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 Post subject: Naomi Fineberg on OCPD in video and article
PostPosted: Sat Jul 26, 2014 1:33 pm 
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Hi All,

The OCD expert Naomi Fineberg talks about OCPD in this 12:29 minute video:

Expert Interviews: Naomi Fineberg on Obsessive Compulsive Personality Disorder (OCPD)
SpectrumNeuroscience

https://www.youtube.com/watch?v=0za3oKruzZs

It's rare to be able to watch someone knowledgeable talk about OCPD, so this was a treat. It doesn't hurt she has a pleasant manner about her. I created a transcript which I'll paste into the next post.

Also, she wrote an article on OCPD, here:

Does Obsessive-Compulsive Personality Disorder Belong Within the Obsessive-Compulsive Spectrum?
Naomi A. Fineberg, MBBS, MA, MRCPsych, Punita Sharma, MBBS, Thanusha Sivakumaran, BSc, Barbara Sahakian, PhD, and Sam Chamberlain, MA
http://www.cnsspectrums.com/aspx/articl ... cleid=1091

As noxious as the thesis is to me, that OCPD might be subsumed under the O-C spectrum, I find much of the article valuable. Curiously, I'd included Table 3 from the article, "Compulsive Personality Assessment Scale", as part of the "Self Tests" at the old MSN OCPD support group, but didn't carry it over when we moved to freeforums in 2009.

Some thoughts on the video:

She begins with a rather textbook rendition of what is OCPD, "In the case of Obsessive-Compulsive Personality Disorder there's a pathological focus on orderliness, perfectionism, need for control, a focus on detail, and a difficulty with change, at the expense of openness, flexibility, and efficiency". Certainly the textbook view is relevant and even important, but it always disturbs me when an initial definition of OCPD doesn't touch on conscience and the OCPDer's special relationship to the feeling of guilt. But, again, "a focus on detail, and a difficulty with change, at the expense of openness, flexibility, and efficiency" is certainly very pertinent. Then in distinguishing OCD from OCPD she brings out the old saw that OCD is ego-dystonic while OCPD is ego-syntonic, while I see a more primary difference being that OCD is an anxiety disorder and OCPD is a personality disorder, and otherwise, are two quite different kinds of disorders.

She suggests OCPDers will most often seek treatment not for OCPD but for "secondary conditions" such as depression or anxiety. She says OCPD is the "commonest kind of personality disorder". On the job, there are both advantages and disadvantages to having OCPD, and that among OCPDers "there's a high celibacy rate.". OCPD "starts early, present by adolescence", "generally runs a life-long course, though it may possibly be amenable to treatments, but, as you pointed out, people with this disorder, despite the fact it is really quite common, very rarely come for treatment for that disorder. There have been very few treatment studies looking at pure Obsessive Personality Disorder (i.e., OCPD). It's usually treated together with some other disorder. We don't have a great deal of data on it.".

When asked if those with OCPD have obsessions or compulsions, she says "So if you broaden the concepts of compulsions and obsessions, they do have disabling repetitive thinking, and behavior patterns, that are disabling.". (This suggest to me despite the name OCPD they do NOT have obsessions or compulsions).

When asked about similarities to Asperger's (which we run into in the forum over and over again), she agrees, "I think the phenomenological evidence that we have suggests the difficulties that people with Asperger's in managing sudden and unpredictable change, is very similar on the face of it, to the difficulties that people with Obsessive-Compulsive Personality face", but that there's a lack of data.

She brings up the "need for completeness and perfection" in OCPD, "completeness" that I find as a new and helpful idea in understanding OCPD. I wonder if here she's taken her experience and understanding of OCD and applied it to OCPD. At least in my case, there might be some tiny detail of a situation that I can't see or resolve, not being able to see the "complete" end product, that can paralyze me from going forward at all. So that the "need for completeness" prevents me from moving forward.

