Obsessive-Compulsive Personality Disorder

Key takeaways

• OCPD is a Cluster C personality disorder characterized by a strong desire for control, rigid adherence to rules, and perfectionism

• OCPD is relatively common, affecting around 4.3% of the population, but can be difficult to diagnose

• Treatment for OCPD is primarily psychotherapy, aimed at helping people explore new ways of thinking and behaving and develop a more flexible mindset

Understanding obsessive-compulsive personality disorder (OCPD)

Obsessive-compulsive personality disorder is a long-term personality disorder. Personality disorders affect someone’s traits, beliefs, attitudes, priorities, and behaviors, often leading them to struggle in many areas of their life.

OCPD is a cluster C personality disorder, which means that it is associated with fearful or anxious emotions. People with OCPD are inflexible, highly focused on rules, and typically exhibit extreme perfectionism.

Personality is often understood in terms of four dimensions: harm avoidance, novelty seeking, reward dependence, and persistence. Each of these is a spectrum, and people may rate highly one some and lower on others. People with OCPD usually score highly on measures of harm avoidance and persistence.^[2]

OCPD vs OCD

Obsessive-compulsive personality disorder is easily mistaken for obsessive-compulsive disorder (OCD) due to their extremely similar names and having some symptoms in common. They are different disorders, however, with different causes, symptoms, and treatments.^[2]

OCPD is a personality disorder, meaning that the symptoms relate to a person’s traits, beliefs, and attitudes. People with this disorder are heavily focused on control, but their thoughts and behaviors are consistent with their underlying beliefs and values (ego-syntonic).

As an anxiety disorder, OCD is different. People with OCD experience delusions, obsessions, or unwanted thoughts that don’t align with their underlying beliefs.^[2]They will often recognize that their actions are irrational or extreme, but feel unable to stop.

Although OCPD and OCD are separate, many people experience both at the same time. Estimates suggest that between 23% and 45% of people with one of these conditions will also have the other.^[3]OCPD is more common than OCD.

How prevalent is OCPD?

OCPD affects around 4.3% of the population, making it the single most common personality disorder.^[1]Because the symptoms of OCPD are less likely to result in the need for acute care, OCPD is less common than other personality disorders in inpatient environments or at the emergency room.^[4]

OCPD symptoms

People with OCPD are generally described as being inflexible, rule-focused, and perfectionistic. This leads to a range of symptoms.^[5]

Cognitive symptoms

OCPD leads to rigid thought patterns. Symptoms in this category include

• Binary or ‘black and white’ thinking.

• Overly focused on rules and details, sometimes missing the ‘bigger picture’.

• Difficulty making decisions.

Interpersonal symptoms

People with OCPD have characteristic difficulties working with others and in their interpersonal relationships. These include

• Difficulty seeing others’ points of view or tolerating other approaches.

• Difficulty compromising.

• Difficulty working with others.

• Highly critical of others.

• Wanting to control others.

Emotional symptoms

Emotional symptoms of OCPD usually appear when it becomes difficult to maintain the control that they crave. These symptoms include

• Strong feelings of frustration and angry outbursts.

• Being easily hurt or humiliated, especially following criticism.

• High levels of self-doubt.

• Struggling with changes in routine.

Behavioral symptoms

Some symptoms of OCPD can be seen in someone’s behavior. Examples include

• A high need for organization, lists, and order.

• Missing deadlines due to perfectionism.

• Subbornness.

• Hoarding behavior, even for items with no sentimental value.

• Lack of perseverance in hobbies or interests, especially those requiring extensive learning or practice.

Risks and complications

Unlike some other personality disorders, OCPD rarely leads to mental health crises or requires hospitalization. Despite this, untreated OCPD can still have significant negative consequences on patients’ lives.

People with OCPD frequently experience difficulties in their work and personal relationships. Their need for perfectionism and control can lead to difficulty working with others and social isolation. OCPD can be especially dangerous in people who also have an eating disorder.

OCPD may make people more vulnerable to mood disorders, such as depression and burnout. Physical health problems associated with OCPD include hypertension and cardiac issues.^[6]

Causes of OCPD

There is no single cause of OCPD. Instead, it results from a combination of factors, including genetic, biological, psychological, and environmental factors.

OCPD has a moderate genetic component, and some genes are closely associated with the characteristic personality traits seen in the disorder.^[7][8]Studies suggest that the genes responsible for selecting different versions of dopamine D3 receptors and serotonin transporters may increase the risk of developing OCPD.^[9][10]

Some researchers suggest that OCPD may be more likely to develop following childhood trauma. Others have suggested that strict parenting styles may be partially responsible, though there is limited support for this belief.^[11]

Who is likely to develop OCPD?

OCPD typically develops in late adolescence or early adulthood.^[2]It is relatively rare for older adults to develop OCPD later in life if they haven’t experienced symptoms when they were younger.

OCPD is more often diagnosed in men than women, though there is some uncertainty about whether this reflects a genuine difference in the probability of developing OCPD or a difference in how those symptoms are interpreted in women compared with men.^[12][13]

Diagnosing OCPD

Obsessive-compulsive personality disorder is usually diagnosed by a mental health professional, for example, a clinical psychologist or psychiatrist. In many cases, people with OCPD initially request help with other mental health problems, such as anxiety or depression, and are unaware that these issues stem from their underlying personality disorder.

Diagnosis of OCPD is largely based on a clinical interview or conversation between the patient and the clinician.^[14]Because people with OCPD may not notice some of their symptoms, it can be helpful for clinicians to speak to other people in the patient’s life. This can be especially helpful in exploring whether these traits were present in adolescence or early adulthood.

