Anancastic personality disorder - symptoms and treatment

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Anancastic personality disorder is a mental imbalance that is characterized by excessive uncertainty and concentration on completing tasks. People with this pathology are characterized by excessive attention to detail, as well as periodically arising obsessive thoughts and ideas. Psychiatrists classify such disorders as anxiety or panic conditions.

The psychiatric department of Dr. Isaev’s Clinic offers treatment for anancastic personality disorder in Moscow. Our doctors are fluent in the technologies of providing immediate care and are able to carry out targeted personality correction using traditional means and innovative methods. Call us and get a free consultation on calling a psychiatrist to your home, outpatient and inpatient treatment.

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.

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.

Stages of the disease

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

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.
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.

Features of people suffering from APD

People with anancastic personality disorder (psychasthenics or anancastics) are very afraid of defeat and failure. And, in order to drown out this fear, they strive for success. They are punctual and pedantic, efficient and obedient, follow the rules and comply with all regulations. Their whole life, all their actions are subordinated to a strict plan, and if something goes wrong, no matter how small, they get lost, fall into a stupor, worry excessively and cannot finish what they started. Perfectionism is another important feature of psychasthenics. They are very picky about themselves and others. They want everything to work out perfectly, just like in their heads, in their fantasies. And if it’s not so, they worry, beat themselves up and those around them. Because of this, it is very difficult to collaborate with anankastniks in a team.

Those who suffer from this mental disorder find it difficult to make decisions, they doubt a lot. Spontaneous, extraordinary actions are alien to them. There are no artists or creative people among them, but they are an excellent workforce, a draft horse, a cog in a huge mechanism, where everyone is assigned a highly specialized, primitive and extremely understandable role. Psychasthenics are driven people, they are strongly influenced by the opinions of others, they are easy to persuade to their beliefs, to impose their goal, to use them.

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.

Diagnosis

ICD-10

This section is transcribed from Personality Disorder. (edit | history)

Diagnostic criteria from the version of the International Classification of Diseases, 10th revision ICD-10, adapted for use in Russia (general diagnostic criteria for personality disorders, which must be met in all subtypes of disorders):[1]

Conditions that are not directly attributable to extensive brain damage or disease or other mental disorder and meet the following criteria:
a) marked disharmony in personal attitudes and behavior, usually involving several areas of functioning, such as affectivity, excitability, impulse control, perceptual and mental processes, as well as style of relating to other people; in different cultural conditions it may be necessary to develop special criteria regarding social norms;
b) the chronic nature of an abnormal style of behavior that arose a long time ago and is not limited to episodes of mental illness;
c) the abnormal style of behavior is comprehensive and clearly disrupts adaptation to a wide range of personal and social situations;
d) the above-mentioned manifestations always arise in childhood or adolescence and continue to exist into adulthood;
e) the disorder causes significant personal distress, but this may only become apparent later in the course of time;
f) usually, but not always, the disorder is accompanied by a significant deterioration in professional and social productivity.
— International Classification of Diseases (10th revision), adapted for use in the Russian Federation — /F60/ Specific personality disorders. Diagnostic criteria[1]

To classify a personality disorder into one of the subtypes defined in ICD-10 (for diagnosis of most subtypes), it is necessary that it meets at least three criteria defined for this type [1].

Diagnostic criteria from the official, international version of ICD-10 from the World Health Organization (general diagnostic criteria for personality disorders, which must be met in all subtypes of disorders):[2]

