Obsessive–compulsive personality disorder
Obsessive–compulsive personality disorder is a cluster C personality disorder 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; an inability to delegate responsibilities or work to others; a miserly spending style; hoarding behavior; restricted functioning in interpersonal relationships; restricted expression of emotion and affect; and a need for control over one's environment and self. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations.
The cause of OCPD is thought to involve a combination of genetic and environmental factors, with the main environmental factor being an overly-controlling parenting style in childhood. The genetic factor is thought involve the DRD3 gene.
This is a distinctly different disorder from obsessive-compulsive disorder, and the relation between the two is contentious. Some studies have found high comorbidity rates between the two disorders, and both may share outside similaritiesrigid and ritual-like behaviors, for example. Hoarding, orderliness, and a need for symmetry and organization are often seen in people with either disorder. Attitudes toward these behaviors differ between people affected with either of the disorders: for people with OCD, these behaviors are egodystonic, being the product of anxiety-inducing and involuntary thoughts. On the other hand, for people with OCPD, they are egosyntonic, being the result of, for example, a strong adherence to routines, a desire for control, or an inclination to achieve perfection. OCPD is highly comorbid with other personality disorders, Asperger's syndrome, eating disorders, and depression.
The disorder is the most common personality disorder in the United States, and is diagnosed twice as often in males as in females.
Signs and symptoms
The main observed symptoms of OCPD are an obsession with order, rules, lists, and schedules; a need for perfection that interferes with task completion and the ability to delegate responsbilities to other people; a devotion to productivity that causes impairment in interpersonal relationships and the ability to relax; rigidity and inflexibility in most areas of life, especially morality and ethics; miserliness and hoarding; and restricted expression of emotion and affect.Some of OCPD's symptoms have been found to be persistent and stable, whilst others were found to be unstable. The stable symptoms are the obsession with perfectionism, reluctance to delegate tasks to others, and the rigidity and stubbornness. On the other hand, the symptoms that were most likely to change over time were the miserly spending style and the excessive devotion to productivity.
Attention to order and perfection
People with OCPD tend to be obsessed with controlling their environments, and in order to satisfy this need for control, they become preoccupied with trivial details, lists, procedures, rules, and schedules. This attention given to the aforementioned causes the person to lose sight of the main objective of the task. For example, a person with OCPD may devise a schedule for cleaning up the house, then decide that the more important tasks should be completed first. Then they might decide that the tasks should be sorted based on the length of time each task would take. They may decide to plan how they will complete each task down to the meticulous detail, and so on and so forth, to the point whereby such a large portion of time was dedicated to optimising the schedule that the person does not have enough time to actually follow the schedule.A person with OCPD may experience problems in their relationships. This can occur, for example, when the person with OCPD insists that their partner follow unreasonable schedules and rules as determined by them. The partner may refuse to do so, and this would cause conflict and disagreement in the relationship, placing a strain on it, because each party feels that the other is neglecting them.
This preoccupation with details and rules makes the person unable to delegate tasks and responsbilities to other people unless they submit to their exact way of completing a task, because they believe that there is only one correct way of doing something. They stubbornly insist that a task or job must be completed their way, and only their way, and may micromanage people when they are assigned a group task. They are frustrated when other people suggest alternative methods. A person with this disorder may reject help even when they desperately need it as they believe that only they can do something correctly.
People with OCPD are obsessed with maintaining perfectionism. The perfectionism and the extremely high-standards that are established are to their detriment and may cause delays and failures to complete objectives and tasks. For example, a person may write an essay for a college, and then believe that it fell short of "perfection", so they continue rewriting it until the deadline is missed and the essay may never be completed due to the extremely high standards that are self-imposed. They are unaware of the fact that other people may become frustrated and annoyed by the repeated delays and hassles that are caused by their behavior. This causes relationships at work to become strained.