For treating OCPD she suggests "cognitive remediation therapy" to address being stuck in details, and SSRIs to become "more flexible, less anxious, less rigid". She compares OCD and OCPD as both having "difficulty shifting attentional set, so this is a difficulty with cognitive flexibility, people will focus on a particular stimulus and then have great difficulty shifting their attention to something new". (I see this as related to OCPDers being stimulus-bound, or stuck on what's in front of their face. In this way, for OCPDers, perception is their god. Philosophically, they've reduced mind to matter. They are "Doubting Thomases" and only believe what they can see and touch. They lack faith and trust.)

Again, in comparing OCD and OCPD, she says "they show cognitive slowness on an executive planning task, they think longer about it before they make a move, and that's, again something where this task is also impaired in people with OCD, so I think that shows an area of congruence".

Regarding data showing those with OCPD may persist in tasks longer than those with OCD, she says "if you continue to live a life despite reward, it might lead to a very impoverished existence.". This certainly rings true to me, speaking to the impoverished inner life of the OCPD, which seems to serve to act as a foundation for making sure things are done right, rather than as a way to infuse joy into the OCPDer's life.

Then near the end a couple of times she says either OCD or OCPD when she really means the other, which to me points up the really harmful consequences we all suffer because of the similarity in names between these two really different disorders.

She sums up by saying (edited for clarity): "I think the take-home message is that OCPD is common; it's easily confused with OCD; it's likely to be treatable; and it's associated with a great deal of distress and disability and needs to be better researched."

All in all I thought she did a very good job. I have to admire someone who can speak extemporaneously and address the issues soberly, properly, and without mistakes. That kind of living and acting in the moment is beyond me.

Sincerely, Paul


Last edited by OCPDmanager on Sat Jul 26, 2014 1:38 pm, edited 1 time in total.
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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Sat Jul 26, 2014 1:35 pm 
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Expert Interviews: Naomi Fineberg on Obsessive Compulsive Personality Disorder (OCPD)
SpectrumNeuroscience

