RIGID PERSONALITY or Obessive Compulsive Personality Disorder

In response to my previous article regarding Dissociative Identity or multi personality disorder, a reader commented that conversely there are those who lack sufficient fragmentation in their personalities and that this condition represents the polar opposite of DID.  This inspired me to research behavioral patterns that I have observed and dealt with for many years but have never thought of in terms of "mental illness".

Looking up the first phrase that came to mind, "rigid personality", I immediately found several articles pertaining to the subject.  Ah yes, the inflexible one, I know thee all too well, and I’ll bet you do too. But what I wanted to know was if this is just a case of someone with a “difficult or stubborn nature” or symptomatic of an underlying psychiatric condition?  It depends.

All traits (objective and behavioral), including those associated with mental disorders, fall somewhere along a wide continuum between two equal and opposite poles, just like everything else in nature. Abnormal is measured by the deviation from a statistical center point representing equilibrium or “normal”.  It is easy to understand how too much “disorder” would be considered abnormal; however, too much “order” renders one inflexible.  For instance, the disordered structure of an unstretched rubber band renders it unstable and weak while the highly ordered structure of glass makes it brittle and prone to breakage.  Equilibrium is found in the middle – equally pliable and strong (think fiberglass reinforced rubber tires).

An overly rigid personality can result in difficulties in a range of areas including, but not limited to:

• Communication and interpersonal skills - both verbal (spoken) and non-verbal (unspoken) such as the ability to open up and share one’s emotions; understanding or caring what others think and feel (empathy); and maintaining and holding a meaningful conversation

• Perception - processing visual and audiological stimuli such as understanding the subtle nuances of humor and sarcasm; reading body language and facial expressions; deciphering intonation and context; spatial manipulation; and artistic ability

• Obsessive behaviors - such as repetition of words or actions, fidgeting, uncontrolled movements (tics) such as blinking or muscular twitches, obsessively following routines or schedules, perfectionism, ritualistic behaviors, or as often found in the workplace - the "Micromanager"

• Lack of flexibility in attitude, opinion, and perception

• Low stress tolerance levels, poor anger control, increased reactiveness

Several of these issues can be found in those suffering from pathological conditions such as Asperger Syndrome or other Autistic Spectrum Disorders (ASDs), Post Traumatic Stress Disorder (PTSD), Senile Dementia, and Obsessive Compulsive Personality Disorder (not to be confused with Obsessive Compulsive Disorder/ OCD), among others.

While Obsessive Compulsive Personality Disorder or Rigid Personality may be associated with a pathological condition, ergo “Nature”, it may have roots in one’s upbringing, environment or cultural background, thus “Nurture”.   It can be learned as a child through the example of those around us.  It may result from excessive discipline, parental pressure, or when a child is made to feel they that nothing they do is right or good enough.  For some it may be a coping/survival mechanism when faced with extreme trauma, abuse and/or brainwashing.  While rigidness may signal a personality disorder it can also viewed as a desirable trait when associated with genius, self discipline, success and leadership.

Those with OCPD rarely change throughout their life nor do they have a desire to so.  They can be highly opinionated, close minded and unyielding.  Don't try to confuse them with the facts - their minds are already made up.  Their commitment to and confidence in their ideals is only matched by the verbosity in which they defend them.  This often leads to conflict with others resulting in stress and frustration, which needless to say, they blame on others.  OCPDs rarely recognize or seek help for their condition.

They have a fixed way of doing things. Usually left brain dominant, they tend to be obsessively neat and organized, striving to keep things under control, always searching for new ways to increase efficiency and productivity while keeping a close and steady eye on the bottom line.  Highly focused and determined they tend to measure their self worth through their finances, careers/interests and their accomplishments rather than their interactions with or relationships with others. These are the types that are married to their jobs. They tend to be perfectionists and become easily irritated and annoyed when their expectations are not met.

Social and communication skills are problematic.  Friendships often fail under the weight of their demands for others to conform to their ways and views.  A highly volatile, argumentive and confrontational nature pushes others away.  Their rigid attitudes of what is “right and wrong” can be extremely overwhelming.  They may be prone to taking prejudiced, biased, discriminatory and condescending stances while lacking the implications of their words and actions.   Unable to openly express feelings and or emotion, they may appear to be stoic and unempathetic to others.  Even those closest to them may find it impossible to break down the barriers that separate them from the rest of the world.

