Journal of Personality Disorders published our paper on a new therapy for obsessive-compulsive personality disorder. In this study we extend what we knew about the clinical utility of our treatment model, namely Evolutionary Systems Therapy.
Obsessive-compulsive personality disorder is the most common personality disorder, with a prevalence of approximately 6.5% in the general population. However, little is known about the effective psychotherapy for this disorder. In this case series, we employed evolutionary systems therapy to support five adults diagnosed with obsessive-compulsive personality disorder. Evolutionary systems therapy is a novel form of psychotherapy that integrates evolutionary psychopathology, compassion-focused therapy, and metacognitively oriented treatments. Primary outcome (personality pathology) was assessed monthly from baseline to follow-up. Secondary outcomes (anxiety, depression, perfectionism, self-criticism, overcontrol) were assessed at initial and final sessions. Moreover, we evaluated the feasibility of intervention (completion, attendance, adverse events). At the end of 6 months of treatment, all the participants reported reliable changes and remitted from diagnosis. These outcomes were maintained at 1-month and 3-month follow-ups. Further research is needed to provide evidence about the acceptability of evolutionary systems therapy in the treatment of obsessive-compulsive personality disorder.
In this five cases series we preliminarily explored the acceptability and feasibility of EST for OCPD. Despite the limitations of a cases series design – which is an important constraint on the generality of the collected outcomes – we reported promising findings. All the patients remitted from diagnosis and showed a significant downward trend in personality pathology. These changes were maintained at the 3-month follow-up. Moreover, we found reliable changes in symptoms such as anxiety and depression and in possible therapeutic targets such as perfectionism, self-criticism and overcontrol. Our study seemingly supports the importance of evolutionarily informed approaches to conceptualization and treatment, which allow distinguishing maladaptive strategies from distinctive personality features. In conclusion, we hope that there will be an increase in studies aimed at developing empirically validated treatments for a highly prevalent disorder with elevated suicidal risk such as OCPD.
This new therapy for obsessive-compulsive personality disorder confirms that Evolutionary Systems Therapy may be effective across the whole spectrum of personality disorders.
Cheli, S. Goldzweig, G. Hewitt, P., Bui, S., & Cavalletti, V. (2025). Evolutionary Systems Therapy for Obsessive-Compulsive Personality Disorder: A Five Case Series. Journal of Personality Disorders, 39(1), 61–76. https://doi.org/10.1521/pedi.2025.39.1.61