Anancastic personality disorder

One of the types of anxiety personality disorder is anankastic disorder. Let's consider the features of this condition, its symptoms, causes, and treatment methods.

Anankastic disorder is a mental disorder 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 ]

Neurotic, stress-related 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.

The pathology has two types: neurotic (obsessive-compulsive disorder, accentuation) and mental (complete desocialization). The treatment of the disease state is carried out by a psychotherapist.

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 disorders. Statistics of anankastic disorder range from 0.5 to 1%. Most often, the pathology is diagnosed in women. [ 2 ]

Moreover, more than 50% of patients are noted to abuse alcohol or drugs. Without timely and professional medical care, 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 rate of 23–45%.

Causes of an anancastic personality disorder

According to the conducted research, the main cause of the psychasthenic condition is a genetic predisposition. The leading factor 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, such patients have persistent signs of anankastic personality disorder. [ 4 ]

The causes of pathology also 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 injuries.
• Organic brain damage.

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

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

Risk factors

In 7% of cases, anankastic disorder is associated with hereditary factors. Birth and craniocerebral trauma also play a major role in its development.

The main risk factors for persistent deviations in personality development include:

• Psychotraumatic situations (physical, psychological violence).
• Increased psycho-emotional stress.
• Stressful situations.
• Emotional instability.
• Age crisis.
• Negative image and living conditions.

In some cases, the disorder accompanies mental illnesses: schizophrenia, autism, manic-depressive psychosis.

Pathogenesis

There are two mechanisms of development of a psychasthenic 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 prohibit and punish excessive displays of emotion and weakness, trying to instill restraint. In adulthood, such children experience guilt and shame for their desires and emotions, fearing punishment. [ 7 ]

In some cases, obsessive thoughts and stiffness are provoked by traumatic events. For example, the death of a close friend or relative, getting into 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 of its effective treatment.

Symptoms of an anancastic personality disorder

There are a number of symptoms that allow one to suspect anankastic personality disorder:

• Doubts and anxiety regarding decisions made and any issues.
• Obsessive thoughts.
• Constantly experiencing unpleasant events.
• Pedantry and love of order.
• Perfectionism.
• Scrupulousness and a sense of duty.
• Pedantry and increased conscientiousness.
• Focus on work.
• Inability to fully express feelings and emotions.
• A ritual of repetitive actions or thoughts.
• Distrust of others.

Anancasts suffer from obsessive thoughts, analysis of their actions and constant pondering of events that have happened to them. Often obsessive thoughts concern everyday situations: “Did I close the front doors, windows?”, “Did I turn off the iron, gas?” and others. Such thoughts 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 gives a person a number of valuable qualities. Anancast strives for reliability in everything, he conscientiously performs and loves his work. Women are exemplary housewives who often overdo it 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 themselves. Such people are characterized by storing old things. They are responsible workers and remain faithful to loved ones. [ 9 ]

First signs

The spectrum of manifestations of persistent deviation in personality development is extensive. But there are a number of early signs that allow one to suspect anankastic disorder:

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

The presence of the above symptoms is a reason to seek medical help. With timely diagnosis and treatment, the psychasthenic condition can be corrected. [ 10 ]

Anankastic personality disorder and psychasthenia

A mental disorder whose main symptoms are impotence, weakness of mental and psychic qualities is psychasthenia. This form of neurosis can be mistaken for psychopathy, which is more related to anankastic personality disorder.

• Psychasthenia develops due to certain life events that traumatize the psyche. For anancasts, this is a hereditary predisposition, stress, and peculiarities of upbringing. Both pathologies occur when blood circulation and nutrition of the brain are disrupted.
• The psychasthenic condition is characterized by excessive suspiciousness, impressionability, vulnerability, timidity, anxiety, indecisiveness and self-doubt. Anankastic pathology occurs with obsessive thoughts, perfectionism, and the inability to express one's emotions. [ 11 ]

Anankastic personality disorder and psychasthenia have much in common in their symptoms and causes of origin. Their distinctive features are expressed in acute depersonalization and sensuality, the absence of hypertrophied self-analysis. Psychasthenics are characterized by excessive doubts, their decisions and actions are perceived by them incomprehensibly and insufficiently accurately. Often the pathology is accompanied by obsessive states, which also happens in anancasts. [ 12 ]

Treatment depends on the stage of the disease. In the early stages, normalization of work and rest, physical activity, positive emotions and proper nutrition are indicated. In particularly severe cases, drug therapy with sessions with a psychotherapist is carried out. [ 13 ]

Complications and consequences

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

Possible consequences and complications:

• High risk of developing addiction (alcohol, drugs, nicotine).
• Suicidal behavior.
• Reckless sexual behavior.
• Mental breakdowns.
• Opposing oneself to the values of society.
• Hypochondria.
• Disclaimer of responsibility for one's own behavior.
• Distrust of others.
• An irresponsible and overly emotional parenting style that leads to mental disorders in children.
• Increased anxiety.
• Depression, psychosis.

Anancast has difficulties with life in society. The patient conflicts with others because of his personal deviations from accepted norms. The person may not be accepted in the group, not perceived as an adult, ridiculed. Such conditions entail depressive pathologies, obsessive-compulsive disorders, psychoses. [ 14 ]

Diagnostics of an anancastic personality disorder

The diagnosis is made based on general signs of personality disorder. Anankastic pathology is confirmed by the presence of three or more of the following symptoms:

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

Anancast is demanding of others. If he occupies a leading position, he ensures that all his rules and recommendations are followed without fail. 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 testing methods that can identify persistent personality deviations. Thus, during the diagnosis of anankastic disorder, the patient may be asked to undergo the following test:

1. Increased anxiety (expecting the worst, constant fears 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, large crowds of people, animals, transport).

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

4. Problems with sleep and falling asleep (frequent awakenings, fatigue and weakness after a full 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, visual impairment, tingling in the extremities, paresthesia).

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

7. Cardiovascular system (rapid heartbeat, 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. Gastrointestinal disorders (difficulty swallowing, abdominal pain, nausea, rumbling in the stomach).

• 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 examination of the patient's condition. There are also special tests for quantitative determination of 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 psychasthenic conditions. First of all, the 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 personality. The final diagnosis is made after a thorough study of the individual characteristics of the patient and a comprehensive study of his morbid condition.

Treatment of an anancastic personality disorder

For the treatment of anancasts, a comprehensive approach is indicated:

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

Psychotherapeutic practice is aimed at correcting the anxious-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 an unconscious level they show strong resistance.

In particularly severe cases, anxiolytics, atypical neuroleptics and a number of other medications may be used. In cases of depressive components, feelings 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 symptoms 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 for a long course of psychoanalysis with supportive drug therapy. [ 18 ]

Prevention

To prevent persistent personality deviation and psychasthenic conditions, social rehabilitation is indicated, which consists of:

• Normalization of intra-family relationships.
• Teaching how to interact correctly with others.
• Acquiring professional skills and practice for everyday life.
• Prevention of traumatic events and changing attitudes towards such situations.

Psychotherapy allows you to develop methods for solving everyday problems and gain faith in your own strength. The patient is recommended to take general strengthening vitamin therapy, get enough sleep and eat a balanced diet. Timely treatment of any diseases and giving up bad habits are 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. The absence of therapy and psychocorrection threatens frequent nervous breakdowns and emotional instability, which is dangerous for others and the anankastic person himself. There is also a risk of the pathology turning into serious psychological diseases, the treatment of which is more serious and long-term.