From the obsessive to the obstinate personality

The obsessives

After the separation, patient 1 took charge of the son the couple had together. He has stable income and has decided not to return to work until the child goes to school. He has no history of hypochondria, but, fixated on the risk that his son might “catch some germ,” his life has turned into hell. He also fears any domestic accident. He doesn't interact with anyone, doesn't leave his son's side, and is incapable of leaving him alone with anyone. He cleans the house tirelessly, cleans his hands, watches to make sure that neither on the floor nor anywhere else there is any small object that could be swallowed by his son, checks the gas valve and checks that the doors are locked to prevent the child from inadvertently escaping from the living room where he must remain. He considers it safer. If he doesn't clean more, it's only so he can keep watch over him. He tries to avoid any potential risk, however remote it may seem. For example: if he gets up in the middle of the night to eat something, he has to put his pajamas in the wash because a crumb might have fallen, which could attract an ant, which in turn could get into his son's ear and hurt him. It cannot be said that he is delusional, but… “at that moment it doesn't seem foolish to me at all.”

Patient 2 is a university student who in recent years has become obsessed with his studies. A brilliant student, his grades are among the best in his class. However, he is always accompanied by the feeling that his exams “will go badly” as well as the feeling of “not having done enough.” He studies a great deal, sleeps little, barely allows himself any rest, and feels exhausted. As the end of the school year approaches he suffers anxious episodes that prevent him from concentrating, which distresses him even more. As a teenager he played soccer and felt guilty over his team's defeats.

Patient 3's wife is desperate. He thinks of nothing but work, and at home he is continually connected to his phone or computer. They sometimes have dinner with friends, but he always wants to go back home “to mull over work.” His work performance is good, the company is entirely satisfied with it, but he takes any setback in a completely personal way. When speaking about himself he uses terms like “pigheaded” or “rigid,” alluding to his rigidity. He doesn't like changes and resists modifying schedules. Austere; his family considers him stingy, but he sees it as a display of “capacity for adaptation to the environment.” His relatives complain that he treats them badly. He acknowledges this, but considers it simply an “excess of sincerity and insufficient tact.” He considers himself a good person, with a great memory, who tries to instill in his son values such as sacrifice, respect, coexistence, and effort. He thinks that his generosity toward his wife has not been reciprocated.

Patient 4 has a perfect family, a perfect life, a perfect company, and controls his anxiety perfectly through breathing exercises. The only problem is that he becomes obsessed with things, he can't stop mulling them over,overdemandsand overwhelms those around him with his relentless insistence. This is the only thing that makes him suffer, given that everything is fine.

Patient 5 is a hospitality entrepreneur. Anxious, he thinks of nothing but his businesses throughout the day. He finds it extremely difficult to delegate, since no one does things the way he wants, so he personally takes on a good part of the obligations, such as shopping. Of an abnormal stinginess, he supervises every last cent spent in his household. He literally fears ending up collecting cardboard on the street. He hatches somewhat far-fetched plansfor saving money: he wants to give his home to one of his children and go live with the other in order to help him pay off the mortgage. Outside the domestic environment he tends to think that everyone is "foolish." His four friends are enough for him, he resists meeting new people and, generally, does not trust others. He believes his penetrating intuition allows him to prejudge, since he is usually not wrong. As a rule, he prefers not to trust at first, which is why he behaves with excessive formality. When offended he gets angry (only sometimes) more than is normal and does not easily forget. He sees himself as a person who is hard toward others' suffering, dry and not given to expressing tender feelings.

Patient 6 delayed pregnancy for many years in order to prioritize professional success. She explains that she has always demanded a great deal of herself, to give more. She fears failing. In recent years she no longer gives the same importance to work, since she has become obsessed with the goal of getting pregnant. That determination absorbs all her thoughts and distresses her greatly. She does not succeed. She lives permanently concerned about not letting anyone down. She acknowledges that other people's comments worry her a great deal, and especially the possibility that she might be identified as a failure. She explains that when she breaks down her mind clouds over, her self-esteem collapses, and she feels incapable of anything.

Patient 7 fled a conflictive family in his adolescence, where he frequently received death threats. He has worked very hard to get ahead and describes himself as productive, competitive, and fast-paced. He suffers from several illnesses and has undergone numerous surgical interventions. He claims to have an extraordinary tolerance for physical pain, which has never kept him from working. Even when he is not working he does not rest either: he fixes a lamp, varnishes, paints the terrace, tidies up. He sleeps poorly. He describes himself as very self-demanding and does not allow himself to make mistakes, although he is permissive with others' mistakes. Some time ago he began to gradually distance himself from his friendships. He felt superior to them, especially because of his sexual attractiveness. He describes himself as unfaithful and at the same time jealous. At work he feels that people talk about him. He finds it hard to take medications and his reading of the package inserts tends to be alarmist. When on one occasion I handed him a lab report, he became absorbed, oblivious to the person in front of him, and sank into a thorough review of it.

Patient 8 holds a temporary position in public administration and, in his free time, prepares for civil service exams in order to obtain a permanent post. He barely allows himself any leisure, since he feels bad when he does not make good use of his time. His study plan is very demanding and he becomes desperate when he fails to reach the goals he has set. At the same time, he feels bad for neglecting household chores and leaving it to his partner to take care of them. Too busy, he has lost contact with his friends and his social circle.

Patient 9, an immigrant, has left her son in her country of origin. She is responsible for a team of computer specialists within a large company and is not satisfied with any of her subordinates. She works tirelessly, well beyond her theoretical working hours. Sometimes also at night and even on weekends. She has gone several years without taking a vacation. She is unable to stop until the problem occupying her has been completely resolved. When she stops working she feels bad, often cries, and consoles herself by drinking too much beer. She feels that her effort is not recognized. In recent months an illness has forced her to take medical leave from her job. She has become depressed.

His family has pushed him to seek consultation because of his bad temper and for driving those around him to distraction. Patient 10 dropped out of school as a young man, he didn't like it, in order to work as a laborer in a family business. Over time, working many hours, more than anyone else, he has come to be the manager, to the full satisfaction of the family group. However, it is in the domestic sphere where his obsessive functioning has overflowed, especially regarding the education and safety of his only child. Since becoming a father he no longer spends the whole day at the company. His need to control the house is excessive. Everything must be tidy and where he has decided it should be; he is convinced that his order is the correct one. He checks by phone what is going to be eaten, whether a certain food has been put out to defrost, etc. Things must be done entirely his way. His insistence on certain matters is exhausting. The excessive anger over "having to repeat things" is damaging the household harmony. He has opinions about everything, including things he knows little about. The marriage has entered a critical stage, but the patient resists separation out of fear of losing control of the situation. He wants to avoid chaos.

All these patients would normally be classified as obsessive, one of the most prevalent personality disorders in the general population (10). Most obsessives are obsessive about something: domestic responsibilities, work, or studies. There are also those who are obsessive about sports, although we have not included any example of that.

None of these vignettes corresponds to a real patient. However, each one has been entirely crafted from fragments of flesh-and-blood patients, who provided the raw material with which they were constructed. The vignettes contain small distortions in the anecdotal elements. The aim was, without altering the fundamental aspects, to prevent the potential identification of the protagonists.

All of them knew themselves to be obsessive or obsessed, but none came in order to stop being or feeling that way. They came because of depression, anxiety, insomnia, or excessive irritability. Some sought consultation because their family members demanded it, tired of their attitudes and behaviors.

The Parallel Personality Disorders

Most authors understand that the term "personality" refers to those stable behavioral predispositions in which some individuals differ from others. We know that when faced with the same situation, different individuals are most likely to react in different ways. It is evident that, at least in part, these differences depend on each person's "way of being" or personality. We refer to those characteristics that tend not to change excessively, either according to context or with the passage of time.

In reality, personality differences are not an exclusively human phenomenon. They have also been observed in the animal world, especially among Primates. Each animal species has its own specific behavioral patterns (if the redundancy may be forgiven), but within those limits, there exist variations among specimens, and these variations often have a lasting character. Thus, some chimpanzees are more or less curious than others, more or less gluttonous, aggressive, independent, submissive, friendly, more or less given to playing with the young, to wandering alone, etc. Each one has its own personality.

We human beings are not only aware that each person has their own particularities in behavior, but these particularities catch our attention, interest us, and we never tire of commenting on them. Anthropologists attest that this was already a daily custom among our hunter-gatherer ancestors.

At first, Psychology applied itself to the scientific study of personalities through the use of multiple-response questionnaires. "Trait" is the term with which each of those characteristics in which differences between subjects occur began to be identified. Traits are usually not dichotomous, something one either has or does not have, but rather acontinuum along which it is possible to place oneself at different points. For example, in the trait "unpleasantness," each individual can position themselves between a maximum (as unpleasant as can be) and a minimum (not unpleasant at all, most pleasant).

At least since Kurt Schneider (24), Psychiatry adopted the idea that the personality of some individuals deviates strongly from the average and that, moreover, it does so in an abnormal way. In the traditional psychiatric approach to the matter of pathological personality, this does not constitute a shapeless magma, or a single diagnosis, but rather is divided into specific entities. Psychiatric classification was initially "typological," which implies that a patient's belonging to type A excludes that same subject's belonging to type B. This strictly typological approach would gradually dilute over time, so that today the diagnosis of two or more personality alterations in the same individual is accepted.

If we focus our attention on the specific personality disorders that appear in the manuals and classifications, we come across a curious fact: some of them bear a close relationship to one of the psychiatric illnesses proper. Thus:

• hysteria (or hysterical neurosis) with the hysterical personality (histrionic from the DSM-III onward),
• schizophrenia with the schizoid personality (and with the schizotypal personality, identified more recently),
• paranoia, with the paranoid personality,
• and phobic neurosis with the avoidant personality.

Between personality and illness, two basic types of relationship are supposed:

1. On the one hand, statistical association. It is supposed that among subjects with personality A, the development of illness A' must be much more frequent than in the general population; and that among subjects with illness A', a history of personality A must be more frequent than in the rest. The possibility that the illness might trigger a change in personality is never considered. In summary: A ⇒ A'.
2. On the other hand, personality and illness must resemble each other; there would be a phenomenological similarity between symptom and trait, the latter being more generalized and diffuse, more resistant to change, and more ego-syntonic. That is: A ≈ A'.

The obsessive personality, according to some study, is the most frequent personality disorder in the general population and could affect nearly one in every 13 adults, at least in the USA (10). It has probably not received attention commensurate with its high prevalence and the significant repercussions it entails.

The disorder would be nothing but the trait-version of obsessive compulsive neurosis. But, is that so? That relationship which is taken for granted, does it really exist? A certain phenomenological resemblance is undeniable. It is obvious that both (obsessive illness and personality of the same name) share the abnormal tendency to concentrate all thoughts and all activity in a restricted field of interests, and to tirelessly "go over the same thing" again and again; but sometimes appearances are deceiving.

To begin with, a brief historical review.

Obsessive personalities

Janet's psychasthenia (1903)

The origins of the obsessive personality are usually located in psychasthenia, a diagnosis conceived and developed by Janet in 1903 that did not survive it except as a historical reference.

Janet set out the clinical picture and his etiological considerations on psychasthenia in several books and over the course of several years. To review them, we will confine ourselves to the work "Les névroses" (16), published in 1909. In this work he attempted to condense his views on the two neuroses that had drawn his attention over the preceding years: hysteria and his psychasthenia.

This section may strike the reader as excessively long-winded and even tedious. For those who prefer to skip it, we offer the conclusion in advance, a very simple one: the clinical description of psychasthenia has nothing to do with the obsessive personality. To attribute to it that primordial role constitutes a mistake. If anything, it was a forerunner of the future neurotic character (11).

Psychasthenia includes an extremely broad range of psychiatric symptoms of every kind, though the most clearly hysterical ones (conversive and dissociative) are excluded, as are the psychotic ones. On the other hand, the anancastic clinical picture is by far the most relevant of the group.

The neuroses

The term "neurosis" was coined in the second half of the 18th century by the Scottish physician and scholar William Cullen (6) to refer to one of the four great Classes into which he sought to distribute the entirety of human diseases. Each class was, in turn, divided into orders, families, genera, and species, following Linnaeus's method. The three remaining classes were pyrexiae (diseases with fever), cachexiae (diseases resulting from bad habits), and locales (localized diseases).

He in turn included among the neuroses “...all diseases of sensation and movement in which pyrexia does not constitute a part of the definitive disease; and all those that do not depend on a local affection of the organs, but on a more general affection of the nervous system”.

Cullen did no more than give continuity to Sydenham's ideas, who had attributed a central role to the nervous system in the functioning of the organism and in the genesis of disease. Sydenham discarded classical theories such as that of humoral imbalances or that of uterine movements. In turn, he inaugurated the broad chapter of "nervous diseases," which Cullen would rename "neuroses" (for a long time both expressions were interchangeable).

As might be expected, since this was nothing less than one of the four great Classes into which all diseases were divided, the list of afflictions it included was truly extensive. Janet (16), citing Sandras (1851), enumerates them: vomiting, diplopia, amaurosis, deafness, convulsions, nervous state, periodic intermittent affections, hysteria, eclampsia, tetanus, hydrophobia, hallucinations, sleepwalking, lethargy, catalepsy, melancholy, nostalgia, hypochondria, transient delirium of the passions, certain intoxications, certain fevers, chorea…

Throughout the 19th century, disagreements followed one after another. Full agreement was never reached, either on the very concept of neurosis or on the morbid species that should be sheltered under that umbrella.

“[...] Grasset, in the fourth edition of his Traité des maladies nerveuses, of 1894, adds not only Parkinson's disease, but also Basedow's exophthalmic goiter. M Raymond, in his last articles of 1907, did not hesitate to append the psychasthenia that I had described in 1905…” (16).

Now then, as neurological pathologies were increasingly isolated and described with greater precision, they tended to break away one by one from their matrix. Consequently, neurosis progressively ceased to be the extremely broad Class that Cullen had conceived, transforming instead into a much more restricted family confined to the field of psychiatry: anxiety neurosis, phobic neurosis, hysterical neurosis, obsessive neurosis, hypochondriacal neurosis, compensation neurosis… as well as other more anecdotal varieties.