Devotion to productivity
Individuals who are affected by OCPD are devoted to work and productivity at the expense of interpersonal relationships and leisure activities, this behavior can not be accounted for by economic necessity, e.g. poverty. They tend to believe that they do not have the sufficient time to relax or enjoy their time as they prioritise their work excessively. They may find it difficult to take a day off, or go on a vacation, and may keep postponing the vacation until it never occurs. They may feel uncomfortable when they do take time off and will take something along with them to work. They tend to choose hobbies that are organized, and they approach them as a serious task requiring work to perfect. It is important to note, however, that the devotion to productivity in OCPD is different from work addiction, in that the former is controlled and ego-syntonic, and the latter is usually uncontrolled, ego-dystonic, and may display signs of withdrawal.Rigidity
Individuals with OCPD are overconscientious, scrupulous, and rigid and inflexible on matters of morality, ethics, and other areas of life. They may force themselves and others to follow rigid moral principles and strict standards of performance. They are self-critical and harsh about their mistakes. These symptoms should not be accounted for or caused by a person's culture or religion.People with this disorder are so obsessed with doing everything the "right and correct" way that they have a hard time understanding and appreciating the ideas, beliefs, and values of other people, and are reluctant to change their views, especially on matters of morality and politics. A study conducted in 2015 on the interpersonal functioning of people with OCPD found that people with OCPD reported low levels of perspective taking when compared to control groups, this is consistent with the rigidity and stubbornness trait.
Miserliness and hoarding
Money is usually viewed as something to be hoarded for future emergencies, this causes an individual with OCPD to hoard it and become frugal. They find it difficult to dispose of items even when they do not have a sentimental value to the owner. They view discarding items as irresponsible and say "you never know when you might need it" as a justification for their hoarding. A more extreme manifestation of hoarding symptoms would lead to a diagnosis of hoarding disorder.Restricted emotions and interpersonal functioning
Individuals with this disorder display little affection and warmth; their relationships and speech tend to have a formal and professional approach, and not much affection is expressed even to loved ones, such as greeting or hugging a significant other at an airport or train station. They have been found to display sensitivity to interpersonally warm and dominant behavior in others, and have been reported to be cold and controlling in their attitude towards others. It maybe that warmth in others may frustrate the interpersonal motives of OCPD individuals, which involve being more emotionally restrained, rigid, and in control in relationships.They are highly careful in their interpersonal interactions. They have little spontaneity when interacting with others, and ensure that their speech follows rigid and austere standards, by excessively scrutinising it. Their speech is filtered for behavior that they may find embarrassing or imperfect, and have a low bar for what they consider to be such. This bar is lowered even further when they are communicating with a superior or a person of high status. For this reason, communication becomes a time-consuming and exhausting endeavour, and this causes avoidance. The avoidance creates a perception of coldness and detachment.
The need for restricting affect is thought of as a defence mechanism by which the person controls their mental landscape. They tend to expunge their passions, and emotions, and classify their memories and experiences as a library of facts and data. Their memories are thought of as intellectualized and rationalized, as opposed to experiences that can be felt. This allows the person to prevent unanticipated emotions or feelings from occurring, and allows the person to remain in control. They view self-exploration as a waste of time, and have a patronising attitude towards emotional people.
They have been found to have the capacity for affective empathy, however, they are limited in their ability to express it appropriately in a social setting. It has been found that they display their empathy in a more cognitive, and intellectualized approach, by escaping into fantasy rather than taking another person's perspective.
