Feb. 7th, 2022

anankastia: (Default)
Fundamental to OCPD is a certain set of rules within our brains. These rules dictate what an optimal/perfect world would be like. We feel discomfort when our surroundings are not in fact optimal/perfect, and are not the same as what the rules dictate they should be like.

Our need for ourselves and our surroundings and the people around us to follow these rules in order to be optimal and perfect is incredibly strong and pervasive throughout every setting. This leads to us spending an incredibly long time doing things like repeatedly erasing and rewriting our work until we feel that it’s perfect, because everything we do must be perfect. We often develop eating disorders, because we need to be perfect. We try to change our surroundings so that they are perfect (i.e. by cleaning excessively). We also want to get others to do what we want in order for things to be perfect—sometimes, when we have more insight, we actively fight the urge if trying to get them to do it will violate their rights and harm them.

In the beginning, we don’t realize these needs and behaviors are detrimental to ourselves. We believe the world is wrong, not us (and we’re not entirely wrong, either!) We firmly believe that the best route to reduce our suffering, going forward, is to try even harder to achieve perfection. We never, ever think about just not doing it—our minds simply shy away from it. At least, up until we finally break, and begin to examine ourselves, to face the hard truths that we have ignored for our entire lives.

OCPD causes pain, because our world is confined by the laws of physics, as are we and the others around us. We physically and mentally cannot successfully make everything perfect. And when our needs are not met—we suffer. We feel intensely uncomfortable. Oftentimes our self-esteem lowers, because we feel as though we have failed at the task(s) most important to us.

How this relates to OCPD’s DSM-V criteria:

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.


2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).


This is caused by our perfectionism—we need things to be done the Right Way, thus we need to do those things the Right Way, and often part of The Way manifests in the form of a need to perfect details, rules, lists, order, organization, and schedules.

My best guess is that OCPD forms (apart from genetic predisposition) as a result of authority figures in our lives being too controlling, demanding too much from us, setting standards too high. So we subconsciously shift—to preempt their anger and disappointment, we decide that we need to do it perfectly, on our own, for ourselves. We develop the need for perfection so that we can find it easier to automatically perform well enough.

But it is not a healthy coping mechanism, an adaptive need. Because as with every personality disorder, there is a catch.

We go overboard with our system of perfectionism. We make the need intense, all-consuming. We close off the option of being imperfect and never think about it again because if we do… well.

We make ourselves feel happy and comfortable doing things perfectly. The more perfect, the better. We convince ourselves that our way must be the right way. We are The Best when it comes to following the rules, to turning in the most perfect work.

We don’t realize that by then, our own standards for ourselves have surpassed even our abusers’ high standards. But by then, it’s too late. The patterns are deeply ingrained, and egosyntonic to boot.

A few days ago I started thinking more in depth about the interplay between OCPD and the capitalist system. When my mother brought up, for me, the possibility of OCPD to my psychiatrist, he said that having “a little bit of OCPD” is an adaptive trait. Makes for better employees and CEOs. I disagree, for the same reasons I disagree with those who say narcissism is rewarded under capitalism.

Inherent to the definition of OCPD, as with narcissism/NPD, is disorder. If your grandiosity doesn’t come with narc injury when it is challenged, it is not narcissism. If your perfectionism/desire to do higher-quality work doesn’t come with certain drawbacks, it is not actual anankastia/“a little bit of OCPD traits.”

Like with NPD, people with OCPD overcompensate. With NPD, we create a false veneer of grandiosity far beyond what is necessary to maintain a reasonable level of contentment with ourselves and our self-esteem. With OCPD, we go overboard with our high standards. We need them too much, and we need perfectionism too much. We need things to be too perfect, even more perfect than what our superiors demand of us. We need the rules/schedules to be followed exactly or else it’s Not Good Enough.

Until we do a lot of self-examination, we are incapable of recognizing that this is not, in fact, the best way to succeed in our environment. We spend so much effort trying to perfect our work, despite our superiors not even needing it to be so perfect, until we go beyond what is actually needed. We spend so much time trying to make it exactly right, erasing and rewriting, backspacing and retyping, discarding and retrying, that we often miss deadlines.

