Anankastic personality disorder

One type of anxiety disorder is anankastic disorder. Consider the features of this condition, its symptoms, causes, methods of treatment.

Anankastic disorder refers to mental pathologies and is characterized by increased anxiety, suspiciousness, perfectionism, obsessions and compulsions. According to the international classification of diseases ICD-10, this disease belongs to category V Mental and behavioral disorders (F00-F99). [1]

Stress-related neurotic and somatoform disorders (F40-F48):

• F40 Phobic anxiety disorders
• F41 Other anxiety disorders
• F42 Obsessive-compulsive disorder
• F43 Reaction to severe stress and adjustment disorders.
• F44 Dissociative (conversion) disorders
• F45 Somatoform disorders
• F48 Other neurotic disorders

Pathology has two types: neurotic (obsessive-compulsive disorder, accentuation) and mental (complete desocialization). The psychotherapist deals with the treatment of the painful condition.

Epidemiology

The prevalence of personality disorders is about 10.6% among the population of our planet. Based on this, one in 10-20 people has mental disabilities. The statistics of anankastic violation range from 0.5 to 1%. Most often, pathology is diagnosed in women. [2]

At the same time, more than 50% of patients are observed to abuse alcohol or drugs. Without timely and professional medical assistance, about 25% of cases of the disease end in suicidal or self-harming behavior. [3]

Among anxiety disorders, obsessive-compulsive disorder (OCD) is one of the most studied comorbid disorders, with a co-occurrence of 23–45%. 

Causes of the anankastic personality disorder

According to the studies conducted, the main cause of the psychasthenic state is a genetic predisposition. In this case, the leading is the social factor, when from a young age the child is in an atmosphere of increased demands and prohibitions on the expression of emotions. In adolescence, these patients have persistent signs of anankastic personality disorder. [4]

Also, the causes of pathology include:

• Neurological problems.
• Personality traits: anxiety, emotional lability.
• Stress.
• Psychological trauma.
• Education with an emphasis on increased responsibility and a sense of duty, prohibitions.
• Traumatic brain and birth trauma.
• Organic brain damage.

Many experts argue that the roots of anankastic disorder go back to childhood. Parents instill in the child an increased sense of responsibility, which is why, in adulthood, a person is afraid to show his emotions and desires. [5]

This condition is not a disease, but its symptoms are difficult to control. Anankast suffers from frequent breakdowns, which he cannot cope with on his own and requires qualified medical care. [6]

Risk factors

In 7% of cases, anankastic disorder is associated with hereditary factors. Also, birth and craniocerebral injuries play an important role in its development.

The main risk factors for persistent personality development disorder include:

• Psycho-traumatic situations (physical, psychological abuse).
• Increased psycho-emotional stress.
• Stressful situations.
• Emotional instability.
• Age crisis.
• Negative lifestyle and living conditions.

In some cases, the disorder is associated with mental illness: schizophrenia, autism, manic-depressive psychosis.

Pathogenesis

There are two mechanisms of development of the psychosthenic state - biological and psychological. The pathogenesis of the first is directly related to physiology, in the second case, these are the features of the formation of the psyche.

Anankastic personality disorder develops in childhood, when parents categorically forbid and punish the excessive manifestation of emotions and weakness, trying to instill restraint. In adulthood, these children experience guilt and shame for their desires and emotions, fearing punishment. [7]

In some cases, obsessive thoughts and stiffness are triggered by traumatic events. For example, the death of a close friend or relative, an accident. Another factor of pathology is manipulation by elders (parents, teachers, friends, kindergarten teachers). Understanding the mechanism of development of the disorder allows you to choose methods for its effective treatment.

Symptoms of the anankastic personality disorder

There are a number of symptoms that make it possible to suspect an anankastic personality disorder:

• Doubt and anxiety about decisions made and any questions.
• Obsessive thoughts.
• Constant experience of unpleasant events.
• Pedantry and love of order.
• Perfectionism.
• Scrupulousness and a sense of duty.
• Boredom and increased conscientiousness.
• Focus on work.
• Failure to fully express feelings and emotions.
• A ritual of the same type of action or thought.
• Distrust of others.

