Using writing, and meditation, and ice cream, and reading, and dreams,

and a whole lot of other tools to rediscover who I am,

after six years living with a man with OCPD.

Tuesday, March 8, 2011

Too Perfect Tuesdays - Chapter One- The Causes of Obsessiveness

This post continues with The Causes of Obsessiveness, from Chapter One.

This series will look at a small snippet of The book on the Perfectionist Personality, aka The Obsessive Compulsive disordered Personality, aka OCPD, each week. Please follow along, leave your comments, engage more on the FaceBook website... whatever your heart calls you to do.

Too Perfect, When Being in Control Gets Out of Control by Allan E. Mallinger, M.D. and Jeanette DeWyze was published by Random House in 1992. 

...happened to have in common a parent whose love seemed conditional, tied to such things as how well they performed, and how "good" or capable they were.  Because they also perceived their parents as critical, negativistic, and hard to please, these bright, sensitive children felt caught in a no-win situation, never feeling that they were good enough - never feeling secure.  Similar stories about childhood experiences are common in my practice.

Let me stress that patients in therapy are reporting their perceptions of their early childhood experiences.  It may well be that the person who will become strongly obsessive perceives his world and its expectations of him differently from other children.

...the parent's behaviors and apparent attitudes reflected self-interest and often a lack of empathy for the child.  ..."I remember having to take piano lessons, which I hated.  My parents made it sounds as if it was for my own good, but it wasn't.  They both had wanted to study music but had been unable to do so."  Another patient put it this way: "My parents insisted on being in control, and it took all the starch out of me.  Over time my spirit was eroded, broken."

Many patients have reiterated this experience: conformance to family and social rules having more importance to the parents than whatever the child was thinking, feeling, wanting, or fearing.   A significant number of my obsessive patients reveal that they didn't feel liked by one or both parents  These patients felt they'd been "good" children and had made real efforts to meet their parents' expectations, only to find a lack of consistent appreciation, or worse, criticism. 
I believe that - to some extent - perfectionism, caution, drivenness, and other obsessive traits are indeed adaptations.  They not only quell some of the anxiety engendered by early feelings of insecurity, but also garner many obvious payoffs.  Still, it is overly simplistic to conclude that early childhood experiences alone cause people to develop obsessive personalities.  Humans are infinitely complex, and while family and subcultural values are hammer and anvil, to a point, the persons genetic and constitutional makeup is the "ore."  
Scores of parents have told me of children who seemed picky, perfectionistic, contemplative, and cautious, almost from birth.  "I remember making Christmas cookies with Max when he was barely two years old," one woman told me.  "When a little piece of dough remained wedged in a corner of the cookie cutter, he insisted I throw the offending cookie away.  I told him that the cookie was just fine, but he burst into tears and wailed that it wasn't perfect, so he wouldn't eat it.  It was crazy!  Later, in nursery school, he refused to fingerpaint with the other children; he thought it was too messy." 
It wouldn't surprise me if scientists one day discovered specific biological underpinnings favoring the development of any of several personality styles, including the obsessive.  Certainly the trend in psychiatry in the last several years has been to discover that more and more psychological and psychiatric problems such as schizophrenia and mood disorders have strong biological roots.

In sum, the likeliest hypothesis as to the cause of obsessiveness is that some people have a constitutional predisposition for being obsessive, and it can be enhanced or minimized by early-life perceptions and experiences.
This nature vs. nurture debate has raged on many of the boards I've visited.  I tend to believe Dr. Mallinger has it right - inborn tendencies, either fed or defused by parenting strategies.

While many people do remember, usually with much emotional pain, failing to please a hyper-critical parent (Tiger Mom are you listening?) the missing part of the puzzle is whether or not that parent behaved in a hyper-critical way because s/he had an obsessive personality.  If so, if that is inborn, then the unlucky child gets a double dose of OCPD - the genetic tendency passed along by the parent, plus an adaptive/survival behavior.

Here's why I lean towards genetics - slash - predisposition:

1) As I have come into contact with Perfectionist Personalities and their SO's all over the world - the behaviors are the SAME.  A middle class woman in Florida, a young Danish father of three, a well-to-do man in Australia, a young mum in the UK, husbands of Middle-Eastern descent.  Jews, Christians, atheists...  Granted I have only come to know those who (or whose partners) can communicate in English, but why does it sound like they are ALL reading the same script?  Surely if this was cultural, there would be significant differences, and there aren't.    (Most American obsessives might hoard, for example, while most New Zealanders would worry about kitchen counter germs.)  These people were not all raised in the same manner, yet their controlling behaviors are the same.  (Not that there aren't minor differences.)

2) Not all have stories of controlling or harsh parents.  My ex b-f did not, nor do many others.  He does, on the other hand, recall painfully laboring over various tests in elementary school, unable to finish a test because he had to make sure that he examined all possible meanings of each question, and every possible answer, and only then could he finish that question, and move on to the next.

3)  Meds help.  For those on, or who have partners on various anti-anxiety drugs, the transformation and decrease in anxiety levels and obsessive behaviors is almost miraculous.  (Of course, not all drugs are suitable for all people, and adjusting dosages, finding new drugs when body systems become acclimated to old ones is an arduous journey in and of itself.  It's not a matter of simply take a pill and life is good.)  Others find much relief in 12 step programs and/or meditation and mindfulness exercises, either instead of or in addition to medications.  But the relief of chemical magic points to something being off-kilter in the brain, that the right meds can help balance.  Or, at least, meds interrupt the obsessive "rut" long enough that through practice, new behaviors can be formed and old habits broken.

4) There does seem to be some link between OCPD, Aspergers, and ADD.  There are some with OCPD in the family who also have autism or Asperger's in the family, pointing to a genetic similarity.  There are many who report their doctors think they might have OCPD (if already diagnosed autistic), or autistic if already diagnosed OCPD, and many share the same kinds of sensory overload issues reported by those living with an OCPDr (sensitivity to noise, light, odors.)  Again, this points towards something present in the brain at birth, rather than purely an adaptive personality mechanism.

Another intriguing possibility - that life experiences several generations back might have changed DNA. 
Scientists at Australia’s University of New South Wales fed healthy, svelte, male rats a high-fat diet (43 percent of calories from fat—a typical American diet). Not surprisingly, the rats put on weight and fat, and developed insulin resistance and glucose intolerance—basically, type 2 diabetes, the scientists reported last month in Nature. None of that was surprising. What made the scientists take notice was the daughters these rats sired: although their mothers were of normal weight and ate a healthy diet while pregnant, daughters of the high-fat-diet dads developed insulin resistance and glucose resistance as adults—even though they never ate a high-fat diet themselves.  (from Sins of the Grandfathers: What happens in Vegas could affect your offspring.  How early-life experiences could cause permanent changes in sperm and eggs.)

Hopefully, we'll never know what genetic changes might
occur as a result of a love affair between a human
and a rat.  For either species.
On the one hand, it doesn't really matter what causes this disorder.  What matters is how to make it less horrible for those who have it and those who live with them.  But then again... you kind of have to know where it comes from.  In the example of the rat daughters, above - their diabetes isn't coming from a poor diet, so simply saying, "No more chips for you!" isn't going to solve the problem.

Hopefully, someday there will be more research into this subject, and real help available for those with OCPD.

 If you are (or know) someone with OCPD - did s/he have a parent with OCPD?
Or hyper-critical?  Or both?  Or neither?
Was there OCPD or autism-spectrum disorders in the family of origin?