Dr. Eric Hollander: OK! Well, Hello. My name is Doctor Eric Hollander, and I'm with the Spectrum Neuroscience Treatment Institute here in New York, as well as Albert Einstein College of Medicine, and we're hosting the International College of Obsessive-Compulsive Spectrum Disorders this week in New York City. We have a number of international experts in OCD and related conditions, and we're very fortunate today to have Professor Naomi Fineberg, who comes to us from the UK, where she runs the National Health Service program for treatment-resistant Obsessive-Compulsive Disorder. She trained at University of Cambridge, and is with the University of Hertvenshire, and I thought that we would talk a little bit about Obsessive-Compulsive Personality Disorder, where people don't really have a good understanding of that, and how it differs from Obsessive-Compulsive Disorder
1:00
itself, and what are some of the characteristics. And I know that you've done a great deal of research looking at neurocognitive difficulties in people with OCD, and Obsessive-Compulsive Personality Disorder. So maybe we can start by, just tell us a little bit about Obsessive-Compulsive Personality Disorder, what is that.
Dr. Naomi Fineberg: Thank you for inviting me, Eric, and you're absolutely right there is a great deal of confusion between Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder, so I'm delighted to be able to talk a little bit about the personality disorder, and try and tease apart the differences with Obsessive-Compulsive Disorder. Personality disorders in general are thought to represent pervasive problems with character and behavior that start early in life and produce all sorts of difficulties -- interpersonal, and social difficulties for people. In the case of
2:00
Obsessive-Compulsive Personality Disorder there's a pathological focus on orderliness, perfectionism, need for control, a focus on detail, and a difficulty with change, at the expense of openness, flexibility, and efficiency, which really gets in the way of people functioning and getting on with their lives. The difference between Obsessive-Compulsive Personality Disorder and OCD is that whereas people with OCD get involved in various ritualistic behaviors and have intrusive thoughts, that they recognize as being senseless, be they checking or washing rituals, or needing to get things right, in the case of the Obsessive-Compulsive Personality, the person really has a set of values and a sense of self that makes them feel that
3:00
there is rationale for doing these behaviors, so they feel these behaviors are really very important, so they don't necessarily recognize them as being alien to them ... yet, by the same token, they're terrifically time-consuming, they result in slowness, they inhibit people, and people with this disorder come across as being inflexible, rigid, and difficult to live or work with.
EH: Now, what usually brings people with Obsessive-Compulsive Personality Disorder into treatment. Why do they come into treatment?
NF: Very often, they come into treatment because they become unwell in some other way. A large proportion of people with personality disorders, about 70%, get depression. They also suffer with anxiety disorders, they suffer with Obsessive-Compulsive Disorder as well
EH: Mmm, hmm.
NF: And it's often these secondary conditions that bring them into
4:00
treatment, but you know it's really interesting, that when you look in primary care and counseling, people with Obsessive-Compulsive Personality Disorder are the commonest kind of personality disorder, in that, receiving treatment for mental problems. I think it's rarely recognized as being the primary problem, it's the secondary co-morbidity that brings people into treatment.
EH: Now are these individuals difficult to live with, or are they hard to work with?
NF: There are huge adaptive advantages, being meticulous, and conscientious, and workaholic, but there are also negative points. People feel a need to complete work before they can move on, so this really slows them down. They find unpredictable change very difficult so they may get irritable and anxious, and even come across as
5:00
aggressive if they're challenged in that way, so they do come across as being judgmental, irritable, lacking a sense of humor, and inflexible. So, whereas there are advantages in having these personality traits, if you have the full disorder, once it becomes more severe, it's actually very difficult to live with, and to live with somebody with those problems.
EH: So do they have a higher rate of divorce, for example, or do they frequently have difficulty on their jobs?
NF: There's a high celibacy rate.
EH: Uh huh
NF: People have difficult staying in work, people have difficulty with their marital relationships, yeah.
EH: And this sort of rigid, perfectionistic pattern, does it start very early in life?
NF: It starts early, present by adolescence, rather like OCD and the other obsessive-compulsive spectrum disorders, and
6:00
generally runs a life-long course, though it may possibly be amenable to treatments, but, as you pointed out, people with this disorder, despite the fact it is really quite common, very rarely come for treatment for that disorder. There have been very few treatment studies looking at pure Obsessive Personality Disorder. It's usually treated together with some other disorder. We don't have a great deal of data on it.
EH: Do people with Obsessive-Compulsive Personality Disorder, do they have obsessions, or compulsions?
NF: Well, not strictly defined if you require the obessions and compulsions as I said to have this ego-dystonic, this alien quality, but they have intrusive doubts, they have intrusive thoughts, they have repetitive checking, repeating behaviors, needing to get things absolutely correct. So if you broaden the concepts
7:00
of compulsions and obsessions, they do have disabling repetitive thinking, and behavior patterns, that are disabling.
EH: Now are there features of Obsessive-Compulsive Personality Disorder present in other disorders, for example, people with Asperger's Syndrome? Is it similar to the rigidity that you might find in that condition?
NF: I think the phenomenological evidence that we have suggests the difficulties that people with Asperger's in managing sudden and unpredictable change, is very similar on the face of it, to the difficulties that people with Obsessive-Compulsive Personality face, and I think there would be great value in trying to probe that domain, and look at the similarities and differences. As far as I'm aware, no one has actually done a head-to-head comparison of those two groups.
EH: And how about the issues of
8:00
morality and scrupulousness, is that characteristic of these individuals?
NF: Yes, hyper-judgmental, hyper-moral. And that may talk to this need for completeness and perfection.
EH: Uh huh.
NF: That everything has to be perfect, while the self has to be perfect, and one judges others as needing to be perfect too. That there's a, there's a feeling of discomfort in the presence of incompleteness and imperfection, which drives the need for perfection.
EH: So how do you treat people with Obsessive-Compulsive Personality Disorder?
NF: Well, there are various approaches you could use ... there's interest in psychological techniques such as cognitive remediation therapy, which tries to target this focus on details, of information processing problem, where people tend to look at the detail rather than the whole picture. Try and help people expand one's horizons,
9:00
by encouraging that, and motivating them to deal with change, and to get used to change, and that involves training exercises. And the other form of treatment could be using a drug treatment commonly used for Obsessive-Compulsive Disorder, a Selective Serotonin Reuptake Inhibitor, and there's some data suggesting in my experience, patients can become more flexible, less anxious, less rigid, when treated with an SSRI.
EH: Now, can you describe the neuro-cognitive impairment that's sort of characteristic of both Obsessive-Compulsive Personality Disorder and then also Obsessive-Compulsive Disorder?
NF: Well as I mentioned, there haven't been many studies in the disorder as a pure form, and, but, the studies that have been done, and we've just recently completed a study, show some of the similar
10:00
abnormalities in Obsessive-Compulsive Personality Disorder that you see in Obsessive-Compulsive Disorder, namely, difficulty shifting attentional set, so this is a difficulty with cognitive flexibility, people will focus on a particular stimulus and then have great difficulty shifting their attention to something new, when prompted to do so. They'd rather stick with the same thing, and I think that really talks to the clinical problems that they show. It's hard for them to multi-task, it's hard for them to move on, they get stuck on the same theme.
EH: Uh huh.
NF: Similarly, they show cognitive slowness on an executive planning task, they think longer about it before they make a move, and that's, again something where this task is also impaired in people with OCD, so I think that shows an area of congruence.
EH: Mmm hmm.
11:00
NF: But there's also some rather new data, suggesting that people with OCD [OCPD -- ed.] actually have stronger persistence than people with OCD, and that may be an area of divergence, where they may persist for longer without reward.
EH: Can persistence be advantageous?
NF: It's, I suppose it's context-dependent, but if you continue to live a life despite reward, it might lead to a very impoverished, uh, impoverished existence.
EH: OK. So what are three points that you'd sort of like to emphasize to our viewers, what do you think is important in terms of a take-home message
NF: I think the take-home message is that Obsessive-Compulsive Dis ... PERSONALITY Disorder is common -- it's easily confused with OCPD [OCD -- ed.]; it's likely to be treatable; and it's associated
12:00
with a great deal of distress and disability and needs to be better researched.
EH: Mmm Hmm. OK. Anything else you'd like to highlight or cover or ...?
NF: Nope.
EH: OK. Well, thanks very much for visiting with us in New York, and looking forward to the International College of Obsessive Compulsive Spectrum Disorder Conference.
NF: Thanks very much for having me. My pleasure.


