safe place with safe people, and just gradually go from there,” Dr. Eric Berko of MetroHealth Medical Center told Cleveland’s Fox 8 News. “Keep a mask in your pocket. It’s OK if you feel uncomfortable, just put it on. There’s no harm or shame in any of that. Gradually get yourself out there, and I think you’ll start to feel better and better.”

2. Force yourself to be social.

As Robert Frost once wrote, the only way out is through. 

If you find yourself saying no to social gatherings or wanting to keep your face mask on in supermarkets and retail shops, try to force yourself to do the opposite. 

“Catch yourself when you’re choosing to avoid even when you aren’t being forced to do so by pandemic-related restrictions,” Moscovitch said. “Do your very best to summon the courage to push yourself to enter those situations and confront your anxiety.” 

3. Find resilience.

According to Brené Brown, people who are resilient in the face of trauma tend to practice three specific acts: 

• The Reckoning, where they admit that they’re feeling different feelings 
• The Rumble, where they conduct a reality check on the narratives surrounding their struggles 
• The Revolution, where they rewrite their stories and transform their mindset on a foundational level 

If you’re struggling with no-mask anxiety — or any other effect of the pandemic — remember that you don’t have to wrestle the issue entirely on your own. 

Start your search for a therapist who can guide you through your struggle and help you live a more fulfilling life today. 

By Dr. Jocelyn Markowicz, PhD, Psychologist

Attachment Hope for Couples: How to Improve Your Security Odds

You walk into the room and lock eyes with the most gorgeous human being you have ever seen. This individual locks eyes with you as well. You begin talking and realize that the chemistry between you is intense. You plan a date. You have several great dates. You fall in love and begin to talk about spending the rest of your lives together. You have the wedding. You go on the honeymoon. You begin to live your day-to-day lives together. (Perhaps not quite in that order.) But then, as you settle into shared lives, you notice that something is changing. The arguments are more frequent. The emotions are not all positive. Why does your partner leave when there is conflict? Why does your partner walk away when you need soothing? Why are they sometimes exhaustingly clingy and other times too independent? John Bowlby and Mary Ainsworth offered an answer rooted in attachment styles to these questions. Several researchers after them offered solutions. I’d like to share them with you. 

The Evolution of a Relationship

It is important to acknowledge that it takes time for interpersonal patterns to emerge within a romantic relationship. A perception bias occurs when you first fall in love that naturally heightens your connection to your partner’s strengths and limits your awareness of their weaknesses. Thus, it is in day-to-day living that you develop more accurate perceptions of patterns that are problematic. 

Why You Relate the Way You Do

In the 1960s, John Bowlby asserted that we learn positive and negative ways of relating based on our parent-child experiences. Our ways of relating are designed to strengthen our bond with our attachment figures (parents/caregivers) growing up. They help us survive. An attachment behavioral system gradually emerges wherein we attempt to regulate our emotions and behaviors toward an attachment figure. To do this, Bowlby (1980) asserted that the attachment system essentially asks the following fundamental question: Is the attachment figure nearby, accessible, and attentive? According to Bowlby (1980), an individual who has experienced a secure attachment is likely to view attachment figures as available, responsive, and helpful. An insecurely attached individual would view attachment figures as inaccessible, untrustworthy, and unreliable.

Different Attachment Styles

Ainsworth expanded on Bowlby’s attachment behavioral system and introduced specific attachment styles that explain our attachment behaviors. She outlined three specific attachment styles: (1) secure attachment and two insecure attachment styles: (1) anxious-resistant, and (2) avoidant (Ainsworth, 1979). In adult romantic relationships, the insecurely attached adult who is anxious-resistant would be dependent on their partner and yet reject their soothing attempts. The insecurely attached adult who is avoidant would not seek emotional or physical comfort from their partner when experiencing emotional distress. 

Bowlby and Ainsworth helped us to understand that our way of relating to others is guided by our early attachment experiences, but do we indeed exhibit the same attachment behaviors in our adult romantic relationships?

