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Profiles of Obsessive-Compulsive Disorder
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In the last section, we discussed three types of obsessive thoughts and effective behavioral strategy number three: Cutting Down Thoughts. These three types of obsessive thoughts included: mental disaster image; violent mental image; and solution thought.
Dr. Robert Cloninger, professor of psychiatry, believes that the inherent differences between personalities results from disparities in three key personality qualities.
In this section, we will examine the Tridimensional personality theory developed by Dr. Cloninger which includes three different dimensions and effective cognitive behavioral therapy strategy number four: "Assertive Dialogue". The three dimensions of the tridimensional personality include: harm avoidance; novelty seeking; and reward dependence.
3 Dimensions of Tridimensional Personality Theory
♦ #1 Harm Avoidance
The first dimension is harm avoidance. This specific dimension controls the severity of the urge to escape from harm or disaster. People who rate relatively low on the harm avoidance scale exhibit extroverted characteristics: friendliness, optimism, and confidence. Those who rate high on the harm avoidance scale, however, exhibit shyness and apprehensiveness. As you may have already guessed, OCD clients appear high on the harm avoidance scale.
Those who do eventually develop severe OCD report enduring extreme worrisome feelings that bordered on paranoia early on in their youth.
Gary, age 23, recounted his early childhood as being wrought with fear of harm. Gary stated, "I hated anything sharp or pointy. The first time I ever picked up a pair of scissors, I accidentally cut myself on them. I won’t touch sharp objects now. My mother constantly told me to stop running, wear warm clothes, don’t touch that it’s hot! She controlled everything when I was a kid and made me so paranoid!"
I asked Gary, "Do you feel that your mother is still controlling you? That her overly cautious attitudes translated into your worries?" Gary stated, "Absolutely! Every time I begin to worry about something, it’s her voice in my head!" Gary’s early development of OCD directly related to his mother’s precautious tendencies.
Think of your Gary. Did he or she develop a high tendency for harm avoidance during childhood?
♦ CBT Technique: Assertive Dialogue
CBT Strategy number four is "Assertive Dialogue." To help Gary stand up to the motherly voice echoing in his head, I asked him to write out an Assertive Dialogue in his journal. I asked Gary to imagine a scene between himself as a child and his mother, Polly, during which she imposes her worries onto him.
Next, I told Gary to picture himself refusing to obey his mother and her irrational requirements. Then, I asked him to write this scene in dialogue form in his ritual journal. Part of the scene was written out as follows:
Polly: Gary, don’t play in the stream, you’ll slip and crack your head open.
Gary: No, Mom. I like playing in the stream. Besides, I’m wearing rubber soled shoes that won’t let me slip.
Polly: You’ll catch a cold and die of pneumonia.
Gary: It’s too hot out here mom. I’ll warm up in the sun afterwards. Now stop worrying!
This last phrase, "stop worrying", was in fact Gary speaking to the thoughts that would prompt him to be over-cautious. Think of your Gary. Could he or she benefit from hearing this section?
♦ #2 Novelty Seeking
The second dimension is novelty seeking. This dimension refers to the desire to seek out new experiences. Those people who rate high on the novelty seeking scale tend to be more willing risk-takers, and would prefer to cope with consequences afterwards. Those who rate low on the novelty seeking scale prefer to take refuge in order and a less energetic personality. OCD clients most always emerge on the low end of this scale.
Taryn, age 35, had lived in the same house for her entire life and had worked for 17 years as a copy clerk. When I asked Taryn why she never moved out or got a better job, she stated, "It’s not like I never had the chance. My boss has offered me countless promotions, but I’m happy where I am. I have no responsibilities and my job is very simple. There is little room for error."
When I asked Taryn to describe her childhood to me, she stated, "My family was very loving and I got along well with them. Nothing ever strenuous happened, we were all very relaxed. I hated going to amusement parks or even new playgrounds. I never felt comfortable and would start to cry." I stated to Taryn, "It seems to me that early on you already had the potential to be a little shy and withdrawn. Is that right?" She stated, "Yeah, that’s right. I just don’t like making trouble."
I then told Taryn, "I think the best thing for you to do right now is to start enhancing your decision making skills. Decision making is inextricably linked to our capacity for new experiences. When you make a decision for the next few weeks, I want you to keep from analyzing it and stick by it, no matter how inane or inconsequential. I want you to stick with your gut."
Think of your Taryn. How would you handle her inability to seek out new experiences?
♦ #3 Reward Dependence
In addition to harm avoidance and novelty seeking, the third dimension that controls personality types is reward dependence. This dimension gauges the independence of a person. Those people who rate low on the reward dependence scale pride themselves on not caring about the opinion of others. They make their choices and stick by them. In contrast, those who rate high on the reward dependence scale cannot survive without the recognition and encouragement of others.
Many people would place OCD clients on the low end of the reward dependence scale due to their inexorable habits regardless of social consequences. In fact, OCD clients describe themselves as "people pleasers."
Tyrese, age 31, can never recall a time in which he displeased his mother or father. He stated, "I’m a very cowardly person. I always have been. I could never stand up for myself, especially to my parents. I was always afraid of what they would think of me. I’m still the same way, even with all my compulsions. I’m always paranoid about what other people will think when they see me tapping my fingers in rhythm to the syllables I’m speaking, or something. To compensate, I’m overly nice to people I don’t even like."
I stated to Tyrese, "Your fear of disappointing someone is translating into your inability to stand up to your own subconscious, which is causing you to perform these rituals." I then asked Tyrese to try the Assertive Dialogue exercise discussed earlier in this section.
Think of your Tyrese. Is he or she a people pleaser too? How would you build up their confidence?
In this section, we discussed the Tridimensional personality theory developed by Dr. Cloninger which includes three different dimensions and effective cognitive behavioral therapy strategy number four: "Assertive Dialogue". The three dimensions of the tridimensional personality included: harm avoidance; novelty seeking; and reward dependence.
In the next section, we will examine effective behavioral strategy number five: Reducing Anxiety. To help an OCD client reduce anxiety during exposure, I use three different techniques. These three techniques included: "Worry Time"; "Helpful Phrases"; and "Paradoxical Thinking."
Peer-Reviewed Journal Article References:
Liggett, J., & Sellbom, M. (2018). Examining the DSM-5 alternative model of personality disorders operationalization of obsessive–compulsive personality disorder in a mental health sample. Personality Disorders: Theory, Research, and Treatment, 9(5), 397–407.
Manduchi, K., & Schoendorff, B. (2012). First steps in FAP: Experiences of beginning Functional Analytic Psychotherapy therapist with an obsessive-compulsive personality disorder client. International Journal of Behavioral Consultation and Therapy, 7(2-3), 72–77.
Olatunji, B. O., Ebesutani, C., & Tolin, D. F. (2019). A bifactor model of obsessive beliefs: Specificity in the prediction of obsessive-compulsive disorder symptoms. Psychological Assessment, 31(2), 210–225.
Solomonov, N., Kuprian, N., Zilcha-Mano, S., Muran, J. C., & Barber, J. P. (2020). Comparing the interpersonal profiles of obsessive-compulsive personality disorder and avoidant personality disorder: Are there homogeneous profiles or interpersonal subtypes? Personality Disorders: Theory, Research, and Treatment. Advance online publication.
What are the three dimensions to the Tridimensional Personality? To select and enter your answer go to .