You don't have to look far to find this personality in action. Just look among the Who’s Who in politics and business, famed divas and dudes of mass media, religious zealots and pontiffs, and the movers and shakers of math and science. The top 1% is teeming with them. They make great lawyers, actuaries, and accountants. The last thing you need is a lawyer who changes his mind during an argument or an accountant that estimates rather than calculates.

On the other hand, they may be closer at hand among your friends, family, neighbors, clients and colleagues.  Many a men will swear their mother-in-laws are OCPD.  The younger generation will see it in the “old” (that is anyone over 35), and they in turn may recognize it in anyone who qualifies for AARP membership. Employees assert that their bosses suffer from it.  Doctors complain about dealing with “difficult” patients all the time.  And I’m sure countless husbands will recognize these traits in their wives and claim they have it for at least a week out of every month.  The holidays seem to bring them out in droves in the form of irritating houseguests.

OCPD may make a person unreachable, an unstoppable and unmovable force, a fierce competitor or simply a pain in the ass.  When dealing with those with extremes of this disorder, remember that each one has a unique story behind how they ended up that way and may suffer from deeper issues that are not apparent on the surface.  Don’t argue with them because it’s a battle you will never win and it only serves to fuel the fire.  A smile and nod works wonders to disarm them even if inside you are stomping mad and screaming “NOOOO!”  Winning their approval, a word of praise or getting them to agree with your ideas is an exercise in futility.  It’s best to gently suggest and let them think they thought of it first.  Most of all remember two things: 1) These traits are on a continuum of varying degrees and we all are OCPD to one extent or another which is probably why it’s so easy to see it in others, and 2) Whether someone is overly flexible or rigid, we can learn something valuable from their example.

WHAT IS DISSOCIATIVE IDENTITY DISORDER (DID)?

Multi-Personality Disorder (MPD) or Dissociative Identity Disorder (DID) is defined as the presence of two or more distinct personalities that continually exert power over the behavior, actions, perceptions, memories and appearances of the person or host, often accompanied by amnesia or the inability to remember events occuring from one state to the next.

This condition has been subject to debate in medical, social, anthropological, philosophical, religious, legal and public arenas for years.  On one side, we have the skeptics who believe this is a manifestation of the power of suggestion during hypnotism, false memories, deception, or the old standard - “hysteria” (talk about one large step backwards).   Conversely, there are countless professionals who see this as a serious illness in which a personality becomes so severely fragmented, that the various parts are no longer able to connect with one and other.

It has been used as a defense in courtrooms, creating contention between forensic psychologists and prosecutors.  The question becomes - When an "alter" has allegedly has committed a crime, who should be held accountable - the host or alter ego?  And how do we handle the logistics of sentencing one or the other?

So what causes this disorder? Can it easily explained away by misfiring neurons or electrical impulses within the brain?  Is it biologically or chemically induced?  Some might argue that it involves possession by an unseen entity.  Others may believe that the patient is momentarily lost in the time/space continuum slipping from one quantum dimension into another.  Maybe it’s a primitive behavior allowing one to adapt to a given environment or situation?  Does the Freudian Conscious Theory offer the answer?  There are as many concepts as misconceptions, variables and presentations, and most of all – questions yet unanswered.

We have all experienced moments of dissociation, whether while daydreaming, getting caught up or lost in the moment or simply zoning out.  There are times we get a little carried away when trying to make an impression or fitting in with the crowd.  Altered states of mind are induced by meditation, hypnosis or sleep.  At times we may “act out of character” leaving us questioning how we could possibly be so brilliant, utterly reckless and stupid or anything in between. We often “pass the buck” uttering clichés such as “The devil made me do it”, “I took a leave of my senses”, “It was divine inspiration”, or “It was the alcohol/drugs/disease talking.”

Intentionally or not, we may forget events or moments through a number of mechanisms including “selective memory”, yet another coping mechanism. Although this ability comes naturally for most, research led by Gerd Thomas Waldhauser, from Lund University in Sweden has shown that we are capable of training ourselves to forget or repress traumatic, embarrassing or unpleasant memories if we suppress them long enough. As quoted by Letitia Landon: “Were it not better to forget than to remember and regret?”

