The Evolutionary Neurodevelopmental Perspective

Because personality refers to the matrix of the total person, each of the preceding perspectives offers limited insight into the compulsive personality as a total phenomenon. Each of these theories explores important facets of a given personality within a particular domain (e.g., cognitive, intrapsychic), but none sufficiently embrace the totality of the person.

The compulsive personality, according to the evolutionary theory of personality (Millon, 1990; Millon & Davis, 1996), is one of two interpersonally conflicted styles, the other being the negativistic personality (or the passive-aggressive personality disorder, as it is referred to in DSM-III-R). Although the dependent, histrionic, narcissistic, and antisocial personalities are all interpersonally imbalanced, they still relate to others in a consistent fashion. Because their needs and agendas are definite, life can be experienced as satisfying, fulfilling, or complete. Dependents, for example, seek support and assistance from others; as long as these resources are forthcoming, their lives are happy. Compulsives and negativists, however, are beset by a severe internal schism; they are deeply ambivalent about their relationships and attachments. Sometimes, they feel they must put their own needs and priorities first; sometimes, they feel they should defer to what others desire. Their fundamental struggle is between obedience and defiance (Rado, 1959).

What separates these two patterns is how this conflict is displayed. Passively conflicted compulsives pursue a strategy of containment. Given their early interpersonal development with demanding, overcontrolling, and perfectionistic parents, they develop introjects that demand self-control and self-containment. Inside, they struggle with issues of conformity and rebellion but transform anger into obedience through the mechanism of reaction formation. In contrast, actively conflicted negativists act out their ambivalence by alternating between actions that are impressively loyal and obedient and actions that are impressively frustrating. Compulsives overconform to rules and strictures; negativists become overly resentful of such impositions. The two personalities appear very different, but they are fundamentally connected by theory. The negativistic personality is discussed in more depth in Chapter 15.

In early development, children begin the struggle to acquire autonomous skills and to achieve a sense of self-competence. During this period, most children become assertive and resistant to parental direction and admonition. Overcontrolling parents respond to these efforts with firm and harsh discipline; they physically curtail the child, berate the child, withdraw love, and so on; in short, they are relentless in their desire to squelch troublesome transgressions. Children who are unable to find solace from this parental assault submit entirely, withdraw into a shell, or become adamant and rebel. However, if children uncover a sphere of operation that leaves them free of parental condemnation, they are likely to reach a compromise; they will restrict their activities just to those areas that meet parental approval. This, then, becomes the action available to the compulsive child; the youngster sticks within circumscribed boundaries and does not venture beyond them.

However, several consequences frequently result from taking this course. Autonomy has been sharply curtailed; these children will not develop adequate self-competence that other, less restricted children acquire. As a result, they have marked doubts about their adequacy beyond the confines to which they have been bound, they fear deviating from the "straight and narrow path," they hesitate and withdraw from new situations, and they are limited in spontaneity, curiosity, and adventurousness. Thus, having little self-confidence and fearing parental wrath for the most trivial of misdeeds, these children submerge impulses toward autonomy and avoid exploring unknowns lest they transgress the approved boundaries.

Overcontrolling parents are generally caring but display their concern within the context of "keeping the child in line," that is, of preventing trouble not only for the child's sake, but for theirs, as well. Thus, overcontrolling parents frequently are punitive in response to transgressions, whereas overprotective parents restrain the child more gently, with love rather than with anger or threats. Overcontrol, then, is similar in certain respects to the techniques of parental hostility, a training process more typical of the antisocial and sadistic developmental patterns. But there is an important distinction here, as well. The hostile parent is punitive regardless of the child's behavior, whereas the overcontrolling parent is punitive only if the child misbehaves. Thus, the parents of compulsives expect their children to live up to parental expectations and condemn them only if they fail to achieve the standards they impose. We may speak of overcontrol as a method of contingent punishment; that is, punishment is selective, occurring only under clearly defined conditions.

Another feature found commonly in the developmental history of the compulsive personality is exposure to conditions that instill a deep sense of responsibility to others and a feeling of guilt when these responsibilities have not been met. These youngsters often are "moralized" to inhibit their natural inclinations toward frivolous play and impulse gratification. They are impressed by the shameful and irresponsible nature of such activities and are warned against the "terrifying" consequences of mischief and sin. This learned sense of guilt diverts the child's anger away from its original object and turns it inward toward the self, where it can be used in the service of further curtailing rebellious feelings. The child is made both fearful of the consequences of aggressive impulses, as well as guilt-ridden for possessing such "ugly" and "sinful" attributes. Any deviant behavior is most assuredly curtailed by this attitude.