Anankastas suffer from obsessive thoughts, analysis of their actions and constant reflection on the events that happened to them. Often, obsessive thoughts relate to everyday situations: "Have I closed the front doors, windows?", "Turned off the iron, gas?" and other. Such reflections overwhelm a person so much that he is unable to cope with them. Patients have an increased sense of duty and love of order, which can annoy others. [8]

At the same time, psychasthenia endows a person with a number of valuable qualities. Anankast strives for reliability in everything, he faithfully performs and loves his job. Women are exemplary housewives who often go overboard with their passion for order, cleanliness, and control. Patients experience problems in expressing their emotions, desires and feelings. This is due to the fear of losing control over oneself. Storage of old things is typical for such people. They are responsible workers and remain faithful to loved ones. [9]

First signs

The spectrum of manifestations of persistent deviations in personality development is extensive. But there are a number of first signs that make it possible to suspect anankastic disorder:

• Obsessive thoughts.
• Emotional coldness.
• Continuous analysis of actions taken and decisions made.
• Focus on work.
• Few friends.
• A tendency to keep old things.
• Pathological perfectionism.
• The need to constantly check the work done.
• Preoccupation with small details with loss of overall assessment of events.
• Planning any action down to the smallest detail.
• Frequent anxiety due to possible danger.

The presence of the above symptoms is a reason for seeking medical help. With timely diagnosis and treatment, the psychosthenic state is amenable to correction. [10]

Anankastic personality disorder and psychasthenia

A mental disorder, the main symptomatology of which is powerlessness, weakness of mental and mental qualities, is psychasthenia. This form of neurosis can be mistaken for psychopathy, to which anankastic personality disorder is more related.

• Psychasthenia develops due to certain life events that traumatize the psyche. For Anankasts, this is a hereditary predisposition, stress and peculiarities of upbringing. Moreover, both pathologies occur when blood circulation and nutrition of the brain are impaired.
• The psychosthenic state is characterized by excessive suspiciousness, impressionability, vulnerability, fearfulness, anxiety, indecision and self-doubt. Anankastny pathology proceeds with obsessive thoughts, perfectionism, inability to show one's emotions. [11]

Anankastic personality disorder and psychasthenia have much in common in their symptoms and causes. Their distinctive features are expressed in acute depersonalization and sensuality, the absence of hypertrophied introspection. For psychasthenics, excessive doubts are characteristic, their decisions and actions are perceived by them incomprehensibly and not accurately enough. Often, the pathology is accompanied by obsessive states, which also happens in Anankasts. [12]

Treatment depends on the stage of the painful condition. In the early stages, the normalization of work and rest, physical activity, positive emotions and good nutrition are shown. In especially severe cases, drug therapy is carried out with sessions with a psychotherapist. [13]

Complications and consequences

The main danger of anankastic disorder is a change and deviation of the personality from the generally accepted behavioral norms adopted in a social environment with social and personal disintegration.

Possible consequences and complications:

• High risk of developing harmful addiction (alcoholic, narcotic, nicotine).
• Suicidal behavior.
• Reckless sexual behavior.
• Mental breakdowns.
• Opposing yourself to the values of society.
• Hypochondria.
• Disclaimer for Your Own Conduct.
• Distrust of others.
• Irresponsible and overly emotional parenting style, which leads to mental disorders in children.
• Increased anxiety.
• Depression, psychosis.

Anankast has difficulties with social life. The patient conflicts with others because of his personal deviations from the accepted norms. A person may not be accepted in a team, not perceived as an adult, mock at him. Such conditions entail depressive pathologies, obsessive-compulsive disorders, psychosis. [14]

Diagnostics of the anankastic personality disorder

The diagnosis is made with general signs of personality disorder. Anankastny pathology is confirmed in the presence of three or more of the following symptoms:

• Excessive caution and unreasonable anxiety.
• Pathological perfectionism.
• Stiffness of thinking.
• Obsessive thoughts, actions.
• Fixation on small details in any business.
• Hypertrophied pedantry.
• Conscientiousness and commitment in work, to the detriment of personal relationships.