G1. An indication that an individual's characteristic and consistent patterns of internal experience and behavior as a whole deviate significantly from the culturally expected and accepted range (or "norm"). Such a deviation must manifest itself in more than one of the following areas: 1) cognitive sphere (that is, the nature of perception and interpretation of objects, people and events; the formation of attitudes and images of “” and “others”);
2) emotionality (range, intensity and adequacy of emotional reactions);
3) controlling drives and satisfying needs;
4) relationships with others and the manner of solving interpersonal situations.
G2. The deviation must be complete in the sense that inflexibility, lack of adaptability, or other dysfunctional characteristics are found in a wide range of personal and social situations (that is, not limited to one “trigger” or situation).
G3. The behavior noted in G2 indicates
personal distress or adverse effects on the social environment.
G4. There must be evidence that the deviation is stable and long-lasting, beginning in late childhood or adolescence.
G5. The disorder cannot be explained as a manifestation or consequence of other mental disorders of adulthood, although episodic or chronic conditions from sections F0 to F7 of this classification may exist simultaneously with it or arise against its background.
G6. Organic brain disease, trauma or brain dysfunction should be excluded as a possible cause of the deviation (if such an organic condition is identified, rubric 07 should be used).
Original text (English)
G1. Evidence that the individual's characteristic and enduring patterns of inner experience and behavior deviate markedly as a whole from the culturally expected and accepted range (or 'norm'). Such deviation must be manifest in more than one of the following areas: (1) cognition (ie ways of perceiving and interpreting things, people and events; forming attitudes and images of self and others);
(2) affectivity (range, intensity and appropriateness of emotional arousal and response);
(3) control over impulses and need gratification;
(4) relating to others and manner of handling interpersonal situations.
G2. The deviation must manifest itself pervasively as behavior that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (ie not being limited to one specific 'triggering' stimulus or situation).
G3. There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behavior referred to under G2.
G4. There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
G5. The deviation cannot be explained as a manifestation or consequence of other adult mental disorders, although episodic or chronic conditions from sections F0 to F7 of this classification may co-exist, or be superimposed on it.
G6. Organic brain disease, injury, or dysfunction must be excluded as possible cause of the deviation (if such organic causation is demonstrable, use category F07).
— International Classification of Diseases (10th revision) — /F60/ Specific personality disorders. Diagnostic criteria[2]

According to ICD-10, anancastic personality disorder is diagnosed if the general diagnostic criteria for a personality disorder are met, plus three or more of the following:

a) excessive tendency to doubt and caution;
b) preoccupation with details, rules, lists, order, organization, or schedules;
c) perfectionism (striving for perfection), which prevents the completion of tasks;
d) excessive conscientiousness, scrupulousness and inadequate concern for productivity at the expense of pleasure and interpersonal connections;
e) increased pedantry and adherence to social conventions;
f) rigidity and stubbornness;
g) unreasonable insistence by a person that others do everything exactly as he does, or an unreasonable reluctance to allow other people to do anything;
h) the appearance of persistent and unwanted thoughts and attractions.

Included:

compulsive personality disorder;
compulsive personality;
obsessive personality disorder;
obsessive personality;
obsessive-compulsive personality.

Excluded:

obsessive-compulsive disorder (42.)[3].

DSM-5

According to the DSM-5, obsessive-compulsive personality disorder is classified as Cluster C.

(anxiety and panic disorders). A person with this disorder is characterized by a marked concern for order, perfectionism, and control over himself and others, which he achieves by sacrificing flexibility, openness, and efficiency in his behavior. To make a diagnosis, four or more of the following characteristics must begin in early adulthood in a variety of contexts, and the disorder must meet the general criteria for a personality disorder. Patient:

Focuses on details, rules, lists, order, organization, or schedules at the expense of the main purpose of the activity.
Exhibits perfectionism that interferes with task completion (e.g., being unable to complete a project because one's own too-strict standards are not met).
Focuses excessively on work and productivity at the expense of leisure and friendships (except in cases where this is due to obvious economic needs).
Overly honest, scrupulous and inflexible in matters of morals, ethics and values (not due to cultural or religious affiliation).
Unable to get rid of worn-out or useless items, even if they have no subjective emotional value.
Refuses to delegate or cooperate with other people until they agree to do things exactly as he does.
Demands from himself and others to be thrifty in spending; money is seen as something to be saved in case of disaster.
Shows inflexibility and stubbornness[4].