Further Research into Attachment Styles 

Hazen and Shaver (1987) evaluated Bowlby’s theoretical premise that early attachment behaviors extend to adulthood and are relatively stable. They conducted research and found that adults also reported the three attachment categories that Ainsworth determined (secure, anxious-resistant, and avoidant). Their research identified that romantic relationships are attachment bonds and share similar attachment behaviors that characterize parent-child interactions. In essence, Bowlby and Ainsworth were right to suggest that we can look at our adult relationships and evaluate our partner’s attachment behaviors based on their childhood attachment experiences. 

Are People Stuck Forever in Patterns from Childhood? 

What happens if you partner with someone with an insecure attachment style? Can their attachment style become secure? 

Researchers had the same questions about whether or not early attachment behaviors could be changed in adulthood. Findings across several studies did indicate that while early attachment style is relatively stable (Kim, Baek, & Park, 2021), attachment behaviors can change (Tmej, AMA et al., 2020; Sims, 2000; Rimane, Steil, Renneberg, & Rosner’s, 2020; Overall, Simpson, & Struthers, 2013; Gazder & Stranton, 2010; Park, Johnson, MacDonald, & Impett, 2019). Therein lies the hope for the couple. So, back to the question, what happens if you partner with an insecurely attached individual? How can you increase your secure attachment odds in your relationship?

Distress in romantic relationships is the leading cause for adults to seek psychological services (Bradbury, 1998). There are specific interventions that increase attachment security or reduce the negative impact of insecure attachment behaviors in romantic relationships. The following interventions are supported by empirical examination.

Transference-Focused Therapy

Transference-focused therapy (TFT) is a therapeutic intervention that aims to reduce impulsivity, stabilize mood, and improve interpersonal and occupational functioning. The intervention is specifically designed for individuals who struggle with borderline personality disorder. Trauma can impact the internalized representations of personality. It is not uncommon for individuals to develop maladaptive personality traits in response to trauma. Trauma impacts attachment bonds. TFT is a great choice for an individual partner in a couple dyad who may also struggle with borderline personality. A recent study found that individuals who participated in TFT moved towards securely attached with some preoccupied behaviors away from insecurely attached with preoccupied behaviors (Tmej, AMA et al., 2020)

Emotionally Focused Therapy

Emotionally focused therapy (EFT) for couples focuses on reshaping distressed couples’ structured, repetitive interactions and the emotional responses that evoke partners and foster the development of a secure emotional bond (Jonson, 1996; Jonson, 1999). The EFT model assumes that the negative emotions and interactional cycles typical of distressed couples represent a struggle for secure attachment (Bowlby, 1969). Sims (2000) randomized 26 couples in which at least one partner had been rated as insecurely attached to EFT or a waitlist control group. Couples in the EFT treatment condition increased their attachment security (and decreased attachment-related avoidance) more than the control couples. 

Trauma-Focused Cognitive Processing Therapy

Trauma-focused cognitive processing therapy (CPT) focuses on changing the dysfunctional beliefs associated with trauma. Trauma during our early attachment years impacts our attachment functioning, thereby shaping how we related to others in romantic relationships. CPT offers hope for couples in that an insecurely attached partner, who has been the victim of trauma, can participate in this mode of treatment to improve functioning. In Rimane, Steil, Renneberg, and Rosner’s (2020) study, individuals who participated in CPT experienced reduced avoidance attachment (insecure) behaviors when assessed post-treatment.

Dyadic Regulation Processes

Dyadic regulation processing occurs in couples therapy and is designed to improve attachment-relevant dyadic interactions between them. Applying the Dyadic Regulation Processing Model, researchers evaluated how partners can buffer the impact of their partner’s anxious resistant or avoidant behaviors due to their insecure attachments. Overall, Simpson and Struthers (2013) videotaped romantic couples discussing relationship problems identified by one partner who wanted changes in the other partner. Results indicated that insecurely attached partners whose partners displayed more softening exhibited less anger and withdrawal, and their discussions were more successful. These partners buffered their insecurely attached partner’s responses by learning to be sensitive to their autonomy needs, validating their viewpoint, and acknowledging their constructive efforts and good qualities.

Partner Relationship Mindfulness

General mindfulness is defined as the awareness of what is happening in the moment. In their study, Gazder and Stranton (2010) defined relationship mindfulness (RM) as open or receptive attention to and awareness of what is taking place internally and externally in a current relationship. They found that an individual’s own daily relationship mindfulness did not buffer the effects of their own insecure attachment on same-day relationship behaviors, but their partner’s daily relationship mindfulness did. In essence, you can buffer the impact of your partner’s insecure attachment behaviors by increasing your own relationship mindfulness. Therapy is a great place to learn how to practice relationship mindfulness techniques.

