Obsessive-Compulsive Personality Disorder Treatment

The literature describing the treatment of OCPD is somewhat confusing because of a lack of clear distinction between OCPD and OCD. This is especially true of the older literature and the earlier pharmacological studies reporting efficacy in obsessional syndromes. Generally, symptoms of OCPD have not been regarded as responsive to biological interventions. Favorable treatment responses to a variety of psychotherapies are consistently described. Intensive dynamic therapies, including psychoanalysis, continue to be recommended as the treatment of choice for OCPD.

Pharmacotherapy
No medications specific for the treatment of OCPD are currently available. The serotonin reuptake inhibitors used in the treatment of OCD have not been carefully studied in the OCPD population. There are a few anecdotal reports of the efficacy of these medications in patients with OCPD, but controlled studies are lacking. Nonspecific anxiolytic agents may be used, but the chronic nature of OCPD presents the potential problem of medication dependency. Swartz (1998) reported that betaxolol, a long-acting ÞÂ-adrenergic blocker, was useful in anxious patients with OCPD. Antidepressants may be useful in OCPD patients with significant depressive symptoms. One study reported that the presence of compulsive personality disorder was a positive predictor of response to serotonergic antidepressants. Ekselius and von Knorring reported that patients with comorbid major depression and OCPD responded to sertraline or citalopram with a reduction in OCPD symptoms.

Brief Psychotherapy Short-term individual therapy may be useful for patients with OCPD, especially those in crisis. Specific, focused goals in helping the individual accommodate to change can be accomplished in a limited number of sessions, generally 10-20. Suess suggested that focusing on validation of the patient's current feelings will help to relieve guilt, self-doubt, and fear and that growth and change are possible within the limits of short-term therapy.