Possible complications of pathology

Anancastic personality disorder is associated with other psychopathological conditions. Most often, patients develop obsessive-compulsive disorder or obsessive-compulsive disorder. This pathology is characterized by similar manifestations: avoidant behavior, the appearance of obsessive thoughts and actions.

The second most common complication is depression. It is associated with a person’s subjective discomfort and deterioration in communication with family and friends. Depressive disorders intensify during the period of decompensation of the pathology, when the symptoms of a personality disorder increase.

These consequences of the disease make it difficult to identify the underlying disease, as they have similar clinical manifestations. Differential diagnosis is carried out by a psychiatrist, who can be called to your home. You can also make an appointment at the clinic to be tested anonymously. If the patient and his relatives wish, information about the disease is not distributed or entered into specialized accounting databases.

Minimum required information

The term anankast comes from the ancient Greek word meaning coercion.

Painful symptoms manifest themselves in the form of obsessions and compulsions. Obsessions are obsessive states of thinking. Compulsions are obsessive actions as a result of obsessive personality changes.

Anancaste disorder manifests itself in character changes in which common sense and results are often sacrificed to formal ideas of order.

It would seem that there is nothing wrong with pedantry that leads to accuracy, commitment and cleanliness. But with anancastic personality disorder, all these good character traits are brought to the point of absurdity. A person with such changes is not just neat, but painfully neat. Every item he has is in a place designated for it once and for all. If the situation has changed and it is necessary to change the order of arrangement of objects, the anancaste personality will stubbornly keep them in the same place, to the detriment of common sense.

The behavioral reactions of this type of people are determined by the characteristics of their psyche. For every event or object, they try to find its place in the world around them. A person with a painfully pedantic character spends his entire life sorting objects and events into their assigned places. He perceives any deviation from the principles and norms he has established for himself very painfully, since this brings discord into the picture of the world that he has once and for all established for himself.

An anonymous person rarely holds leadership positions, as he does not have flexibility of thinking. Such a person is good where it is necessary to constantly comply with strictly established rules, for example, when checking vehicles before operating them.

Diagnosis of anancastic personality disorder

Due to the fact that adolescents have a highly pronounced accentuation of personality, a diagnosis of “anancastic disorder” can only be made after 16-17 years of age. The main method of diagnosis is a conversation with a person, as well as collecting existing complaints. To exclude organic damage to the brain (malignant neoplasms, traumatic brain injury), computed tomography or magnetic resonance imaging is performed. Electroencephalography is indicated for all patients.

The identification of anancastic personality disorder is based on the criteria of the American Manual of Mental Disorders (DSM-5):

Obsessions with compulsive counting, repetition, or order.
Having thoughts with forbidden or judgmental content. They can be sexual, religious or other in nature.
Fear of harming oneself or others, leading to re-examination of actions.
Cleanliness rituals, such as washing hands multiple times when touching “other people’s” things.
Pathological hoarding, characterized by obsessive actions.

When making a diagnosis, the doctor also takes into account accompanying symptoms. For example, in the absence of empathy or avoidance of communication with other people, Asperger's syndrome and other autism spectrum disorders may be suspected.

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.

Treatment of anancastic personality disorder in Moscow

Therapy for anancastic personality disorder is carried out in several stages. Initially, patients are recommended to be prescribed antidepressants and cognitive behavioral therapy. Subsequently, preference is given to psychotherapeutic methods, and medications are used as a supplement.

Cognitive behavioral therapy is the “gold standard” for treating the disorder. The specialist identifies frequent automatic thoughts in the patient that trigger obsessive ideas and actions. As a rule, in one patient their number ranges from 5 to 8. After this, the psychotherapist teaches the person to slow them down, get distracted, or replace habitual thinking patterns.