Partner with Someone with a Secure Attachment Style

As outlined, various treatment interventions can move an individual and couple towards more secure attachment relating. At this point, you may be thinking that hope is only achieved within a therapeutic setting. I have good news for you. If you are a securely attached individual, you play an important role in your relationship with an insecurely attached partner. Experiencing secure behaviors within romantic relationships can reduce representations of insecure attachment style (Park, Johnson, MacDonald, & Impett, 2019). How romantic! Your secure attachment behaviors can provide a secure base for your insecurely attached partner to grow. In the context of your relationship, you and your partner will experience many life events together. In their most recent study, Fraley, Gillath, and Deboek (2020) found that life events could change attachment style presentations in adulthood, with some changes yielding an enduring pattern.  

What Lies within Our Power?

We cannot go back to our childhood and choose caregivers that would prevent us from developing an insecure attachment style. We, therefore, cannot prevent the impact of any dysfunctional early childhood attachment experiences on who we are, interpersonally, as adults. However, there is hope. We can increase our secure attachment odds by choosing partners who are securely attached. We can participate in couples therapy interventions. We can also offer a secure attachment base for our insecurely attached partner. Attachment styles do not equate to fixed potential in your relationship – there is always room for growth. 

If you’re ready to explore how therapy can help you and your relationship, click through to find a couples therapist near you.

References

Ainsworth, M. D. S. (1979). Attachment as related to mother-infant interaction. In Advances in the study of behavior (Vol. 9, pp. 1-51). Academic Press.

Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.

Bowlby, J. (1980). Loss: Sadness & depression. Attachment and Loss (vol. 3); (International psycho-analytical library no.109). London: Hogarth Press.

Bradbury, T. N. (1998). The developmental course of marital dysfunction. New York: Cambridge University Press.

Gazder, T. & Stanton, S. C.E (2020). Partners’ Relationship Mindfulness Promotes Better Daily Relationship Behaviors for Insecurely Attached Individuals. Int J Environ Res Public Health. 5;17(19):7267.

Hazen, C., & Shaver, P.R. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524.

Johnson, S. (1996). The practice of emotionally focused marital therapy: Creating connection. New York. Brunner/Mazel.

Johnson, S. (1999). Emotionally focused couples therapy: Straight to the heart. 

In J. Donovan (Ed.), Short term couple therapy (pp. 14-42). New York Guilford Press.

Fraley, R.C., Gillath, O. & Deboeck,P.R.(2020, August13).Do Life Events Lead to Changes in Adult Attachment Styles? A Naturalistic Longitudinal Investigation. Journal of Personality and Social Psychology. 

Kim, S.‐H., Baek, M., & Park, S. (2021). Association of parent–child experiences with insecure attachment in adulthood: A systematic review and meta‐analysis. Journal of Family Theory & Review.

Overall, N.C., & Simpson J. A.( 2013) Regulation processes in close relationships. In: Simpson JA, Campbell L, editors. The Oxford handbook of close relationships. New York: Oxford University Press; 2013. pp. 427–451.

Park, Y., Johnson, M. D., MacDonald, G., & Impett, E. A. (2019). Perceiving gratitude from a romantic partner predicts decreases in attachment anxiety. Developmental Psychology, 55(12), 2692–2700.

Rimane, E., Steil, R., Renneberg, B. & Rosner, R. (2020). Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. European Child and Adolescent Psychiatry.

Sims A. Unpublished doctoral dissertation. University of Ottawa; Canada: 2000. Working models of attachment: The impact of emotionally focused marital therapy.

Tmej, A., Fischer-Kern, M., Doering, S., Hörz-Sagstetter, S., Rentrop, M., & Buchheim, A. (2021). Borderline patients before and after one year of transference-focused psychotherapy (TFP): A detailed analysis of change of attachment representations. Psychoanalytic Psychology, 38(1), 12–21.

By Gary Trosclair, DMA, Licensed Clinical Social Worker

Do you really have OCD? Or is it OCPD?

