Anancastic personality disorder: causes, symptoms and treatment of the disease

Anancastic personality disorder (APD) is a congenital or early acquired character anomaly that interferes with a person’s full adaptation in society and is manifested by pronounced subjective problems due to a person’s tendency to doubt, double-check, obsessive thoughts, etc. If a person is anantcastic, this condition can lead to a decrease in social interaction, financial problems and difficulties in obtaining education.

The main risk factors for developing anancastic personality disorder:

• hereditary predisposition (about 7%);
• age crisis;
• psychotraumatic situation (including facts of physical or mental violence);
• massive hormonal changes;
• excessive psycho-emotional stress;
• persistent stress; and so on.

Anancaste disorder, as a rule, debuts at school age with excessive shyness, constant fear of doing something wrong and worsens when the patient begins to live independently and is forced to bear responsibility for himself and his family.

Types

How can people with anancastic personality disorder be classified? Types of deviations occur at different levels. In psychotic and neurotic, at the same time, the personal characteristics characteristic of this type are preserved in everyone. Some groups of doctors divide anancastic personality disorder into compulsive and obsessive types, others do not.

The obsessive-compulsive character is fundamentally based on such protective mechanisms as “isolation of affect”, in which the emotional component of the experience is leveled out by “reactive formation”, when a negative feeling is transformed into a positive one and vice versa. The person is also convinced that he can completely control all processes - these people are overcome by a mania of total control.

Characteristics and symptoms of APD

Photo by Jimmy Fermin on Unsplash
ARL changes a person’s lifestyle, his views, thoughts, feelings. Even his character. ARL is expressed in:

• obsessive thoughts;
• phobias;
• obsessive actions.

Intrusive thoughts

These are thoughts that a person cannot cope with. They arise constantly, pursue him, accompany his every action. In APD, these thoughts are often aggressive and may include:

• the need to constantly remember something;
• double-checking (don’t harm yourself and others; what if something bad happens);
• sexually perverted thoughts and images;
• visualization of “terrible” consequences;
• "magical" thinking.

What is anancastic personality disorder?

At the unconscious level, there is a constant stream of thought that predicts the consequences of a particular event, including negative ones. We all understand that a fire can happen in our apartment at any moment. However, the brain of a normal person automatically filters this stream of thought, relieving our consciousness of “extra” workload.

But this does not happen in a person suffering from APD. He is constantly subject to negative thoughts and tends to attach too much importance to them. He loses the ability to think critically and evaluate himself and others.

Obsessive thoughts take over a person, subjugate his behavior and life in general.

Phobias

Fears associated with APD can be very diverse. This is the fear of harming yourself, other people, animals, the fear of stealing something, doing something bad. There may be a fear of pollution (fear of germs, viruses, animals, diseases, household chemicals, radiation, radiation, etc.).

Obsessive actions

Constantly repeating uncontrollable actions that can be expressed:

• hoarding or collecting;
• rituals (for example, pulling the front door handle twice before leaving);
• constant restoration of order;
• pronouncing meaningless sounds and words;

• obsessions with symmetry and accuracy (for example, all papers on the table should be in a perfectly even stack, books should be arranged in alphabetical order, mugs on the shelf should be in an even row and at the same distance from each other).

With APD, you cannot help but perform compulsive actions because you attach important meaning to them. You think that if you don’t perform this or that ritual, something bad will happen. With the help of obsessive actions, you escape from the cause of your phobias.

Causes

The most common causes of the disorder include:

• genetic predisposition;
• birth and traumatic brain injuries suffered at an early age;
• mental illness (the disorder often accompanies autism, manic-depressive psychosis, schizophrenia);
• long-term suppressed anxiety or aggression.

According to experts, anancastic personality disorder is formed in children whose families have high demands not only on behavior, but also on emotions. This leads to the fact that the child begins to feel guilty for his inability to control feelings and desires, as well as fear of punishment.

Symptoms

Such disorders are characterized by inertia of thinking, stubbornness, excessive fixation of attention on details, and obsessive behavior that occurs periodically.

Obsessive thoughts often concern everyday moments. Patients perceive them as tiring and painful, and they try to resist them. But the thoughts involuntarily return again. Such thoughts lead to attacks of compulsions, which are expressed in obsessive actions in order to prevent adverse consequences. As a rule, such consequences are unlikely.

Sometimes excessive attention to detail takes on a very pronounced form, which interferes with the performance of professional duties and full-fledged life activities. Patients develop their own ideas about quality. They are usually more strict than is customary. In everyday life, a whole system of housekeeping is formed. Moreover, it is difficult to convince a person to change the procedure he has established.

Classification and stages of development of anancastic personality disorder

APD begins in childhood or adolescence. Throughout its course, it goes through a number of successive stages, which can be repeated and returned.

The two main phases of personality disorders are:

• compensation;
• decompensation.