Under capitalism (as well as school, the predecessor to us becoming slaves to the capitalist system), this becomes utter hell, because our perfectionism involves internalizing externally imposed rules and standards like we did in the process of our childhood development of the disorder, and capitalism forces upon us a lot of rules and standards and guidelines. Once we decide we have to follow a certain external rule society gives us, we begin perfecting and “improving” it.

I feel stressed when I don’t know how to correctly follow the rules. I often feel relieved when I am exempted from doing something with a lot of complicated rules or which would be difficult to optimize/perfect. Tack on a dash of autism (so I struggle to understand the intent behind allistics’ instructions unless they’re clear and literal) and (now-recovered) social anxiety which makes it difficult for me to ask for clarification, and you can see why I have meltdowns in school so often.

A key trait we experience is believing that the problem is with either (or simultaneously) 1) others, for not needing perfection as much as we do, or 2) with us, for not being good enough at working, perfect enough, skilled enough. That if we just Tried Harder, we would be able to accomplish what our perfectionism demanded. That the most efficient way to make us finally happy is to be better at working, not to take away our need for perfectionism. This is extremely difficult when we also happen to have comorbid disorders which fuck up our executive function (for me, ADHD and for a long time MDD too). I’m describing my entire life right now and finally putting my struggles into words and also kind of crying.

3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).


OCPD is not defined at its core as an “overproductivity disorder.” Nevertheless, it is an effect—nearly every second of every minute of every day, we have at least something on our endless to-do lists. We don’t really view doing those things as leisure, even if they enjoy them—they’re classified as Work, because they are something we have to do. We have to be productive 24/7, working on our to-do lists 24/7, because if we don’t—well, we don’t think about that. We just Have To. There are barely enough hours in the day for even neurotypicals to survive under capitalism, much less those of us who have to go far above and beyond even those high demands the system imposes upon us. I’m better at this now, but throughout most of my life I’ve felt very uncomfortable having anything but Work Time. I would long for free time, and at the same time yell at myself the moment I thought about having some before my to-do list was done. I joked a lot about never having any free time in all twenty-four hours of every day. I didn’t realize that this wasn’t exactly funny, or fun, or good, or normal.

4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).


One common manifestation/part of our perfectionism (I don’t really personally experience this one, but I’ll try my best to explain it here) is applying our high valuation of external rules to moral/ethical rules. As well as needing to follow them to an extreme degree, we need others to accommodate us in our attempts to follow them, leading to interpersonal difficulties.

5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.


Another common way in which our perfectionism manifests: hoarding. I used to do this a lot before I became addicted to AO3 and researching and Tumblr and the focus of my perfectionism switched. My closet is full of all sorts of weird shit I’ve collected which I refuse to throw away. I would feel suboptimal and imperfect if I threw something away, because what if I needed it later to do my work better? Which spiraled into having a whole system with the hoarding, with rules (i.e. “if you see this on the ground, you have to pick it up and take it home and put it in the collection, these are the rules for what is and is not required to be taken home based on how useful it is,” complete with full-length philosophical debates in my head arguing about what the rules should be).

6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.


Our needs are so specific and important to us, and different from everyone else’s, that no one else would, by default, do things our way. If we try to give them instructions on how we would want it done, it’s hard, because our needs are so detailed and specific that the easiest way to get the thing done the right way is to do it ourselves.

7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.


Again related to the same mechanisms behind our hoarding, and most likely an extension of a mindset of “being miserly/suffering/not allowing yourself to have good things” being imposed upon us in childhood. I’m not allowed to spend money online without parental supervision, and until I started having aspirations for online projects I never really wanted to buy anything, so I haven’t had an opportunity to struggle much with this personally.

