What Is… Obsessive Compulsive Personality Disorder (OCPD)

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is obsessive compulsive personality disorder.

When people say that someone is “a little OCD,” chances are, what they’re referring to has little, if anything, to do with obsessive compulsive disorder. What they’re talking about is actually far more like obsessive compulsive personality disorder (OCPD) than OCD. Granted, most people haven’t heard of OCPD, but it’s a lot closer to the popular OCD stereotype than OCD itself is.

OCPD symptoms

OCPD involves a pattern of persistent preoccupation with order and control, as well as perfectionism. It’s in the DSM-5’s cluster C of personality disorders. In the World Health Organization’s International Classification of Diseases (ICD-11), it’s called anankastic personality disorder.

Obsessive compulsive personality disorder symptoms include:

• preoccupied with details, rules, schedules, organization, and lists
• perfectionism to the extent that it interferes with completing tasks
• leisure activities and friends are neglected in favour of excessive work and productivity
• unwillingness to get rid of worthless objects that don’t serve a purpose
• reluctant to delegate work to others because they can’t be trusted to do it the right way
• avoidance of spending money out of concern for future disasters
• rigidity and stubbornness

Like any personality disorder, symptoms have already begun by early adulthood, and they cause significant impairment in overall functioning. It’s “normal” for people to have some of these traits, to some extent, some of the time, but if you’re like me and lists and organization make your life easier rather than making it hard, that’s not a disorder.

People with OCPD also tend to be very rigid, with black-and-white thinking, a strong need for control, and difficulty adapting to change. They tend to be deferential to authority, not accept any bending of rules, and have a rigid moral code. Their inflexibility and excessive amounts of time spent on details causes inefficiency and delays in getting things done. Difficulties with compromise and attempts to control others and get them to do things their way (which is seen as the “correct” way) can contribute to difficulties in interpersonal functioning.

OCPD occurs in between 2-8% of the population, and it may be more common in males, although that finding hasn’t been consistent. There appears to be a heritable component, although specific involved genes haven’t been identified.

The difference between OCD and OCPD

Obsessive thoughts in OCD are often ego-dystonic, meaning they’re intrusive, unwanted thoughts that have barged into their heads and are inconsistent with who they are. Someone with contamination OCD doesn’t develop those obsessions and compulsions because they’re hyper-preoccupied with cleanliness, and there is no possible clean that could ever be decontaminated enough to satisfy the OCD.

In obsessive compulsive personality disorder, thoughts tend to be ego-syntonic, so they’re consistent with what the person actually wants and believes. Someone with OCPD might want their house cleaned in exactly a certain way because that’s the only “right” way to do it. Friction can develop in social relationships because of the need for control on the part of the person with OCPD.

Between 15-28% of individuals with OCD have comorbid OCPD. OCPD commonly co-occurs with mood and anxiety disorders.

Treatment

Treatment can be difficult, especially since part of OCPD is believing that one is doing things the “right” way. As a result, people with the disorder may not have enough insight to see the need for treatment. In terms of pharmacotherapy, some benefits have been shown from the SSRI antidepressant fluvoxamine and the mood stabilizer carbamazepine.

In terms of psychotherapy options, cognitive behavioural therapy (CBT) can be helpful, and it’s been associated with decreased anxiety related to OCPD symptoms. Interpersonal therapy and schema therapy may be helpful for depressive symptoms in patients with OCPD, and psychodynamic psychotherapy may help patients to develop greater insight.

During my nursing career, I don’t think I ever worked with any clients diagnosed with OCPD. I can’t think of anyone I knew socially that seemed to have it, either. But the people I’ve known who fit the colloquial description of being “a little OCD” were definitely far closer to OCPD than OCD.

Is this a disorder that you were familiar with? And does it sound to you like there’s a resemblance to the way “a little OCD” gets used inappropriately?

Further reading: Top workplace struggles of people with obsessive-compulsive personality disorder (OCPD) by She Seems Normal

References

• Diedrich, A., & Voderholzer, U. (2015). Obsessive-compulsive personality disorder: A current review. Current psychiatry reports, 17(2), 1-10.
• International OCD Foundation
• OCD UK
• Rowland, T. A., Jainer, A. K., & Panchal, R. (2017). Living with obsessional personality. BJPsych Bulletin, 41(6), 366-367.
• Thamby, A., & Khanna, S. (2019). The role of personality disorders in obsessive-compulsive disorder. Indian Journal of Psychiatry, 61(Suppl 1), S114.
• Wikipedia
• Zimmerman, M. (2021). Obsessive compulsive personality disorder (OCPD). Merck Manual Professional Version.