During the compensation phase, the features of APD are smoothed out, bring minimal subjective discomfort, and the person is able to get along with them. Often, to achieve this, he adjusts his life accordingly: he creates a safe environment around himself of people who can support him and help him cope with anxieties and difficulties, chooses a job with minimal responsibility (although people with APD can find a reason to worry everywhere), etc. .

The decompensation phase is a period of exacerbation of maladaptive personality traits, increased anxiety, doubt and indecision. This leads to severe subjective discomfort and interferes with full adaptation in society. During these periods, people may experience symptoms of depression from ongoing worry and anxiety, disruption to their relationships, and other social distress.

Stages of the disease

Anankastny violation has two phases: compensation and decompensation. They successively replace each other and have characteristic differences:

1. During the compensation stage, the severity of symptoms is minimal. The patient feels slight discomfort, but his mental or physical performance is not reduced. During this period, he normalizes his life: communicates with loved ones, creates a safe social environment for himself. It helps him reduce anxiety and overcome existing fears. A person finds a job with a low level of responsibility, due to which he can work successfully. During compensation, psychotherapeutic treatment methods are very effective.
2. The period of decompensation is associated with a sharp exacerbation of clinical manifestations. The general level of anxiety increases, doubts and indecision are constantly present. The patient begins to feel severe discomfort, which prevents him from adapting to society. The condition may be complicated by depression and affective disorders. Difficulties arise in communicating with other people, which can result in a breakdown in relationships, including family, business, friendships, and relatives.

The main factor in the transition of the compensation phase to decompensation is a traumatic event. It may concern the patient himself or relate to him indirectly.

When should you suspect a disorder?

To suspect anancastic personality disorder, you should pay attention to the following symptoms:

• constant, unnecessary doubts and double-checks, excessive caution;
• excessive preoccupation with details: rules, schedule, organization, subordination, which sometimes harms the process itself;
• a clear focus only on the “ideal” result of the activity or “nothing at all”, perfectionism, which significantly inhibits the mentioned activity;
• over-obligation and over-conscientiousness, which fixates a person on the activity being performed to the detriment of his personal life;
• thoroughness, strict adherence to social norms and orders;
• inability to adapt to a changed situation, stubbornness, panicky reluctance to change the planned plan;
• the requirement to do everything “just like him”, an inexplicable inability to cede part of the work to other people.

The last point is worth considering in a little more detail. The fact is that the anankast is absolutely convinced that he is the only one who performs some type of activity the way it needs to be performed. And it doesn’t matter what it is: drawing up an important financial report or hanging the keys to offices on the nails of the duty officer at the entrance.

How to avoid making a mistake with a diagnosis?

In order to have confidence in the diagnosis, the sick person must meet certain characteristics, which usually appear already at the initial stage of the formation of personal qualities. When anancaste disorder develops, a person becomes stingy. He is constantly concerned about saving a certain amount for an emergency. This could be a natural disaster, catastrophe, or other reason.

In this situation, a person perceives financial well-being not just as money, but as an opportunity for salvation. It is difficult, almost impossible, to convince such a person and force him to make concessions; he desperately defends his opinion, absolutely confident that he is right.

Establishing diagnosis

The diagnosis is made based on the analysis of the following psychopathological symptoms:

• constant doubts and anxiety;
• pathological perfectionism;
• painful pedantry;
• excessive detail;
• stubbornness;
• requiring others to comply with its rules;
• suppression of one's own desires for the sake of one's own rules.

It is believed that if a person has at least three of the listed signs, then such a person is anankast.

Diagnostics

If we talk about making a diagnosis, this should be done only after appropriate observations of a person’s behavior over a certain period of time. It is advisable to make a diagnosis when a person reaches adulthood, since character traits characteristic of young people in adolescence should also be taken into account.

To make an accurate diagnosis, the following important aspects must be taken into account:

1. Manifestations of the disorder must be total and independent of circumstances.
2. Stability of symptoms that were observed in adolescence and continue to be present in older age.
3. Excessive tendency to doubt, which cannot be confused with a person’s everyday doubts in connection with life circumstances.
4. Unreasonable occurrence of persistent thoughts that do not change over time.
5. The presence of perfectionism, which prevents the person from achieving the goals and objectives set for him.

Clinical manifestations: symptoms and signs

Anancastic personality disorder is characterized by various symptoms. Signs of the disease begin in adolescence and progress continuously without treatment. The first symptoms include frequent doubts of a person who cannot make any decision and worries about the possible unfavorable outcomes of his choice. This leads to pathological perfectionism. It is manifested by beliefs in the inferiority of the results obtained, constant self-accusation and self-flagellation.