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Sat Jul 26, 2014 2:31 pm 
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Thanks for posting this Paul. Very informative.gs


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Sun Jul 27, 2014 9:56 am 
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Thanks for taking the time to post this. Very informative and will add it to my files for reference.


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Mon Jul 28, 2014 8:48 am 
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It's interesting to note that Dr. Fineberg stated OCPD is quite common, which surprised me. We're all very fortunate to have found this board for the generosity of knowledge and information offered on here. Many thanks for posting, Paul.


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Tue Jul 29, 2014 10:37 am 
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This was very helpful especially the parts about meta cognition, the inability to shift from obsessive themed thoughts, and taking a long time making executive decisions.


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Tue Jul 29, 2014 1:53 pm 
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Great article. Thank you for posting!

I continue to be puzzled as to why OCPD is so unknown. For example, I, and I'm sure many others came across the term by accident, while surfing. I have the feeling even some MDs and counsellors are completely unaware of OCPD (vs OCD).

As a matter of fact, its predecessor, Freud's "anal retentiveness" seems to be much better known. A couple of people I've spoken to about OCPD have said "Oh! You're talking about anal retentiveness!". Maybe we should go back to calling it that, despite the rather uncomplimentary name.

And, is it really true that OCPD is relatively easy to get under control as implied in this interview and other places?


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Sat Aug 02, 2014 10:00 am 
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Hi cman,

cman wrote:
Great article. Thank you for posting!

And, is it really true that OCPD is relatively easy to get under control as implied in this interview and other places?


Where does she say that?

