Obsessive Compulsive Personality Disorder (OCPD)

What is obsessive-compulsive personality disorder?

Individuals diagnosed with OCPD focus on rules, procedures, schedules, and lists so much that they are distracted from the core point of the activity, project, or task. They get so lost in details that they do not use their time well and often leave the crucial part of the project for last.

While they are so focused or preoccupied with perfection or control in one aspect of their life, they often neglect other factors. For example, they are often failing to meet deadlines and straining relationships.

OCPD differs from obsessive-compulsive disorder (OCD) in that people with OCPD are unaware of the consequences of their behavior and feel that they are correct. At the same time, patients with OCPD will think that everyone else is incapable of following rules or getting things ‘right.’ Compared to OCD, people with OCPD exhibit consistent behavior over a long period and are inflexible in their standards.

Symptoms of obsessive-compulsive personality disorder

Someone with OCPD focuses on rules, order, and control with no room for flexibility. This control targets themselves, their situations, and how others act or conduct themselves. Symptoms generally begin in early adulthood.

These behaviors are considered a problem when they ultimately interfere with completing tasks, decreasing the quality of a person’s physical, emotional, and social well-being. Unfortunately, these patients are unaware that their behaviors affect others.^[1]

Obsessive-compulsive symptoms include:

• Imposing their standards on spouses, relatives, co-workers, and their environment
• Preferring to be solitary in their endeavors so that the ‘right’ standards are reached
• Standards set on themselves, or others, are unrealistic and hinder the completion of tasks
• Mistrusting the help of others or imposing specific rules that must be obeyed to the letter
• Finding it difficult to delegate and reject help even if behind schedule
• Preoccupation with details so that there isn’t a good use of time
• Neglecting other aspects of their lives when focused on one task
• Being rigid about issues of morality, ethics, and values
• Being harshly self-critical
• Being stiff and formal with rigid mannerisms
• Having trouble seeing things from another person’s perspective
• Avoiding or quitting activities that they cannot immediately master, limiting their potential
• Hoarding useless items
• Hoarding money for future disasters
• Overly devoting themselves to working even if they are financially stable
• Being unwilling to cut corners when necessary
• Being submissive to authorities and dutiful, insisting on exact compliance with rules

Causes of obsessive-compulsive personality disorder

The exact cause of OCPD is not known. However, several factors can put an individual at higher risk of developing the medical condition. OCPD is generally associated with a combination of genetics or family history and childhood experiences.

People with OCPD generally have relatives with the same disorder, so a genetic component is suspected. However, there has not been any association with a particular gene or group of genes.

Experts believe that specific childhood experiences may lead to the development of OCPD. It is thought that inherited genes only increase the susceptibility to OCPD, while an external trigger will lead to the development of the disorder.^[2] Some of these childhood experiences include:

• Overprotective environment
• Environment where the child feels they need to follow strict rules, be perfect or be perfectly obedient to avoid harsh punishments
• Parental detachment or lack of emotion

According to epidemiological studies, OCPD is the most prevalent personality disorder within the general population and occurs in 2- 8% of people in the US.^[3] Those with an existing personality disorder are more at risk of developing OCPD, especially those suffering from severe OCD. Men are also twice as likely to develop OCPD as females.

Diagnosing OCPD

Patients are diagnosed according to the clinical criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, also known as the DSM-5.^[4]

A provider may want to rule out any physical condition causing the symptoms and refer the patient to a specialist (i.e., a psychiatrist). The psychiatrist or other mental health professional will conduct psychological assessments through questionnaires or talk sessions.

Patients with OCPD show a consistent obsessive pattern with order, meticulousness, and control of the self and others. Symptoms should begin in early adulthood for this diagnosis. The pattern is detected through evidence of four or more of the following symptoms:^[5]

• Preoccupation and excessive attention to minute details, rules, schedules, organization, and lists, to the detriment of the main task
• Perfectionism which hampers the ability to deal with everyday issues
• Excessive devotion to work that results in neglecting interpersonal relationships and leisure time
• Extreme perfectionism, diligence, and inflexibility regarding ethical matters and values
• Hoarding worn or useless objects
• Difficulty delegating work or working with others unless these follow the patient’s instructions to the letter
• Hoarding money for future disasters
• Rigidity in actions and way of thinking

Treatment for OCPD

People living with OCPD do not think something is wrong with them and are unaware of the effects of their behavior on others. And so, the first hurdle is getting the patient to seek treatment. Unfortunately, most people will only give in to seeking treatment once they see an effect that threatens their job, social status, or relationship. They often would have been given an ultimatum by their partner or boss before seeking professional help.