“But most authors add nothing to the domain of the neuroses; on the contrary, they take away from it. Many phenomena formerly called neuropathic are ascribed to diatheses, to infectious diseases, to intoxications, to compressions, irritations, traumas, which act on the cerebral or spinal emergence of the nerves, or at some point along their course. Thus tetanus, considered for a long time a type of neurosis, has come to be an infectious disease related to Nicolaïef's bacillus, and angina pectoris has come to be a disease of the coronary arteries, etc.” (16).

If, on the one hand, the repertoire of concrete neuroses tended gradually to diminish, the definition of the concept had run aground at a point that was not satisfactory and from which it was likewise not known how to escape.

“Sandras understands by nervous diseases ‘all those in which the functions of the nervous system are altered, without it being possible, in the current state of our knowledge, to find, as an original cause, a material, localized and necessary alteration of the organs” (16).

This definition by exclusion suffered from significant drawbacks. If the absence of lesions is what truly characterizes the neuroses, then we would fall into the absurdity of a disease without bodily alterations, something that was inconceivable. On the other hand, if what is at stake is that the lesions have simply not yet been identified, it would remain to be clarified whether underlying the multiple symptoms of the neuroses there is a single localization or whether it is a matter of an affectation of different points of the brain (and, therefore, of different diseases).

There existed, in any case, a novel theory, according to which the cause of the neuroses need not be sought in any cerebral lesion, but rather was situated on psychological ground. Throughout the nineteenth century, observations by alienists, psychologists, and magnetizers had accumulated, all of which pointed to the same thing: that it is in thoughts, emotions, and feelings that the genesis of neurotic symptoms should be sought.

This explanation did not satisfy Janet, who continued to think in terms of a necessary organic etiology. What he was indeed willing to admit is that, in their outward manifestation, the neuroses (the few that remained at the dawn of the 20th century) had a common denominator. This shared element is what inclined him to think, either of a single disease, or of a set of closely related diseases.

Janet's original theory affirms that it is the "functions" (feeding, intellectual functions, visceral functions...) that are altered in neuroses. These functions are constituted by a multiplicity of elements ranging from the simplest to the highest; the latter necessarily develop after the acquisition of the former. If we take feeding as an example of a function, gastric secretion would be one of its simplest elements. Bringing food to the mouth would be situated at a higher level. And appropriately deploying the set of norms and rituals required by a formal dinner with strangers would be situated at the highest rung of the ladder, that of behaviors that develop last. This theory, briefly outlined, would explain the frequent onset in adolescence, the worsening coinciding with the most delicate moments in people's lives (such as marriage), or the greater difficulty in locating the causative lesion, given that it would have a much more diffuse seat in the cerebral cortex. In other words, according to Janet, neuroses would be the consequence of a failure in the maturational process of the functions. The arrest would have occurred precisely at the moment of acquisition of the highest and most complex elements of each of them. This explains that sensation –expressed by family members– of infantilism, of an early arrest of biographical development.

Janet placed his psychasthenia as a variant of a single illness, the neurosis, or as part of a group of closely related illnesses, the neuroses. But the matter that now concerns us is another: is it true that it is in psychasthenia where we must seek the birth, or at least the prefiguration, of obsessive personality disorder?

To answer this question we will take into consideration each of the elements that Janet integrated into the clinical picture. In this way, it will be possible for us to contrast to what extent these elements anticipated the traits of the current obsessive personality.

The symptoms of psychasthenia

Psychasthenics are characterized, in the first place, by certain ideas that the author calls "obsessions of psychasthenics." These are defined in opposition to the "fixed ideas" that arise in hysterical patients during dissociative crises. Indeed, while the latter are forgotten once the critical episode has ended, psychasthenics are fully conscious of their obsessions. In any case, they may have difficulty recounting them, as they find them uncomfortable and embarrassing (an early sign of the egodystonic character that would in time be attributed to them).

Obsessive ideas –according to the author– are often accompanied by two phenomena: impulses (or "impulsions") and irrepressible doubts.

Contemporary psychopathology, for its part, divides anancastic phenomena into two large groups: obsessions and compulsions. This binary schema differs from Janet's (obsessive ideas + impulses + irrepressible doubts) and the fit between the two proves complex:

Current obsessions would include:

• Most of Janet's obsessive ideas (not all).
• A part of what Janet grouped among the impulses (specifically, the phobias of impulsion).
• The irrepressible doubts.

As for the impulses Janet spoke of, today we would ascribe some to OCD compulsions and others to genuine alterations in impulse control.

Likewise, Janet developed the themes or contents characteristic of obsessions. The exposition of many of them remains fully valid.

Sacrilegious obsessions and impulses consist of the repetition of mental images completely unacceptable to a religious person, or of impulses toward the commission of acts constituting the greatest of sins: sacrilege.

Impulsion to crime:"[...] they constantly think of some criminal action that they do not wish to commit, but toward which they feel tempted" (16). Described thus, the impulsions of psychasthenics scarcely differ from any other impulse (to set fire to a forest, to rape…) which the patient resists tooth and nail. But there is indeed a difference. The phobia of impulsion, rather than a genuine impulse, is a fantasy, an irrational fear that the impulse might arise and, above all, that it could not be mastered. This difference had already been vaguely glimpsed by Janet: "[...]he imagines himself being pushed to rape an old woman, on a bench, in front of a church" (16). It is not that he is pushed (by an impulse) and resists it; it is simply that he "imagines" himself to be so.

Genital obsessions and impulsions. “How many young girls are afraid of finding themselves free, wishing to take refuge in convents, because they imagine themselves being pushed to approach their brothers or all the men who come in” (16). Among the genital obsessions of psychasthenics, Janet included those of individuals who claim to feel attracted to persons of their own sex. In reality, they fear feeling attracted to persons of their own sex, and they imaginatively represent to themselves the feared situations. But this would not be a true homosexual desire.

The variegated section on “obsessions and impulsions of shame regarding oneself” includes phenomena that today we would not relate to anancastic clinical practice and whose common denominator is feelings of contempt, remorse, displeasure and—above all—shame, in relation to oneself.

Psychasthenia

“[...] The patient torments himself and constantly accuses himself for everything he does. He has to denigrate and humiliate himself and even punish and torture himself [...] The same applies whether the displeasure concerns his intelligence or his senses; patients are convinced, or claim to be, that they cannot see or hear. They want to verify all objects by touching them and touch them again and again. They become obsessed with the thought of madness, claim to be mad, and, what is worse, feel driven to behave as if mad: ‘I see houses and people upside down, I say foolish things, I am going to smash my head against the walls, look at my eyes and you will see my vacant stare.’ They have the obsession that their personality has changed and that their memory has been transformed” (16).

In this section he also includes déjà vu, and another phenomenon—this one indeed—with clear anancastic connotations: “[...] young women tormented by the thought that they do not love their fiancés (16)”.

The section on “obsessions of shame regarding one’s own body” includes other symptomatic pictures that likewise do not correspond, none of them, to what is now called obsessive-compulsive disorder: anorexia nervosa, simple social phobias (fear of blushing, of writing in public…), writer’s cramp, sexual aversion, or olfactory reference delusion. Also mentioned are “shame regarding bladder functions” (social phobia?) and the “obsession concerning abdominal gases in those persons who voluntarily cloister themselves” (which seems close to what is known as olfactory reference delusion).

Hypochondriacal obsessions close the chapter on obsessions. The author mentions fears such as swallowing needles, dirt, contamination, contagion, or contracting any illness. These are fears that often have a marked egodystonic and recurrent character, and that lead to the performance of obsessive rituals.

Finally, Janet speaks to us of the "incomplete obsessions," among which he includes pathologies equally foreign to the current obsessive compulsive disorder, such as dipsomania and morphinomania. Incomplete obsessions are characterized by the presence of an impulse in the absence of the corresponding obsessive idea. He also includes in this chapter the remorse derived from the belief of having committed a crime in the past (delusional depression? false memory syndrome?).

Janet's observations were not limited to the content of obsessive ideas but also to their form. He defined with great precision what that egodystonic character that we attribute to obsessive ideas consists of: "He doubts his idea enormously [...] he does not have the impression that the idea belongs to him [...] it seems to impose itself upon him [...] it lacks certitude, freedom [...] he is willing to declare that his obsession is ridiculous, which does not prevent him from worrying and thinking about it incessantly" (16).

The clinical picture of Janet's psychasthenia was not limited to obsessive ideas and the phenomena associated with them (doubts and impulsions), but incorporated other elements such as "psychasthenic verbal agitations." These agitations included, first of all, the tendency of some patients to talk incessantly about their obsessive experiences, boring the people around them with their interminable accounts. They also encompassed what we can call "verbal compulsions," in which the patient cannot resist the imperious need to enumerate the objects he sees, utter foul words or sacrileges, repeat invented and meaningless words, etc. He also rightly emphasized that the patient may limit himself to murmuring these words or repeating them mentally without anyone noticing.

The tics of neurasthenics referred to brief muscular contractures limited to a small muscle group (mainly in the face). Today we know that such tics are not, strictly speaking, an obsessive phenomenon, although on some occasions they can indeed be associated with OCD.

Janet also included among the tics another type of movement: we are referring to the anancastic compulsions that, unlike tics, maintain a vague logical connection with obsessive ideas.

This chapter includes the "verification manias," such as that of the patient who shakes his head again and again to verify that his hat is still in place, or that of the patient who cannot help touching her own body to prove to herself that she has not gained weight, or the compulsion of the adolescent girl who repeatedly struck her head three times and touched her ear to check that her earring was still in place and securely fastened. A patient with a "symmetry mania" walked jumping from stone to stone in order to provide both of his feet with the same sensations. Patients with "symbol manias" perform small gestures or movements that hold, for them, an entirely arbitrary meaning. In the "temptation manias" the patient merely begins a gesture (such as a strike) that is never completed. Among the "precaution manias," washing compulsions stand out without doubt, though they are not the only ones. The "repetition manias" include the repetition of standardized motor sequences. Another type of compulsion seeks to compensate for an imbalance (such as the patient who would look for a man to shake hands with after shaking hands with a woman) or to atone for a guilt over an act not yet committed (for example, through the incessant repetition of prayers).

The symptoms of neurasthenia that Janet assigned to the chapter on "phobias of action and situation" are the following:

Those presentations in which an intense anguish prevents the patient from carrying out a certain task. He provides no examples, but it undoubtedly corresponds to the "performance anxiety" that in some patients is associated with activities such as exams, driving, the performance of work duties, etc.

"Akinesia algera" can affect individuals who have suffered an accident that has left, as a sequela, a more or less intense pain. The terror of reactivating the pain leads them to a significant paralysis, entirely disproportionate.

Patients with basophobia do not dare to walk (?).

Patients with akathisia cannot remain still in a chair.

In phobias of objects, the anxiety is triggered by the mere sight of a certain object.

Agoraphobia

Claustrophobia

Phobias of social situations, among which erythrophobia can be mentioned.

None of these pathologies can truly be placed within the field of obsessive disorders.

In the chapter on the "algias of psychasthenics" are included those clinical pictures characterized by a pain that affects both specific muscles and organs. The pain may be more or less continuous, or it may occur only when the muscle or organ is forced to work, or when it is subjected to palpation or pressure. Persistent pain may go hand in hand with the conviction of suffering from some illness, such as cancer. The pain can immobilize the patient for months, as well as keep him from letting anyone examine him. Itching and skin discomforts of all kinds produce great distress and can sometimes be interpreted as "frogs moving beneath the skin, an unpleasant tongue licking, worms, rotten intestines sliding along...". There are patients who find odors distressing (for one patient, all odors remind him of bodily fluids, another associates them with the fear of inhaling toxic elements...). Still others cannot tolerate noises, which leads them to move house, soundproof their dwelling, etc. Microphonophobia is characterized by the fact that it is small noises, not particularly loud, that torment the patient. Janet's photophobic patient had such an intolerance to the simple act of seeing that she was forced to cover her eyes completely and act as though she were blind.

Among the "dysgnosias of psychasthenics," Janet placed a rather disparate repertoire of clinical phenomena that include alterations in the cognitive and sensory realms, as well as in the "familiarity" of psychic experiences. The first of the "dysgnosias" is that of patients who feel that their attention is disturbed, distracted, and who cannot reflect on what they hear. Another group of patients consists of those who perceive surrounding objects as small, distant, or strange. Another dysgnosia is that of those who see objects as double, deformed, or transformed. He also mentions those who feel that the surrounding reality is merely imaginary or even a dream. A symptom similar to déjà vu is that of patients who notice that their words, their acts, or their sensations are the repetition of words, acts, or sensations that had already occurred in the past, in the same order and in exactly the same way. To some psychasthenic patients it seems that everything has been turned around, so that what was previously on the right is now on the left, and vice versa. Finally, feelings of depersonalization range from simple estrangement from oneself to the feeling of having disappeared, of having been replaced, or, in the most severe cases, of being dead.

In the chapter on "alterations of instincts and visceral functions," Janet developed a broad repertoire of symptoms shared –according to him– with hysterical patients. Among them we can highlight: insomnia, hyperphagia, and polydipsia. The "psychasthenic sitiergias" differed from hysterical anorexia in that the rejection of food would stem from obsessive or phobic ideas: scrupulous defenders of animal life, scrupulous individuals who think they have not done enough to deserve food… Here he also included hypochondriacs, fearful, for example, of expanding their stomach or producing too much stool. Unlike hysterical vomiting, that of psychasthenics is self-induced and responds to the need to relieve a discomfort felt after eating. Both hysteria and psychasthenia can present with pollakiuria, but in the second case it usually derives from rituals that force the patient to return repeatedly to the restroom. As for the "retentions" of psychasthenics, these may be due to shyness, to various discomforts, to hypochondriacal ideas, or to scruples surrounding urination.