Anankast is demanding of others. If he occupies a leading position, then he achieves the unswerving implementation of all his rules and recommendations. In some cases, the patient does not accept the work of other people and tries to take everything upon himself. [15]

Test

There are several clinical test methods available to identify persistent personality disorders. So, during the diagnosis of anankastic disorder, the patient may be offered to undergo the following test:

1. Increased anxiety (expectation of the worst, constant fear and irritability).

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

2. Tension and emotional instability.

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

3. Phobias (darkness, crowds, animals, vehicles).

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

4. Problems with sleep and falling asleep (frequent awakenings, weakness and weakness after a good night's rest, nightmares).

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

5. Intellectual component (difficulty concentrating, memory impairment).

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

6. Sensations (ringing in the ears, weakness, blurred vision, tingling in the limbs, paresthesia).

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

7. Cardiovascular system (palpitations, chest pain, pulsation in the temples).

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

8. Respiratory disorders.

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

9. Disorders in the gastrointestinal tract (difficulty swallowing, abdominal pain, nausea, rumbling in the abdomen).

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

10. Behavior during personal conversation (restlessness, active gestures and gait, tremors, frequent changes in facial expressions, sighs or rapid breathing).

• No
• Weakly expressed
• Moderately
• Strongly expressed
• Severe degree

The presence of three or more affirmative answers is a reason for further study of the patient's condition. There are also special tests to quantify the components of obsessive-compulsive disorders, psychasthenia, neuroses and other painful conditions. [16]

Differential diagnosis

An obligatory component of the diagnosis of anankastic personality disorder is differentiation with other psychosthenic conditions. First of all, pathology is compared with obsessive-compulsive disorder, which has similar symptoms, but differs in its dynamics, treatment tactics and prognosis for recovery.

Persistent personality deviation is differentiated from organic pathologies of the brain, generalized anxiety disorder , neuroses, autism , schizophrenia, epileptoid accentuation of the personality. The final diagnosis is made after a thorough study of the individual characteristics of the patient and a comprehensive study of his painful condition.

Treatment of the anankastic personality disorder

An integrated approach is shown for the treatment of anankast:

• Psychotherapy.
• Drug therapy (antipsychotics, anxiolytics, antidepressants).
• Physiotherapy techniques.

Psychotherapeutic practice is aimed at correcting anxiety-suspicious state. Treatment tactics directly depend on the severity of the disorder, the level of discomfort and the general condition of the patient. On a conscious level, patients accept psychocorrection, but on the unconscious level they show strong resistance.

In especially severe cases, it is possible to use anxiolytics, atypical antipsychotics and a number of other medicines. With depressive components, a feeling of depersonalization and pronounced impulsivity, anticonvulsants are prescribed, which reduce outbursts of anger and uncontrolled impulses. [17]

If anankastic personality disorder is one of the signs of a more serious mental illness, then treatment is aimed at eliminating the underlying disease. As a rule, the pathological condition can be corrected or completely eliminated within a year. With severe symptoms, the disorder becomes chronic. In this case, the patient is referred to a long course of psychoanalysis with supportive drug therapy. [18]

Prevention

To prevent persistent personality deviation and psychosthenic states, social rehabilitation is shown, which consists of:

• Normalization of intra-family relations.
• Learning to properly interact with others.
• Acquiring professional skills and practice for everyday life.
• Prevention of traumatic events and a change in attitude towards such situations.

Psychotherapy allows you to develop methods for solving everyday problems, to gain faith in yourself. The patient is recommended general strengthening vitamin therapy, good sleep and balanced nutrition. Timely treatment of any diseases, giving up bad habits is also important. [19]

Forecast

Anankastic personality disorder has a favorable prognosis in most cases. With timely diagnosis and treatment, patients manage to correct their condition and live a full life. Lack of therapy and psychocorrection threatens with frequent nervous breakdowns and emotional instability, which is dangerous for others and the Anankast himself. There is also a risk of the pathology turning into serious psychological diseases, the treatment of which is more serious and prolonged.