Personality & Character Disorders Pt 5: O-C & P-A Types in Depth

As mentioned in last week’s post (see: Personality and Character Disorders Pt 4: O-C and P-A Types), obsessive-compulsive and passive-aggressive personalities are generally among the more “neurotic” as opposed to character-impaired personality types.  As such, they tend to create as much or more distress for themselves as they do for others, unless, of course, their “styles” of relating have reached such a level of intensity, inflexibility, and resistance to modification that they rise to the level of a personality “disorder.”  In this week’s article, we’ll take a much closer look at how these deeply (albeit mostly unconsciously) “ambivalent” personalities get to be the way they are, the kinds of problems their “styles” invite into their own lives and the lives of others, and the kinds of therapeutic interventions that can help them change.

Obsessive-Compulsive Personalities

O-C personalities are deeply conflicted (ambivalent) souls who really want to cut loose, do as they wish, exert personal power and control, and defy convention but are also so apprehensive about doing so (as the result of a fairly well-developed social conscience and a high sensitivity to feelings of guilt) that they simply dare not let themselves step out of line.  As a result, they repress their baser urges, overly conform to perceived societal expectations, and satisfy their longing for power and control by channeling (sublimating) any aggressive energies through the strict controls they impose, most generally, upon themselves.  Of course, most of this goes on pretty much outside of their conscious awareness.

When folks are not obsessive-compulsive in their interaction style to the the extreme, they are frequently viewed by others as industrious, diligent, hard-working, fastidious, reliable, and trustworthy.  They can sometimes come across as a bit “cold,” overly serious-minded, or nit-picky.  And the more intense and inflexible their o-c “style” is, the more rigid, stubborn, judgmental, perfectionistic, and even uncooperative, demanding and self-righteous they can appear to others.

Passive-Aggressive Personalities

The conflict raging within the passive-aggressive is so “active” and open that it’s hard to miss.  They want to act autonomously but struggle with dependency issues.  They want to take a stand but dread the possibility a decision they make will result in egg on their face.  And more than anything  else they want to be happy for and about themselves (as well as others) but find themselves feeling only short-changed, envious, and negativistic.  They’re chronically moody, and often sullen, contentious, and above-all, resistant to perceived demands.  Their resistance often has a self-defeating quality, especially when expressed through procrastination and indecision.  They can be bitterly critical and cynical, and have a difficult time being content with themselves as well as allowing themselves to share and relish in the success and good fortune of others.  Obstructive, pessimistic, and always vacillating between needy dependence and contentious independence, life can be very difficult with these folks even when their “style” is not of the severity or degree of resistance to modification that it can truly be considered a “disorder.”  And when the person in a relationship with you  has a full blown Passive-Aggressive Personality Disorder (PAPD), life with them can be a real nightmare.  Why?  Because it’s so hard to simply disengage with them when they’re doing their negativistic, whining, petulant, and vacillating “thing.”  Tell them to simply go and do the shopping they said they really needed to do instead of whining that you’d rather go out to dinner and they’ll immediately retort that you just don’t want to be with them.  Tell them that you’d love to have dinner if that’s what they’d prefer and they can do the shopping later and they’ll complain that you’re just saying that to make yourself feel better. There’s no “winning” with passive-aggressives – only negativistic, vacillating, entanglements.  You try to avoid the traps, but they’re easy to get into and really hard to get out of.

Anyone who’s lived or worked with one of these “active-ambivalent” (the description given by Millon) knows that although they are difficult folks, their very different from the crafty manipulative wolves in disguise I label “covert-aggressive” in my book In Sheep’s Clothing.  And we’ll be talking about manipulators and other character-impaired personalities in the two articles to follow.

How Do They Get to Be That Way?

There’s no firm evidence on the kinds of biological or experiential factors that contribute to the development of the o-c pattern, but there are some indications that on the constitutional side, o-c folks might be neurologically “wired” to experience the emotions of fear and anger at a much more intense level than most folks and may also have a temperamental predisposition toward extreme displays of fear and anger (hence, the adaptive “need” for tight controls).

As far as early learning experiences go, it was once thought that overly punitive parenting was largely responsible for encouraging this personality style.  But perhaps even more important than parental over-control or excessive punishment is the role of conditional reinforcement and parental approval.  That is, more than other personality types, o-c personalities tend to have experienced childhoods in which it became clear to them early on what was necessary to secure the reinforcement and, especially, the approval they sought from external sources.  “Be good, keep your baser instincts in check, and do well,” they learned, and “you’ll be valued and rewarded.”