The "agitation crises of psychasthenics" are triggered, in some cases, by the obligation to perform an action (such as eating in public) that the patient finds distressing. In hypochondriacs, crises are triggered by actions such as urinating, walking, or moving some part of the body. They think that these kinds of actions may be harmful to their health. In Janet's description (which largely refers us back to anxiety crises), the "agitation crises" present with three orders of symptoms: ruminations, varied movements (self-limited attempts at motor agitation, which usually do not go beyond breaking some small object), and visceral alterations (palpitations and accelerated breathing).

The agitation crises are preceded by the "periods of depression of psychasthenics." They constitute, so to speak, the background against which the crises episodically break out during shorter spans of time. What defines the depressive periods are the "phenomena of insufficiency": insufficiency of attention, insufficiency of memory, and insufficiency of will (with the innumerable varieties of abulia). Depersonalization, derealization, indecision, slowness, and the inability to complete acts are also elements characteristic of the depressive periods.

Janet speaks of a "psychasthenic mental state," of an emotivity characteristic of psychasthenic patients. How can it be recognized? Palpitations, irregular breathing, or flushing are not useful for distinguishing the anguish of psychasthenic patients from normal and natural human fear. The difference must be sought elsewhere, which the author captures in two general traits: the loss of the function of reality and the diminution of psychic tension.

By "loss of the function of the real," if we descend to a somewhat more concrete level, Janet was referring to elements such as indecision, lack of resolute capacity, of conviction, and of attention. The psychasthenic would be incapable of experiencing feelings appropriate to the situation, and would live in a permanent sense of lack of fullness, of unreality. The present is unbearable for them, and they prefer to take refuge in the past, in their fantasies, to psychologize or philosophize. Clumsy, lacking practical sense, they avoid all kinds of commitments and efforts, given that the demands of reality only stoke their internal debates, their scruples, and their anguish.

The "decrease in psychic tension" implies that the psychasthenic patient would find himself in a state similar to that of fatigue or drowsiness. Consequently, he would experience the same type of phenomena associated with these two conditions, though in a more intense and persistent manner. This is how the author interprets motor disturbances, irritability, obsessive daydreams, visceral alterations, tedium, loss of precision in action, slowness in bringing memories to consciousness… The loss of mental tension would be triggered, in subjects predisposed by heredity, by factors such as intoxications, fatigue, or emotional shocks. That energy which the patient withdraws from the higher cerebral functions is, in turn, what would favor the outbreak of "inferior phenomena."

Psychasthenia does not anticipate the obsessive personality

This concludes the summary of the lengthy clinical description of psychasthenia. Is there anything in it that allows us to affirm that it foreshadowed, sketched, or introduced the future obsessive personality? The answer is no.

Neither do the neuroses

And what can be said of the elements common to all neurotic pathology (hysteria, psychasthenia, and, eventually, other neuroses)? For Janet, neurotics suffer from a general weakness of the nervous system that would express itself in a set of "stigmata."

Neurotics feel weak and dissatisfied with themselves. They think that their feelings, words, and actions are of little worth, incomplete, that they go unnoticed. The great stigma of neurotics is boredom; no external stimulus is capable of drawing them out of their state.

The neurotic's dissatisfaction causes him to sink into endless lamentations, or else to devote all his energy to the search for whatever might rescue him from his situation. The patient may seek the excitement that relieves his discomfort in alcohol, food, walks, or shouting, or else seek the attention, support, and affection of other people. To this end, he will not hesitate to resort to the greatest eccentricities.

Laziness and the tendency toward daydreaming are accompanied by a marked difficulty in maintaining attention and memorizing, so that a frequent first manifestation of the neurosis is the abandonment of studies.

The emotional life of neurotics, according to Janet, is distinguished by a weakening, such that they barely react emotionally to circumstances and do nothing but repeat the same display of emotions over and over again. Indecisive, insecure, and lacking in will, they are incapable of initiating any new activity, and so they repeat the same routines indefinitely. In general, their actions are slow, they do not finish on time, and they eventually abandon them. Owing to their weakness, they are also incapable of confronting or defending themselves. In boarding schools, neurotic children are easily the object of mockery and humiliation.

Absolutely none of this reminds us of the obsessives we presented at the beginning of this chapter; one might even say they are situated at the opposite pole.

We will have to look for the origin of the obsessive personality elsewhere.

Freud (1909)

Freud. Anal character.

“The people I am going to describe deserve our attention for regularly presenting an association of three characteristics: they are rigorous, stingy and tenacious. Each of these words encompasses a small group of related characteristic traits. The quality of ‘rigorous’ comprises both individual neatness and scrupulousness in the fulfillment of habitual duties and personal reliability [in the sense of being a person ‘of one’s word’]; the opposite of ‘neat’ would be, in this sense, careless or negligent. The exaggeration of stinginess can become avarice, and tenacity turn into obstinacy, with a tendency toward anger and vengeful inclinations easily attaching to it” (8).

In this brief paragraph Freud introduced us to a psychological type that, with nuances, corresponds to the modern obsessive personality disorder. However, the name he gave to this character was different: “anal.” Why anal? What does a subgroup of people particularly perfectionistic, stingy, and tenacious have to do with the anus?

According to Freud, the maturational process involves a series of consecutive stages in which the libido becomes fixed to different mucosae, following a preestablished order. One of these stages is the anal stage, in which the child's main source of pleasure would derive from two activities: the retention of feces and their expulsion.

Well then, the clinical histories of patients with the aforementioned personality traits would have revealed to him that, in their childhood, behaviors linked to anal eroticism had had a particular importance and duration in them.

Freud. Anal character.

“It is easy to gather from the early childhood history of these persons that it took them relatively a long time to overcome infantile fecal incontinence, and that even in later childhood they suffered sporadic failures of that function. As children, they seem to have been among those who refuse to empty their bowels when placed on the chamber pot, because they derive a subsidiary pleasure from defecation, since they tell us that even a few years later they enjoyed holding back defecation, and recall—though with less reservation regarding their brothers and sisters than regarding themselves—performing all sorts of unseemly actions with feces already expelled. From these indications we infer that these persons were born with a sexual constitution in which the erogenicity of the anal zone is particularly strong” (8).

Since these behaviors directly linked to anal pleasure eventually disappear, Freud postulated that character traits would depend on the intervention of secondary mechanisms such as reaction formation or sublimation. Thus, the obstinacy of the adult would reproduce the child's stubbornness in retaining feces. The numerous myths, tales, and superstitions that equate money with filth, or directly with feces (such as the Babylonian belief that gold is “the feces of hell”), also support the relationship Freud found between personality traits and antecedents of anal hypereroticism. (As far as I know, no subsequent research has been able to confirm these defecatory antecedents in subjects diagnosed with obsessive personality).

It should be noted that in his writing Freud did not make a single comment on the relationship between the "anal" personality pattern and the obsessive neurosis that he himself had also identified some years earlier. The only link that is—implicitly—established is etiological: the origins of both must be sought in the same phase of psychosexual development.

Eventually the idea would come to be accepted that these persevering, self-demanding, perfectionist, and miserly individuals represented the trait-version of obsessive neurosis. It ended up seeming something obvious. It wasn't worth dwelling on any further.

Ernest Jones (1918)

E. Jones was a Welsh nationalist, neurologist and psychoanalyst, a prolific author and the first great popularizer of Freudian thought in the English language. In 1918 he published "Anal-Erotic Character Traits" (17). Most authors recognize this book as the next great milestone (after Freud's description of the anal character) in the history of the obsessive personality. Indeed, his contribution was no small one:

• He described in greater detail the components of infantile anal erotism and linked each of them to specific traits and behaviors characteristic of adulthood.
• He delved deeper into the traits of the "anal personality" that Freud had merely sketched out a few years earlier.
• He expanded upon Freud's anal character (adding to Freud's original description his own contributions and those of Sadger).

Many of these additions –though not all– have been preserved in subsequent clinical descriptions.

The following quotations provide us with a general overview of the components of anal erotism, according to the author. Upon each of these components, one of two possible defensive mechanisms may act: either sublimation or reaction formation. In turn, each of the possible dyads thus formed (facet of anal erotism + defensive mechanism) during childhood is related to a range of behaviors characteristic of the adult.

"The mucous membrane lining the anus and the anal canal possesses the capacity, when excited, to give rise to sexual sensations, just as the membrane covering the entrance to the alimentary tract does. The sensations vary in intensity with the strength of the stimulus, a fact often exploited by children, who will sometimes obstinately postpone the act of defecation in order to heighten the pleasurable sensation when it occurs, forming a habit that may lead to chronic constipation in adulthood" (17).

"If we first consider the child's attitude toward the act itself [...] we find that there are two typical traits that are never absent [...] One is the child's determination to obtain as much pleasure as possible from the act, the other is the effort to retain the greatest possible control over it, in opposition to the educational efforts imposed upon him from the environment.

The first of these endeavors is carried out by postponing defecation as long as possible. Children have been observed to go to the extreme of squatting down and plugging the opening with the heel in order to hold the feces until the last possible moment, and then defecating with intense concentration, appearing at that moment annoyed by any external influence that might disturb them” (17).

“One can separate, specifically, the interest [...] placed in the act of defecation itself from that placed in the product of that act” (17).

“The most typical product of the sublimation of the tendency to retain [feces] is the character trait of avarice [...] the refusal to give and the desire to hoard…” (17).

“[...] tenacity is undoubtedly related to the first of the two interests mentioned [that given to the act of defecating] and the sense of order to the second [that placed in the product, that is, the feces], while stinginess is determined by both interests equally” (17).

“The principal reaction formation applied to the tendency to retain is the heightened sense of order [...] an extension of cleanliness, in accordance with the saying that affirms that ‘dirt is matter in the wrong place” (17).

“We now turn to the character traits that derive from the interest in the product of excretion itself [...] All represent positive reactions (sublimation) or negative ones (reaction formation)” (17).

“[...] something should be said about unconscious copro-symbols [...] food [...] any dirty material [...] street garbage (including, of course, manure), dirty sheets, coal dust, refuse from the house or garden [...] money and children” (17).

“[...] in one of the varieties the person's aim is to throw the product at another object, living or non-living [...] the impulse to stain statues with ink, or the perverse impulse to soil women or their clothing by throwing ink, acid, or chemical substances at them [...] the erotic passion for children…” (17).

“Many children consider it an injustice that what they have produced with such interest is suddenly taken from them, and this leads to reinforcing resentment against any interference with the individual, which results in an intense feeling against any form of injustice…

[...] They are particularly troubled by the idea that something might be taken from them against their will, especially if it is something that symbolizes feces in the unconscious, as is the case with money…” (17).

“[...] the importance that early educational interference with anal-erotic activities plays in the genesis of hatred” (17).

“Interest in the act of defecation often leads to interest in the setting of defecation, that is, in the anal canal [...] a tendency to be preoccupied with the hidden side of various things and situations. This can manifest itself in very different ways: in curiosity about the back or hidden side of objects and places (such as the desire to live on the opposite side of a hill because it turns its back on a particular place), in a disposition to make numerous errors in distinguishing right from left, East from West, in reversing words and letters when writing, and so on [...] fascination with underground passages, channels, tunnels, etc.” (17).

“[...] the psychological derivations of the flatus complex, of the child's interest in the production of intestinal gas [...] aversion to air that has already been breathed, with a fanaticism for fresh air, a passionate interest in the control of breathing…” (17).

A distinction must be made between those adult behaviors that are integrated into the anal-erotic character and those others which, while retaining a genetic relationship with infantile anal eroticism, manifest themselves in an isolated manner, not necessarily associated with the rest of the components of the aforementioned personality. This may be the case with those reflected in the two preceding quotations.

Another type of behavior that the author also links to anal eroticism has too universal a character, and consequently, it makes no sense to integrate them into a particular character pattern.

“The erotic-anal complex is genetically related to two of the most fundamental and far-reaching instincts: the instinct to possess and the instinct to create or produce, respectively” (17).

“The desire to further manipulate the product and create from it leads to various sublimations, beginning with the usual fondness of children for molding and manipulating plastic material or putty. The most common sublimation in this direction is cooking, which can later be replaced by an aversion to cooking or continue as a passion. It finds broad application in two other spheres of life: the industrial and the artistic. Examples of the first are metal molding, construction, carpentry, engraving, etc., while examples of the second are sculpture, architecture, woodcraft, photography, etc.” (17).

After this brief digression into such a curious facet of psychoanalytic thought, it is time to return to the matter at hand: the description of the obsessive personality (anal at that time). We already know that Jones detailed somewhat further the traits briefly introduced by Freud some years earlier.

The tenacity is the third element of the Freudian triad. It entails, first of all, a way of devoting oneself to the task with the greatest possible effort and intensity, “as if one's life depended on it,” to use a common expression. Jones spoke of “feverish concentration.” Tenacity also implies the determination not to finish until the task is complete, to the detriment of rest, sleep, pleasures, and even other obligations, which are temporarily set aside.

Anal-erotic personality. Ernest Jones.

“And then they immerse themselves in the work with a desperate and often almost fierce energy that nothing can thwart; any interference constitutes an intense annoyance. It is characteristic of these people to react excessively to interference, especially when combined with a marked concentration disproportionate to the importance of the task. A related trait is intense persistence in the task once begun. They do not allow themselves to be distracted, even if later considerations might bring a different perspective regarding the desirability or value of the task” (17).

In any case, tenacity does not apply solely to that task which at a given moment takes precedence over everything else, but tends to generalize to all aspects of the individual's life. This persistent attitude ultimately leads to exhaustion.

Anal-erotic personality. Ernest Jones.

“[...] they take everything too seriously, and their life is an endless struggle for things to be right…” (17).

It is obvious that, despite the often high costs, tenacity also brings rewards.

Anal-erotic character. Ernest Jones.

“[...] has its reward in the quality of the results. These people often show an extraordinary capacity to work their way through difficulties and, by their persistence, get things done in spite of apparently insurmountable obstacles” (17).

Jones identified three types of actions to which the anal character above all applies its morbid determination: those associated with morality and the sense of duty, those intrinsically unpleasant, and those related to cleanliness.

Anal-erotic character. Ernest Jones.

“There are three classes of actions that are particularly liable to be affected in this way [by anal erotism]. In the first place, tasks that involve a special sense of duty or of what is right; consequently, tasks that are especially moral” (17).