If we combine these factors with the dynamics of the human mind, an infinite number of results may occur depending on individual circumstances.

Our “personalities” are a highly complex and unique conglomeration of traits that influence cognition, motives and behaviors in response to various stimuli.  They may include adaptive or maladaptive aspects.  Certain traits may seem insignificant or merely of nuisance value.  For most of us, the brain is capable of filtering through this, compartmentalizing various aspects and qualities in an effort to avoid cognitive dissonance or the anxiety produced when faced with contradicting information or perceptions.  In turn, we may create a separate identity or “alter ego” that behaves contrary to the standards we were brought up with or one that is more effective in dealing with particular stresses or triggers.  When heralded by circumstance or chemical influence, they may become distorted and greatly amplified.  For most this is a fleeting moment, or until the effects of a given substance has worn off.  For others, however, it may become a way of life, consciously or subconsciously.

Dissociation is an innate survival mechanism that kicks in to protect us against pain, stress, anxiety, guilt or shame that is more than our minds can handle.  However, when one struggles with condition such as Borderline Personality disorder (BPD), the response may become ingrained as a means of coping.  Self-perception becomes highly distorted and personality, highly fragmented and disconnected.  In order to deal with the overwhelming chaos of mixed emotions and associated characteristics and behaviors, the psyche splits them, assigning them to separate entities.

The creative mind breathes life into each new persona giving them their own unique history, memories, appearance, voice, mannerisms, characteristics and means of expressing themselves.  This is a defense mechanism brought on through a desperate need for validation and acceptance. Although this may seem foreign and disconcerting to others, this action enables the patient to display repressed characteristics/emotions, giving them a voice and visibility to the outside world.  

Having faced this condition myself as a young adult, I can best explain it in terms of viewing oneself in a full-length mirror.  As long as its surface is smooth, it reflects back a true image of you as a whole. Distort or manipulate the surface with abuse, trauma, neglect (mental, physical or emotional), and you will see what those responsible want you to see.  If the stresses exerted upon it become too much, the mirror will shatter, as does your psyche.  Each piece is different, offering its own distorted reflection of limited aspects of us.  When we try to put the mirror back together, or “reintergrate” the pieces, it may not reflect the original image.  Some fractured pieces may be missing or damaged. Others may no longer fit.  However, this is not always a bad thing.  As beautifully quoted by Barbara Bloom ~ “When the Japanese mend broken objects, they aggrandize the damage by filling the cracks with gold. They believe that when something's suffered damage and has a history it becomes more beautiful.”

Alters come and go depending on triggers and circumstance.  Some may be aware of each other and are able to converse.  On the other hand, there are those that step in, pushing others aside.  When this happens, it feels as though an unwelcome guest has barged in and taken control of your mind and body.  In my experience, amnesia may or may not occur.  I don't believe this is a "one size fits all" condition with easily defined borders.  In my opinion, each presentation is as unique as the individual experiencing it.

It is important to note that, although it may seem as though an individual is "acting", true DID is not a controlled exercise or dramatic performance intended to fool and manipulate others.  Unfortunately, as with so many things, there have been those who have muddied the waters for their moment in the spotlight or financial gain.

"Sybil”, the 1973 acclaimed novel/movie described the treatment of Sybil Dorsett who suffered from Multi-Personality Disorder and sparked a revolution in popular psychology. It’s no surprise that this resulted in an enormous increase in the number of cases diagnosed, as fads and fashion are often products of the media. The public, as well as medical community were eager for answers and thus became subject to the power of suggestion. The question became – was this story true or was someone trying to pull the wool over our eyes? According to Sybil Exposed, a new book by author Debbie Nathan, the answer is “readers beware”; most of the story is based on lies.  Questions regarding the patient’s and therapist’s motives, honesty, and the possibility of false memories planted as the result of hypnosis have been raised. However, as misguided as this case may have been, it is not grounds for dismissing DID nor the countless recorded cases of it.

