Obsessive-Compulsive Personality Disorder

a paranoid patient    Credit: verywell mind Opens in new window

Obsessive-compulsive personality disorder (OCPD) is characterized by a pervasive and maladaptive pattern of excessive perfectionism, preoccupation with orderliness and details, and need for control over one’s environment (Wheaton & Pinto, 2017).

OCPD is one many personality disorders that are associated with significant impairment in occupational and academic functioning, and in both intrapersonal and interpersonal functioning.

Case Vignette
Andrew is a 45-year old accountant. His wife has brought him for consultation because he is depressed. He is not sleeping or eating, has 11 pounds and is anxious all the time about losing his job. He reports that he has recently been struggling at work since the firm was taken over by new employers who are expecting him to complete more auditing work in less time, and he is highly anxious about making mistakes. He says he has always been extremely conscientious and reports difficulties delegating his work as well as a tendency to get easily distracted by details. Andrew cites as an example the fact that he would find small discrepancies, such as pennies missing at audit, highly distracting and spends longer than he should searching for the source of insignificant error. As a result, he is slower than most of his colleagues, but he claims that the quality of his work is of the highest standard and that previously his meticulousness was not seen as a problem. He is angry and of his new employers for taking a different attitude. He thinks he has been unfairly treated and is not prepared to change the way he works. He admits to long-standing workaholic tendencies, has almost no social life apart from his relationship with his wife, and holds judgmental attitudes. He hoards outdated electrical items in the shed. He is noted to make poor eye contact. His wife describes him as obstinate, rigid, and stubborn but also loyal and trustworthy.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines personality disorders Opens in new window as impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits and categorizes personality disorders into three different clusters (A, B, and C) based on descriptive similarities. OCPD is classified as one of three Cluster C (“anxious-fearful”) personality disorder types.

DSM-5 specifically emphasizes that OCPD traits of orderliness, perfectionism, and mental and interpersonal control are expressed at the expense of flexibility, openness, and efficiency (American Psychiatry Association 2013).

OCPD Definition in DSM

DSM-I (American Psychiatry Association 1952) introduced compulsive personality disorder, defined by chronic, excessive, or obsessive concern and by adherence to standards of conscience or of conformity.

A strong emphasis was placed on rigidity, reduced capacity for relaxation, overinhibition, overconscientiousness, and an inordinate capacity for work.

In DSM-II (American Psychiatry Association 1968), the name of the condition was changed to obsessive-compulsive personality disorder, and individuals with this disorder were described as rigid, over-inhibited, over-conscientious, and over-dutiful.

DSM-II also introduced the term anankastic personality to reduce confusion between the personality disorder and OCD. However, this new term was subsequently removed from following editions.

In DSM-III (American Psychiatric Association 1980), the name was changed back to compulsive personality disorder, and a feature of “restricted ability to express warm and tender emotions” was included, which once again distinguished the personality disorder from OCD Opens in new window.

This new feature closely resembled what we would consider, in modern classification, to be traits of autistic spectrum disorders. Indeed, OCPD and autistic spectrum disorders Opens in new window are commonly mistaken for each other, at least in the clinical psychiatry setting (Galdelkarim et al., in press).

Additional personality features included in the DSM-III definition were perfectionism, insistence that others submit to the individuals way of doing things, excessive devotion to work and productivity, and indecisiveness (American Psychiatric Association 1980).

DSM-III-R (American Psychiatric Association 1987) included new criteria, including preoccupation with details (to the extent that the major point of the activity is lost), scrupulousness, inflexibility, lack of generosity, and hoarding. Presence of five criteria were required for the diagnosis.

DSM-5 Diagnostic Criteria for OCPD

The eight current DSM-5 criteria for OCPD diagnosis have not changed substantially since DSM-IV was introduced in 1994 (American Psychiatric Association 1994). Those criteria are:

  1. preoccupation with details,
  2. perfectionism interfering with task completion,
  3. excessive devotion to work and productivity,
  4. overconscientiousness,
  5. hoarding,
  6. reluctance to delegate,
  7. miserly spending style, and
  8. rigidity and stubbornness.

The OCPD diagnosis requires that at least four (or more) of the listed specific criteria be met. Of the DSM-5 criteria, hoarding is perhaps the least specific for OCPD, in that it also appears in the description of OCD and counts as the principal criterion for the new diagnosis of hoarding disorder (an OCRD).

Indeed, suggestions have been made that in the future OCPD may be more appropriately classified within the OCRDs Opens in new window, owing to the growing recognition of overlapping clinical and biological factors (Stein et al. 2016).