OCD has become a household term we casually use to refer to anyone who needs to have things a certain way. As a casual term, it works well. It gives us a general sense of what’s being described. But if it’s used as an actual diagnosis to determine therapeutic treatment, it can cause problems. People who we might casually say have OCD may actually have a different condition, and the differences between these conditions call for a different approach to treatment.  

OCD, Obsessive-Compulsive Disorder, may look similar at first to a different condition, OCPD, Obsessive-Compulsive Personality Disorder, which is often overlooked and even misdiagnosed by clinicians. But OCD is an anxiety disorder, while OCPD is a personality disorder.

Diagnostic Difficulties

Far fewer people have OCD than have OCPD: 1.2% of the population has OCD,[1] while as much as 7.9% has OCPD.[2]   

About 20% of the people who have OCD also have OCPD,[3] making it difficult to distinguish between the two. And both diagnoses can be either severe or less-debilitating. Many people have some traits of Obsessive-Compulsive Personality Disorder but do not meet the full diagnostic criteria. These individuals can be very productive and fairly well-adapted socially.

Proper diagnosis should be completed by a licensed mental health professional. But following are some fundamental differences that may help you to better understand yourself in either case.

Symptoms: Specific vs. Generalized

People with OCD have specific obsessions (thoughts that are intrusive, involuntary, repetitive, irrational, and anxiety-provoking) and specific ritualistic compulsions (repetitive behaviors they can’t stop, such as checking and washing). On the other hand, the entire personality of someone with OCPD is affected by an overwhelming need to prioritize control, perfectionism, and order.

While people with OCD may try to control very particular things in order to quiet their obsessions, people with OCPD tend to be controlling universally. It’s as if the space they need to control is much larger. It’s not just the cupboards, it’s their entire world, and they can become very rigid about it.

Emotional Differences

People with OCD are more likely to feel anxious when specific things aren’t the way they want them to be. People with OCPD are more likely to feel angry if things aren’t the way they believe they should be.  

For instance, Angie, who suffers from OCD, is concerned about how the dishes get washed because she feels anxious if they aren’t absolutely clean.

But Arthur, who suffers from OCPD, insists that the correct thing is to have the entire house in order all the time. People with OCPD may justify their efforts to control by trying to prove that their way is the right way. They feel that they are trying to do the right thing to make life better for everyone, and their efforts can be helpful. But in many cases, they may become rigid in their actions, and, contrary to their motivations, they can make things more difficult for others.

People with OCD don’t necessarily restrict their emotions. However, they do try to control their thoughts (which can range from mildly uncomfortable to very disturbing) by doing compulsive things, such as repetitive and ritualistic cleaning and checking. 

But people with OCPD often try to control their emotions as well as their environment. They’re known for delaying gratification. They often give priority to their work, neglecting relationships and their own wellbeing. The emotions they are most aware of are anger, frustration, and resentment. They are more reluctant to be vulnerable than those with OCD, and may not even be aware of any underlying anxiety.

Angie gets anxious if the top is off the toothpaste tube because she fears germs. Arthur gets angry because it’s wrong to leave it off.

Shame or Pride about Their Condition

People with OCD don’t like their obsessions and compulsions and willingly seek help.

People with full-blown OCPD, because they try so hard to live their lives according to moral principles, are very proud of the way they live and don’t understand that they have a disorder. They tend to seek help only when forced to do so by a partner or when they become so depressed from trying to live with such demanding standards that they can’t go on that way any longer.

Motivations

People who have OCD are motivated to stay safe and to prevent catastrophes. People with OCPD are more motivated by rules and perfectionism. While they may justify their control by pointing to possible catastrophes, their underlying motivation often has more to do with wanting to avoid chastisement, blame, or failing to fulfill their responsibilities.

People with OCD are more clearly motivated to relieve their anxiety. While people with OCPD may also have underlying anxiety or a fear of being abandoned, their conscious concern is that they want to be respected rather than criticized.  

Behavioral Differences

While people with OCD may often behave in an insecure way because of their obsessions and compulsions, people with OCPD may become domineering, trying to hide their insecurities from themselves and others.  

People who have OCD spend much of their time in compulsive rituals such as cleaning and organizing. People with OCPD spend more time planning and working.