More recently the subject was resurrected and given a new life in the popular TV series “The United States of Tara”, a comedic drama created and produced by Steven Spielberg which began airing on Showtime in 2009. Once again, the plot revolved around a female suffering from DID.  However, in this case, it was portrayed as a condition that one could live with given a supportive family along with proper treatment. While it shed light on a deeply stigmatised condition, the unprompted and sudden changes in character were sprinkled with an overdose of creative license, designed to entertain rather than to represent “real” patients (although I do not discount the fact that some may relate to this type of expression by alters).

Whether you suffer from DID or know someone that does, understand that it is a coping mechanism that kicks in when facing painful or traumatic events, or when perceived triggers threaten us. By nature, we try to reduce anxiety and confusion by attempting to oversimplify the human psyche as we are challenged to fit square pegs into round holes. Each alter ego is a part of us and serves a purpose, in spite of whether it strengthens us or trips us up.

Acceptance is crucial as each alter has a story waiting to be heard and issues that need to be resolved before it can return to its rightful place in the bigger picture. Look for the main root, the time and place of birth of alter and address the deeper issues.  In time, the coping mechanisms will no longer be necessary. Most of all remember, each ”personality” is part of a soul trying to find its way home.

PSSD or Post SSRI Sexual Dysfunction

PSSD stands for Post SSRI Sexual Dysfunction.

It is estimated that up to 50 - 80% of patients that take SSRIs (Selective Serotinin Reuptake Inhibitors or antidepressants) suffer from sexual dysfunction to one degree or another.  This may occur while taking the drug or upon discontinuation of use.   The actual numbers are difficult to confirm as many people may feel uncomfortable discussing intimate issues with their physician out of shame, embarrassment or fear of stigma.  It should be noted that PSSD can occur on mild-high dosages, short-long term treatment and when  discontinuing SSRIs. Every person is different and no two cases are the same.  Dysfunction may last from weeks to months, or permanently in some cases.

PSSD may include:

• Low or non-existent libido or sexual drive
• Anorgasmia or muted, premature, delayed or absent orgasm or ejaculation 
• Sexual Anhedonia - reduced or lack of pleasure during orgasm or ejaculation 
• Vaginal dryness or reduced lubrication
• Decreased vaginal, clitoral or penile sensitivity, ranging from mild to complete genital anesthesia
• PGAD or Persistent Genital Arousal Syndrome in women unrelated to desire.  Similar to Restless Leg Syndrome, this condition and can be extremely dibilitating, uncomfortable or even painful. ^
• Spontanious orgasams or ejaculations
• Priapism - erection lasting 4 or more hours, a potentially harmful condition considered to be a medical emergency that can result in permanent vascular damage
• ED - inability to develop or maintian an erection of the penis
• Loss or decreased response to sexual stimuli (visual or physical)
• Reduced semen volume
• Impotency

FDA-approved indictaions for treatment with SSRI's include: ^

Depression
OCD or Obsessive - Compulsive Disorder 
Bulimia Nervosa
PMMD or Premenstrual Dysphoric Disorder
Panic Disorder
PTSD or Post Traumatic Stress Disorder
GAD or Generalized Anxiety Disorder
Social Phobia

 "Off Labeling", or the practice of doctors prescribing these drugs for indications for which they have not been approved  is rampant. Such conditions include:

Alcohol Dependency
Chronic Pain
Fibromyalgia
Back Pain
Migraine Headaches
Diabetic Neuropathy
Anorexia
Binge Eating

and of all things - Sexual Dysfunction.  This is simply criminal. The only sexual dysfunction SSRIs have been shown to effectively treat is premature ejaculation, while still potentially causing the other undesirable effects mentioned above.  Additionally, it requires continuous daily use to prevent this problem.   Only two drugs have shown promise in immediate & occasional use: Chlomipramine and Viagra.

If we return to the first and primary indication for antidepressants, namely DEPRESSION,  first it must be recognized that among the most common symptoms are low or non-existent sexual desire and dulled ability to experience pleasure.  If this is already an issue you are concerned with, careful consideration should be taken before beginning treatment with SSRIs. The last thing you want to do is make a bad situation worse.

SSRI's have been shown to be highly effective in improving mood, alleviating self- loathing, revitalizing energy, and returning a sense of normalcy to the depressed individual, which is why they are used as a first-line treatment by medical doctors and psychiatrists.  It should be noted, however, they also have been shown to reduce inhibitions,  give rise to suicidal thoughts and tendencies, cause aggression and mania, induce insomnia and restlessness, and may lead to Bipolar Disease.  However, the most counterintuitive side-effect of all - Antidepressants may cause Depression.