Anal-erotic character. Ernest Jones.

“[…] Secondly, tasks that are intrinsically disagreeable or tedious, toward which there is at first a resistance […] such as tidying cupboards, cleaning the pantry, keeping up a diary, or writing a daily report” (17).

Anal-erotic character. Ernest Jones.

“[…] third class, in which the task relates to objects that are unconscious symbols of the products of excretion […] any form of dust or dirt, anything connected with paper, any kind of waste product, and money” (17).

Freud's first trait of the anal character was orderliness, expressed in “scrupulousness in the performance of habitual duties.” Jones, on the other hand, spoke of perfectionism, a concept close to the former and, in the future, fully incorporated into the obsessive personality.

Anal-erotic personality. Ernest Jones.

“[…] the desire for perfection is manifest. Nothing can be done halfway” (17).

Anal-erotic personality. Ernest Jones.

“When they finally manage to apply themselves to the task [of answering accumulated letters] they do so conscientiously, applying all their energy and interest, thereby surprising long-forgotten relatives with an excellently written and detailed update; they dispatch epistles rather than write letters in the ordinary sense.

[…] they often take great care over the fineness and beauty of their handwriting” (17).

Anal-erotic personality. Ernest Jones.

“[…] cannot write a letter, to give an example, until every object on the desk is placed in its exact position, until the pen or pencil is found in a precise order […] an attitude that certainly has an anal-erotic origin” (17).

The “vengeful inclinations” were, according to Freud, an additional element of the anal character. Ernest Jones reiterated them, though without any further elaboration.

Anal-erotic personality. Ernest Jones.

“[...] vindictive desire for revenge when they are harmed or frustrated, which in many individuals of this type develops to the utmost degree” (17).

Freud's second additional element, the “tendency to anger,” is likewise not absent from Ernest Jones's description.

Anal-erotic personality. Ernest Jones.

“It may be suspected that infantile anal erotism has been inadequately handled in anyone who is a victim of chronic irritability or bad temper” (17).

Ernest Jones expanded Freud's brief and precise description with new elements.

A trait to which the Welshman attached great importance and on which he elaborated at length is the delay in beginning activities. Over time, procrastination would fall into oblivion. This was a mistake.

Anal-erotic personality. Ernest Jones.

"They delay and postpone what they have to do until the eleventh or even twelfth hour" (17).

Anal-erotic personality. Ernest Jones.

"First there occurs a silent, pensive period, during which the plan is gradually worked out, often half unconsciously. At this point they should not be pressed, which would result only in flustered irritation. They keep postponing the preliminary steps as long as possible, until the rest of the participants despair of the possibility of finishing the task, at least on time. Then comes a fit of concentrated, feverish activity" (17).

The following list completes the behaviors that Ernest Jones associated with anal eroticism and that would manifest, with greater or lesser frequency, in individuals with an anal pattern of personality:

• The defense of Nature against the advance of urbanization.
• A verbose discursive style that attempts to be exhaustive in the presentation of data and argument. It tends to be tedious for the interlocutor.
• Not allowing interruptions while he is the one speaking.
• Following his own path and resisting doing so at the pace set by others.
• Inability to delegate.
• A very positive evaluation of himself, with a tendency to consider himself perfect.
• A cognitive style marked by a scant predisposition to consider alternatives to his own view of things.
• Periods of elevated mood.
• Possibility of being unusually submissive.
• Great susceptibility to any injustice or harm of which they might be victims.
• Low tolerance for the imperfections they may encounter in different situations.
• Ascetic exercises.
• Attraction to everything that is hidden.
• Attitudes of great tenderness that may overlap with abnormally tyrannical and authoritarian behaviors.
• Effort to achieve intellectual coherence in argumentation.
• Exercises for the purification of one's own body.
• Insistent proselytizing of their own ideas.

DSM

Some decades later, the first edition of the DSM included a compulsive personality that clearly constituted an extension of Sigmund Freud's anal personality. The choice of a different term (compulsive instead of anal) with which to name it made it possible to sidestep Freudian etiological hypotheses. It is not clear to what extent the choice of the expression compulsive was intended to relate the disorder to neurosis (“obsessive-compulsive”) or whether it was used in a broader and unspecific sense (as in “compulsive buyers”).

Compulsive personality. DSM-I (1952).

“These individuals are characterized by a chronic, excessive, or obsessive adherence to moral demands or conformity. They may be very reserved, meticulous people and may have an inordinate capacity for work. They tend to be rigid and lacking a normal capacity to relax. Although their chronic tension may lead them to neurotic illness, this is not a constant consequence. The reaction may develop through the persistence of an adolescent behavior pattern, or as a regression from more mature functioning as a result of stress” (1).

In 1968, the second edition of the manual (2) already establishes in a diaphanous way the relationship with obsessive neurosis. The new denomination, “obsessive compulsive personality (anancastic)” leaves no room for doubt. Furthermore, it is stated that the disorder may precede obsessive compulsive neurosis. The clinical description contains no change with respect to the previous one, with the exception of the addition of the concept over-dutiful, which we can translate as “very diligent.”

Twelve years later (in 1980), the new DSM-III introduced important innovations: the diagnostic entities were no longer presented through a brief vignette, but through an extensive description that necessarily included more elements than the previous version. Of no lesser importance was the inclusion of a synthesis in the form of operational criteria whose purpose was to serve research rather than clinical practice.

Subsequent editions of the DSM limited themselves to introducing small nuances and adding somewhat more detail and specificity to the general clinical picture.

Westen’s obsessive personality

Drew Westen is a multifaceted author who in the year ’99 published an interesting work (26) on personality disorders. The application of multivariate analysis to the responses obtained on the Shedler-Westen Assessment Procedure-200 (SWAP-200) test produced several personality dimensions, one of which could be identified, without a doubt, with the obsessive personality of the DSMs. However, the overlap is not complete: Westen’s obsessive factor includes items not previously described. Furthermore, many of those characteristics on which there is indeed agreement contain relatively original nuances.

Obsessive personality by aggregation

In order to obtain as broad a view as possible of the obsessive personality, we have proceeded as follows:

Reading and analysis of the texts of Freud and Ernst Jones, the DSM I, II, III and 5, as well as the items of Westen's compulsive scale.

Isolation and enumeration of the constituent elements of each description. This is a necessarily arbitrary process. The transformation of a linear descriptive text into a list of items will produce different results depending on who carries it out. We have tried to break down each text into reasonable conceptual units, neither excessively limited and concrete, nor too vague.

Comparing the items thus obtained, we have sought which ones are repeated and in which authors or texts. Here it is worth making another observation. Each text uses its own vocabulary and the descriptions contain nuances that vary. We have tried to group together those that reflect the same reality, accepting that the descriptions are not perfect copies of one another.

Let us, then, begin with the aggregated obsessive personality.

At the beginning of this chapter we introduced several clinical cases through vignettes. All, or almost all, shared one trait: excessive self-demand and the application of superhuman effort toward achieving what was self-demanded.

Self-demand involves doing what needs to be done, of course, but it also implies doing it well, without errors, which lengthens the process. The obsessive applies himself to it with energy, perseverance, and thoroughness, paying attention to every detail.

Perhaps it is this need to repeatedly check their own mistakes that can make them seem like indecisive people.

Obsessive self-demand has a less visible but no less important side. It is not only about applying extreme zeal to doing well what must be done. It is also about not doing, under any circumstances, that which must not be done. This second battle is fought in a much less visible space: that of the conscience. The result also goes unnoticed, insofar as it does not take shape in anything tangible.

Self-demand is closely related to that trait considered central to the obsessive personality: perfectionism. The obsessive person insists that the things he does be perfect, flawless, unimprovable.

Anal-erotic personality. Ernest Jones.

“[…] the desire for perfection is manifest. Nothing can be done halfway” (17).

Anal-erotic personality. Ernest Jones.

“[…] they take everything too seriously, and their life is an endless struggle forthings to be right…” (17).

In any case, perfection, for the obsessive, is a necessary but insufficient condition. He aspires to something more. For the obsessive, perfection has little value if it is within anyone's reach. He needs challenges, arduous, unique, difficult objectives that require sustained effort.

Absolute perfection is always unattainable. And, for some authors, the force that drives the obsessive is not so much the trophy of perfection achieved as rivalry. From this perspective, perfectionism would be a relational fact. The ultimate goal of the obsessive would not be simply to do it perfectly well, but rather to do it better than others. Or to be, simply, much better, the best.

What ultimately drives him is, perhaps, grandeur and recognition.

Self-demand, in the first place, applies to those tasks that one may consider as inescapable obligations.

By default, we tend to assume that the duties we are referring to are work-related ones. The obsessive sacrifices everything for their work.

Self-demand is also directed toward cleanliness and care of one's outward appearance.

Obsessiveness would lead, according to Jones, to the need to extend cleanliness to the interior of the body itself.

Self-demand affects the order in the arrangement of things. The obsessive feels an aversion to chaos, and objects must be placed in space according to criteria of geometric or conceptual rationality.

Anal-erotic personality. Ernest Jones.

“[...] one cannot write a letter, to give an example, until every object on the desk is placed in its exact position, until the pen or the pencil are found in a precise order [...] an attitude that certainly has an erotic-anal origin” (17).

The natural tendency of the obsessive is to extend his self-demanding –and competitive– attitude even to leisure and recreational activities.

Obsessive perfectionism is applied not only to what the person does, but to how they do it: in an orderly and rational way; it is the opposite of improvising through intuitions and momentary impulses.

Excessively high goals and rigidity in the self-imposed means to achieve them can produce the opposite effect: inoperativeness.

However, it is no less true that other obsessives achieve great accomplishments in their field of action (typically professional performance)

It is well known that a good part of the most (professionally) successful executives and professionals display radically obsessive ways of working. Lists, outlines, and schedules do not always hinder work; rather, depending on how they are used, they can increase productivity.

A trait described only by Jones is procrastination. For the author, the obsessive person often postpones the start of tasks; before that, he sinks into a period of ill-humored self-absorption and perhaps planning. When he goes into action he does so late, but displaying astonishing energy and inexhaustibility. Although later texts did not reiterate this interesting characteristic, I personally know someone who responds to this pattern with precision. It would be a very striking pattern, though not universal among obsessives.

An example, provided by E. Jones.

Anal-erotic personality. Ernest Jones.

“When they finally manage to apply themselves to the task [of answering the accumulated letters] they do so conscientiously, applying all their energy and interest, thereby surprising long-forgotten relatives with an excellently written and detailed update; they dispatch epistles rather than write letters in the ordinary sense.

[...] they often take great care over the fineness and beauty of their handwriting” (17).

Perfectionism is not only a demand upon oneself, it also constitutes a demand directed at others, which will necessarily complicate the relationship with the rest of the world. Jones asserts that one of the causes of obsessive irritability is that the subject cannot bear things being wrong; the obsessive would be a highly demanding person not only toward himself, but also toward his surroundings. He wants everything perfect. The most defenseless victims of the perfectionist hetero-demand are, without doubt, the children.

Anal-erotic personality. Ernest Jones.

“[...] incapacity to enjoy any pleasurable situation unless all the concurrent circumstances are sufficiently perfect. People with this trait are very sensitive to any disturbing or discordant element. Their well-being is affected by the slightest influences” (17).

Perfectionism interferes with the ability to work as a team; obsessives do not trust that others can achieve impeccable results and prefer to act alone. They think they will do it better.

After perfectionism, the field in which we find the most references in clinical descriptions of the obsessive personality is that of interpersonal relationships. The difficulties are of every kind.

Obsessives would be irritable and domineering people.

At the same time, they can act in exactly the opposite way.

We should not be surprised, then, that the obsessive is particularly attentive to the hierarchical situation of those people with whom he interacts, in order to behave in a manner consistent with his relative position (whether of dominance or submission).

According to the DSM, obsessives are also distinguished by a serious, formal, and constrained attitude, to the detriment of spontaneity and empathy.

The DSM-III mentioned some trait suggesting a certain overlap with psychopathy.

Other descriptions include traits that point us toward paranoidism.

By contrast, Westen's study reveals some positive, desirable elements associated with success. Not everything would be harmful.

The following quotes speak to us about the cognitive style and discourse of the obsessive. They are very clear and require no additional comments.

Westen, on the other hand, reaches much more benevolent, almost antithetical conclusions.

Obsessives experience a kind of blockage that prevents them from relaxing and experiencing or expressing emotions.

Stinginess constitutes one of the three essential traits of Freud's anal personality, which he conceived as a prolongation, in adulthood, of the impulse to retain (feces). The DSMs have maintained this trait, unlike Westen's study, in which it is not added to the rest of the items of the obsessive personality.

The accumulation of objects (with the resulting saturation of the dwelling) is recognized by the DSM-5 as a trait intrinsic to the obsessive personality. However, hoarding (or Diogenes syndrome) usually constitutes an independent diagnosis included—indeed—among the disorders of the obsessive-compulsive spectrum.

Jones's description, undoubtedly the most detailed of all, contains elements that only he managed to perceive and that are certainly intriguing.

Finally, let us mention two diffuse concepts that permeate everything the obsessive does.

Closed-mindedness, for example, prevents reaching compromise solutions with other individuals. The obsessive accepts only one alternative: the correct one, their own.

The traits of the obsessive personality "by aggregation" can be arranged in the manner of the layers of an onion. On one hand, the more nuclear elements, those in which most or all of the descriptions coincide, are found in the central part, in the nucleus. On the periphery of the onion would be placed those elements included by only a few or by a single one of the descriptions. These traits are much less relevant in clinical practice. Nevertheless, we have tried not to omit any of them since, for our purposes, their interest is no less.

Adjacent obsessive personalities

Simple obsessive personality

We often overlook an interesting fact: the mental process by which clinicians reach our diagnoses does not coincide either with the operative criteria of official classifications or with the more extensive descriptions found in manuals. Inadvertently, we tend to give priority to some of the symptoms and to forget the others, those whose objectification is more laborious or uncomfortable. This bias is particularly common in the case of personality disorders, whose diagnosis requires more time than is usually available. Since our primary interest is the illness rather than the personality, we tend toward a diagnosis of the latter that is quick, superficial, and not very reflective.