Largely because of these early experiences, the clinical profile of the adult compulsive personality emerges as one that not only defers to authority, but often worships it, internalizing all aspects of conformity and responsibility in an effort to eschew any shadings of oppositional character or action in self. This mandate of compliance and responsibility permeates all aspects of compulsives' existence, especially work. From the perspective of superiors, compulsives seem like the model of conscientiousness. To their subordinates, however, they are often sadistic taskmasters, demanding of their workers exactly what their parents demanded of them, while offering only slim mercy to those who shirk their duties. At a surface level, compulsives resemble the dependent personality, but underneath, they possess characteristics of the antisocial. To bind their oppositional urges and reinforce their controls, compulsives become overly conforming and overly submissive. They not only follow rules and customs but also vigorously defend them, overcompensating so much that they become caricatures of order and propriety. Resisting their impulses and repressing their antagonisms, they proceed systematically, meticulously, and rigidly through their daily routine, fearing that any deviation from their regimen could lead to angry outbursts or a loss of self-control. The compulsive personality is described through the clinical domains in Table 7.1. In the following section, it is contrasted with other constructs also derived from the evolutionary theory.

Contrast with Related Personalities

Perhaps more than any other personality, the traits that make up the compulsive pattern are tightly interwoven. As a result, the disorder is only rarely confused with other personality patterns. However, there are theoretical relationships and similarities to other personality patterns. Both compulsives and dependents, for example, conform to the expectations of others and often fail to make progress in their goals, but for different reasons. The dependent conforms out of deep feelings of inadequacy and fears losing supportive partners. In effect, dependents borrow the maturity and efficacy of their significant others as a means of insulating them from the demands of adult responsibility. Failure to conform puts the relationship at risk, leading to fantasies of abandonment and helplessness and on to episodes of anxiety, worry, and even panic. Wishes are the opposite of fears, and the dependent wishes to remain childlike—to be forever cared for in a world of love and happiness where infant and caretaker are magically fused as a single being.

TABLE 7.1 The Compulsive Personality: Functional and Structural Domains

Functional Domains

Structural Domains

Disciplined

Conscientious

Expressive Behavior

Maintains a regulated, highly structured and strictly organized life; perfectionism interferes with decision making and task completion.

Self-Image

Sees self as devoted to work, industrious, reliable, meticulous, and efficient, largely to the exclusion of leisure activities; fearful of error or misjudgment, hence overvalues aspects of self that exhibit discipline, perfection, prudence, and loyalty.

Respectful

Concealed

Interpersonal Conduct

Exhibits unusual adherence to social conventions and proprieties, as well as being scrupulous and overconscientious about matters of morality and ethics; prefers polite, formal, and correct personal relationships, usually insisting that subordinates adhere to personally established rules and methods.

Object-

Representations

Only those internalized representations with their associated inner affects and attitudes that can be socially approved are allowed conscious awareness or behavioral expression; as a result, actions and memories are highly regulated, forbidden impulses sequestered and tightly bound, personal and social conflicts defensively denied, kept from awareness, maintained under stringent control.

Constricted

Compartmentalized

Cognitive Style

Constructs world in terms of rules, regulations, schedules, and hierarchies; is rigid, stubborn, and indecisive and notably upset by unfamiliar or novel ideas and customs.

Morphologic Organization

Morphologic structures are rigidly organized in a tightly consolidated system that is clearly partitioned into numerous distinct and segregated constellations of drive, memory, and cognition, with few open channels to permit interplay among these components.

Reaction Formation

Solemn

Regulatory Mechanism

Repeatedly presents positive thoughts and socially commendable behaviors that are diametrically opposite deeper contrary and forbidden feelings; displays reasonableness and maturity when faced with circumstances that evoke anger or dismay in others.

Mood/ Temperament

Is unrelaxed, tense, joyless, and grim; restrains warm feelings and keeps most emotions under tight control.

Note: Shaded domains are the most salient for this personality prototype.

Note: Shaded domains are the most salient for this personality prototype.