OCD efforts are usually maladaptive, except insofar as it helps them to maintain good hygiene. In contrast, some OCPD traits can be adaptive in a practical way, allowing them to succeed in the outer world, even if it makes them very unhappy. Because they are very conscientious, meticulous, energetic, and committed, they can make significant contributions in many fields, from art to public service to accounting. Most successful performers and athletes are compulsive to some degree.

Differences Among Compulsive Personalities

There are wide variations in the degree of unhealthiness among people with compulsive personalities, based on how controlling, perfectionistic, and rigid they are. Some, who don’t technically have OCPD but only have some compulsive traits, have very few maladaptive symptoms and can be very helpful in planning, organizing, and getting things done.

And there are wide variations in the style of compulsive personality: some are domineering, some are workaholics, some are compulsive people-pleasers, and others are so obsessive about getting things just right that they can’t get anything done.

Treatment

There is significant research to demonstrate that targeting the specific symptoms of OCD, as short-term Cognitive Behavioral Therapy (CBT) does,[4] can be effective for treating OCD.

There is far less research regarding the treatment of OCPD. In fact, according to psychologist and researcher Anthony Pinto, “there is no empirically validated gold standard treatment for OCPD.”[5]

However, there is reason to believe that approaching OCPD treatment by targeting specific symptoms may not be as effective as it is for OCD because of the pervasive nature of personality disorders. OCPD may benefit from a longer course of treatment in psychodynamic or expressive therapy.[6] This approach can help the individual to understand the possible benefits of their inherent personality style and to understand how those same traits can turn destructive when taken to extremes. Psychodynamic therapy can help them develop a better relationship with their emotions and use their need for control and perfectionism in a healthier way.

Getting to the Root Causes of OCPD

The causes of OCPD include genetic, environmental, and dynamic factors. These dynamic factors include the strategy the individual unconsciously adopted to cope with their particular combination of inherited traits and family situation. We can refer to these dynamic factors as old tapes, triggers, complexes, schemas, or patterns that they play out unwittingly, as if they were still living in the past with their families.

Attempting to treat the systemic, unconscious, and underlying character organization of OCPD by targeting just its external manifestations may not shift the underlying causes.

For example, some compulsives cope with their anxiety by externalizing, by getting those around them to do what they think should be done so that they feel safer. Other compulsives cope by internalizing, by taking too much responsibility on themselves and becoming people-pleasers to avoid a feared abandonment.

In most cases, people with OCPD feel a great need to prove themselves, and they attempt to do so with perfection, order, and control.  

Whatever the underlying dynamic, a therapeutic experience that gives the individual a chance to identify their specific coping strategy by seeing their old tapes play out in session with a therapist can be very effective. Does the client try to control the therapist? Does the client try to control his own emotions in session? Do they try to prove to the therapist that they are ethically good? This process often requires patiently developing awareness of emotions and the capacity to tolerate them in session, rather than reacting to them by trying to control themselves or the therapist.

The Potential Benefits of Compulsive Personality

If your basic character style is compulsive by nature, you won’t be able to change that. But you can begin to use your natural meticulousness, conscientiousness, and tendency to plan in a healthier, more conscious way that works well for you and the people around you. This can’t happen if efforts to change includes only trying to eradicate symptoms.  

I have referred to anxiety and a need for respect as motivations for the individual with OCPD. But on an even deeper level, they are motivated by a desire to help, plan, and repair in ways that can benefit everyone. Finding that original motivation can equip the OCPD sufferer with insight and direction, which can help them to heal and to be more helpful to those around them.

Footnotes

[1] National Institute of Mental Health website. Obsessive-Compulsive Disorder. https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd.shtml. Retrieved 12.23.20.

[2] 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.

[3] Mancebo, M. C., Jane L Eisen, Jon E. Grant, Steven A. Rasmussen (2005). Obsessive Compulsive Personality Disorder and Obsessive Compulsive Disorder: Clinical Characteristics, Diagnostic Difficulties, and Treatment. Annals of Clinical Psychiatry, 17(4), 197-204. doi:10.3109/10401230500295305

[4] Foa, Edna B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience. Jun; 12(2): 199–207.

[5] 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.

[6] Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98-109. doi:10.1037/a0018378

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