Sincerely, Paul


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Sat Aug 02, 2014 1:34 pm 
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Maybe an over-reaction on my part. But I felt it was implied by her statement "it's likely to be treatable" (towards the end of the interview). I guess it's kind of vague. Also, under "Prognosis", many websites say "Outlook for OCPD tends to be better than that for other personality disorders". Again vague, and unclear in what sense the word "outlook" is used, since they go on to say "The rigidness and control of OCPD may prevent many of the complications such as drug abuse, which are common in other personality disorders".


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Sun Aug 03, 2014 11:54 am 
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Hi cman,

cman wrote:
Maybe an over-reaction on my part. But I felt it was implied by her statement "it's likely to be treatable" (towards the end of the interview). I guess it's kind of vague.


Psychopathic personality, that is, lack of conscience, is widely considered untreatable. I suppose the presumption is it's impossible to grow a conscience from nothing, but quite possible to tamp down a conscience which in OCPD dominates the personality.

All of the Cluster B shame-intolerant, narcissistic-based personalities (antisocial/psychopathic, borderline, histrionic, and narcissistic) are also considered quite difficult to treat, compared to OCPD which is based on guilt-intolerance (harsh conscience).

Another issue is treatment versus cure. What is that line between OCPD (disorder) and OCP (personality)? Is it a line that can just be stepped over when you get there? Is it a big step or a small step? If someone is OCPD, they're never going to turn into a psychopath with no conscience. They're always going to have a stronger than average conscience. So in that way, one with OCPD is never going to become a "normal" person. He's always going to lean a bit towards compulsive, in my opinion.

So I wonder that treatment of OCPD may not change their basic character, but may instead help them see a little more of the big picture, open up their heart a little bit, be a little less loud, angry, negative, critical, pessimistic. Maybe learn to value human connection a little more than they do now, and to value things, stuff, objects a little less than they do now. But as far as a "cure" goes, I just don't see that.

cman wrote:
Also, under "Prognosis", many websites say "Outlook for OCPD tends to be better than that for other personality disorders".


In my limited understanding I consider OCPD to be the personality disorder most amenable to treatment. But it doesn't help that OCPD and treatments for OCPD are not very well-known, and not proven effective one way or another.

Sincerely, Paul


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Thu Oct 08, 2015 3:57 pm 
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Thanks for posting this up Paul. I haven't been here for some time, and shame on me for not being part of the support in the group..... :oops:

Just off the top of my head reaction to this, after my having "worked" on my issues- [OCPD, PTSD, Depression/anxiety- for the last 6 years, only becoming aware of the OCPD & PTSD at that time, and then realizing more fully the depression and anxiety]- I would refer someone that I felt was having problems dealing with life because I felt they were showing signs of OCPD as I have come to know it, to this group and certain threads, tests, etc....... rather than sit them down to watch/listen to this video in which this [so called] expert would tend to confuse someone who may have been told they could be helped by it.

Granted, I am most likely being all that I and my OCPD are or can be, but as you've brought up in your last post Paul, I believe in my 4 or 5 years of really working on my OCPD negatives, I have become a "kinder and gentler" OCPD'r.

So true, the conscience part of it, which the good expert doesn't seem to address enough in my opinion, and because of my conscience, I believe that fact- that an "expert" is making statements that are mis-leading and almost contradictory, should cause us, who have a more intimate knowledge of OCPD to question all of what "the experts" say about it.

I'm thinking of starting a thread about we OCPD'rs and current events in the world, but for here and now, just trying to find truth and reality in the "expert"
opinion-- trying my best to not let rational thinking be affected by any or all of the aspects of my/our OCPD, just going by what the "expert" has said..... and yes, quite welcome to have some dialogue about it, but..... if all it accomplishes is making some people "feel good" about themselves, without actually effecting any real solutions to their struggles, then, in my opinion, it really doesn't accomplish anything. So much like so much of what is going on in our world these days, with very, very little done about any of the negative things, other than lip service and that, usually by some "experts" who really don't know what to do about most of those things other than appease the general public...... who are either too busy working to look into the issues and any good/wise solutions, or just don't care, ie; no conscience, and those in power or control-- "experts"? so easily manipulate.