Five factor model
A study conducted in 2010 found links between several traits in the five factor model and OCPD. The study used several instruments to measure the relationship between the OCPD diagnostic criteria and the five factor model of personality. The results are displayed in the table below.Millon's subtypes
In his book, Personality Disorders in Modern Life, Theodore Millon describes 5 types of obsessive-compulsive personality disorder, which he shortened to compulsive personality disorder.The Conscientious Compulsive
Millon described those with the conscientious compulsive traits as displaying a dependent manifestation of compulsive personality disorder. Those with conscientious compulsivity view themselves as helpful, co-operative, and compromising. They tend to downplay their achievements and abilities, and base their self-esteem on the opinion and expectations of those around them, as this compensates for their feelings of self-doubt and instability. They believe that by working hard and striving for perfection, they will receive care and love from others. On the other hand, they believe that making a mistake, or failing to perform perfectly will lead to ostracization and abandonment. The fear created by this mindset causes the person to never be satisfied with their work, which in turn causes perpetual feelings on anxiety.The Puritanical Compulsive
The puritanical compulsive is thought of as a blend of paranoid and compulsive features. They are believed to have strong internal impulses, that are countered vociferously through the use of religion. They are constantly battling their impulses and sexual drives, which they view as irrational, and attempt to purify and pacify these urges by adopting a cold and detached lifestyle. They tend to create an enemy which they use to vent their hostility, such as "non-believers", or "lazy people". They are patronizing, bigoted, and zealous in their attitude towards others, their beliefs are polarized into "good" and "evil".The Bureaucratic Compulsive
The bureaucratic compulsive displays signs of narcissistic traits alongside the compulsivity. They are thought of as champions of tradition, values, and hierarchy. They cherish organizations that follow hierarchies, and feel comforted by the definitive roles between subordinates and superiors and known expectations and responsibilities. They derive their identity and sense of purpose from the systems in which they work in. They project an image of diligence, reliability, and commitment to their institution. They view work and productivity and in a tunnel-vision fashion, rating it as either done, or not. They may use their power and status to inflict fear and obedience in their subordinates if they do not strictly follow their rules and procedures, and derive pleasure from the sense of control and power that they acquire by doing so.The Parsimonious Compulsive
The parsimonious compulsive is hoarding and possessive in nature, they behave in a manner congruent with schizoid traits. They are selfish, miserly, and are suspicious of others' intentions, believing that others may strive to take away their possessions. This behavior is thought to be caused by parents who deprived their child of wants or wishes, whilst providing the basic necessities required. This causes the child to develop an extreme protective approach to their belongings, often being self-sufficient and distant from others. This shielding behavior is used to protect from the discovery of their urges, desires, and imperfections.The Bedevilled Compulsive
This form of compulsive personality is a mixture of negativistic and compulsive behavior. They have an unstable sense of identity, and tend to be indecisive. When faced with dilemmas, they procrastinate and attempt to stall the decision through any means at their hand. They are in constant conflict between their desires and will, and will engage in self-defeating behavior and self-torture in order to resolve their internal conflicts.Cause
The cause of OCPD is thought to involve a combination of genetic and environmental factors. Under the genetic theory, people with a form of the DRD3 gene will probably develop OCPD and depression, particularly if they are male. But genetic concomitants may lie dormant until triggered by events in the lives of those who are predisposed to OCPD. These events could include parenting styles that are over-involved and/or overly protective, as well as trauma faced during childhood. Traumas that could lead to OCPD include physical, emotional, or sexual abuse, or other psychological trauma. Under the environmental theory, OCPD is a learned behavior. Further research is needed to determine the relative importance of genetic and environmental factors.The parenting style experienced by those with OCPD is can usually be conceptualized as authoritarian and over-controlling. Their parents expected perfection and flawlessness in their child. They are taught to inhibit and control their impulses, and to avoid horseplay. They are also expected to behave like rational and mature adults, and little affection is shown to them. The parents use shame as a form of controlling their children whenever they step outside the rigid boundaries established. Accomplishments are ignored and downplayed, and the child rarely receives praise or reward. The child grows up continuously in fear of making mistakes. By the time the person reaches adolescence, they incorporate their parents' tactics as part of them, and now they are the ones who instil shame in themselves as a means to controlling their behavior.