8. Shows rigidity and stubbornness.


Basically the result of us trying to apply our perfectionistic standards to our standards. We’re rigid, we’re stubborn af, we refuse to yield to others’ suggestions because our way is, in our minds, the most perfect and optimal way.

anankastia: (Default)
Anon: I read in the DSM that people with PPD can have comorbid BPD. What does that look like? Are there any recourses or comparisons of symptoms? No rush!
Let’s start with similarities/comparisons.

 

image

I’ve complained repeatedly on Twitter about how the DSM PD criteria and descriptions usually discuss effect, not cause, and in a shallow/surface-level manner which doesn’t cut to the core of the issue. The overlap stated here is that both BPD and PPD can cause angry reactions to minor stimuli. However, it says nothing about why.

The intense anger in BPD is linked to their overall emotional dysregulation. It is often also triggered by rejection, as a coping mechanism/attempted replacement for the pain of abandonment, perceived abandonment, or abandonment anxiety. The anxiety can be triggered by minor events, because of their emotional impermanence, because they need to overcompensate for their feelings of emptiness, and because childhood trauma has taught them to be hypervigilant about potential abandonment.

With PPD, individuals might feel angry at people they suspect to be harming them/planning to harm them for, well, wanting to harm them. Minor events can trigger them to believe that harm/intent of harm is occurring, thus the passage above.

A tendency towards a reasoning bias that jumps to conclusions has been a consistent and robustly replicated finding of empirical research in paranoia [87] [88]. This work must be interpreted in light of the severe thought disorder encountered in psychotic populations. Research in samples with non-psychotic, PPD individuals has confirmed that the same reasoning bias applies in PPD [89]. Similarly, in community samples on non-psychotic, non-patients, “jumping to conclusions” is predictive of paranoia [90].

A similar mechanism works in individuals with BPD—except with BPD, the result is an expectation of abandonment or paranoia about being abandoned, not paranoia about being plotted/conspired against/harmed.

Further similarities:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793931/

Replicating the association of PPD with childhood trauma, PPD is associated with higher levels of emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse relative to normal control subjects, as measured by the Childhood Trauma Questionnaire (CTQ) [123] (Table 4). There were no significant differences between PPD+BPD, PPD-only, and BPD groups for any of the CTQ subscale scores. The results confirm previous reports of strong relationships between PPD and childhood trauma. Interestingly, PPD, unlike BPD, was not correlated with the CTQ Lie scale, a measure of positive response bias. This would suggest that retrospective reports of childhood trauma by PPD individuals are not contaminated by response bias.

A subset of subjects completed a multi-dimensional questionnaire assessment of cognitive and emotional empathy, the Interpersonal Reactivity Index (IRI; [124]) (Table 6). So, for reasons of statistical power, two separate ANOVAs were computed to control PPD and BPD to normal controls. PPD and BPD shared a pattern of diminished cognitive empathy (decreased Perspective Taking), and some aspects of enhanced emotional empathy (increased Personal Distress). These data replicate previous work finding decreased cognitive empathy and intact or increased emotional empathy in BPD [125], and suggest that PPD shares a similar profile with respect to empathy. To our knowledge, this is the first characterization of social cognition in PPD.

Let’s look over the general criteria.

PPD:

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.

2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.

3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.

4. Reads hidden demeaning or threatening meanings into benign remarks or events.

5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).

6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.

7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

These are all basically examples of effects of the core reasoning bias in PPD, which leads to an irrationally disproportionate high level of suspicion of others. These would make for an immensely distressing personal experience, as having no one you believe you can trust makes you feel unsafe and constantly on edge. Not fun.

