Obsessive-compulsive personality disorder, sometimes called anankastic personality disorder, describes a long-standing pattern of rigidity, perfectionism and a strong need for control. It often occurs alongside depression, and when the two appear together, depression tends to be harder to shift.
Radically open dialectical behaviour therapy, or RO DBT, was developed for problems of excessive self-control rather than the more familiar difficulties with impulsivity. Steinhoff and colleagues re-examined data from RefraMED, a multisite randomised trial of 250 people with treatment-refractory depression, meaning depression that had not responded to previous treatment. Participants received either usual care or RO DBT added to usual care.
Among the participants who also had obsessive-compulsive personality disorder, those who received RO DBT showed significantly better emotional approach coping, which covers recognising and communicating emotions, and better psychological flexibility at 12 months. There was no significant difference for depression symptoms or interpersonal functioning. Having the personality disorder did not predict worse outcomes within the RO DBT group, and did not weaken the treatment's effects.
The honest summary is that RO DBT looks promising for the traits at the centre of this personality style, without evidence here of an added benefit for the depression itself.
If perfectionism or rigidity is costing you, a psychologist can help.
The problem this addresses
Obsessive-compulsive personality disorder, known in the ICD as anankastic personality disorder, is a persistent pattern of maladaptive perfectionism, inflexibility, and a need for order and control. It is not the same as obsessive compulsive disorder, which involves intrusive thoughts and compulsive rituals a person usually experiences as unwanted. The personality style is closer to a way of operating that feels correct from the inside while narrowing life from the outside.
It is commonly comorbid with major depressive disorder, and that combination is associated with worse outcomes and with treatment refraction, meaning depression that persists despite adequate treatment.
Radically open dialectical behaviour therapy is a newer transdiagnostic intervention, transdiagnostic meaning it targets processes shared across several diagnoses rather than a single disorder. Where standard dialectical behaviour therapy was built for undercontrol, RO DBT was built for overcontrol: excessive inhibition, rigidity, and a reluctance to signal emotion to others. It explicitly targets the traits that define this personality disorder, which is why it has been theorised as a treatment for it. That theory had not been tested.
What the researchers did
This was a secondary analysis of RefraMED, a multisite randomised controlled trial comparing treatment as usual against RO DBT added to treatment as usual for treatment-refractory depression, with 250 participants. A secondary analysis re-examines data collected for a different primary question. It can generate strong leads, but it was not what the trial was designed and powered to answer, and that limits how firmly its results can be held.
Of the 250 participants, 117 met criteria for obsessive-compulsive personality disorder and 162 received RO DBT. Linear regression predicted symptoms at 7 months, the end of treatment, and at 12 months, follow-up, controlling for baseline symptoms so that later scores are compared on an even footing.
Three questions were asked. Among participants with the personality disorder, did RO DBT added to usual care beat usual care alone? Within the group receiving RO DBT, did those with the personality disorder fare differently from those without it? And across everyone, did the diagnosis change how well the treatment worked, which is what moderation means?
What it found
At 12 months, participants with obsessive-compulsive personality disorder who received RO DBT added to usual care had significantly improved emotional approach coping, which covers recognising and communicating emotion, and significantly improved psychological flexibility, compared with usual care alone. These results survived correction for testing multiple outcomes at once, a step that guards against a chance finding appearing significant simply because many comparisons were made.
No significant differences were found for depression symptoms or interpersonal functioning. Within the RO DBT group, the presence of the personality disorder did not predict any outcome, and it did not moderate the effect of treatment, indicating the therapy worked about as well for those with the diagnosis as for those without it.
How to read it
The gains sit precisely where the theory said they would: in flexibility and in the recognition and communication of emotion, which are the traits RO DBT was designed to shift. That is meaningful, and the authors describe the therapy as showing promise as a potential evidence-based treatment for the disorder, particularly alongside refractory depression.
It is equally important that depression symptoms did not differ significantly. This analysis supports RO DBT for the personality traits, not as a way of lifting depression that other treatments have failed to reach.
If rigid standards, perfectionism, or difficulty expressing what you feel are affecting your work or relationships, a psychologist can help you look at it.