Diagnosis
DSM-5
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a widely used manual for diagnosing mental disorders, places obsessive compulsive personality disorder under section II, under the "personality disorders" chapter, and defines it as: "a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts". A diagnosis of OCPD is only received when four out of the eight criteria are met.Alternative model for diagnosis
The DSM-5 also includes an alternative set of diagnostic criteria as per the dimensional model of conceptualising personality disorders. Under the proposed set of criteria, a person only receives a diagnosis when there is an impairment in two out of four areas of one's personality functioning, and when there are three out of four pathological traits, one of which must be rigid perfectionism.The patient must also meet the general criteria C through G for a personality disorder, which state that the traits and symptoms being displayed by the patient must be stable and unchanging over time with an onset of at least adolescence or early adulthood, visible in a variety of situations, not caused by another mental disorder, not caused by a substance or medical condition, and abnormal in comparison to a person's developmental stage and culture/religion.
A study in 2007 found that OCPD is etiologically distinct from avoidant and dependent personality disorders, suggesting it is incorrectly categorized as a Cluster C disorder.
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 which 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. 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 on 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 obsessive-compulsive personality disorder 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.
- 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. Obsessive–compulsive personality disorder 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.
ICD-10
Comorbidity
Several disorders have been observed to have a higher risk of comorbidity with OCPD, they include: obsessive-compulsive disorder, eating disorders, Asperger's syndrome, and depression.Obsessive-compulsive disorder
OCPD is often confused with obsessive-compulsive disorder. Despite the similar names, they are two distinct disorders. Some OCPD individuals do have OCD, and the two are sometimes 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.Some OCPD features are common in those afflicted with OCD. For example, perfectionism, hoarding, and preoccupation in details were found in people with OCD and not in people without OCD, showing a particular relationship between these OCPD traits with OCD. The reverse is true as well: certain OCD symptoms appear to have close parallels in OCPD ones. This is particularly the case for checking and ordering and symmetry symptoms. OCPD samples who have OCD are particularly likely to endorse obsessions and compulsions regarding symmetry and organization. Washing symptoms, which are among the most common OCD symptoms, do not appear to have much of a link with OCPD, in contrast.
There is significant similarity in the symptoms of OCD and OCPD, which can lead to complexity in distinguishing them clinically. For example, perfectionism is an OCPD criterion and a symptom of OCD if it involves the need for tidiness, symmetry, and organization. Hoarding is also considered both a compulsion found in OCD and a criterion for OCPD in the DSM-5. Even though OCD and OCPD are seemingly separate disorders there are obvious redundancies between the two concerning several symptoms.
Regardless of similarities between the OCPD criteria and the obsessions and compulsions found in OCD, there are discrete qualitative dissimilarities between these disorders, predominantly in the functional part of symptoms. Unlike OCPD, OCD is described as invasive, stressful, time-consuming obsessions and habits aimed at reducing the obsession related stress. OCD symptoms are at times regarded as ego-dystonic because they are experienced as alien and repulsive to the person. Therefore, there is a greater mental anxiety associated with OCD.
In contrast, the symptoms seen in OCPD, although they are repetitive, are not linked with repulsive thoughts, images, or urges. OCPD characteristics and behaviors are known as ego-syntonic, as people with this disorder view them as suitable and correct. On the other hand, the main features of perfectionism and inflexibility can result in considerable suffering in an individual with OCPD as a result of the associated need for control.
A 2014 study found a second difference between OCPD and OCD: samples afflicted with OCPD, regardless of the presence of comorbid OCD, are more rigid in behavior and have a greater delayed gratification than either those afflicted with OCD or healthy control samples. Delayed gratification is a measure of self-control; it expresses one's capacity to suppress the impulse to pursue more immediate gratification in order to acquire greater rewards in the future.
Recent studies using DSM-IV criteria have persistently found high rates of OCPD in persons with OCD, with an approximate range of 23% to 32% in persons with OCD. Data suggest that there may be specificity in the link between OCD and OCPD. OCPD rates are consistently higher in persons with OCD than in healthy population controls using DSM-IV criteria.
Comorbidity between OCD and OCPD has been linked to a lower age of onset, a more severe presentation of symptoms, more significant impairment in functioning, poorer insight, and higher comorbidity of depression and anxiety. The presence of OCPD also predicted a higher rate of relapse for OCD.