In contrast, adult self-control and maturity are core values of the compulsive's self-image. Whereas dependents flee demands of work, maturity, and achievement, compulsives view such things as fundamental to their very identity. Although some compulsives are indecisive and easily overwhelmed cognitively by their inability to select a single option from a large number of possibilities, it is not the lack of fundamental competencies that prevents them from moving forward as it is for the dependent. Elsa is a fine picture of self-control and maturity. However, she is unable to complete the task of choosing a text and exhibits other patterns of compulsive behavior, including overconscientiousness about grading papers and correcting sentence structure.

Similarities are also seen between compulsive and schizoid personalities. Compulsives' devotion to institutional rules and social conventions colors their interpersonal behavior with a passivity that superficially resembles the schizoid. You can imagine that Holden, regarded as being a "stuffed shirt lacking real human compassion," might approach this on his more formal and less emotional days. Moreover, both compulsives and schizoids lack richness in their emotional life. For the schizoid, however, the absence of emotion reflects a basic incapacity for affective experience beginning in infancy, with a basic lack of attachment to caretakers, and continuing into adulthood. In contrast, the impoverished emotional life of the compulsive is connected to a self-image of earnestness and interpersonal reserve and the effort to block, stifle, or transform affect, wherever it is found. Accordingly, compulsives are best described as emotionally constricted, whereas schizoids are best seen as emotionally vacant.

Both compulsives and paranoids often possess deeply hidden feelings of hostility. The compulsive's anger, however, is more readily concealed behind a smiling façade of conformity, whereas the paranoid's anger is much closer to the surface and is even occasionally acted on. Moreover, paranoids readily show their irritability, whereas compulsives are more likely to transform hostility into overconformity through reaction formation or shift the expression of their anger from authority figures toward subordinates through the mechanism of displacement. In reaction formation, for example, an individual with both strong aggressive urges and strong strictures against their expression may overcon-form to superego demands in an attempt to compensate for guilty feelings. In displacement, aggressive feelings are redirected away from figures who might retaliate in kind and toward objects or persons who are incapable of any real threat. Thus, rather than scream at their supervisors, angry compulsives may use their position of power and knowledge of institutional rules to sabotage those who they feel have not accorded them sufficient respect or whom they simply view as not having paid their dues in life. In contrast, paranoids transform aggression by projecting feelings of hostility; in effect, they avoid responsibility for such emotions by attributing them to others and thus become the object of attack and persecution themselves.

The indirect expression of hostility and the presence of interpersonal conflict between their own desires, urges, and agendas and those of others also tie together the compulsive and negativistic personalities. However, as seen previously, the compulsive has a variety of means available to transform aggression, including its total sublimation. Frequently, this creates the façade of normality seen in certain traits, such as calm, reserve, and organization. In contrast, the actively conflicted negativist vacillates between passive-aggressive behavior that, like the compulsive's, conforms to expectations of others but only at a superficial level. Both are responses to overcontrolling authority, but whereas the compulsive follows the rules to please those in positions of power, the negativist uses the rules as a means of undermining those in power. Donald probably wouldn't have such intense somatic concerns if he could only, like a good negativist, allow himself to "throw a wrench into the works" once in a while and enjoy the resulting chaos.

Pathways to Symptom Expression

Like most people with personality disorders, compulsives are naturally prone to express certain symptoms when faced with periods of prolonged or intense stress. As always, it is important to remember that many Axis I syndromes derive logically from deeply engrained personality patterns and the same Axis I syndrome has different significance to different underlying dynamics. Compulsives who develop somatic concerns, for example, like Donald, will do so for reasons different from avoidants. As you read the following paragraphs, try to identify the connection between personality and symptom disorder.

Obsessive-Compulsive Disorder

On initially examining the DSM-IV, you may naturally conclude that obsessive-compulsive disorder (OCD), which refers to unwanted and intrusive thoughts and actions, is obviously related to the obsessive-compulsive personality. After all, the two are identically named, as if some theoretical or empirical basis linking them were already established. However, although the relationship between these two disorders has been the subject of a great deal of speculation and empirical research, their relationship remains highly controversial. A review of the literature concluded that only a small minority of subjects diagnosed with obsessive-compulsive disorder are also diagnosed as compulsive personalities (Black & Noyes, 1997). Many are instead diagnosed as avoidants (Skodol, Oldham, Hyler, & Stein, 1995) or even as dependent, histrionic, or paranoid (Rodrigues & Del Porto, 1995). Moreover, tentative outcome studies suggest that where both disorders do exist in the same person, obsessive-compulsive disorder may be successfully treated while leaving the compulsive personality unaffected (McKay, Neziroglu, Todaro, & Yaryura-Tobias, 1996).