From my clinical experience, I have found these folks to have developed a fairly sophisticated conscience early in life, and one that is highly sensitive to feelings of guilt (this guilt-sensitivity is a prime feature I discuss in Character Disturbance).  Remember, guilt is the bad feeling you get with regard to actions you take or consider taking (as opposed to shame which is a feeling more connected to how you see yourself as a person).  And I see this guilt-sensitivity as a big issue for the o-c personality all through their emotional and psychological development.   It hangs them up at the developmental stage Erikson calls “Initiative vs. Guilt” (critical at around ages 3-5).  I also strongly suspect, although there’s very little hard data at the moment to support the notion, that we’ll one day find some kind of a link between the factors that predispose some aspects of the autistic spectrum disorders and the factors that predispose some of the thought and behavioral rigidity and apparent social aloofness common to o-c personalities.

It’s uncertain what constitutional factors might predispose P-A personality development.  Two possibilities are an innate intolerance for frustration and a low threshold for irritation.  Other possibilities are a predisposition toward irregularities of mood and emotion, which makes it difficult for them to develop emotional and temperamental balance and stability, and a predisposition to easy despondency.

From a learning perspective, one contributing “dynamic” to the development of this active-ambivalent style is a deeply divided and mixed-message-giving parental environment where one parent is overly doting and unconditionally affirming whereas the other parent is overly critical and disapproving.  As a result, the child grows up simultaneously expecting and craving not only unconditional approval but also rejection and disappointment, setting up the internal dynamics of ambivalence, especially regarding issues of autonomy and independence.

In Character Disturbance, I note that while excessive guilt-sensitivity appears the key factor in the emotional development of the obsessive-compulsive personality, excessive shame-sensitivity appears the key factor in the development of the passive-aggressive personality.  That excessive shame sensitivity could really hang them up developmentally at the crucial stage (around ages 2-3) that Erikson postulates is primarily defined by acquiring a sense of personal autonomy vs. shame and doubt.

What Kinds of Problems Do These “Styles” Cause?

The less intense and inflexible the style, and the more neurotic the style, the more o-c personalities are prone to causing distress for themselves.  Typically, their distress is manifested in Axis I disorders such as anxiety disorders (including OCD), psychosomatic and “conversion” disorders (e.g., peptic ulcers, stress-induced headaches, etc.), and mood disorders.  And, as I mentioned early on in this series (see, for example:  Personality and Character Disorders – Part 3), the kinds of clinical syndromes people display are almost always intimately connected with their overall personality or coping style.  For example, it’s not uncommon for o-c individuals who for some reason have suddenly experienced a great loss of control (e.g., a big change in job status or marital situation) to become highly anxious and/or depressed.  And such problems will inevitably recur in similar circumstances if the underlying personality dynamics are not addressed.

When the o-c style becomes so intense, inflexible, and unyielding even in the face of adverse consequence and thus rises to the level of a true “disorder,” not only are there likely to be psychological ramifications for the o-c person him/herself but also big problems in relationships with other people.  OCPD (Obsessive-Compulsive Personality Disordered) people can be so stubborn, uncompromising, demanding, seemingly detached, and nit-picky that they’re simply impossible to work with or live with.  And, if they should have other problematic personality traits as well (e.g., it’s not uncommon for a person with OCPD to have some C-A [covert-aggressive] characteristics, too), they can be among the most tyrannical and dictatorial persons on the planet.

P-A personalities are remarkably self-defeating.  In their procrastination, indecisiveness, negativity, and passive resistance, they generally perpetuate a pattern of disappointment in life with no real insight into the role their emotional dynamics play in their interpersonal and occupational failures.  They are prone to mood disorders, especially recurring bouts of depression as well as chronic low-level depression or “dysthymia.”  They’re also prone to mood swings, including shifts in mood that may be small and rapid.  They’re not quite as emotionally and behaviorally labile as borderline personalities, but if they should have other personalty characteristics, especially borderline personality characteristics, they can be extremely erratic and unpredictable both emotionally and behaviorally.

What Hope is There for Them?