Asperger's syndrome
There are considerable similarities and overlap between Asperger's syndrome and OCPD, such as list-making, inflexible adherence to rules, and obsessive aspects of Asperger's syndrome, although the latter may be distinguished from OCPD especially regarding affective behaviors, worse social skills, difficulties with Theory of Mind and intense intellectual interests e.g. an ability to recall every aspect of a hobby. A 2009 study involving adult autistic people found that 40% of those diagnosed with Asperger's syndrome met the diagnostic requirements for a comorbid OCPD diagnosis.Eating disorders
Stiff and rigid personalities have been consistently linked with eating disorders, especially with anorexia nervosa. Anorexia Nervosa is an eating disorder that is characterized by excessive amounts of restriction regarding food intake in fear of gaining weight. People who experience this disorder also experience body dysmorphia. Divergences between different studies as to the incidence of OCPD among people diagnosed with anorexia nervosa and bulimia nervosa have been found, which may in part reflect differences in the methodology chosen in different studies, as well as the difficulties of diagnosing personality disorders. In the table below, results are shown for the frequency of OCPD among people diagnosed with anorexia- non-specified subtype, restrictive subtype, binge/purge subtype with a history of bulimia nervosa and people diagnosed with Bulimia Nervosa.| Study | ANN | RAN | BPAN | BN |
| Arderluh et al. | 71.4% | 46.7-64% | 40% | |
| Halmi et al. | 31% | 32% | 24% | |
| Halmi et al. | 6% | 11-13% | 0% | |
| Anderluh et al. | 61% | 46% | ||
| Matsunaga et al. | 43.8% | 25% | 25% |
Regardless of the prevalence of the full-fledged OCPD among eating disordered samples, the presence of this personality disorder and its over-controlled quality has been found to be positively correlated with a range of complications in eating disorders, as opposed to impulsive features—those linked with histrionic personality disorder, for example—which predict better outcome from treatment. OCPD predicts more severe symptoms of AN, worse remission rates, and the presence of aggravating behaviors such as compulsive exercising. Compulsive exercising in eating disordered samples, along with smaller lifetime BMI and illness duration among people with AN, also correlates positively and significantly with an important OCPD trait: perfectionism.
Perfectionism has been linked with AN in research for decades. A researcher in 1949 described the behavior of the average “anorexic girl” as being "rigid" and "hyperconscious", observing a tendency to "eatness, meticulosity, and a mulish stubbornness not amenable to reason make her a rank perfectionist". Perfectionism can be a life enduring trait in the biographies of people living with AN. It is felt before the onset of the eating disorder, generally in childhood, during the illness, as well as after remission. The incessant striving for thinness among people with AN is itself a manifestation of this trait, of an insistence upon meeting unattainably high standards of performance. Because of its chronicity, those with eating disorders also display perfectionistic tendencies in other domains of life than dieting and weight control. Over-achievement at school, for example, has been observed among people with AN, as a result of their over-industrious behavior.
A Swedish study found that hospitalization for eating disorders was around twice more common among girls who took advanced courses and achieved high average grades than among those who had medium or low grades. The link with over-achievement was particularly high among those hospitalized for AN, which was 3.5 times as common among those with high grades as in those with other grade levels. In some individuals with bulimia nervosa, the seemingly conflicting traits of impulsivity and perfectionism are present.
Apart from perfectionism, other OCPD traits have been observed in the childhoods of those with eating disorders in much higher frequency than among control samples, including among their unaffected counterparts.