These findings, however, show only that obsessions and compulsions are not specific to the compulsive personality but instead occur in a variety of other patterns, which we would expect. Psychodynamic theorists, for example, have also linked obsessions to the narcissistic personality (see McWilliams, 1994). Whereas compulsives need perfection to avoid superego condemnation, the intrusive thoughts of narcissists are related to perceived flaws or limitations within themselves. Compulsives must satisfy the demands of a carping internalized parent, but narcissists need to believe in their own intrinsic superiority.

Both may, therefore, develop obsessive-compulsive disorder, but the content and meaning of such symptoms are likely to be different. The compulsive personality is, therefore, linked to obsessive-compulsive disorder, but through logic that relates the nature of the personality to the nature of the disorder. Obsessive checking, for example, appears to be more strongly associated with the compulsive pattern than is compulsive washing (Gibbs & Oltmanns, 1995; Rosen & Tallis, 1995) and with the trait of perfectionism in particular (Ferrari, 1995). The association of checking with compulsive personalities can be regarded as an attentional pathology that might be related to their characteristic level of attention (Shapiro, 1965) in conjunction with fears of error. Thus, the checker seems to be asking, "Did I really turn off the stove?" perhaps in response to a chronically activated internalized parental voice that keeps asking repeatedly, "Are you sure you've done everything right?" To keep this voice quiet, sooner or later you'll check the stove again, just to get a little peace.

Other Anxiety Disorders

Compulsives are frequently among candidates for the development of other anxiety disorders as well, including social phobia (Turner, Beidel, Borden, & Stanley, 1991) and generalized anxiety disorders (Nestadt, Romanoski, Samuels, Folstein, & McHugh, 1992). Many compulsives, especially those who have endured prolonged periods of stress (perhaps brought on by their own indecisiveness), develop the fear that their social façade will disintegrate, either because they are found to be inadequate and, therefore, become shamed beyond measure or because they themselves might snap under pressure and vent their aggressive feelings directly. Because most compulsives seem driven internally to accomplish their goals, the constant presence of tension often becomes part and parcel of their being. As a result, it can be difficult to distinguish the personality pattern from the clinical syndrome. On the positive side, however, many compulsives use the energy derived from anxiety to fuel their characteristic diligence and conscientiousness. Anxious energy is redirected into containment.

Somatoform Disorders

The somatoform disorders include conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. Although Case 7.1 features a compulsive personality and intensified somatic concerns, little research is available that relates these syndromes to the compulsive personality. Rost, Akins, Brown, and Smith (1992), however, found that although other personality patterns are more common, notably avoidant, paranoid, and self-defeating, somatization disorder is often diagnosed with compulsive personality disorder as well. Symptoms include pain, gastrointestinal illness, sexual dysfunction, and pseudoneurologic symptoms, none of which can be explained by a legitimate medical condition.

For compulsives, bodily ailments may be used as a means of rationalizing failures and inadequacies or a means of "saving face" by ascribing shortcomings to causes obviously beyond their control. Compulsives who succeed in spite of their illnesses reap a secondary gain: Those in charge reward them for their noble suffering or for persevering in the face of adversity, thus turning illness into an opportunity for praise and respect. Moreover, sickness allows them to escape the condemnation of a sadistic superego that is always ready with blame. The manifestation of physical symptoms can also be seen as an expression of accumulated tension and anxiety turned inward toward the body. For some, there is nowhere else anxiety can be expressed, for its presence destroys their façade of competency. Sometimes, the accumulation of tension and secondary gain work hand-inhand, as with our queasy compulsive Donald, who must be under incredible pressure yet can maintain an "efficient operation" at work even when the discomfort is intense. Undoubtedly, he thinks his managers respect him for keeping at it rather than giving in to some nagging physical ailment.

Although the idea of being ill probably runs counter to their logical, rational, intellectual, sober, and controlled self-image, compulsives do exhibit a drive toward perfection that can cause them to become obsessed with minor imperfections that cannot be eliminated or overcome. Perhaps for this reason, compulsive personalities sometimes develop body dysmorphic disorder (Neziroglu, McKay, Todaro, & Yaryura-Tobias, 1996), a preoccupation that some part of the anatomy or appearance is defective. Once identified, the supposedly deformed part becomes the focus of constant and intense scrutiny. Such persons might examine their "wrinkled lips" or "crooked nose" in the mirror repeatedly many times a day, for example, or even make repeated suicide attempts (Veale, Boocock, Gournay, & Dryden, 1996).