Unfortunately, the medical community heavily uses these drugs in children and teens, exposing them to the risks of reduced sexual pleasure, performance and impaired reproductive abilities as they mature.  Already studies have shown that while the number of teens receiving these drugs is increasing expoentially, sexual activity among the same group has been on a downward trend.  For those looking to promote celibacy, lowering the risk of teen pregnacies, or reducing population growth this may be a bonus, however, the long term effects may not be as positive as one would hope. Additionally, parents should be careful making decisions for their children, that could have life-long impact on their welfare and happiness, unless they are in dire need and there are no other alternatives. It's never too early to consider these possibilities.

Contrary to popular belief, your brain is your largest sex organ. When behaving properly, it produces neurotransmitters (brain chemicals including serotonin) that  increase the communication between cells. Upon stimulation through sensory input, these chemicals signal the body  to increase blood flow to the sexual organs when stimulated and voila - sexual arousal occurs.   Free serotonin is functional (a feel good chemical).   Depression, however, can interfere with the signals. SSRI's block the re-uptake or re-absorption of serotonin into the neurons, thus improving overall mood.  Unfortunately, once again, the drugs can also cause depression both up and downstairs. These factors must be weighed out carefully.

Sexual Dysfunction for an individual can raise havoc with self- esteem, confidence, and anxiety. We live in a world where sexuality is paraded in front of our faces 24/7. Advertising, media, TV, movies, music, fashion - sex is everywhere.  It's only natural to want to live up to these "images" in spite of how inflated they may be.   While one quarter of society suffers from HSD or  Hypoactive Sexual Drive, few talk about it, leaving all too many people feeling inferior or different [while that's far from the case].  It's even more devastating when you used to have the drive, but  find it slowly fading.  Until we learn to measure ourselves as  individuals rather than being compared to artificial standards, we will continue to suffer.

Sexual problems for couples can produce stress, straining their relationship and further complicating dysfunction.  It interferes with connectiveness, intimacy, and the ability to bear children. In spite of the fact that a classic study called "Sex in America" found that 1/3 of couples were having sex only a few times a year, once again the media begs for us to believe a different story. The Social Media Gurus chant that active sexual relations, up to three times a week, should be taking place for everyone from teens to those in their 90's.  Obsession with celebrity portrayals of "Mr. & Mrs. America" on screen and pornography leaves people with unrealistic expectations. PSSD only worsens this issue unless properly addressed. A couple willing to weather the storm and take a new course though, can find new and exciting seas to sail with mutually satisfying results.

Newer antidepressants including Wellbutrin, Remeron, Serzone and Survector (not available in the U.S.) have few or no sexual side effects. ED (Erectile Dysfunction) drugs may be added. Hormones can be used to boost libdo in some cases. Couples or sexual therapy can be helpful in finding alternative methods of coping with this disorder. While PSSD or HSD is the most common complaint addressed by marital/sex counselors, millions of couples suffer in silence.

Open communication for this condition is essential.  Talk to your M.D., ask your psychiatrist if there are alternatives.  Most of all, discuss this issue with your spouce or significant other. And please - report side effects to the FDA. 

 http://www.fda.gov/Safety/MedWatch/default.htm 

Most of all, relax. You are far from alone and this is not your fault.  Don't let anyone tell you it's all in your head.  Seek help and don't feel ashamed or embarrassed. Trust me, they've heard it all before.

^ Waldinger (2008-12-17). "Persistent Imminent Orgasms in Women are Associated with Restless Legs". Science Daily (ScienceDaily LLC). http://www.sciencedaily.com/releases/2008/12/081216115010.htm. Retrieved 2009-06-20

^ Formulary

^ Drug Facts and Comparisons. St. Louis: Facts and Comparisons, a Wolters Kluwer Co; 2002.

^ McEvoy GK. AHFS DrugInformation. Bethesda, MD:American Society of Health-System Pharmacists; 2001./Source: K.C. Lee, PharmD, M.D. Feldman, MD, and P.R. Finley, PharmD