Treatment can be divided into three types:

Talk based therapies

Cognitive behavioral therapy (CBT) and psychodynamic therapy are both talk-based therapies that can help with OCPD. ^[6]

In CBT, the patient is aided in recognizing perceptions about the self and others that may be inaccurate. In addition, the therapist helps the patient develop coping strategies to deal with their unhelpful thoughts when they occur.

In psychodynamic therapy, the therapist helps the patient identify behavioral patterns linked to early childhood experiences. Then, the therapist and patient understand the beliefs and thought patterns developed due to these experiences.

Medications

Medications such as selective serotonin reuptake inhibitors (SSRIs) decrease the anxiety surrounding OCPD. They help to reduce depressive symptoms associated with social isolation and angry outbursts that patients may be prone to (when things don’t go according to plan). In addition, decreasing temper flares minimizes damage to relationships or jobs that may already suffer from ongoing issues.

Relaxation therapies

Relaxation therapies decrease the stress and sense of urgency often felt by patients. Practices include yoga, pilates, and tai chi. These therapies require focus and deep breathing, helping the patient stay in the moment and mindful of their actions.

Self-care for OCPD

With OCPD, patients often experience stress and a sense of urgency related to their fixations and high control standards. However, if you have OCPD, there are things you can do to improve your quality of life.^[7]

• Practice self-compassion. When disappointed in a mistake or a deadline not met, try to understand what you can do to address the root cause. Recognize that not every problem has a solution, and you may need to reevaluate and accept some situations. Listen to your self-talk and adjust it by putting things into perspective to avoid catastrophizing.
• Manage your emotions and learn to identify them by looking out for physical symptoms, e.g., fast heartbeat or sweaty hands. Accept and look at emotions as a normal function rather than a weakness.
• Try to maintain social relationships by not fixating on winning and trying to resolve issues. Avoid placing blame and use “I” statements rather than “You” statements. Instead, learn to apologize when necessary.

Helping someone with OCPD

Encouraging loved ones to get treatment or take up techniques to help with their mental health condition is tricky since patients often don’t believe they need such treatment. Sometimes, it helps for activities to be framed as something to be done as a couple or team rather than to ‘fix’ a problem.

Mindful breathing, relaxation techniques, regular exercise, enough rest, and the consumption of healthy meals are all activities that should be encouraged openly.

To help a loved one:

• Learn about OCPD from trusted sources
• Listen to the patient to understand their perspective
• Offer love, support, and encouragement
• Appreciate the person and see the good in them
• Avoid escalating anger or hostility
• Recognize the limitations of your ability to provide treatment
• Encourage the patient to seek support from professionals

As a friend or relative of a person with OCPD, you may need to create boundaries and become more assertive in your interactions.

Outlook for OCPD

The outlook of OCPD is better than that of several other personality disorders. During treatment, patients are made aware of how others are affected by their behavior and compulsions. This may be an impetus for them to try to change some of their tendencies.

Unlike other personality disorders, patients with OCPD are less likely to become addicted to alcohol and drugs, factors that would worsen the disease’s outlook.

Success depends on finding the treatment option that is right for the particular patient. Still, therapy can help to improve their relationships and interactions and their ability to empathize with those around them.

Frequently asked questions about OCPD

How common is OCPD?

OCPD affects around 1 in 10 people in the US and is one of the most common personality disorders. It tends to affect men much more than women and tends to run in families. OCPD is diagnosed in adulthood, with the symptoms presenting in early adulthood. Some patients recall a need for perfectionism starting from childhood.

OCPD often occurs with comorbidities such as anxiety, narcissistic personality disorder, and depression. Patients with debilitating OCD have a higher chance of being diagnosed with OCPD.

OCPD vs OCD – What is the difference?

OCPD is a personality disorder, while OCD is an anxiety disorder. This means that patients with OCPD will exhibit symptoms consistently as part of their character, while those with OCD have symptoms that get worse or better depending their anxiety level.

People with OCD experience intrusive and troubling thoughts (obsessions), resulting in behaviors that compel and overpower them (compulsions). However, they experience true obsessions and compulsions that are atypical and distressing, and they are aware of their unusual nature.

On the other hand, those with OCPD do not believe they have a problem and think they are justified in their actions. Instead, they value and want to continue living within a rigid, inflexible structure that they believe others are incapable of rising to.

Although the differences might appear clear on paper, certain overlapping personality traits might make confuse individual cases. For example, OCPD is more common than OCD, and individuals may have both disorders. Thus, a qualified healthcare professional must always be entrusted with diagnosis and care.^[8]