| Childhood OCPD trait | AN | RAN | BPAN | BN | OCPD | OCPD+OCD | OCD | Sisters of anorexics | Control samples |
| Perfectionism | 78% | 65.4% | 72.2% | 50.0% | 85.2% | 67.9% | 42.9% | 31% | 0—24% |
| Inflexibility | 31% | 76.9% | 61.1% | 25.0% | 66.7% | 50.0% | 32.1% | 9% | 0—5% |
| Rule-bound trait | 41% | 61.5% | 77.8% | 50.0% | 22% | 15—17.9% | |||
| Doubt and cautiousness | 28% | 27.3% | 46.7% | 21.4% | 3% | 0—5% | |||
| Order and symmetry | 6% | 38.5% | 31.3% | 10.7% | 66.7% | 46.4% | 17.9% | 3% | 0—3.6% |
Like those afflicted with OCPD, people with AN and BN tend to have a great need for order and symmetry in their activities and surroundings, something seen in their relationship with a third disorder, OCD. Eating disorders are largely comorbid with OCD; with studies showing that OCD symptoms are nearly as severe among people with AN as among a classic OCD sample, and that this remains so even after discounting food- and weight-related obsessions and compulsions.
Those with eating disorders are less likely, however, to develop the multi-object obsessions and compulsions of people with classic OCD, who self-report symptoms related to a multitude of themes such as violence, sex, washing, moral taboos etc. The symptoms of both people with anorexia nervosa and bulimics, however, tend to be more restricted to symmetry and orderliness concerns. The same has been noted in samples afflicted with comorbid OCPD and OCD, who are more likely to harbor obsessions and compulsions about symmetry and order than those who have OCD only.
At least one paper has made an explicit link between OCPD and the OCD symptoms endorsed by people with AN, noticing that in the samples under studyone person with both comorbid AN and OCD and another with OCD but no present eating disorderthose with comorbid AN and OCD were more likely to be diagnosed with OCPD than those with OCD only. In a larger sample which included people with anorexia and people with bulimia, it was found that all three eating disordered groups were more likely to develop symptoms about order and symmetry than the OCD-only group. Among women recovered from AN, orderliness concerns remain higher than among control samples without an eating disorder history.
The obsessive compulsive personality traits of over-attention to details and inflexibility have been found in cognitive testing of people with anorexia; this group, compared to healthy controls, will display average to above average performance in tests requiring accuracy and the avoiding of errors but poorly on tests requiring mental flexibility and central coherence, i.e., the ability to integrate details of information into a bigger narrative. Over-attention to details among people with anorexia and weak central coherence are linked with a well-known cognitive failure in this group, that of missing "the big picture", a characteristic of the cognitive style of those with OCPD.
Both anorexia nervosa and non-eating disordered OCPD samples have been found to share the trait of increased self-control, an above average ability to delay gratification in the name of a greater good to be received in the future. Among people with anorexia specifically, this trait is manifested in their capacity to repress a key natural urge, that of satisfying hunger, in order to be 'rewarded' with weight loss. In a 2012 paper, it was verified that this trait exists among AN sufferers beyond food and weight themes. AN sufferers, especially those of the restricting type, were observed to save money handed to them by researchers more persistently than a control sample.
A similar experiment was tested on four non-eating disordered samples—one with OCPD only, another from OCD only, a third afflicted with both OCPD and OCD, and a sample of healthy controls. Delayed gratification was found to be pronounced among those with OCPD but not those with OCD only or the control samples, who had similar performances to one another. Delayed gratification, they found, was highly correlated with the severity of OCPD, i.e., the greater the capacity to delay gratification in a person afflicted with OCPD, the more impairing was the disorder. As the authors noticed, psychiatric disorders—substance abuse, for example—may be marked by impulse deregulation, in contrast, OCPD and anorexia nervosa stand out as the only disorders shown to spring forth from the opposite quality: excessive self-control.
Some family studies have found a close genetic link between OCPD and AN. Lilenfeld et al. 1998, compared for a variety of psychiatric diagnoses three sets of women—one suffering from the restricting type of anorexia nervosa, another from bulimia nervosa, and a group of control women without an eating disorder—plus their respective relatives unaffected by eating disorders. They found a much higher incidence of OCPD among AN sufferers and their relatives than in the control samples and the latter's own relatives. Additionally, the rates of OCPD among relatives of people with AN with that personality disorder and those without it were about the same—evidence, in the authors' words, "suggesting shared familial transmission of AN and OCPD".
