Why Target Overcontrol?

Anorexia nervosa, chronic depression, and obsessive-compulsive personality disorder are all examples of mental health problems characterized by excessive self control.

A quick examination of the ten personality disorders (PDs) listed as being on Axis II in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5 (American Psychiatric Association, 2013) reveals that they all involve some form of pervasive and long-standing difficulty with emotion or impulse control and with interpersonal relationships. What may be less obvious, however, is that it is possible to further demarcate these features into two superordinate classes or domains, which overlap with the well-established division between the internalizing and externalizing disorders (Achenbach, 1966; Crijnen, Achenbach, & Verhulst, 1997). According to the DSM-5, PDs of undercontrol (borderline PD, histrionic PD, antisocial PD, and narcissistic PD) are characterized by low inhibitory control and chaotic or dramatic relationships, whereas PDs of overcontrol (obsessive-compulsive PD, avoidant PD, paranoid PD, and schizoid PD) are characterized by excessive inhibitory control and an aloof or distant interpersonal style (Lynch, Hempel, & Clark, 2015).

Undercontrol and overcontrol are not one-dimensional personality constructs; that is, they do not simply represent opposite ends of a self-control continuum. Each is a multifaceted construct reflecting core genotypic (related to biology) and phenotypic (related to behavioral expression) differences between spectrums of disorders. As such, these two multifaceted constructs give rise to two important treatment implications:

  1. Treatment needs to account for individual differences in biotemperament that may bias perception and impair learning and flexible responding.
  2. Treatments targeting problems of overcontrol require interventions designed to relax inhibitory control and increase emotional expressiveness, receptivity, and flexibility whereas treatments targeting problems of undercontrol should emphasize interventions that enhance inhibitory control and reduce mood-dependent behavior.