Some articles about IRL people with PPD (note: they are from the POVs of outsiders, not sufferers themselves, so expect some bias and NTs-making-our-issues-about-themselves):

https://www.families.com/paranoid-personality-disorder-peters-story

https://www.brightquest.com/blog/living-with-paranoid-personality-disorder-how-our-family-survived/

https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2016.110103

https://sci-hub.se/10.1002/jclp.23201

I hunted around for posts by people with PPD about their experience. It was difficult sifting through all the ones about “dealing with a loved one with PPD,” but I eventually stumbled across these:

https://www.youtube.com/watch?v=mROYI1Mckz0

A video I made to help you understand the nightmare of living PPD and how unhappy it makes me.

https://themighty.com/2018/12/paranoid-personality-disorder/

We peeled back the first layer and exposed a deep rooted paranoia. I first noticed the symptoms, which truthfully were always there, when my wife said, “Why do you always assume the worst of me?” and, “Stop jumping to conclusions.” It suddenly hit me: I had heard her say that consistently since I really gained traction with my recovery. So, to Google I went, searching through various sites, focusing on the ones I knew were trustworthy. Through my digging, I stumbled upon paranoid personality disorder, or PPD.

There are also the Tumblr tags if you want to hear more of pwPPDs’ experiences.

BPD, on the other hand:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

https://bpdrotten.tumblr.com/post/158394113961/

3. Identity disturbance: markedly and persistently unstable self-image or sense of self.

https://www.verywellmind.com/borderline-personality-disorder-identity-issues-425488

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793931/

Relationships between PPD and impulsivity and aggression are depicted in Table 5Overall, both BPD and PPD are characterized by higher levels of impulsivity and aggression than normal controls. However, BPD is more impulsive and more self-injurious than PPD, the latter finding mirroring the higher rate of suicide attempt in BPD. However, PPD is significantly more aggressive than BPD. Effects of comorbidity are also seen. PPD comorbidity with BPD increases aggression relative to BPD alone. BPD comorbidity with PPD increases impulsivity and self-aggression. These results highlight the importance of recognizing PPD when it is comorbid with other more widely acknowledged personality disorders.

5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793931/

Although both PPD and BPD have a higher rate of suicide attempt and self-injurious behavior relative to normal controls, BPD has a significantly higher rate of suicide and self-injurious behavior than PPD. Interestingly, the comorbid PPD+BPD group has a higher rate of suicide attempt and self-injurious behavior than the PPD only group but the comorbid PPD+BPD group did not have a higher rate of suicide attempt and self-injurious behavior than the BPD group. This suggests that having comorbid PPD does not increase the risk of suicide or self-injury in individuals with BPD, while having comorbid BPD does increase the risk of suicide in individuals with PPD. This is the first data that we are aware of addressing the risk of suicide and self-injury in PPD.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

7. Chronic feelings of emptiness.

https://anezkadragon.tumblr.com/post/666229678322892800/

https://shitborderlinesdo.tumblr.com/post/130694849984/

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

https://shitborderlinesdo.tumblr.com/post/157393553684/is-paranoia-part-of-bpd

BPD can cause paranoia/paranoid ideation during times of stress (typically linked to a psychotic episode). If you are paranoid outside of times of stress, strongly and consistently, it it likely it is being caused by something else.

I’ll note that it depends on the type of paranoia, though. Paranoia that people will leave you, or are going behind your back, are all paranoid thoughts commonly caused by BPD.

dissociation masterpost

An individual with comorbid PPD and BPD would experience traits from both disorders: constant suspicion that people esp. those close to them are planning to harm them based on little to no logical evidence; constantly assuming that people have malicious or otherwise negative intent when interacting with them; holding grudges; struggles with trusting others; constantly fearing their loved ones will turn against them or abandon them; frequent behaviors to avert predicted harm or abandonment; as well as emotional dysregulation (especially anger), feelings of emptiness, suicidality, strong self-destructive impulses, splitting, and an unstable sense of self-identity.

https://paranoidpdsuggestion.tumblr.com/post/665989953592950784/

Other symptoms you might relate to: 

- being a bit humorless and unable to take certain jokes and possibly becoming hostile/angry if you feel someone is insulting or belittling you in some way
- belief that others are out to get you in some way, such as by being harmed or deceived
- the perception of innocent remarks or nonthreatening situations as personal attacks
- having delusions and possibly experiencing psychotic episodes - extremely stubborn nature
- difficulty apologizing

BPD - it has paranoia as a symptom (stress related paranoia), intrusive thoughts, jealousy, and grudge holding (usually caused by splitting)