Well then, colloquially one can be an obsessive about something in particular (such as cleanliness, running, stamps, or diet) or one can be an obsessive without further qualification, about nothing in particular. This second group of patients are those we usually identify as afflicted with a personality disorder; it is assumed that they apply their (obsessive) way of operating to everything they do throughout the day. Now then, in practice, the tasks that truly count are those that constitute the fundamental obligations that society sets for us: study, paid work, and/or attention to the domestic environment (the house, things, children, the sick, and the elderly…).

Thus arises a simple obsessive personality (in contrast to the aggregated one, which is quite complex) in which the essential thing is absolutely energetic, persistent, exclusive, and absorbing personal devotion to the task. Whether that devotion arises from a search for perfection, from wanting to become rich, from surpassing rivals, from addiction, from conviction, or from appeasing an internalized stern father is not the essential point. What interests us here is the manner of devoting oneself to the activity, not the reason why.

For that quick, everyday diagnosis of the simple obsessive personality, a simple rule of four "mores" would serve. The way in which the (simple) obsessive applies himself to his activity is distinguished by:

• MORE TIME: he devotes more hours a day, more days per week and more weeks per year to his activity than is reasonable.
• MORE PRODUCTIVITY: the obsessive strives to obtain the maximum benefit from every unit of time devoted to the task, to the detriment of enjoying it.
• MORE QUALITY: the obsessive tries to make the fruit of his work irreproachable, without flaws, perfect.
• MORE QUANTITY: when the result of the work is measured (also or exclusively) by units, the obsessive will strive to surpass every bar set.

Type A

In the 1950s, two American cardiologists (Meyer Friedman and Ray Rosenman) began a study—which took them several years—on the personality pattern of patients with ischemic heart disease. The fruit of their work was the type A, associated with a significant increase in cardiovascular risk.

Type A subjects were characterized by the following (13):

• An intense and sustained drive directed toward goals set by themselves, but poorly defined.
• A deep inclination and disposition to compete.
• A persistent desire for recognition and advancement.
• Involvement in multiple tasks, always with time limits for completion.
• A propensity to accelerate the execution of both physical and mental tasks.
• Extraordinary mental and physical alertness.

This personality pattern would, on the other hand, be associated with higher academic and professional performance. Not always: in some tests poor results were observed. This occurred when the task to be performed was complex and under pressure.

Over the years the association with coronary pathology would be called into question. Not all publications could confirm the correlation, and those that did tended to be precisely the investigations funded by the tobacco industry. The interest of cigarette manufacturers, one may suppose, was to divert attention away from themselves.

The overlaps of type A with the clinical picture of the obsessive personality are obvious. It is worth highlighting the fact that two cardiologists came to identify it on their own. Following an entirely independent path, they converged with the psychiatric diagnostic tradition at the same point.

Work addiction

There is a growing body of literature on work addiction or workaholism. Both terms can be used interchangeably, although the second appears more frequently outside academic circles, with a more diffuse meaning and even a positive connotation.

The list of behavioral or "non-chemical" addictions (where we find pathologies such as compulsive shopping, pathological gambling, or internet gaming addiction) is slowly incorporating this new entity. In any case, most articles are still published in work psychology journals.

The definitions of the disorder are still too numerous, as are the measurement instruments or the classification into subtypes. For example, some authors distinguish between an enthusiastic workaholism, that of those who truly enjoy their work and devote themselves to it for pleasure, and a harmful, dysphoric workaholism, that of those who dislike carrying out their work. Others question this distinction; after all, heroin is also highly pleasurable.

Still, some realities seem evident at first glance. The obsessive's morbid tendency to work naturally lends itself to being interpreted with the terminology and concepts associated with addictions: uncontrollable impulse, loss of control, progressive absorption in the activity in question, disappearance of other interests, psychosocial deterioration resulting from exclusive dedication to the addiction, withdrawal syndrome...

These same patients allow us to make two different diagnoses depending on the lenses through which we observe them. The same behaviors can be conceptualized as symptoms of a disease (workaholism) or as traits of a personality disorder (the obsessive one). It is a somewhat paradoxical situation. The interested reader can access Andreassen's excellent review (4).

Karoshi

This Japanese term has been translated as death from overwork (14). The first death attributed to excessive work occurred in 1969 (it is, therefore, a modern phenomenon). Over time it would come to be considered a veritable plague.

In the 1970s the Japanese began studying a phenomenon that also affects non-communist Korea and China. These are sudden deaths, which usually occur at the workplace itself, of cardiovascular etiology, occurring in subjects who work too much. The cutoff point between normality and excess is often set at 60 hours per week (when the average South Korean workweek is 68).

Well then, it could be verified that cardiovascular risk indeed increased in parallel with excessive work and that there were also collateral victims: families. The deterioration of family life is due not only to the absence of the male, but also derives from the development of "negative feelings" toward one's own family. The more laboriousness, the more animosity toward the spouse and children.

To the objective hours of work other risk elements should be added:

• The stress associated with the work itself (demanding or impossible goals, mistreatment, etc.).
• In some cases, malnutrition due to lack of time to eat.
• The habit of socializing with people from one's own company or from the "business world" once the workday has ended, which in turn is associated with the inhalation of tobacco smoke and alcohol intake.

In the Japanese islands, the karoshi phenomenon has been a subject of debate in the media and a motive for political initiatives. In line with the Japanese tradition of consensus, governments have repeatedly urged companies to reduce their employees' working hours. An important obstacle to the advancement of this policy –which cannot help but surprise us– has been the lack of cooperation from employees, who insisted on remaining active, though avoiding leaving any record of their activity. A reason frequently given by workers –even more surprising– is that this is the way to compensate for their own shortcomings in the workplace. The “lack of awareness of illness” seems to be the norm, and it is the families who most often call the specially set up telephone lines.

Having arrived at this point, a brief recapitulation:

The character type that Freud called anal has survived to the present day with great solidity, unlike what has happened with the vast majority of diagnostic proposals in the field of personality disorders.

It should be noted that in multivariate analysis studies such as Westen's, in which previous diagnostic categories are largely disregarded, a dimension unequivocally identifiable with the obsessive personality also emerges.

In any case, there are differences between the various descriptions. They are not identical but similar.

Let us return to the question we were asking at the beginning of the chapter: this way of being that we no longer call anal, but rather anancastic, compulsive, obsessive or obsessive-compulsive, is it really the trait version of obsessive neurosis? Is it the personality disorder parallel to OCD, as its very name suggests?

The answer to this question must be sought in two orders of evidence. The first is that of statistical association, and the second must revolve around phenomenological resemblance.

Is the obsessive personality the trait-version of obsessive neurosis?

Clinical association

According to the exhaustive review by Diedrich (7), several studies conclude that the obsessive personality is more frequent among patients with OCD than in the general population or among patients with other psychiatric diagnoses. The same author cites several articles indicating that, among patients diagnosed with OCD, obsessive personality disorder is more common than any other. It would seem, then, that the link between neurosis and personality truly exists.

However, according to publications cited in the same article, the frequencies of the obsessive personality in other psychiatric disorders would also be elevated:

• Anxiety disorders, 23%.
• Affective disorders, 24%.
• Substance abuse, 12-25%.
• Alcohol dependence, 31%.
• Panic disorder, 17%.
• Hypochondriasis, 15-22%.
• Eating disorders, 13%.
• Unipolar depression, 14%.
• Generalized anxiety, 34%.
• Social phobia, 33%...

These substantial percentages must be compared with the prevalence of the obsessive personality in the general population (3-5%) and in patients with obsessive neurosis (23-45%). One might say that the obsessive personality is a sort of common background to a great part of psychiatric pathology, and that its association with OCD is less specific than one might have expected.

Another group of publications, with results that are difficult to interpret, also introduce nuances. When we consider one by one the symptoms of OCD and one by one the constitutive traits of the obsessive personality, not all of them tend to be associated with the other pathology. Patients with a double diagnosis constitute a subgroup with well-defined symptoms and traits.

Thus, the epidemiological evidence turns out to be confusing and does not fully confirm the close and privileged association that is supposed to exist between obsessive personality and obsessive neurosis.

Phenomenological resemblance

The other lens through which the relationship between OCD and its supposed parallel personality can be studied is that of phenomenological similarity. At first glance, it does seem that the existence of a close kinship would be confirmed.

In OCD, both obsessive ideas and rituals tend to repeat themselves over and over, persistently. The obsessive personality, for its part, incessantly deploys the same effort toward the achievement of its goals. And, in most cases, this implies repeating the same activities. The element common to both, one might say, is reiteration.

The anancastic neurotic carries out his compulsions in a stereotyped manner, always the same. In a similar way, the obsessive personality submits to an absolute discipline: to its lists, schedules, timetables, and plans. Both share the same rigidity.

All the descriptions of the obsessive personality emphasize perfectionism: in work results, in hygiene and attire, in the order of things, etc. The clinical picture of OCD, for its part, often reflects a genuine horror of imperfection, a permanent doubt regarding possible incorrectness (in the placement of things, bodily hygiene, household appliances…). A third connecting thread between personality and neurosis, then, is that of perfection.

The relationship between obsessive neurosis and the obsessive personality seems so evident that it does not deserve to be examined again nor called into question. However...

Obsession versus pertinacity

It is worth remembering that the concept of obsession is often used with a certain looseness in a way that encompasses both a) properly obsessive (anankastic) ideas and b) the type of fixed (or overvalued) ideas that in the first chapter of The Paranoid Group we include among the pertinacious (paranoid, non-anankastic patients). This dichotomy allows us to confront the obsessive personality not with one but with two psychopathological phenomena: OCD and pertinacity (fixed idea). The question that needs to be answered is: which one does the obsessive personality truly resemble, if either of the two? Does it more closely resemble the obsessive-anankastic idea or pertinacity?

To answer this question, it is first necessary to tease apart the differences between the two.

First difference: the subjects

The two are distinguished not only by their formal characteristics, but also by their contents.

Without any pretension of being exhaustive, let us recall some of the most common "themes" of obsessions:

• Ideas of catastrophe, that something serious might happen to the patient themselves or to one of their loved ones; these are often associated with rituals of exactness in the execution of simple daily activities, with the aim of warding off the dreaded misfortune.
• Ideas of having inadvertently caused harm to someone: typically, having run over a pedestrian with the car. These drivers often feel compelled to return to a particular spot, a crossroads or a traffic light, to verify that there are no victims. Others repeatedly inspect the underside of the vehicle to make sure there are no bloodstains or human remains.
• In impulse phobia, the patient fears losing control and harming themselves (throwing themselves onto the subway tracks, falling from a window) or harming a loved one (typically a baby), usually with knives or scissors. The patient tries to keep sharp objects out of their sight.
• Patients who fantasize about sacrilegious images or impulses, always religious people, experience their obsessive symptoms with great shame and guilt.
• The fear of contagion and contamination figures among the most frequent anankastic phenomena. To avoid such contagion, the patient embarks on a series of repetitive activities and avoidances that are invariably devoid of any prophylactic efficacy (one patient does not allow the hems of their trousers to touch the ground, another inspects everything they are about to touch or step on so as not to come into contact with any stain, etc.). Compulsive washing, which can last for hours and may be carried out with harmful substances such as bleach, is common and constitutes, in all likelihood, the most characteristic image of the patient with OCD.
• Of great interest are those patients who cannot bypass the overwhelming need to resolve doubts —for example, spelling doubts— that come into their heads. They usually turn to those around them to obtain an answer and dispel them, at least momentarily.

Let us now recall, also without any intention of being exhaustive, the most frequent or prototypical pertinacities:

• Individuals querulants who do not reach the point of suffering genuine delusional activity. They attempt to redress through legal channels an injustice —most certainly real— that they have suffered.
• Stalkers. In general, they seek to take revenge for a harm or affront suffered, or to obtain at least public compensation or recognition. Two particular cases within this group are hypochondriacal persecutors (who tend to target a specific doctor) and spurned boyfriends or husbands.
• The amorous stalkers behave in a manner very similar to patients with an erotomania delusion, although they do not experience delusions.
• The reformers are individuals who devote their lives entirely to a social or political cause to the detriment of their own well-being. These are generally simplistic and utopian projects.
• Numerous subjects with megalomanic ideas (thaumaturges, individuals endowed with the power to diagnose illnesses, inventors, representatives of the divinity on this planet, etc.) find themselves in a murky terrain in which it is not clear whether one can truly speak of delusional activity or whether we must settle for the subordinate diagnosis of pertinacity.
• Finally, we should not fail to mention some classic categories, such as that of misunderstood artists and writers or nature fanatics.

The enumeration of obsessive ideas and fixed ideas allows us to distinguish between them, although there are overlaps, such as hypochondriacal preoccupations. The same concern about illness can be situated within the anankastic field or the paranoid one (overvalued ideas and delusions). Consequently, the theme or content does not always allow us to distinguish between the two psychopathological phenomena.

Is there a common thread or some set of formal characteristics with which it might be possible to distinguish the obsessive-anankastic idea from pertinacity?

Second difference: guilt versus harm/grandiosity

One would say that obsessive ideas, in general, contain the fear of sin, of wrongdoing, of impropriety; whether by action or omission; whether by having done it in the past or being able to do it in the future; whether in deed, word, or thought. Did I run over an unknown pedestrian? Can I sin with a sacrilegious thought or act? Would I be capable of taking my child's life? Did I get infected by not having been careful enough, by having been careless? I know I checked, but will the house flood because I wasn't careful enough and didn't turn off the tap, or didn't turn it off all the way?

In some cases this common thread seems more difficult to discern. Even so, with a little imagination, it can still hold true. For example, in the case of obsessive doubts."I'm supposed to know this and I know that I know it, but, what if Barcelona is spelled with a V?" Note that the doubts do not arise in those fields in which the patient may be ignorant, and it is acceptable to be so, but rather in matters whose knowledge is taken for granted and which could suggest that he is a boor.

As for the common thread running through the various themes of the fixed idea, we already discussed it in the first chapter of the book. They all revolve around two poles: the persecutory one (the one of harm and damage) and the pole of grandiosity, superiority, and utopia. Just like delusions, which they so closely resemble.