Main indications for cognitive behavioral therapy:

mild or moderate severity of the disorder;
the patient does not have depression or anxiety;
the patient trusts the specialist;
negative attitude towards medicines.

Antidepressants may be used as a replacement for or in conjunction with cognitive behavioral therapy. Psychiatrists prefer selective serotonin reuptake inhibitors: Fluoxetine and others. They are used for 12 months. If they are ineffective, it is possible to prescribe Clomipramine, which is administered intravenously for 7-10 days.

If medications do not help, then non-drug approaches are used: transcranial direct current stimulation, invasive neurostimulation methods, or electroconvulsive therapy.

Neurosurgery is used in a small number of patients when pharmacotherapy and cognitive-behavioral methods are ineffective. The operations involve destruction of the anterior cingulate cortex. This allows you to eliminate obsessive thoughts and actions.

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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Prevention of violations

There is no specific prevention for anancastic personality disorder. This is due to the fact that the specific causes of the development of the disease have not been identified. Therefore, prevention can be aimed at eliminating risk factors. Primary prevention is indicated for all children and is based on preventing the development of the disease. This includes the following actions:

Children must be protected from abuse or abuse.
In case of psychotraumatic conditions, the child must be provided with high-quality psychological assistance.
Parents should maintain strong, positive emotional relationships with their children. In the absence of this, the child has an increased risk of developing personality disorders, Asperger's syndrome and other disorders.

An unreliable relationship with parents leads to the child being afraid of making mistakes and developing various fears. As he grows up, he tries to find a person who would support him and approve of his actions. In the process of therapy, this becomes a psychotherapist who creates the opportunity for the patient to express his emotions and not focus on his own fears.

Secondary prevention is carried out in people with identified anancastic personality disorder. It is aimed at preventing decompensation and the development of pathological complications. The doctor explains to the patient the need for long-term cognitive behavioral therapy or medication. In addition, the patient must follow a number of recommendations:

comply with medical prescriptions;
do not stop taking antidepressants, even if the symptoms of the pathology disappear;
avoid stressful situations at work or in the family;
Take a vacation during an exacerbation.

Comprehensive prevention prevents the progression of the disease. If symptoms worsen or new discomfort appears, a person should consult their doctor. Treatment at home during the decompensation stage is ineffective, since the patient needs constant medical supervision.

Possibilities of modern medicine

Treatment for anancastic personality disorder is mainly psychotherapeutic.

For mild types of disorders, regular individual psychotherapeutic sessions using psychoanalytic techniques are sufficient.

Behavioral therapy sessions are conducted to correct compulsive symptoms. This is necessary to reduce the patient’s sensitivity to stimuli that provoke obsessive actions.

In severe cases, drug therapy is used. Anxiolytics are used to reduce anxiety. This temporary medicinal reduction of anxiety significantly helps during psychotherapeutic sessions. Atypical neuroleptics are also prescribed, which smooth out pathological symptoms without causing motor disorders. In cases where painful changes are aggravated by depression, monoamine oxidase inhibitors and mild antidepressants are recommended.

The prognosis with timely treatment is favorable. Symptoms of the disorder almost always disappear after courses of psychotherapy. If they do not go away completely, they are reduced to a level acceptable for social adaptation.

Preventing the occurrence of birth injuries and brain injuries in early childhood is one of the methods for preventing anancastic personality disorders. In cases of complicated heredity, care should be taken to treat the child’s psyche, especially at an early age.

In most cases, it is difficult to communicate with such people; they often like to argue over trifles and are very stubborn. A person with a personality disorder perceives reality in a distorted form, and these symptoms manifest themselves in any situation.

This diagnosis is not made before the age of 18. However, to make a diagnosis, symptoms must have been continuously present for the previous five years. There are several main types of personality disorders: antisocial, narcissistic, borderline, histrionic, obsessive-compulsive, paranoid, schizoid, schizotypal, dependent and avoidant. There are several other varieties, but they are beyond the scope of our discussion.