And, as with all PDs, there is also a possibility or having one or a few people around whom symptoms are uniquely more or less severe: with BPD, the term “favorite person” is used to indicate an individual around whom the abandonment anxiety is much more severe, much smaller indications of potential abandonment/rejection are exaggerated far more, there is an extreme need for constant positive interaction, and the splitting is much more black-and-white and frequent. Whereas with PPD there is often a “trusted person” around whom the paranoia is much reduced. I imagine there are possibly the opposites present for each disorder too (i.e. someone around whom a pwBPD would feel less abandonment anxiety around; someone whom a pwPPD would feel even more paranoid about, etc.) (So far I’ve only seen both sides discussed when it comes to NPD: FPs whose criticism is much harder to cope with vs. FPs whose criticism is much easier to cope with, etc. I wrote a long comment about it on Instagram, I’ll share it here later if you want.)

Experiences of people with comorbid PPD and BPD:

https://paranoidpdsuggestion.tumblr.com/search/bpd

recourses

Therapy for BPD: 

https://www.nyp.org/bpdresourcecenter/treatment
https://www.psychologytoday.com/us/therapists/borderline-personality
https://frtc.ltd/how-to-find-a-bpd-therapist-near-you

Therapy for PPD:

https://www.promisesbehavioralhealth.com/mental-health-treatment-programs/paranoid-personality-disorder-therapy-program/
https://www.counselling-directory.org.uk/ppd.html#whatshouldibelookingforinacounsellor

BPD self-care:

https://www.mind.org.uk/information-support/types-of-mental-health-problems/borderline-personality-disorder-bpd/self-care-for-bpd/

DBT workbook:

https://www.pdfdrive.com/the-dialectical-behavior-therapy-skills-workbook-e19134904.html

Self-care for paranoia:

https://www.mind.org.uk/information-support/types-of-mental-health-problems/paranoia/helping-yourself/

Paranoia worksheets:

https://mentalhealthworksheets.com/cbt-paranoia-worksheet/
https://www.getselfhelp.co.uk/docs/PsychosisSelfHelp.pdf


anankastia: (Default)
For Antisocials

Seeking Treatment for ASPD
Tips for background-checking a therapist

ASPD Self-Help Resources
Coping with anger
Coping with boredom
Coping with irritability
Coping
 with violent thoughts
Tips for being nicer

Tips for reducing instinctive lying/manipulation

Redemption arc


Understanding Prosocials
Writing prosocial characters when you have ASPD


Tumblr ASPD Blogs

your-aspd-dad
carnivorous-tomatoes
anotheraspdfolk

For Individuals Questioning ASPD

About ASPD
ASPD DSM-V checklist
DSM-V alternative PD model on ASPD 
ASPD criteria rewrite
Venn diagrams to aid with differential diagnosis
What is ASPD? (Anti Social Personality Disorder)
Criminality, self-determined morality, aversion to authority, and oppositional defiance in ASPD
Low empathy, violent urges, irritability, and impulsivity in ASPD
Empathy infographic
Cognitive vs. affective empathy

Firsthand Accounts of Living with ASPD
Life with Antisocial Personality Disorder (ASPD)
“What is it like to be a psychopath?”
An Interview with a Sociopath
Living with ASPD

For Prosocials

About Stigma Against ASPD
The Stigma of Personality Disorders
Understanding Antisocial Personality: The Stigma Tied to ASPD
The Hidden Suffering of the Psychopath
Antisocial Personality Disorder: A Mentalizing Framework
Attitudes toward Antisocial Personality Disorder Among Clinicians

Discourse
The origins of anti-ASPD stigma
Issues with defining ASPD by behavior
Why the concept of “sociopathic”/“psychopathic” abuse is bullshit
Theory regarding why antisocials might be more likely to harm than prosocials

ASPD Writing Tips
How to write a character with aspd ~ from someone with aspd
Writing Characters with ASPD/Sociopaths
Improving ASPD rep in media

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