Third difference: doubt versus conviction

The obsessive asks himself: What if…? What if I have run someone over? What if the gas is not turned off? What if something horrible happens because I don't carry out the ritual? It is completely absurd, but, what if…? What if I contract AIDS by stepping on blood in the street? What if Barcelona is spelled with a V? The obsessive's doubt is somewhat special: it arises in the field of consciousness as a question that resists disappearing, but, at the same time, the patient is aware of the senselessness of that question. Even so, he cannot help but be tormented by the doubt.

In the same way, he is fully aware of the absurdity of his repetitive behaviors; he knows perfectly well that they lack any efficacy whatsoever and that they lead him nowhere.

Pertinacity, on the other hand, is a conviction, a categorical assertion. "I know how to build a happy world." "This doctor has ruined my life." "Water cures everything." And so on.

In summary, we could say that obsessive-idea ≈ pseudo-doubt, while fixed-idea ≈ conviction (non-delusional, pre-delusional).

Two qualifications must be added to this simple schema.

The most severely obsessive patients, especially after decades of illness, eventually lose their sense of reality and their doubts seem to transform into genuine beliefs. The rituals lose their ego-dystonic character and patients no longer resist carrying them out.

When the conviction of the pertinacious person (or of the delusional one, it makes no difference) attenuates, when they draw closer to reality and begin to seriously admit the possibility of being wrong, at that moment we can say that the patient doubts. This is, in that case, a genuine doubt, radically different from the one that repeatedly makes its presence felt in the consciousness of a patient with OCD.

Fourth difference, between the anankastic ritual and the activity of the pertinacious person

Let us take as examples anankastic washing, on the one hand, and pertinacious querulous individuals, on the other.

The obsessive patient wants to eliminate any germ that might survive on their hands. They do so by washing them over and over again with the same products, often in a ritualized manner, as in religious ceremonies. They open and close the tap always with the same hand, apply the antiseptic product in a specific way, rinse, repeat the process an exact number of times, and so on. At the same time, they tend to overlook many other basic hygienic measures. Either they are not being consistent, or it is that, deep down, their horror of contagion is not truly such. In the end, they would be more of a maniac than a genuine hypochondriac.

The activity of the querulous patient, on the other hand, is completely different — one could say more congruent. They neither repeat the same action over and over, nor do so in a ritualized manner. In their complaints they seek effectiveness, and they may equally devote entire days to studying the Civil Code, to preparing their written submissions, or to seeking allies in their crusade through the courts.

OCD tends to deploy a limited number of actions (compulsions), or even to repeat no more than one, always the same one; the pertinacious person, for their part, develops a much broader range of activities: all those they believe will lead them to achieve their goal in the most immediate and thorough way possible.

The obsessive carries out their rituals fully aware of their futility; the activity of the pertinacious person, quite to the contrary, is in keeping with their objectives.

The obsessive's ritual is perfectly defined in its components and momentarily makes them feel calm, relieved; until the unease returns. It is a circular process that never ends. The pertinacious person, on the other hand, follows a linear process that, even as it advances, also never ends. Like the sailor who tries to reach the horizon, they never get a respite like that of the anankastic. The pertinacious person never gets to claim victory; success eludes them.

Fifth: qualitative differences in thematic overlaps

We said that the anankastic contents and those of fixed ideas are distinct; this disparity facilitates the differential diagnosis. Nevertheless, there are several overlaps in which the same theme can present itself, interchangeably, as an obsession or as an overvalued idea. This is the case with hypochondria, with hoarding, and with aggression.

In all three cases we must pay attention to the details.

Hypochondria

Anankastic hypochondriac ideas revolve mainly around contamination by germs. They are associated with washing compulsions (of the hands, the body, food, clothing…) and various avoidances (not touching a certain object, not approaching a certain place, not ingesting certain things, etc.). The compulsions and avoidances are completely disproportionate, absurd, and even harmful. Even so, for the anankastic, the most important thing is the execution of the rituals and the fulfillment of their avoidances. They do not fear the bacterium but rather themselves; they fear not having done what was appropriate and doubt whether they have acted correctly (aware that their compulsions are, in reality, absurd and useless).

The overvalued hypochondriac, on the other hand, is genuinely concerned about actually having contracted or being able to contract the illness. They act in a manner consistent with their fear: they try to get doctors to confirm or rule out the condition with absolute certainty, they study it, they search the literature for the treatment and apply it, just in case, whenever possible, etc. The feared illnesses are infectious diseases and cancer, above all. Both adapt very well to the paranoid rhetoric of war. Like other types of enemies, the hypochondriac attack can come equally from outside (invading germs) as from within (treacherous, malignant cells). Both invade, weaken, and ultimately kill the patient. Treatment tends to be expressed in warlike terms, as a great battle.

Hoarding

The accumulation of objects has classically been considered an obsessive symptom. More recently (3) it has become an independent diagnosis, albeit included in the obsessive spectrum.

But the truth is that there are two ways of accumulating:

The anankastic patient hoards useless objects (magazines, old clothes...) just in case, in case they might ever be needed. He knows they will be of no use to him, but he is incapable of parting with said objects. "What if I need that information someday, what if it comes back into fashion someday...?"

The "pertinacious accumulation", or paranoid accumulation, derives from a clear will to hoard rather than from an inability to part with objects. It is related to persecution or to megalomania: weapons, gold, cars, etc. A megalomaniac patient —with mystical experiences— hoarded enormous quantities of supposedly recyclable scrap metal and waste because it made him "feel in solidarity with all the poor and needy".

Aggression

Anankastic and pertinacious aggressive ideas or impulses are also radically different:

The obsessive person is terrified by the guilty thought of having been able to harm an innocent and even beloved person, or of being able to do so in the future. He does not want to, but he is assailed by doubt as to whether he might at some point lose control of himself.

The pertinacious harasser fears that he himself will be the one attacked, the victim of his enemy. He wants to attack him and often does so, since he considers it his right because it is just. When he restrains himself it is out of prudence or cowardice, but not for lack of desire.

Obsessive personality and pertinacity

What is common to all the patients presented in the first section of this chapter is the fervor with which they throw themselves into work (in a broad sense, also encompassing study and household tasks) and into their goals. They have their reasons, their objectives, and their ambitions; these are not always formulated in a clear and articulate way, but they have them. The arguments the obsessive puts forward for sacrificing everything for work may seem flimsy to us; even so, the obsessive firmly adheres to his whys. No anankastic doubts whatsoever. He displays the conviction and coherence of the querulant, the inventor, or the persecutory hypochondriac. He acts like someone pertinacious in his pursuit of success, not like a neurotic who wavers and is paralyzed by insecurity and scruples.

The force that drives him is not the guilty doubt of the anankastic, nor is it any fear that even he himself might find absurd. The obsessive does not ward off any improbable catastrophe, nor does he atone (at least consciously) for any uncommitted sin. What drives him is the aspiration—conscious and fully embraced—to do something great and valuable, something that can be respected and admired. If there is one thing he is convinced of, it is that this is his duty. However, although he does not act to alleviate any guilt, he may indeed feel guilty for failing to act. It is a different kind of guilt, one that is not found at the point of departure but at the point of arrival; it presents itself to us as a consequence of inaction, not as a cause of action.

His is an ego-syntonic idea—that is, in full harmony with the rest of his person. If any parasitic thought comes to mind, it will be, in any case, the thought of straying from his path or of abandoning his endeavor. The obsessive lives in consonance with his aspirations; they are his own, a part of him.

We do not know whether he seeks perfection or success, whether he wants to do things well or to be the best. Be that as it may, he organizes his activities and his efforts, his pauses and his bursts of speed, according to his ultimate objective. That objective may prove elusive and unattainable, yet in any case he never stops moving in the right direction. In this respect, the obsessive seems more like the trait-version of pertinacity than of the obsessive idea of OCD. His behavior—like that of the pertinacious person—follows a linear course, directed toward a fixed point on the horizon. It does not trace the circles that bring the anankastic patient back to his starting point, over and over again.

If we confine our analysis to obsessive behaviors in the workplace, we might think, at first glance, that the obsessive's excessive activity is the fruit of calculation. He works in order to enjoy prosperity. At least, that is what he himself often claims. And yet, if we observe him closely, things may be happening in a different way.

The obsessive's work has a strange quality that likens him to the cloistered monk. It often does not seem that prosperity matters much to him, for he lives an austere lifestyle, with barely any needs, one that is difficult to understand. He continues to work tirelessly when he no longer needs to. He has accumulated more than enough, yet he resists retiring when age or illness makes it advisable. In his free time, he prefers to plan or to ruminate about his work rather than surrender to the enjoyment of its fruits. The monks' laborious life has a meaning: ad majorem gloriam Dei. But the obsessive (with some exceptions) does not put forward spiritual reasons, only justifications of this world:

• Recognition and power.
• The happiness of the family.
• The progress of society.
• Duty.

First motivation: recognition and power. Although they resist acknowledging it openly, many obsessive patients seek recognition and status. Through professional or business success they aspire to occupy a prominent position, to be known and respected. Precisely for this reason, it is common for them to combine an austere lifestyle when it comes to themselves, in the private sphere, with a ready willingness to spend on representation and image. Others seem more interested in recognition from their family circle. The obsessive often seeks the approval of his parents (or one of them), even after they have passed away. "Something he could be proud of" is a phrase I have heard on more than a few occasions.

Second motivation: the happiness of the family. Another recurring argument is that of creating a legacy (financial, real estate, business-related, etc.) that guarantees the future of the children and their children's children. That they remain shielded, at the very least, from poverty or, better still, that they be the ones who allow themselves what the obsessive himself, despite having the means, has never permitted himself. The obsessive would not renounce the "good life" (a term that is never, in any way, used to refer to his own lifestyle) because it is harmful or deserving of rejection; it is simply that he prefers to offer it to his descendants.

Third motivation: the progress of society. A third group of arguments alludes to social advancement. The emphasis on incessantly improving, innovating, and perfecting procedures or the results of one's work is justified because it means contributing to the material well-being of society as a whole (which was not the case either in Prehistory or before the Industrial Revolution). In a world like ours, where industriousness has replaced piety as the supreme virtue, doing things well, improving and even innovating, means doing what is right—that which will result in a better world.

Fourth motivation: duty. In other cases where ambition weighs less and rigidity weighs more, the obsessive simply acts in the belief that he is fulfilling his obligation. Regardless of the results, he does what he has to do. The motivation is moral.

Does the obsessive's way of acting and his lines of argument not refer us back to the behavior and arguments of the pertinacious?

Let us take, as an example, a prominent group of pertinacious individuals: the reformers. Their goal is to build a perfect political order. For that dream they are willing to sacrifice everything. They seek to establish a society free of conflict that guarantees universal happiness. They deploy an ingenuous mixture of extreme altruism (renouncing any other personal interest) and vanity, for they are not only the intellectual architects of the new social and political order, but dream of being the leaders who will impose it and the rulers who will govern it.

In what ways do the obsessive and the reformer resemble each other? Both struggle tirelessly for a better future (for society, for their own family, or for themselves). Both tend to magnify the impact and importance of their work. Both share the same austere attitude and, though it may not seem so, an antimaterialistic one. Both sacrifice the enjoyment of life, their desires, and to a great extent their loved ones, in pursuit of an ideal that, in all likelihood, they will not see fully realized by the end of their lives. Persevering effort and narrow-mindedness lead the reformer to poverty and even to destitution. The same does not happen to the obsessive, but he may end up losing his family, his health, and even his life, like the Karoshi who collapses exhausted over the keyboard.

As for the arguments with which the reformer explains his unbridled activism, they run parallel to those of the obsessive: duty, progress, the legacy for future generations (which are no longer limited to biological descendants), or the glory he deserves and which is his destiny.

So then:

• If there are numerous arguments for ruling out that the obsessive personality is the trait version of the obsessive idea of OCD (as the very name implies),
• if the obsessive personality seems rather to be the trait version of the overvalued idea or pertinacity,
• and if pertinacity is nothing other than a variant of paranoid behavior, then,
• one may expect the universal constants of paranoid behavior to unfold within the obsessive personality.

To evaluate this hypothesis we will place face to face (a) our "aggregate obsessive personality" and (b) the constitutive elements of paranoid behavior that have emerged from the study of paranoid contagion groups. Do they overlap and coincide? That is what we must determine.

The obsessive personality as an unfolding of paranoid behavior

Pride, distrust, and rigidity

First element of the paranoid constitution: pride, grandiosity

The paranoid person sees himself as endowed with more intelligence, more strength, more courage, or more positive attributes than most. His superiority allows him to look at others with contempt, whether he acknowledges it or not.

Is overestimation of oneself present in the obsessive personality?

Somewhat attenuated, pride was already detected by E. Jones among his anal patients.

The same author, however, admits that this "good opinion" may go somewhat further.

Anal-erotic personality. Ernest Jones.

“[...] the exalted belief in personal perfection…” (17).

Four traits ascribed to the aggregate obsessive personality point us back (albeit veiledly) to the superiority complex: effort, inability to delegate, purity, and curative omnipotence.

a) Effort

The PCGs taught us that superiority is not merely a self-evaluation, a good grade that the militant assigns to himself, to his things and to his activities, nor a comforting sensation that arrives free of charge, by the mere fact of having enlisted in a given group. Frequently, superiority is also a mandate: one must strive and earn it. The life of the cult member, like that of the true fanatic, is distinguished by absolute devotion to the cause, without sparing any effort. He feels rejection toward sleep and rest and feels obliged to make a permanent effort on behalf of the goals that the leadership determines. Resting is not good: the cult member cannot allow himself this, because he must work toward goals that are too important. Being a co-participant in something so great makes the militant feel, himself, like someone important.

The obsessive person also strives to the utmost, wants to progress, to improve, to surpass others and to surpass himself… he will strive as much as necessary to become superior.

b) Delegation

The same dynamic of superiority underlies a trait attributed to the anal personality: the inability to delegate. This is how E. Jones saw it.

Anal-erotic personality. Ernest Jones.