Many of the psychotherapies designed for neurotics are tailor-made for helping o-c personalities.  In supportive therapy where unconditional positive regard is shown, the obsessive-compulsive can find “permission” to loosen the tight reins they’ve held on themselves and to let out their feelings without reservation.  In the process, they can slowly learn that it’s okay to be who they are and to have the urges they have.  Then they can learn to exercise more conscious and deliberate controls when it comes to the really important stuff and learn to let go and relax about when it comes to the relatively insignificant stuff.  In the process, they then can learn to relate in a more human, less anxious, less rigid and more flexible way.  Treatment through conventional psychotherapies is much more challenging when it comes to passive-aggressive personalities.  That’s because their struggles with autonomy vs. shame and doubt and independence vs. dependence are so intense and deeply rooted and so deeply rooted and “actively” sustained in their coping style.  They’ll latch onto a therapist with great intensity, but then resist almost every suggestion offered them to carve out a more independent self-advancing life because to accept someone’s suggestion for a better course inherently involves reckoning with the inadequacy of one’s own course, thus inviting feelings of shame.  And submitting to someone’s guidance and direction is not something a person deeply ambivalent about independence vs. dependence issues is all that thrilled about either.  So, guiding the passive-aggressive through the process of uncovering and working through their unhealthy “dynamics” is necessarily a venture that must be carefully paced and tactfully done.

Now, I noted earlier that passive-aggressive personalities are prone to low-level, chronic dysthymia.  And interestingly enough, I’ve had many individuals with strong passive-aggressive personality traits become entirely different people when placed on the right antidepressant medication.  Ending the easy despondency, increasing energy level, and improving motivation appeared to be the key to breaking the vicious cycle fueling the dysfunctional coping style, and over time, the style itself became modified and remained so even when medication was no longer necessary.

The next (and last) two articles in the series will take an in-depth look at the personality styles that are more commonly associated with character impairment.

17 thoughts on “Personality & Character Disorders Pt 5: O-C & P-A Types in Depth

  1. Thank you, this explains very well how o-c and p-a people can get better. Also surprised that mere medication can help p-a personalities to improve.

  2. What’s up with less discussion in the comments recently? Hope to be able to change the matter.

    How do you folks generally deal with a passive-aggressive person?

    1. Individuals rarely fit into narrowly defined “styles” of interaction. In fact, the narrowness of style is one of the things that leads to personality “disorder.” So it’s quite possible for someone to have both O-C and P-A traits (besides, they’re both “ambivalent” coping styles, just slightly different manifestations of the style). It’s also possible for someone to have a “mixed” personality disorder, whereby they have such intensity and inflexibility in their style that it’s rightfully considered a disorder but the style itself is comprised of several different features (i.e. traits of several different coping styles, each of which might be present to a relatively greater or lesser degree than the others). In fact, many folks who both need psychological guidance but are resistant to traditional forms of it have personality disturbances and most of those disturbances are of the “mixed” variety. But clinicians are loathe to point to that disturbance as the primary diagnosis for a lot of reasons.

      1. So then, what does that type of individual DO?? All of these “issues” are seemingly very misunderstood by not only the general public but by clinicians as well! I can attest to the difficulty in trying to find a therapist who is familiar with the aftermath of one of these losers! Then combine that with wanting someone who has some working knowledge of FASD and living in a relatively small area………’s frustrating and I WANT to get help!
        Dr. Simon……can we PLEASE clone you?? LOL!! 🙂

      2. From what I’ve heard of these kinds of people secondhand and read vignettes of them, I think obsessive-compulsives nag, criticize, condemn and nitpick the hell out of whatever at hand.

        I see it passive-aggressive grumblers are more subtle. They nag as well and they whine and complain.

        I understand the matter like this and please do correct me if I’m off the mark in any way: Aggression, if undisciplined, leads to unchecked pursuit of desires and trampling of personal responsibility. However, if natural aggression isn’t handled the right way and instead is treated as something that vanishes out of existence if ignored, if it’s banished outside awareness as if it doesn’t exist, then it becomes passive and gets a person stuck in a constant state of low-lever anger, grumpiness and pissiness.

        1. “Pure” O-C personalities make life much more miserable for themselves than they do for others, always striving to accede to unrealistic self-imposed demands. But when such personalities have some C-A traits, too, they can seem like they want to shove those purported high standards down everyone else’s throats. Big difference.

  3. A question popped into my mind and I think it’s best to ask in the newest article’s comments even though this may not relate to the content of the article.

    What does a lack of self-respect feel like? Is there any specific feeling that can be traced back to that? Can someone be completely lacking in self-respect even though they don’t care at all?

