Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Threats of Violence

There are the patients that come to each visit with all xrays, lab reports, MRI results, progress notes, correspondence and detailed outlines of symptoms plotted against date, time of the day, weather conditions and activity levels. Rather than being able to effectively interact with the patient, the agenda appears to be to note, appreciate and comment upon the detailed work that they have provided.

These patients comprise that group of obsessive-compulsive personalities who have been injured. Obsessive-Compulsive Personality Disorder is a developmental defect in which there is a preoccupation with control and orderliness.

The person is often inflexible/stubborn and may have been more invested in work than family, friends or leisure. Such individuals become detail-orientated, and, for them, organization has more importance than the larger picture of their lives. Such individuals often cannot allow others to work effectively, concerned that others cannot work as precisely or efficiently as they. This need for control can be all consuming such that the very quality of life, especially family life, is undermined.

They cannot appreciate that in order for the rest of us to do our work, they must willingly accept the role of a patient and defer in large measure to our judgment and decisions. They become agitated when their control is threatened.

The solution? Give them control. Before you reject that out-of-hand, realize that you will not change their personality disorder, talk them out of it or have them relinquish it. They may even be aware of it, but deferring to others is not within their makeup. So, give them specific assignments. Assure them that you appreciate all the records that they carry, but those records are now in their chart and that you have, indeed, reviewed them. Tell them that you admire the detailed records that they keep upon their symptoms but that you have a new and very important assignment for them. You need them to keep a journal on the non-injury activities in which they engage such as walks they take and out-of-home interactions in which they engage. Remind them that their medical records will be more complete if they can provide a single paragraph summarizing their (emphasized) progress since their last visit, that such concise summaries are helpful.

There are, in fact, many ways in which their personality disorder can more effectively serve, rather than thwart, the doctor-patient relationship and enable for effective use of brief office visits.

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