Other clinical manifestations:

• Double-checking the work done, constantly checking the results with the final indicator.
• When performing tasks, a person concentrates on secondary details, trying to bring them to perfection. The main goal may not be achieved.
• The patient is meticulous, he approaches the work with concern. This leads to a loss of satisfaction from the actions taken.
• The range of possible emotions is small. People with anancastic personality disorder are unable to express affection or joy.
• The focus of attention in everyday life shifts to maintaining order and algorithms for performing any actions. Relationships with other people begin to deteriorate.
• Obsessive thoughts and actions, as well as the creation of rituals that may be illogical. For example, the patient selects certain clothes for certain occasions or walks the same route a day with important events.
• Before starting action, a person carefully plans his work, looks for flaws in the plan, and tries to eliminate them in advance.
• There is no spontaneity or emotional outbursts; everything is calculated and predetermined.
• Delegation of authority to perform any work is not possible. A person fears for its dishonest execution.

In the absence of therapy, the symptoms of the disease progress, leading to maladaptation of the person in society. Subjective discomfort and depression reduce the level of quality of life.

Treatment of anancastic personality disorder

Psychotherapeutic treatment of anancastic personality disorder is aimed at eliminating the anxious and suspicious state and depends on the severity of the disorder and the discomfort caused. Patients accept all methods of psychotherapeutic treatment on a conscious level, but on an unconscious level they show strong resistance.

In severe forms of anancastic personality disorder, anxiolytics and atypical antipsychotics are used. For minor manifestations of autonomic disorders, beta-blockers are indicated.

There are contraindications, consultation with a specialist is necessary!

For anancastic personality disorder, which is accompanied by depression, the doctor prescribes antidepressants. If the disorder is one of the symptoms of a mental illness, treatment is aimed at treating the underlying disease.

In most cases, manifestations of anancastic personality disorder can be eliminated or minimized within a year from the start of treatment. If symptoms persist, the disorder becomes chronic.

Personality type

Many psychologists identify a special, anancastic personality type, not considering this disorder a disorder, but simply considering it to be a person’s characteristics. But there are psychological schools that consider such behavior and reactions to be deviations from the norm. In any case, if you find similar symptoms in yourself or your loved ones, consult a psychiatrist or first a psychologist.

Both points of view are unanimous in one thing: if a low level of manifestation simply causes increased nervousness of a person and can manifest itself in the form of accentuation (at a neurotic level), then a more aggravated severity leads to deep problems of socialization and is called anancastic psychopathy. Consultations with specialists will not be superfluous in any of the cases; discomfort must be resolved.

Possible complications and consequences

The main consequence of anancastic personality disorder is a significant change and (or) deviation from generally accepted behavioral norms and trends accepted in a specific social environment, accompanied by personal and social disintegration.

Anancastic personality disorder often accompanies mental illnesses such as autism, manic-depressive psychosis, and schizophrenia.

In this case, there is the formation of certain disturbances in the actions, thinking and perceptions of others, which leads to a deterioration in the quality of life of the patient and his immediate environment.

Prevention of anancastic personality disorder

• Prevention of traumatic influences
• Proper child rearing
• Changing patients' attitudes towards traumatic situations using persuasion, self-hypnosis, suggestion.

Occurrence of the disease

In modern psychiatry, it is believed that anancastic personality disorder occurs in people who have changes in the electrical activity of various parts of the brain. The cause of their appearance may be organic damage to the central nervous system during pregnancy, during childbirth or after it.

Anyone can experience these sensations without any pathology. However, when they become predominant in a person, mental disorder occurs. His features appear clearly, one has only to observe the behavior of a suspicious person.

The main risk factors in the development of the disease include the following prerequisites:

• Mental disorders in the family history, indicating a hereditary predisposition. It is detected in 5-10% of cases of anancaste disorder.
• Adolescence is associated with the manifestation of mental disorders and rapid and rapid hormonal maturation.
• Excessive stress of an acute or chronic nature.
• Severe hormonal disorders leading to disruption of brain function.
• Any psychotraumatic situations, and they can be both negative and positive.

Anancastic personality disorder manifests itself at school age. The first symptoms are excessive shyness, fear of making a mistake. Symptoms intensify in cases where a person begins to live alone or starts a family. Due to the lack of a common view on the causes of the disease, specific prevention and treatment are impossible.

Forecast

In most cases, the prognosis is favorable. Manifestations of anancaste disorder can be eliminated or reduced to an acceptable level within a year from the start of treatment. If its symptoms persist, the disorder becomes chronic, with periods of improvement and deterioration.

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Treatment

In the treatment of anancastic disorder, an integrated approach is required (pharmacotherapy supplemented with psychotherapeutic influence):

• antipsychotic drugs;
• anxiolytics;
• antidepressants;
• group and individual psychotherapy;
• treatment of concomitant vegetative manifestations (sweating, palpitations, headaches, changes in blood pressure, etc.) if necessary;
• art therapy, color therapy and other techniques based on creative activity.

Patients with ananthastic personality disorder need qualified psychiatrist help and drug therapy