Once established, body dysmorphic disorder is probably driven by a combination of compulsives' distorted level of attention (Shapiro, 1965), described previously, and their tendency toward black-and-white thinking. By allocating their total attention to the perceived defect, it becomes magnified completely out of proportion, consuming their entire awareness. At the same time, their dichotomous thinking makes a realistic assessment impossible. Rather than falling somewhere in the middle of the aesthetic range, they judge their nose or lips to be all bad, thus creating a vicious circle from which there is no release. Other personalities may be diagnosed with body dysmorphic disorder as well but probably for somewhat different reasons. Avoidants, for example, feel shamed by their defect and fear that it will bring them into public scrutiny; narcissists feel deflated; and histrionics, whose cognitions are remarkably imprecise, just feel globally ugly. Compulsives, however, probably feel that their defect causes others to take them less seriously or otherwise distracts others from properly focusing on their public image or position of power.

Dissociative Disorders

Avoidant, borderline, and compulsive personalities are common in subjects diagnosed with dissociative experiences (Simeon, Gross, Guralnik, & Stein, 1997), defined as "a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment" (DSM-IV, 1994, p. 477). Many kinds of dissociation are possible. In dissociative amnesia, the individual is left with gaps in memory, usually due to some traumatic or highly stressful experience that cannot be recalled. Dissociative fugue is similar to dissociative amnesia, but features sudden flight away from home. In effect, the person wishes to not only forget but also get away. In dissociative identity disorder, formerly called multiple personality disorder, seemingly separate selves coexist within the same person.

Compulsives would seem naturally vulnerable to experiences of depersonalization, particularly a sense of detachment or estrangement from self and the idea that the surrounding world has somehow become unreal or dreamlike. The link between the disorder and the larger personality pattern derives from the compulsive's characteristic overcon-trol of feeling, excessive intellectualization, and distorted attentional processes. Because emotions are so threatening to them, compulsives stultify and dichotomize their world as a means of making it more controllable. Taken to the extreme, however, perceptions of self, others, and environment can become completely purged of life. At this point, the compulsive becomes a machine functioning in a mechanical world governed by deterministic rules. Obviously, the line between depersonalization and delusion can become rather thin. W. Reich (1933), in fact, spoke of these persons as "living machines."

Depression and Other Mood Disorders

Compulsive personalities are naturally inclined toward depressive feelings. By overcontrolling and denying emotions and wishes and focusing themselves on detail work, they exist at a greater level of safety, but without much joy. In effect, their daily lives are deprived of the positive emotions that most of us take for granted, as all three of the cases presented illustrate. Whereas most people have their good days and bad days, compulsives just keep grinding forward with an emotional state best described as grim, reserved, or barren. As such, they experience few reinforcements in their interpersonal relationships. Others simply find them either boring or controlling and seek simply to minimize their interactions, leaving the compulsive feeling puzzled or rejected. Unfortunately, their tendency to sublimate conflict and quash any expression of affect leaves most compulsives so estranged from their own emotions, yet so dedicated to hard work and performance, that many just plod onward, unaware of how depressed they appear. Elsa, for example, could not emotionally acknowledge the reasons that brought her to the counseling center; we don't know if she is angry with her class or depressed because at some level she recognizes her shortcomings and the disappointment of others.

Compulsives whose defensive controls remain intact exist perpetually in a dysthymic twilight, but those in the grips of major depression are more likely to have suffered some kind of defensive breach related to their own intrinsic ambivalences. Psychodynamic theorists, for example, have long regarded depression as anger turned inward, directed against the self. Unable to resolve the conflict between obedience and defiance, compulsives may belittle their own competencies and become mired in feelings of guilt, condemnation, and shame. Some may come to resent or even hate themselves for displaying weakness and indecision and use depressive feelings as a means of self-punishment, believing that they deserve to suffer. Alternatively, compulsives with more insight may come to hate themselves for the happiness they have given up in conforming to external pressures or criticize themselves for imagined failures or for letting others take advantage of their drudgery.

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Free Yourself from Panic Attacks

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