General effects of OCPD

Individuals with OCPD present with a range of general difficulties, including increased disability across important life domains as well as an increased likelihood of specific psychological disorders.

For instance, data from the Collaborative Longitudinal Personality Disorder Study (CLPDS; McGlashan et al., 2000) found that 75% of individuals suffering from OCPD also suffered from major depressive disorder at some point in their lives.

While recent evidence suggests that OCPD is associated with lesser degrees of disability than other personality disorders, in one study 90% of individuals with OCPD were still found to have moderate or severe impairment in at least one area of functioning (Skodol et al., 2002).

Furthermore, OCPD was associated with as much disability as major depression in areas relating to work and study.

Individuals with OCPD may present with a range of other psychological difficulties, including anxiety disorders, mood disorders, adjustment problems (particularly during stressful periods), physical symptoms, and somatoform disorders such as hypochondriasis. For instance, data from the CLPDS (McGlashan et al., 2000) suggest that more than 20% of individuals diagnosed with OCPD reported symptoms consistent with general anxiety disorder (GAD) or OCD.

Intrapersonal and interpersonal difficulties are common among individuals with OCPD. For instance, affected individuals rarely experience a sense of security either internally or externally.

Early life experiences that have linked mistakes and infringement or moral codes with parental rejection result in uncertainty about self-worth and fears about errors and imperfections (Guidano & Liotti, 1983; Millon, 1996).

This results in inflexible adherence to ethical, religious or moral codes, and repeated attempts to prove one’s worth by avoiding ‘failure’ and achieving ‘perfection’ (Beck and Freeman, 1990; Guidano & Liotti, 1983). The resulting perfectionism and intolerance for uncertainty increases vulnerability to a range of psychopathology (Flett & Hewitt, 2002; Tolin et al., 2003).

Individuals with OCPD are particularly challenged by the external world. They have a strong need to control their social and physical environment, and find it hard to trust others as they perceive them as irresponsible and incompetent (Beck & Freeman, 1990; Millon, 1996).

Hostility towards others develops from an assumed coercion to accept the standards imposed by others, an assumption that is derived from their early experiences of constraint and discipline when they contravened parental rules (Millon & Davis, 1996).

Fear of social disapproval evolves from such other-directedness and an assumption of rejection following any possible infringement of strict and restrictive moral codes.

Hence, in order to resolve their ambivalence towards others, individuals with OCPD are likely to become preoccupied with socially prescribed perfectionism, self-control, social order, rules and regulations.

As individuals with OCPD come to recognize that others do not share their own high standards and moral codes, they experience internal conflict between hostility towards others and a fear of social disapproval (Millon, 1996).

Their perception of unsatisfactory performance by others also results in feelings of frustration and anger, increased feelings of personal responsibility and the need to control the environment and themselves. However, individuals with OCPD also fear revealing their internalized hostility.

They experience a fear that these feelings may spiral out of control and reveal their imperfections, resulting in their rejection by others (Millon, 1981). This internal struggle results in further attempts for control, rigidity of behavior and affective restriction (McWilliams, 1994).

Individuals with OCPD compartmentalize many aspects of their lives (Millon, 1996). They rigidly allocate times for every task. In their attempts to maintain control they disregard their own emotional reactions to events and suppress memories. Such efforts for emotional and cognitive control result in lack of self-knowledge and difficulties with regulating their emotions.

They may manage to avoid thinking about specific issues (e.g., relationships) during weekdays, which may be dedicated solely to work; however, they may consistently ruminate about these topics during weekends or at vacation times.

Total absorption in the task at hand may result in a lashing out at any disturbance. In some cases, such compartmentalization may lead to extreme feelings of detachment from oneself, difficulties recalling recent important life events and a continuous sense of never feeling emotion or being in the world.

Individuals with OCPD show an excessive, dysfunctional devotion to achievement, activities of mastery, and work. Their basic insecurity, fear of exploration and intolerance for uncertainty hinders the development of a range of social roles.

Rather than having several social roles, individuals with OCPD over-invest in socially sanctioned, structured social roles such as job competence. As a result of this excessive reliance on one social role, they become anxious, and overwhelmed by small changes in their work environment.

They try to maintain control through excessive attention to detail, regulations and procedures. Again, their perfectionism and lack of trust in others results in a reluctance to delegate tasks, they may reject reactive solutions and assistance from others due to their mistrust and fear of novelty.

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