I don't think we should tear the interview to shreds, but when we hear certain things that don't line up with each other, we definitely need to stop and get those things into the truth and reality part of life, whether we all like it or not.

Quote:
Professor Naomi Fineberg, who comes to us from the UK, where she runs the National Health Service program for treatment-resistant Obsessive-Compulsive Disorder.
Note that Professor Fineberg runs a program that here states that OCD is treatment-resistant, and yet I don't remember any talk about any treatments being resisted.

Both the interviewer and the Professor, unfortunately, do not take the opportunity to "seperate" our OCPD from the OCD more fully and distinctly, rather using similarities common to both to confuse the uninformed person. In my opinion, that would have been a much better starting point to make and adhere to throughout the rest of the interview. When I tell people about my OCPD, and I "see" they are thinking of Howard Hughes and his 14" long fingernails, I tell them No, not that at all.

When Professor Fineberg lists a whole paragraph or two of "data" concerning the findings of research from things that "may" be similar to some other disorder, or "can" be this or that, and then sums it all up by saying they need more "data"
Quote:
We don't have a great deal of data on it
They're not making themselves credible with me by these kinds of "expert" talk.

It may be that my/our OCPD is not a welcome kind of personality or personal view of the world, a world with a conscience, that right is right and wrong is wrong..... but if some OCPD person tries to point out something that is truly wrong, self evident to any human who isn't brain dead..... then that OCPD person is judged in need of treatment?
Quote:
"....there are also negative points. People feel a need to complete work before they can move on, so this really slows them down."
Ok, Professor, who or what is being slowed down because work is being completed? I think you make an excellent case of this- your interview/work not being complete, and yet you feel that it has or will accomplish something.

It really gives me the impression that the Professor and the "studies" of our OCPD are almost responding as they feel society expects them to, as society expects us with OCPD to respond, as they do, to whatever happens in society- good or bad, in ways that go to the opposite extreme that we OCPD'rs can go in our rigidness on moral issues, perfectionism, etc. I have noticed some hint of this during my 10 years of counseling-- that we OCPD'rs are almost prejudged just like other people may be profiled-- society, employers, co-workers, etc who aren't dealing with their own possible realities, let alone realities in general, think anyone who points out a truth or reality with a bit of passion is in need of mental health treatment.

Aye, aye..... good thing this is here and not in the general public reading, because I can see how a lot of people nowadays could take this all as my saying (in true OCPD fashion) that we OCPD'rs aren't the problem-- the NONE Awares are the problem....... well, part of it anyhow.

Thanks again Paul and everyone else for listening, and sharing. I know in my journey, my Zoloft has helped- but without my doing my part, my training myself to change my behaviours, listening to my counsellor and you all here....... that has helped me more than anything.


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 Post subject: Re: Naomi Fineberg on OCPD in video and article
PostPosted: Thu Oct 08, 2015 5:19 pm 
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Cap'n Black wrote:
It may be that my/our OCPD is not a welcome kind of personality or personal view of the world, a world with a conscience, that right is right and wrong is wrong..... but if some OCPD person tries to point out something that is truly wrong, self evident to any human who isn't brain dead..... then that OCPD person is judged in need of treatment?


I'm friends with a professor of myrmecology and he thinks like an OCPDer. Many scientists have OCPD ideals. Here's an example:

https://www.youtube.com/watch?v=HWPblU8VUyM

Someone who speaks against weapons, the heart is an European. It is in Europe rather not normal to have a gun in the house. An example: An American man who had weapons in Switzerland and once around shot drunk, was put in a psychiatric hospital with the diagnosis of Narcissistic Personality. They did not want him released, but the court released him. All believed that the man is very dangerous. He went back to the US and immediately got a job and was very popular in his profession. All found that he was charming and wonderful. So it is also very important to see where you live. A cowboy would be a patient in Switzerland. :lol:


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