In this study, BN sufferers and their relatives were not found to have elevated rates of OCPD. Strober et al. 2007, in a similarly intended study, found much higher incidence of OCPD among relatives of AN than among relatives of a healthy control sample. Along with diagnoses of OCD and generalized anxiety disorder, OCPD was the one that best distinguished between the two groups.
Other disorders
People with OCPD often tend to general pessimism and/or underlying form of depression. This can at times become so serious that suicide is a risk. Indeed, one study suggests that personality disorders are a substrate to psychiatric morbidity. They may cause more problems in functioning than a major depressive episode.Another study found a rate of comorbidity higher than the general population between OCPD and substance use disorder, major depressive disorder, dysthymia, bipolar I & II, generalized anxiety disorder, panic disorder, social anxiety disorder, and other personality disorders, with the most comorbid personality disorder out of those tested being paranoid personality disorder, followed by schizoid, and avoidant personality disorders, respectively. The table on the left shows the lifetime rates of comorbidity between OCPD and other psychiatric disorders.
The study found that the rates of comorbidity between OCPD and other personality orders was around 34%, with the highest OCPD comorbidities occurring in dependent, histrionic, and schizoid personality disorders.
Treatment
Treatment for OCPD includes psychotherapy, cognitive behavioral therapy, behavior therapy or self-help. Medication may be prescribed. In behavior therapy, a person with OCPD discusses with a psychotherapist ways of changing compulsions into healthier, productive behaviors. Cognitive analytic therapy is an effective form of behavior therapy.Treatment is complicated if the person does not accept that they have OCPD, or believes that their thoughts or behaviors are in some sense correct and therefore should not be changed. Medication alone is generally not indicated for this personality disorder.
People with OCPD are three times more likely to receive individual psychotherapy than people with major depressive disorder. There are higher rates of primary care utilization. There are no known properly controlled studies of treatment options for OCPD. More research is needed to explore better treatment options.
Epidemiology
Estimates for the prevalence of OCPD in the general population range from 2.1% to 7.9%. A large U.S. study found a prevalence rate of 7.9%, making it the most common personality disorder. Men are diagnosed with OCPD about twice as often as women. It is estimated to occur in 8-9% of psychiatric outpatient settings. However, there is evidence to suggest that the disorder has no prevalence in either gender.History
Psychoanalytic
In 1908, Sigmund Freud named what is now known as obsessive-compulsive or anankastic personality disorder "anal retentive character". He identified the main strands of the personality type as a preoccupation with orderliness, parsimony, and obstinacy. The concept fits his theory of psychosexual development.OCPD was first included in DSM-II, and was largely based on Sigmund Freud's notion of the obsessive personality or anal-erotic character style characterized by orderliness, parsimony, and obstinacy.
The diagnostic criteria for OCPD have gone through considerable changes with each DSM modification. For example, the DSM-IV stopped using two criteria present in the DSM-III-R, constrained expression of affection and indecisiveness, mainly based on reviews of the empirical literature that found these traits did not contain internal consistency. Since the early 1990s, considerable research continues to characterize OCPD and its core features, including the tendency for it to run in families along with eating disorders and even to appear in childhood.
According to the DSM-IV, OCPD is classified as a 'Cluster C' personality disorder. There was a dispute about the categorization of OCPD as an Axis II anxiety disorder. It has been argued that it is more appropriate for OCPD to appear alongside OC spectrum disorders including OCD, body dysmorphic disorder, compulsive hoarding, trichotillomania, compulsive skin-picking, tic disorders, autistic disorders, and eating disorders.
Although the DSM-IV attempted to distinguish between OCPD and OCD by focusing on the absence of obsessions and compulsions in OCPD, OC personality traits are easily mistaken for abnormal cognitions or values considered to underpin OCD. Aspects of self-directed perfectionism, such as believing a perfect solution is commendable, discomfort if things are sensed not to have been done completely, and doubting one's actions were performed correctly, have also been proposed as enduring features of OCD. Moreover, in DSM-IV field trials, a majority of OCD patients reported being unsure whether their OC symptoms really were unreasonable.