To diagnose OCPD, clinicians need to find at least four symptoms from the following list, and these symptoms must have been present for much of the patient’s life.

1. Preoccupation with details, rules, lists, order, organization, or schedules to the extent that the central point of the activity is lost.

2. Perfectionism that interferes with task completion.

3. Excessive devotion to work and productivity, excluding leisure activities and friendships.

4. Over-conscientiousness and inflexibility about morality, ethics, or values.

5. Difficulty in discarding worn-out or worthless objects with no sentimental value.

6. Reluctance to delegate tasks or work.

7. Adoption of a miserly spending style toward self and others.

8. Demonstration of rigidity and stubbornness.

For a diagnosis, these symptoms must cause problems the the patient, for example, in their social life, work, or education. They also cannot be solely due to other disorders or substance use.

Tests and assessments for OCPD

Clinicians trying to diagnose OCPD may use specialized tests or assessment tools. These include

• Minnesota Multiphasic Personality Inventory-3.^[15]

• Millon Clinical Multiaxial Inventory-IV.^[16]

• Personality Assessment Inventory.^[17]

• Personality Inventory for DSM-5 (PID-5).^[18]

Treatment for OCPD

Obsessive-compulsive personality disorder is mainly treated through psychotherapy (also known as talk therapy). Different types of psychotherapy will have different approaches, but the aim is usually to help people with OCPD understand their condition and develop new ways of thinking about and interacting with the world.

Psychodynamic therapy helps patients develop insight into both the problems their OCPD is causing and some of the anxieties or insecurities that led to it. Cognitive behavioral therapy (CBT) aims to challenge thought patterns and beliefs that create and maintain the symptoms. Other therapeutic approaches that are commonly used to treat OCPD include schema therapy and interpersonal therapy (IPT).^[19][20]

There are no medications licensed by the FDA to treat OCPD, but they are still sometimes used. Selective serotonin reuptake inhibitors (SSRIs) and antipsychotic medications have both been used, but there is mixed evidence about whether they are effective.^[21]

Self-management for OCPD

People with obsessive-compulsive personality disorder value being in control, which can make self-management of the condition appealing. There are several helpful steps you can take to reduce the symptoms of OCPD and help create a more flexible mindset.

Improve awareness

Managing OCPD is made significantly harder if you struggle to recognize areas where your condition is causing problems. Improving your self-awareness and understanding of OCPD can help you target your efforts.

Learning more about OCPD, including the effect it has on your life and the people around you, is a helpful first step. Talking to other people who also have OCPD, for example, as part of peer-support groups, can offer new insights and help you feel understood.

Manage stress

People with OCPD often experience high levels of stress, which has emotional and physical consequences. Finding ways to reduce your stress levels can help avoid some of those effects. Consider practicing mindfulness, spending more time outside, and using other relaxation techniques.

Letting go of responsibility and delegating is especially difficult for people with OCPD, but learning to do so can help reduce your stress. Consider trying to hand over small, low-importance tasks to become more comfortable with reducing your responsibility.

Explore your expectations

Perfectionism is one of the most challenging symptoms of OCPD, causing problems in different areas of life. Starting to challenge your expectations for yourself and others is a helpful first step in overcoming this.

Be curious about other people’s expectations, and try to recognize both the risks and advantages of different approaches to tasks. Think about what would be necessary to achieve a ‘good enough’ task and challenge yourself to stop once that has been achieved.

It’s also helpful to practice being compassionate, to yourself and others, when things fail to meet your perfectionist standards.

Build stronger relationships

Try to pay attention to your relationships with important people in your life. Again, be curious. Ask about their perspective and try to understand how their beliefs and values work for them, without trying to convince them that your way is better.

Helping someone with OCPD

Helping someone with obsessive-compulsive personality disorder can be difficult, especially if they are certain that there is nothing wrong with them or their way of approaching life. Here are some ways to offer help and support.

Validate their progress

Change is difficult for people with OCPD, and it’s easy for them to feel as though they’re not doing something right or that they are about to be criticized. Offer validation and support when you see them trying to be more flexible in their approach or when they attempt to delegate. It’s helpful to focus on progress and growth, rather than focusing entirely on end points and outcomes.

Be open about the effect of their actions

People with OCPD can be highly critical of others, which is often hurtful. Explain the effect that their criticism has on you, but try to avoid being critical of them in return. Using phrases such as “I feel” allows you to highlight your experiences without blaming them or telling them that they’re in the wrong.

Challenge gently

It’s important to challenge people with OCPD when they cross a line or when their overly-rigid worldview starts to cause problems, but these challenges are rarely welcome. Keeping challenges gentle can allow your loved one to take your points on board without becoming overly defensive.

A gentle challenge when they are judging someone else too harshly might include asking whether there are any alternative explanations or perspectives. You could offer some suggestions before asking whether they can think of any others.

Another gentle challenge could be to point out situations where their perfectionism has made something more difficult for them than it needed to be. Again, this needs to be presented tactfully and with care.

Prioritize self-care

Helping someone with OCPD can be difficult and exhausting. Make sure you don’t burn yourself out trying to help them. Take time for self-care and excuse yourself from conversations in which you feel too attacked.

Remember that you can’t change anyone else, and it’s not your responsibility to try. Your role is to offer support and new perspectives for them to consider, rather than ‘fixing’ them.

Final thoughts

OCPD is a long-term mental health condition that usually requires professional help to overcome. Medication is rarely helpful, but psychotherapy can help people with OCPD recognize the impact of their illness and develop a more flexible mindset.