Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder (OCPD) is a chronic condition in which a person demonstrates an excessive focus on details, order and rules, and the need to achieve a perfect outcome, often in a way that interferes with daily life. They can be stubborn, insisting that things must be done their way. The desire for order, perfection, productivity, and control can impede their ability to finish tasks, to collaborate with other people, and to treat social activities or hobbies as purely recreational. In addition to demanding that others follow certain rules or meet high standards, people with OCPD can be severely self-critical.

OCPD is one of the most common personality disorders, according to the DSM-5; prevalence estimates range from 2.1 to 7.9 percent. OCPD is classified as a "Cluster C" personality disorder, as are avoidant personality disorder and dependent personality disorder. Anxiety and fear are the features shared by each of these disorders.

OCPD is distinct from obsessive-compulsive disorder (OCD). While the disorders share features such as a strong preoccupation with details and rules in some area of one's life, they differ in important ways. People with OCPD do not have unwanted thoughts that compel them to create routines or rituals, as do those with OCD. In contrast, people with OCPD experience their thoughts and behavior as rational and purposeful. Their symptoms are stable across time, whereas symptoms of OCD often change over time and in response to anxiety-provoking circumstances.

Symptoms

Individuals with obsessive-compulsive personality disorder, according to the DSM-5, are overly concerned with orderliness, perfectionism, and control, a pattern that begins by early adulthood and includes four or more of the following:

  • A preoccupation with order and details that results in the person missing the point of an activity
  • Perfectionism that hinders the completion of tasks
  • Devotion to work and productivity to an extent that is excessive and not explained by economic needs
  • Excessive conscientiousness and inflexibility related to morality or values (not explained by one's culture or religion)
  • Inability to get rid of worn or worthless objects, even if they lack sentimental value
  • Reluctance to delegate tasks to or work with others unless things are done his or her way
  • Reluctance to spend money on oneself or others and a belief that money should be hoarded for emergencies
  • Rigidity and stubbornness

People with OCPD may face challenges in their work or social life related to these symptoms. For example, they may delay starting or finishing a task because they cannot settle on the "best" or "right" way to complete it. A loss of control in particular situations may provoke frustration. Those with OCPD often have difficulty expressing feelings of affection and may be uncomfortable with others' expressions of emotion. They may also not appreciate how their insistence on thoroughness negatively impacts others.

While there is overlap between some symptoms of OCPD and those of obsessive-compulsive disorder (OCD), and they co-occur in some people, they are distinct disorders. And though OCPD can involve hoarding-like behavior, the DSM-5 recommends that a diagnosis of hoarding disorder be reserved for severely disruptive or hazardous cases of hoarding.

OCPD can also share some characteristics with other personality disorders, but there are important differences. While people with narcissistic personality disorder may look down on the abilities of others, for example, they are unlikely to be self-critical in the way that those with OCPD are. Similarly, those with other personality disorders may be disinclined to give to others but lack the financial self-constraint associated with OCPD.

Causes

Research indicates that genetics explains a considerable amount of the risk of developing OCPD. The disorder also appears to be diagnosed approximately twice as frequently in males as it is in females, according to the DSM-5.

While genetics are a factor, some theories posit that parenting style can steer a vulnerable individual towards the OCPD spectrum, especially if the parent is highly controlling or protective, or highly punitive. In this scenario, the personality disorder develops as a coping mechanism to avoid punishment. Because OCPD-like behavior has been documented in very young children, it is hard to assess the ways in which parenting and genetics might interact to stoke the disorder. 

Treatment

Some forms of psychotherapy may be useful for treating obsessive-compulsive personality disorder. There is some evidence that cognitive therapy and cognitive behavioral therapy—related forms of therapy that seeks to address unhelpful thoughts and behaviors—can reduce the severity of symptoms. SSRIs have also been investigated as potential treatments for OCPD.

As is the case with all personality disorders, those who have OCPD may not experience it as a problem, but as a way of life. Many people with OCPD do not seek treatment because they are not disturbed by the behaviors that characterize the disorder, and in some cases find them beneficial. When people with OCPD do seek treatment, it may be because they were referred by a family member, because they have an obsessive-compulsive disorder, or because they experience anxiety about the inability to live according to their own rules and standards. 

References

  • Diagnostic and Statistical Manual, Fifth Edition
  • Diedrich, Alice & Voderholzer, Ulrich. (2015). Obsessive–Compulsive Personality Disorder: a Current Review. Current psychiatry reports. 17. 547. 10.1007/s11920-014-0547-8. 
  • Obsessive Compulsive Personality Disorder Fact Sheet, The International OCD Foundation.