  4. J, remember that link I posted about the difference between self-respect and self-esteem?
    I wonder…….self-esteem = “I appear to be”, like things I have, looks, talent, possessions, (a mask)?
    Self-Respect = choices I have made that not only impact me in a positive way but others? Self denial and self discipline vs self serving selfishness breeds self-respect. Doing things you don’t necessarily WANT to do but are in the best interest of yourself and others = self-respect.
    Self-esteem = outer vs self-respect = inner??
    And, if you don’t care about yourSELF or the welfare of others, if you don’t respect yourself enough to take care of yourSELF…… I would say that there is no sign of respect. When you respect something or someone you hold them or it in high regard and base your actions accordingly. You value that thing or that person and your actions reflect that. Like a car that you value, the way you care for that car reflects it. you take care of it.
    Im, um, rambling here!! LOL Good question though J

    1. Better read it all over again. A while has passed since the last time. Thanks for correction, Dr Simon and Puddle.

  5. Dr Simon,

    I can’t express the gratitude I feel for you to bring this matter to the daylight. I am a man who recently turned 35, and when I read this part: “OCPD (Obsessive-Compulsive Personality Disordered) people can be so stubborn, uncompromising, demanding, seemingly detached, and nit-picky that they’re simply impossible to work with or live with. And, if they should have other problematic personality traits as well (e.g., it’s not uncommon for a person with OCPD to have some C-A [covert-aggressive] characteristics, too), they can be among the most tyrannical and dictatorial persons on the planet”

    I discovered this is the mirror image of my mother!
    In my youth she drove me so mad that I fell into substance abuse (THC)and this along with her despicable behavior led me to a psychotic episode. I then was hospitalized and treated with Risperdal Consta and diagnosed with Schizophrenia (despite being first of promotion in High School)

    Now I’m being treated with long acting Paliperidone and now I’m more active, running, lifting weights, etc.. I have co-founded a Tech startup with 2 associates where I am the CTO. The problem is that the company is in its infancy and investment stage, so in order to save my mother offered me to live in her house until we have enough customers to generate sufficient income for all the staff.

    I have discovered now my mother only offered me a roof in order
    to have the upper hand over me, I work about 14-16 hours a day in my company but when I arrive home, my mother starts shouting and violently hitting me because I forgot to put a shirt in the dirty laundry basket, etc.. She makes a mountain from little things, she is prone to violence, always whinning and critizicing, with negativistic attitudes, etc.. She knows I have no place to go until the company generates more income but routinely menaces me with kicking me from the house, always nagging, criticizing, shouting.. She is totally unbearable, and I can’t talk to my Psychiatrist about her because she acts so sweet and making herself the martyr (the martyr for raisisng two kids alone, a thing she herself has provoked because she made life impossible to my biological father)so the Psychiatrist is fooled and he could think I have a Psychotic relapse (never had one) for talking bad about her.

    Now I see your article about people with OCD and Covert Agression and I assure you this matches 100% my mother’s behavior.

    How can an individual like me who is under Paliperidone treatment bring this woman to the attention of her Psychiatrist without being seen as crazy or paranoid? Most Spanish Psychiatrists are totally oblivious to passive-aggression, OCD and covert aggression. What can I do?

      1. That’s a pretty good idea! I’ll try to use a hidden smartphone with camera, or record her audio when she explodes. The problem is she is completely random and unpredictable in her temper tantrums, but I’ll try. Thank you!

    1. Joseph, for a variety of reasons, it’s not possible for me to make sound assessments or give direct feedback about anyone’s particular circumstances from such a distance and especially within a forum like this. I’m happy you’ve found some of my work helpful in understanding and dealing with your situation. And I hope that as you familiarize yourself with more of my work, you might gains some additional helpful insights.

  6. Hi Dr. Simon,
    My sister spoils and caters to her daughter and her daughters children. She wonders why they have a sense of entitlement. She wants to drag me into the same way of dealing with them. Drop what I am doing to help them when they expect bailing out and will not do for themselves. There is no concern for me and my needs. They act like they are doing me a favor by wanting me to help them. Can one person be a narcissist and also an enabler-codependent too. They act like I have a problem if I say no and confront them about their entitlement and thanklessness. They think that getting to visit my nephew is their gift to me while I give free babysitting services, etc. to them. If we have dinner together, then they really did me a favor! They think I should be an ATM and discount medicine provider also. They see nothing wrong with this. I am the person with a problem. My sister will have no thought about using me so her daughter will not be inconvenienced. What about my being inconvenienced by taking my time and using my resources to help them. I have less than they do. They think it is their right to pick my pocket without thought or guilt. I am embarrassed to be related to these people. I love them but I refuse to live like this. Thank you for any word you can give me.

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