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Obsessive-Compulsive Personality Disorder (OCPD)

By Robert M. A. Hirschfeld, MD, DeWitt Wallace Senior Scholar and Professor, Department of Psychiatry, Weill Cornell Medical College

Obsessive-compulsive personality disorder is characterized by a pervasive preoccupation with orderliness, perfectionism, and control (with no room for flexibility or efficiency) that ultimately interferes with completing a task.

  • People with obsessive-compulsive personality disorder need to be in control and do things in a specific way in their pursuit of perfectionism.

  • Doctors diagnose obsessive-compulsive personality disorder based on specific symptoms, including preoccupation with details, rules, schedules, organization, and lists and a focus on doing something perfectly that interferes with completing a task.

  • Psychodynamic psychotherapy and cognitive-behavioral therapy may help.

Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.

Because people with obsessive-compulsive personality disorder need to be in control, they tend to do things alone and to mistrust the help of others.

Obsessive-compulsive personality disorder is one of the most common personality disorders. It is estimated to occur in about 2 to 8% of the general population. It is more common among men.

Certain traits that run in families—compulsivity, a limited range of emotion, and perfectionism—are thought to contribute to this disorder.

Other disorders are also often present. People often also have one or more of the following:

Unlike obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder does not involve true obsessions (recurring, unwanted, intrusive thoughts that cause great anxiety) and compulsions (rituals people feel driven to do to control their obsessions), such as excessive hand washing or repeated checking to make sure a door is locked. Also, people with OCD are often distressed by their lack of control over compulsions. In contrast, people with obsessive-compulsive personality disorder are comfortable with their obsessive-compulsive behavior because they believe it is needed to achieve their goals of order, perfectionism, and control.

Symptoms

Focus on order and perfectionism

People with obsessive-compulsive personality disorder are preoccupied with order, perfectionism, and control of themselves and situations. To maintain a sense of control, people focus on rules, trivial details, procedures, schedules, and lists. This preoccupation interferes with their ability to be flexible, effective, and open to different ideas. Rigid and stubborn in their activities, these people insist that everything be done in a specific way.

Effects on work

Because people with this disorder focus on rules, details, and organizational issues, they lose the main point of a project or activity. These people repeatedly check for mistakes and pay attention to every detail. They do not make good use of their time, often leaving the most important tasks until the end. Their preoccupation with the details and making sure everything is perfect can endlessly delay completion of a task. They are unaware of how their behavior affects their co-workers. When focused on one task, these people may neglect all other aspects of their life.

Because people with obsessive-compulsive personality disorder want everything done in a specific way, they have difficulty delegating tasks and working with others. When working with others, they may make detailed lists about how a task should be done and become upset if a co-worker suggests an alternative way. They may reject help even when they are behind schedule.

People with obsessive-compulsive personality disorder tend to be very dedicated to work and productivity. Their motivation is not financial necessity.

Effects on other aspects of life

Because they are so dedicated to work, they neglect leisure activities and relationships. They may think they have no time to relax or go out with friends. They may postpone a vacation so long that it does not happen, or they may feel they must take work with them so that they do not waste time. Time spent with friends, when it occurs, tends to be in a formally organized activity (such as a sport). Hobbies and recreational activities are considered important tasks requiring organization and hard work to master. Their goal is perfection.

These people plan ahead in great detail and do not wish to consider changes. Their relentless rigidity may frustrate co-workers and friends.

Expression of affection is also tightly controlled. People with this disorder may relate to others in a formal, stiff, or serious way. Often, they speak only after they think of the perfect thing to say. They may focus on logic and intellect and be intolerant of emotional or expressive behavior.

Other symptoms

People with obsessive-compulsive personality disorder may be overzealous, picky, and rigid about issues of morality, ethics, and values. They apply rigid moral principles to themselves and to others and are harshly self-critical.

These people are rigidly deferential to authorities and insist on exact compliance to rules, with no exceptions for extenuating circumstances.

Discarding worn-out or worthless items (such as broken appliances), even those with no sentimental value, is very difficult.

People with this disorder may be reluctant to spend money, which they think should be saved in case of future disasters.

Diagnosis

  • A doctor's evaluation, based on specific criteria

For doctors to diagnose obsessive-compulsive personality disorder, people must be persistently preoccupied with order, perfectionism, and control of self, others, and situations, as shown by at least four of the following:

  • They are preoccupied with details, rules, schedules, organization, and lists.

  • Their attempts to do something perfectly interferes with completion of tasks.

  • They are extremely devoted to work and productivity (not because of financial necessity), resulting in neglect of leisure activities and friends.

  • They are excessively conscientious, exacting, and inflexible regarding ethical and moral issues and values.

  • They resist throwing out worn-out or worthless objects, even those with no sentimental value.

  • They are reluctant to delegate or work with other people unless others agree to do things exactly as they want.

  • They are reluctant to spend money on themselves and others because they see it as something to be saved for future disasters.

  • They are rigid and stubborn.

Also, symptoms must have begun by early adulthood.

Treatment

  • Psychodynamic psychotherapy

  • Cognitive-behavioral therapy

  • Certain antidepressants

General treatment of obsessive-compulsive personality disorder is similar to that for all personality disorders

The person's rigidity, obstinacy, and need for control may interfere with treatment.

Psychodynamic therapy and cognitive-behavioral therapy may help people with obsessive-compulsive personality disorder.

Certain antidepressants called selective serotonin reuptake inhibitors (SSRIs) may also be useful.