Obsessive-Compulsive Personality Disorder

Learning Objectives

  • Describe the characteristics and diagnosis of obsessive-compulsive personality disorder

Now we will explore the final cluster C personality disorder, obsessive-compulsive personality disorder (OCPD). OCPD is different from the previously covered obsessive-compulsive disorder (OCD).

Table 1. DSM-5 Personality Disorders
Avoidant socially inhibited and oversensitive to negative evaluation; avoids occupations that involve interpersonal contact because of fears of criticism or rejection; avoids relationships with others unless guaranteed to be accepted unconditionally; feels inadequate and views self as socially inept and unappealing; unwilling to take risks or engage in new activities if they may prove embarrassing C
Dependent allows others to take over and run their life; is submissive, clingy, and fears separation; cannot make decisions without advice and reassurance from others; lacks self-confidence; cannot do things on their own; feels uncomfortable or helpless when alone C
Obsessive-Compulsive pervasive need for perfectionism that interferes with the ability to complete tasks; preoccupied with details, rules, order, and schedules; excessively devoted to work at the expense of leisure and friendships; rigid, inflexible, and stubborn; insists things be done a certain way; miserly with money C

Obsessive-Compulsive Personality Disorder

A graphic of a checklist on a clipboard.

Figure 1. People with OCPD may obsess over lists and rules.

Obsessive–compulsive personality disorder (OCPD) is a Cluster C personality disorder marked by an excessive need for orderliness, neatness, and perfectionism. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations.

Obsessive-compulsive personality disorder (OCPD) is marked by an excessive obsession with rules, lists, schedules, and order; a need for perfectionism that interferes with efficiency and the ability to complete tasks; a devotion to productivity that hinders interpersonal relationships and leisure time; rigidity and zealousness on matters of morality and ethics; and an inability to delegate responsibilities or work to others. People with obsessive-compulsive personality disorder (OCPD) tend to be obsessed with controlling their environments; to satisfy this need for control, they become preoccupied with trivial details, lists, procedures, rules, and schedules.

Individuals with OCPD are at one extreme of the conscientiousness continuum. While conscientiousness is a desirable trait generally, its extreme presentation for those with OCPD leads to interpersonal problems. OCPD individuals present as over-controlled and this characteristic extends to the relationships they have with other people. Individuals with OCPD are referential to authority and rules. OCPD individuals may therefore punish those who violate their strict standards. The inability to accept differences in beliefs or behaviors from others often leads to high conflict and controlling relationships with coworkers, spouses, and children.

Differential Diagnosis

There are several mental disorders in the DSM-5 that are listed as differential diagnoses for OCPD. They are as follows:

  • obsessive-compulsive disorder. OCD and OCPD may have a similar name wh,ich may cause confusion; however, OCD can be easily distinguished from OCPD by the absence of true obsessions or compulsions.
  • hoarding disorder. A diagnosis of hoarding disorder is only considered when the hoarding behavior exhibited is causing severe impairment in the functioning of the person, such as an inability to access rooms in a house due to excessive hoarding.
  • narcissistic personality disorder (NPD). Individuals with narcissistic personality disorder may believe that they are perfect and that no one else can be as perfect or right as them; however, people with narcissistic personality disorder usually believe that they have achieved perfection and cannot get better, whereas those with OCPD do not believe that they have achieved perfection and are self-critical. Those with NPD tend to be stingy and lack generosity; however, they are usually generous when spending on themselves, unlike those with OCPD who hoard money and are miserly towards themselves and others.
  • antisocial personality disorder. Similarly, individuals with anti personality disorder are not generous and miserly around others, although they usually over-indulge themselves and are sometimes reckless in spending.
  • schizoid personality disorder. Schizoid personality disorder and OCPD may both display restricted affectivity and coldness; however, in OCPD, this is usually due to a controlling attitude, whereas in SPD, it occurs due to a lack of ability to experience emotion and display affection.
    A person measuring and cutting blades of grass to be the same size.

    Figure 2. While obsessive-compulsive personality traits can sometimes be useful, they are usually excessive and can be damaging to ones life and relationships.

  • Other personality traits. Obsessive-compulsive personality traits may be particularly useful and helpful, especially in productive environments. Only when these traits become extreme, maladaptive, and cause clinically significant impairment in several aspects of one’s life should a diagnosis of OCPD be considered.
  • personality change due to another medical condition. OCPD must be differentiated from a personality change due to a medical condition, which affects the central nervous system, and may cause changes in behavior and traits.
  • substance use disorders. Substance use may cause the advent of obsessive-compulsive traits. It is necessary that this is distinguished from underlying and persistent behavior, which must occur when a person is not under influence of a substance.