“[...] the conviction that no one can perform the task in question as well as he himself, and that he cannot trust that no one will do it correctly [...] they refuse to delegate any part of the work, however urgent it may be, to a substitute or assistant” (17).

Anal-erotic personality. Ernest Jones.

“The relationship between the last discussed trait [the inability to delegate] and narcissism and the exalted belief in personal perfection… is clear” (17).

If he has no alternative but to hand over responsibility, the obsessive will not fail to watch that things are done correctly, that is, his way. Not the way of others.

In the clinic, hypochondriac or querulous delusional patients behave in a similar way. They treat their doctors and lawyers as if they were their employees, and closely supervise each of their steps or decisions. They want them to act exactly their way.

c) Purity

Sometimes paranoid superiority refers to one's own body and is expressed in terms of purity. This is a metaphor inspired by water (or diamonds). It is frequent in religious sectarian groups and also occurs in paranoid patients. The absence of impurity implies, in a way, a state of perfection, of clarity, in which negative or harmful elements have been completely eliminated.

In some cases one's own purity is simply taken for granted: it derives from mere militancy in the cult. Most of the time, however, it requires an activity aimed at eliminating that which prevents reaching the ideal. Compulsive washing, diets (often vegetarian) or the intake of large amounts of water serve this purpose.

Jones, for his part, relates purification behaviors to the anal personality.

Anal-erotic personality. Ernest Jones.

"I have found that the anal erotic reaction often extends to the inside of the body, with the conviction that everything inside is inherently dirty. I have known people who even refuse to put their finger in their mouth, and who have the habit of drinking large amounts of water daily with the idea of purifying the dirt inside their body" (17).

d) Counter-hypochondriasis

We already discussed at the time the megalomaniac ideas of paranoid individuals and groups in relation to health: ideas concerning immunity to diseases, ideas regarding the possession of extraordinary healing powers, prodigious techniques, etc.

Jones described something similar in his anal patients.

Anal-erotic personality. Ernest Jones.

"[...] and the conviction that breathing exercises provide apanacea for physical and mental ills" (17).

Second element: enemies / enmity

Paranoid character

"[...] the essential traits of the paranoid character are the following:
- overestimation of oneself;
- distrust;
- falseness of judgment…" (19).

As the reader will recall, we prefer to speak of enemies, on one hand, and of enmity behavior, on the other. In turn, we broke down the latter into several elements, for analytical purposes:

• The motivations of enmity behavior: distrust, resentment, and honor.
• Hyperalertness.
• The emotions: fear and hatred.
• The behaviors: attack and flight.

In this scheme, distrust is nothing more than one of the components of enmity behavior.

Regarding the identity of enemies, we develop the idea that they are not always other human beings. They can be animals, pathogenic agents, incorporeal spiritual beings, etc. We also discuss the possibility that hostile behavior may be deployed against real adversaries, of flesh and blood: when they have real ones, they do not need to invent them.

Well then. If the obsessive personality is a variant of paranoid behavior: Who is the enemy?

a) The enemy of the obsessive personality

The obsessive personality is competitive, always wants to win, to surpass others and, in the end, to defeat them. To this end he applies all his ingenuity and all his effort. Although it may sound strange to us, the competitive mentality of the obsessive is not so far removed from the mentality of war. War, after all, is nothing but a competition to the death. The obsessive's rivals are those with whom he competes in the professional, sporting, or whatever other realm. From a broader perspective, everyone who might come to overshadow him in achievements, in prestige, or in social recognition is an enemy.

But there is more. What, ultimately, drives the obsessive to persevere in his self-demand is the gaze of the other, the need for approval, the what will they say.

"Extraordinary sensitivity…"; it is society as a whole that has acquired, in the eyes of the obsessive, that threatening tonality that the paranoid frequently ascribes to a much smaller number of individuals. The paranoid fears the looks, the laughter, or the whispers of others, because he thinks they refer to him and are directed against him, and he cannot bear it. Mutatis mutandis, one might say that the obsessive's impulse to be impeccable and not to allow himself the slightest mistake responds to the need to avoid the contempt, mockery, or hostility of people.

This would be the persecutory background of the obsessive's self-demand (which must be added to the other background, the narcissistic one). Being at bottom a paranoid, he feels the weight of others' gazes converging on his person, and it is this weight that leads him to avoid any error. He does what is right in order to gain approval, and he needs approval because that way he avoids rejection. Or so he believes, because, contrary to what one might expect, his competitiveness, and especially his success, can indeed arouse the ill will and envy of those around him.

Although it may not have much scientific value and relying solely on clinical experience, I would venture to affirm that self-referential interpretations are particularly frequent among individuals with obsessive personality. Not universal, of course, but considerably more common than in other patients. One need only ask.

In short, every paranoid needs enemies, and, in the case of the obsessive, this place is occupied by a diffuse being that we can identify as "people" or "society." It acquires a bit more concreteness when it takes the form of rivals or competitors with first and last names.

b) Enmity in the obsessive personality

Some of the clinical descriptions of the obsessive personality include elements that in chapter 10 we identified as constituents of enmity behavior.

Resentment is the tendency to cling in a disproportionate way to the memory of affronts suffered and to act (or dream of acting) accordingly. This trait was associated with the anal personality.

The refined paranoid sense of honor compels one to respond both to inappropriate treatment by others and to injustices. The person of honor tolerates neither contempt nor iniquity. Nor do anal personalities:

Anal-erotic personality. Ernest Jones.

“[...] which results in intense feeling against any form of injustice…” (17).

Anal-erotic personality. Ernest Jones.

“In adulthood they are particularly sensitive regarding justice, to the point of pedantry…” (17).

The two emotional experiences that are typically associated with paranoid enmity are fear and hatred (or anger). E. Jones attributed to his patients with anal personality an excessive tendency toward anger:

Anal-erotic personality. Ernest Jones.

“It may be suspected that infantile anal eroticism has been handled inadequately in anyone who is a victim of a chronic irritability or of bad temper” (17).

Third element: rigidity

Paranoid character

“[...] the essential traits of the paranoid character are the following:
- overestimation of oneself;
- distrust;
- falseness of judgment…” (19).

Other classic authors used the term psychorigidity to refer to the paranoid cognitive style. It alludes to inflexibility, to the great resistance if not impossibility of change. Regarding obsessives:

Anal-erotic personality. Ernest Jones.

“[...] the matter has only one side and is not open to any kind of discussion” (17).

We studied in chapter 16 how paranoid groups isolate themselves and close themselves off to contact or exchanges with their environment. The closed attitude is also characteristic of IPs, in general. This closure prevents, of course, the exchange of opinions or ideas.

Obsessives would also not be inclined to let themselves be influenced by the opinions of others.

The paranoid cognitive style is characterized not only by its fixation on an idea and resistance to modifying it, but by a tenacious and passionate defense of that idea. Feeling himself to be the possessor of truth, the paranoid has no need to seek it. He applies all his logic and argumentative capacity to defending that truth which he is certain he holds in his hands. He neither listens nor engages in dialogue; he monologues and attempts to persuade.

Something similar has been attributed to obsessives.

His combative attitude, his need to con-vince, leads the paranoid individual to develop a cognitive style that attempts to be self-demanding in logical rigor, in precision, in order, in the appearance of coherence. His ideal is that of absolute irrefutability. As for the obsessive:

Anal-erotic personality. Ernest Jones.

“[...] passion for lucidity of thought; they delight in clarifying things, prone to classifying…” (17).

Argumentative tenacity leads the paranoid individual to develop a particular form of listening that always seeks the weak points of the opponent, those that will allow him to disarm him. This listening, however, goes hand in hand with an absolutely closed attitude that does not contemplate the possibility of accepting the other's reason. It is a mere strategy of confrontation. One of the items of Westen's obsessive personality may perhaps be related to this facet.

"Capacity to recognize" does not mean capacity to admit.

A notable characteristic of paranoid discourse is the omission of allusions to specific people, dates, or places. Instead, they prefer abstract and impersonal content. As for the obsessives:

Let us recap. We have confirmed that the three classic constitutive elements of paranoid behavior are integrated into the obsessive personality. Indeed, the latter appears to be driven both by grandiosity and by enmity. In turn, the cognitive style of the obsessive would be characterized by the same inflexibility as the paranoid.

In the following section we will proceed in the reverse direction: starting from the traits attributed to the anal-obsessive personality, we will investigate their presence or absence in paranoid behavior.

The fourth leg: other manifestations of paranoid behavior

Perfectionism

The aspiration to perfection permeates the life of the obsessive, it defines them. Does it also define that of the IPP? The truth is that in our description of paranoid behavior we did not include any chapter specifically devoted to perfectionism. Nevertheless, the imperative of perfection rears its head in other manifestations of paranoid behavior such as messianism, superiority, or hyperhierarchization.

a) Messianism

Most cultic groups—including the tiniest ones—are convinced of their capacity to significantly improve the world, save it, or bring about some form of complete happiness. Peace or the absence of confrontations, equality, immunity from illness (or from bullets), or absolute prosperity stand out among the messianic fantasies. In the end, their promise is that of a perfect world, a world whose attainment always deserves a major effort.

If the obsessive attaches so much importance to the results of their work it is because they magnify its relevance and impact. They tend to detach from reality and to feel that their professional, academic, or entrepreneurial activity is something more than a drop in the ocean. They experience a tiny, but equally comforting, version of messianism. They will not save the world, but they make it much better, and to this they devote all their energies.

b) Superiority

Anal-erotic personality. Ernest Jones.

“[...] the exalted belief in personal perfection…” (17).

The obsessive personality and the IPP share that perception of themselves that makes them feel above the rest: they are superior for being who they are, for being as they are, or for what they have. They are also superior for what they do, which must be something great and perfect, something bigger and better than what others do. This obliges them to make titanic efforts.

In this way, cult groups embark on ambitious projects (proselytizing, architectural, or of any other kind) that are completely disproportionate to their real capabilities. Exhaustion always accompanies the militant of the most extreme groups, just as it accompanies the obsessive.

The self-demand of the cult member is maximal, and it is a demand that, as with obsessives, extends to order and cleanliness (of the premises), to care of external appearance, and to the structuring of time. This is because what one does and achieves, as well as the appearance with which one presents oneself to others, must be consistent with their superiority; they cannot contradict it.

Necessarily, one's own perfection is determined in relation to the imperfection of others. An execution with flaws makes one doubt the superiority of the one performing it. A perfect execution, on the contrary, sustains the complex of superiority: that of the cult member and that of the obsessive.

c) Hyperhierarchization

The cult member renounces rest, leisure, and his own interests for the sake of the group's objectives and the directives that, as things proceed, emanate from the leadership. His exhausting effort is one more expression of submission to the authority of the group and its leaders.

It is not so evident that the obsessive's effort is related to submission to anyone, given that it seems to be he himself who charts his own path. However, seen another way, the obsessive is the one who most fanatically abides by the ideals and values of modern society and the one who most meekly submits to the scrutiny of what will they say. And all this without even mentioning his absolute devotion to the company he belongs to. The obsessive employee often behaves like a cult member within an organization that is not necessarily one.

Greed

Anal-erotic personality. Ernest Jones.

“The anal-erotic complex is genetically related to two of the most fundamental and far-reaching instincts: the instinct to possess and that of creating or producing, respectively” (17).

The propensity to accumulate money is a trait that has been associated with the obsessive personality since its origins. It is also associated with paranoid behavior, as we explained in the chapter on expansionism.

If we delve somewhat further into paranoid/obsessive greed, an apparent connection with other facets of paranoid behavior becomes evident.

a) Catastrophism

It is claimed that the obsessive person accumulates money “as protection against future misfortunes.” The distrust toward circumstances, that bias toward thinking things will go wrong, is the cause of the greed.

b) Interpersonal distrust

There is a second connection between greed and (paranoid) distrust:

Anal-erotic personality. Ernest Jones.

“[...] They are particularly concerned with the idea that something might be taken from them against their will, especially if it is something that symbolizes feces in the unconscious, as is the case with money” (17).

The obsessive miser fears being dispossessed of what he holds so dear by whoever approaches him. This basic distrust comes between him and the world around him and causes him not only to accumulate money, but also to hide it.

c) Narcissism

Accumulating money, perhaps more in our society than in others, transforms the subject into a privileged individual (superiority), someone who can do and have things that are denied to others. The accumulator may decide not to do them or have them, but it is his decision, not an imposition forced upon him by poverty. The accumulation of wealth allows the obsessive to feel the same "self-overestimation" that has been attributed to IGPs. The key is not only having a lot, but having more than, or better, much more than, others.

Isolation

Let us recall that the hyperactivity of the obsessive personality limits and deteriorates its social network: personal relationships require time, time that it does not have.

Exactly the same thing happens to members of PCGs, completely absorbed by the imperatives of the group, as well as to numerous delusional patients with the demands of their delusions. Such is the dedication to their thing that the rest of the facets of their life necessarily suffer.

Isolation, however, is not only the consequence of monothematic hyperactivity. It is something more than a side effect: it derives directly from paranoid activation, from the inability to trust the other or from the contempt the other inspires. Paranoidization, in itself, entails the propensity to distance oneself from others. If the obsessive is, ultimately, a paranoid, it is likely that he not only isolates himself as a consequence of work, but also uses work to isolate himself (even if he does not know it).

The corollary of the impulse toward isolation, toward living apart from others even when they are right beside them, consists in not listening to them nor allowing oneself to be influenced by them.

In this way, the obsessive personality does things as it wants and when it wants:

Anal-erotic personality. Ernest Jones.

“It is just as hard to push them into a given course of action as to stop them once they have begun it” (17).

Anal-erotic personality. Ernest Jones.

“[...] people of this type are particularly sensitive to having their time taken from them against their will, and insist in a thousand ways on being the masters of their own time.” (17).

The paranoid usually exhibits this same independence. So does the cult member, who accepts no influence other than that of his group and dispenses with all others.

Differentiation

Anal-erotic personality. Ernest Jones.

“[...] they have a strongly marked individuality” (17).