Here are 10 signs that suggest a person has a personality disorder:

1. He constantly has mutual misunderstandings with others.

He often hears in the words of others what they did not actually say. The narcissist feels that he is being idealized, although he is far from ideal, and those suffering from avoidant personality disorder hear contempt and anger in the words of others, which in fact are not there. In fact, such a person hears in the words of others the content of his own internal dialogue (insecurity or feelings of superiority).

2. He perceives reality incorrectly.

By incorrectly interpreting the words of others, such people often have false ideas about what kind of relationship they have with others and what status they occupy in society. For example, hysterical individuals quickly begin to consider themselves the best friends of a person they have just met, not realizing that their new acquaintance does not think so.

3. They often spoil others' fun.

For example, they tell how the film will end, come up with unlikely reasons why someone’s plans might fail, spoil others’ mood by causing scenes over trifles. They do all this to be the center of attention, to prove to others that they are smart and right - a typical manifestation of obsessive-compulsive and narcissistic traits.

4. They don't understand that "no" means no.

The tendency to violate the personal boundaries of others is a typical symptom. Sufferers of these disorders do not recognize the right of others to set boundaries and easily violate any boundaries they do not like. People with antisocial and borderline personality disorders violate other people's boundaries for other reasons - the former get pleasure from it, and the latter often do not even realize that they are violating something.

5. They try to make themselves look like victims.

To avoid responsibility, people with personality disorders tend to portray themselves as victims, for example by talking about their difficult childhoods and long-standing psychological traumas. But it's one thing for someone with post-traumatic stress disorder (PTSD) to suffer from painful flashbacks; it's another thing entirely for someone to manipulate others or avoid responsibility by portraying themselves as victims and talking about a difficult past. Paranoid, dependent or antisocial individuals are especially prone to this.

6. They have an imbalance in their personal relationships.

Some disorders (borderline, hysterical and dependent) are characterized by too close and emotional relationships, while other people (with narcissistic, avoidant, schizoid, schizotypal, obsessive-compulsive or antisocial disorder), on the contrary, have almost no access to emotional intimacy. In any case, relationships are built unbalanced - either too close, or cold and distant.

7. It is very difficult for them to change themselves.

Growth and development are almost impossible for such people. They are capable of changing, but extremely slowly. Disorders usually cannot be completely cured, with the exception of borderline disorder, which research shows responds well to certain types of psychotherapy.

Is it possible to cure anancastic personality disorder, and how?

Depending on the severity, the following methods are used:

behavioral therapy;
psychoanalysis;
medicinal.

Treatment approaches vary depending on the severity of the disorder and the discomfort it causes to the patient.

More than 9,000 people got rid of their psychological problems using this technique.

Anancastic personality disorder in a mild form does not interfere with life activities, therefore it can be perceived as a character trait or a change in mood. In this case, methods of behavioral therapy and psychoanalysis are used. Behavioral therapy techniques allow you to reduce sensitivity to stimuli that cause compulsions, teach the patient to adequately respond to what is happening, especially to any changes, something unexpected. Psychoanalysis, in turn, allows us to determine the causes of obsessions, their roots, and help us understand and accept them.

In more severe cases, anancastic personality disorder is similar to obsessive-compulsive disorder and requires medication. In this case they use:

atypical antipsychotics;
anxiolytics;
monoamine oxidase inhibitors;
serotonergic antidepressants.

Anancastic disorder is often accompanied by vegetative (physiological) manifestations:

Sweating;
Rapid heartbeat, tachycardia;
Dyspnea;
Sleep disorders;
Loss of appetite, etc.

And, if these disorders are serious and interfere with normal life, symptomatic medications, such as beta blockers, may be prescribed.

Anancastic personality disorder can also be a symptom of another more serious mental illness, such as depression. Then antidepressants, barbiturates and other drugs are used to suppress the primary disease.