Etiology

The cause of OCPD is thought to involve a combination of genetic and environmental factors, namely problems with attachment. The cause of OCPD is thought to involve a combination of genetic and environmental factors. There is clear evidence to support the theory that OCPD is genetically inherited; however, the relevance and impact of genetic factors varies with studies placing it somewhere between 27% and 78%.[1] Too few studies have dealt with the specific gene involved in the disorder’s heritability, and more research is required to ascertain the exact genes.

Other studies have found links between attachment theory and the development of OCPD. According to this hypothesis, those with OCPD have never developed a secure attachment style, had overbearing parents, were shown little care, and were unable to develop empathetically and emotionally.

Epidemiology

Estimates for the prevalence of OCPD in the general population range from 3%-8%, making it the most common personality disorder. Some studies show no gender differences, but others show OCPD more prevalent among men.

A diagnosis of OCPD is common with anxiety disorders, substance use disorders, and mood disorders. OCPD is also highly comorbid with Cluster A personality disorders, especially paranoid and schizotypal personality disorders. OCPD has also been linked to a higher relapse in those who are treated for major depressive disorder, and a higher risk of suicidal behavior. OCPD is also linked to hypochondriasis, with some studies estimating a rate of co-occurrence as high as 55.7%. In people with eating disorders, 13% also have OCPD.

Treatment

Treatment involves psychotherapy, such as CBT, and sometimes antidepressants.

Obsessive-Compulsive Personality Disorder is Not Obsessive-Compulsive Disorder

OCPD is often confused with OCD. Despite the similar names, they are two distinct disorders. Some OCPD individuals do have OCD, and the two can be found in the same family, sometimes along with eating disorders. People with OCPD do not generally feel the need to repeatedly perform ritualistic actions—a common symptom of OCD—and usually find pleasure in perfecting a task whereas people with OCD are often more distressed after their actions.

People with OCPD tend to be obsessed with controlling their environments; to satisfy this need for control, they become preoccupied with trivial details, lists, procedures, rules, and schedules. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations.

Both disorders may share outside similarities; rigid and ritual-like behaviors, for example. Attitudes toward these behaviors differ between people affected with either of the disorders: for people with OCD, these behaviors are unwanted and involuntary, being the product of anxiety-inducing and involuntary thoughts. On the other hand, for people with OCPD, the person perceives them as rational and wanted, being the result of, for example, strong adherence to routines, a desire for control, or a need for perfection. OCPD is highly comorbid with other personality disorders, Asperger’s syndrome, eating disorders, anxiety, mood disorders, and substance use disorders.

Obsessive-compulsive personality disorder (OCPD) is marked by an excessive obsession with rules, lists, schedules, and order; a need for perfectionism that interferes with efficiency and the ability to complete tasks; a devotion to productivity that hinders interpersonal relationships and leisure time; rigidity and zealousness on matters of morality and ethics; and an inability to delegate responsibilities or work to others.

This video explains the differences between OCD and OCPD:

You can view the transcript for “What is the difference between OCD and OCPD?” here (opens in new window).

Case STUDY: OCPD

Mark is a 42-year-old, single male who lives with his parents. He has been unemployed for some time because he has had difficulty maintaining employment. Most recently, he was not able to meet production demands at his factory job because he got consumed with making each package perfect before moving on to the next package. One weekend, when his family planned to visit the grandparents, Mark started packing on Wednesday afternoon but did not finish the packing until Saturday, when it was too late to go. Mark’s employment and personal relationships are impacted by his rigidity and extreme attention to detail. Mark was diagnosed with obsessive-compulsive personality disorder.

In therapy, Mark was very punctual in treatment and never missed a session; he talked freely and in great detail. The initial part of therapy mainly dealt with family relationships. When the time came to leave the sessions, he would often continue talking and delaying even when the therapist was standing at the door.

Key Takeaways: Obsessive-Compulsive Personality Disorder

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Glossary

obsessive-compulsive personality disorder: characterized by a preoccupation with orderliness, perfectionism, and rigidity in behaviors and relationships

obsessive-compulsive disorder: a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency

  1. Diedrich A, Voderholzer U (February 2015). "Obsessive-compulsive personality disorder: a current review". Current Psychiatry Reports. 17 (2): 2. doi:10.1007/s11920-014-0547-8. PMID 25617042. S2CID 20999600. ↵