Both paranoids and members of cult groups have a marked tendency to differentiate themselves from their surroundings. In Chapter 17 we reviewed the various facets in which the tendency toward originality, toward difference, becomes evident.

Proselytism

E. Jones attributed to anal-erotic personalities a great passion for persuading.

Anal-erotic personality. Ernest Jones.

“A passion for the propagandism of ideas…” (17).

Anal-erotic personality. Ernest Jones.

“They are notoriously tiresome [...] once they have taken up an issue they do not stop until they have gone over it from end to end and said what they wanted to say…” (17).

Anal-erotic personality. Ernest Jones.

“[...] and in the meantime no one is permitted to interrupt or meddle in the matter. Those who attempt it are simply ignored or provoke great anger” (17).

When they do not hide them, delusional patients almost always try to convince others of their ideas. They seek allies among those who may prove most useful to them, owing to their knowledge, their position, or their influence. Sectarian groups devote an enormous effort to convincing and recruiting new followers. On many occasions, and in parallel, they seek the recognition, dissemination, and social acceptance of their convictions, without this necessarily entailing incorporation into the group.

Moralism

This general attitude should be reflected in concrete behaviors in which the high ethical demand is made manifest. For example, according to Freud, obsessives do not lie.

And it is that…

Anal-erotic personality. Ernest Jones.

“There are three classes of actions that are particularly liable to be affected in this way [by anal erotism]. In the first place, tasks that carry with them a special sense of duty or of what is right; consequently, especially moral tasks” (17).

Of course, rigorism has also been identified as one of the manifestations of paranoia.

Paranoia.

“[...] in the clinical picture of paranoia. Among the objective characteristics are included [...] rectitude...” (8).

In the corresponding chapter we stated that one manifestation of the hyperhierarchization of the PCG is the punctilious and uncritical compliance with rules by the group's members, especially those in the lower positions of the hierarchy; moreover, the cult member also strives to watch over and impose compliance on the rest of the group's members.

Even so, the moralism of the obsessive and that of the cult member are not identical. The behavioral norms in the PCG tend toward originality and toward differentiating themselves from those of the broader society, which does not happen with the obsessive. The latter submits to generally accepted ethical criteria. Moreover, the PCG member is willing to modify his principles whenever the group determines it, something scarcely applicable to the obsessive.

Regulationism

Cults and totalitarian societies tend toward regulatory excess, toward reducing the individual's margin for spontaneity, and toward having everything determined from top to bottom. Regulationism reflects the hyperhierarchization of the PCG. Promulgating rule after rule is an act of authority; accepting and complying with them is an act of submission.

Obsessives, for their part, do something similar. They impose on themselves, and impose on others, more rules than everyone else by taking seriously that enormous chapter of minor prescriptions that most people overlook. The obsessive is incapable of turning a blind eye to anything. Like the cult member, or like the paranoid, his life is regulated by a plethora of obligations that he simply must fulfill.

Finally, it must be remembered that scrupulousness applies not only to what is done, but to the way in which it is done. It affects the what and also the how.

A concern entirely transferable to cult groups and to the most totalitarian societies.

Independence, dominance and submission

Anal-erotic personality. Ernest Jones.

"They rebel against authority and insist on following their own path" (17).

Anal-erotic personality. Ernest Jones.

“As children they are extraordinarily disobedient [...] later they may develop a reactive formation leading to an unusual docility” (17).

It seems complicated that such contradictory traits could coexist in the same profile of individuals. Can one be submissive and authoritarian at the same time? Obedient and bossy? Isn't that the opposite? Is it coherent that if our obsessives are so individualistic, they are, at the same time, so attentive to questions of hierarchy? What do they care? It's something that should be indifferent to them: an independent person neither lets themselves be subjugated nor wants to subjugate anyone.

The study of paranoid contagion groups, and of cults in particular, can shed some light on this

It all depends on before whom. The follower shows indifference –when not hostility– toward people outside their group and toward the surrounding environment; they follow their path solely according to what the PCG they belong to dictates. On the other hand, with the rest of the group's members they establish an always asymmetrical relationship in which they are obliged to distinguish whether the person in front of them is below or above in hierarchical status, and act accordingly.

There are two concrete manifestations of the obsessive personality by aggregation that, interpreted from the point of view of paranoid behavior, seem to reflect the impulse toward submission.

a) Suffering

Obsessives force themselves to do what they don't feel like doing.

Anal-erotic personality. Ernest Jones.

"There are three classes of actions that are particularly prone to being affected in this way [by anal eroticism]. Secondly, intrinsically unpleasant or tedious taskstoward which, from the outset, there is a rejection [...] such as organizing closets, cleaning the pantry, completing a diary, or writing a daily report" (17).

One step further, and we can speak of true ascetic practices. Obsessives impose on themselves various degrees of austerity, frugality, pain, or discomfort.

Anal-erotic personality. Ernest Jones.

"There are people who never feel content with their capacity for self-control, and who continually experiment with themselves in order to increase it [...] drinking tea without sugar, giving up smoking for a while, sticking their legs out of bed on a cold night and allowing all kinds of ascetic performances to confirm to themselves their power of self-control [...] the lasting influence of the infantile ambition to achieve control of one's own sphincters" (17).

Undoubtedly, some of these practices turn out to be striking.

Anal-erotic personality. Ernest Jones.

"[...] the tendency not to change one's underwear more than absolutely necessary" (17).

In the PCGs, the deprivation of pleasures, or the self-provocation active of suffering, constitute a manifestation of submission. Adepts willingly comply with painful demands to which they would never submit in any other context; they do so whenever they are ordered to. Among obsessives, however, the one who gives the orders and the one who complies is the same person.

b) Repetition

The PCGs usually insist on the performance of frequent ceremonial acts. The rituals serve to underscore integration and submission to the group and, very frequently, to induce states of collective enthusiasm. It is usual for them to be repeated frequently and regularly. Everyday behaviors also tend to be repeated; since times and activities are hyperregulated, the life of the cult member becomes particularly monotonous and repetitive. As regards obsessives:

Control

It is said that the obsessive person is attentive to what happens around them, to what and who is there, to where everything is located, to what decisions are made and why, etc.

The paranoid hypervigilance, which seeks to detect risks in time, carries with it that same need to have everything "under control."

Also relevant here is the control of information that occurs in cult groups, with their demand for absolute sincerity from adherents, the reciprocal surveillance among group members, the violations of privacy, and the systematic denunciation to authority figures of any suspicious behavior or attitude. The control of information, in this case on the part of the leaders, is absolute.

Obsessive bond

The descriptions of the obsessive personality in the various DSMs allude to certain alterations in the way of relating to others. These alterations coincide, to a great extent, with what was described in Chapter 21.

Some of the characteristics that we attributed to the IPPs turn out to also be characteristics of obsessives. Thus:

Coldness.

Formalism.

Because of this same formalism, the obsessive will prefer those situations in which the objective is to do something to those others in which what matters is being with.

Secrecy.

Cruelty.

In the paranoid universe, passions related to great abstract or impersonal matters tend to take the place of genuine human interaction. Perhaps something similar happens in the obsessive personality. For example:

E. Jones would even appreciate in his obsessives that same mixture of passionate love, absorption, and hierarchical asymmetry so characteristic of cult groups.

Anal-erotic personality. Ernest Jones.

“[...] the exquisite tenderness of which some people of this type are capable, especially with children [...] A curious accompaniment of this tenderness is a curious tendency toward the loved (and possessed) object; these people are frequently dictatorial and even tyrannical, and are extremely intolerant of any show of independence on the part of the loved object” (17).

Exaltation

The states of maniform enthusiasm that occur in paranoid contagion groups and that are also associated with megalomanic delusions have their small reflection in the obsessive personality.

Anal-erotic personality. Ernest Jones.

“Periods of activity are normally followed by a marked sense of elevation and self-satisfaction…” (17).

Ineffectiveness

The DSMs state on more than one occasion that the obsessive personality can be ineffective in its performance, despite the great efforts it deploys.

This loss of effectiveness would come about for various reasons. E. Jones spoke of procrastination, the tendency to postpone the start of tasks.

In some patients with paranoid traits and in the biographies of some totalitarian leaders one can find this same alternation between periods of withdrawal and inactivity and other periods of feverish activity and combativeness. One might say that phases in which the attitude of flight predominates alternate with others in which attack is unleashed.

For their part, the DSMs suggest a somewhat more subtle variant of procrastination. Obsessives would tend to leave the most important elements of the task for last. Since it is common to lack time for the full completion of the work, they run the risk that the only parts that are actually finished are the least necessary ones.

The inefficacy of obsessives, according to the DSM, would also depend on two other traits likewise associated with paranoid behavior: rule-mongering and perfectionism.

Challenges, objectives, or ambitions

According to Westen, the obsessive pursues a goal that is not immediate and that, consequently, will require sustained effort over time.

One of the manifestations of the high cohesion of the PCGs is their capacity to mobilize jointly, as a single body, in pursuit of collective goals that may be very long-term. They do so with the same tenacity as those with delusional illnesses and obsessives in their respective fields of interest.

Non-paranoid traits

To be fair, we cannot overlook certain observations by Westen whose fit within the paranoid model proves complicated.

These observations suggest that obsessive personality disorder (if indeed it is a disorder) may entail a deviation from the mean for the better. In this regard, we cannot offer a simple and plausible explanation, although perhaps we should return to concepts such as hypersociability and paranoid leadership.

Some other observation from the DSM, for its part, offers a tone that is perhaps more anancastic than paranoid.

Cluster A

The DSMs distribute personality disorders into three large groups (cluster) based on resemblance and co-occurrence.

If the obsessive personality is not the trait-version of OCD but rather of the overvalued idea, first cousin to delusion, quintessence of paranoia… and if the overlaps between aggregated obsessive personality and paranoid behavior are really as extensive and manifest as they seem… then it is reasonable to expect that the obsessive personality would be associated, above all, with the paranoid personality and perhaps, by extension, with those most closely related to it: the schizoid and the schizotypal. In other words, it should migrate from cluster C to cluster A. Does this happen? Some studies—although not all—support the idea.

Year 2000. Rossi and his collaborators (23) studied personality disorders (DSM-III-R) in a sample of 400 consecutive patients admitted to a psychiatric ward. The semi-structured interviews were administered once the clinical condition had notably remitted, in the days prior to discharge, with the aim of minimizing as much as possible the potential distortion arising from acute psychiatric pathology. As in other studies, multiple diagnoses were common. The authors calculated the odds ratio of obsessive-compulsive personality against each of the other pathological personalities. For each of the personality disorders, this is the figure obtained by dividing the frequency with which said disorder appears among patients with an obsessive personality (numerator) by the frequency with which said disorder appears in the studied population as a whole (denominator). Well then, with some difference, the disorder most associated with the obsessive personality was the paranoid one (OR: 5.9), followed by the schizoid (OR: 4.5) and the schizotypal (OR: 4.1).

Two years earlier, in 1998, Stuart and several authors (25) had published a multicenter study with 1,116 patients focused mainly on determining whether the co-diagnoses confirm the classification of the eleven disorders into three distinct clusters. In the specific case of the obsessive personality, indeed, the main association occurred with the avoidant personality (OR: 4.72), also belonging to cluster C. However, the following associations, in order of importance, occurred with: the paranoid personality (OR: 4.46), the schizoid personality (OR: 4.21), and the schizotypal personality (OR: 3.05).

Based on the data obtained in the “National Epidemiologic Survey on Alcohol and Related Conditions”, Grant et al. published in 2012 a study (10) concerning obsessive-compulsive personality. Among other things, they analyzed the association of obsessive-compulsive personality with other personality disorders. After controlling for the effect of sociodemographic variables, the disorder with which it was most strongly associated was the paranoid disorder (OR 4.1), followed by the schizoid (OR 3.7) and the histrionic (OR 3.1).

Year 2008. Hummelen et al. (12) study the personality disturbances of more than 2000 patients referred to twelve psychiatric day hospitals in Norway. They use for this the LEAD method, characterized by bringing together information from different sources, the semi-structured interview being one of them. One of their conclusions is the following: “[...] obsessive compulsive personality disorder was more strongly associated with paranoid personality disorder than with any other personality disorder. Although not [statistically] significant, there was also a close association between obsessive compulsive personality disorder and the schizoid and narcissistic disorders” (this latter result being compatible with the overestimation of themselves that the classic authors attributed to the paranoid constitution).

1988. Not all studies, far from it, confirm the closeness of obsessive personality to paranoid personality, or to cluster A. Hyler and Lyons used the factor analysis technique on the evaluations of 552 patients carried out by 287 psychiatrists (15). They obtained four independent dimensions. Three of them coincided with the traditional DSM clusters, while compulsive personality formed, on its own, an independent dimension. Even so, the personality disorders most closely associated with obsessive personality, in this order, were the avoidant, the paranoid, and the narcissistic; only the first of these in a statistically significant way.

Hyler's work replicated both the method and the result of a study published in 1985 by Kass (18), which also obtained four dimensions. The difference is that, in this case, the main association of the obsessive personality was with the narcissistic one.

In 1997, Blais and his collaborators (5) used a completely different format with which they obtained three independent factors in which the personality disorders were grouped. Their three dimensions did not coincide with the traditional DSM clusters. Indeed, in the first of these factors the following personalities were included: schizotypal, schizoid, avoidant, obsessive, and paranoid.

Conclusion

The analysis of each of the traits that make up the (aggregate) obsessive personality reveals that they find a natural accommodation in the description of paranoid behavior.

Studies of association with other personality disorders point in the same direction.

The relationship could be formulated in the following terms: obsessive personality is a concrete form in which paranoid activation manifests itself. It emerges when the third leg of the classic tripod –rigidity– is what appears in the foreground, the most evident, and habitually, the only thing perceived at first glance.

Bringing to light the other two legs requires a more conscientious and less hasty evaluation than clinical practice usually allows.

Consequently, the obsessive personality (or compulsive, or obsessive-compulsive, or anancastic) should migrate from the anancastic field to the paranoid one. And to signal the change of location, it would be advisable to adopt a new name: obstinate personality. We cannot think of a better one. We thus connect with the first of the variants of paranoid personality that Millon (21) postulated at the time.