By Mark Zimmerman, MD, Rhode Island Hospital
Content last modified May 2021
Obsessive-compulsive personality disorder is characterized by a pervasive preoccupation with organization, perfectionism, and control (no room for flexibility) that essentially delays or interferes with completing a task. Diagnosis is by clinical criteria. Treatment is with psychodynamic psychotherapy, cognitive behavioral therapy, and selective serotonin reuptake inhibitors (SSRIs).
(See also Overview of Personality Disorders.)
Because patients with obsessive-compulsive personality disorder need to be in control, they tend to be lonely in their efforts and distrust the help of others.
It is estimated that about 2.1% to 7.9% of the general population have obsessive-compulsive personality disorder; is more common among men.
Family traits of compulsiveness, restricted range of emotions, and perfectionism are thought to contribute to this disorder.
Comorbidities may be present. Patients also often have depressive disorder (major or persistent depressive disorder) or alcoholism.
Signs and symptoms of obsessive-compulsive personality disorder
Obsessive-compulsive personality disorder symptoms may decrease even over a period of time as short as 1 year, but their long-term persistence (i.e., remission and relapse rates) is less clear.
In patients with obsessive-compulsive personality disorder, preoccupation with order, perfectionism, and control of themselves and situations interfere with flexibility, effectiveness, and receptivity. Rigid and stubborn in their activities, these patients insist that everything be done in a specific way.
To maintain a sense of control, patients focus on rules, minute details, procedures, schedules, and lists. As a result, the main point of a project or activity is lost. These patients repeatedly check for errors and give extraordinary attention to detail. They don't make good use of their time, often leaving the most important tasks until last. Your concern for detail and assurance that everything is perfect can delay completion indefinitely. They are unaware of how their behavior affects co-workers. When focused on a single task, these patients can neglect all other aspects of life.
Because these patients want everything done in a specific way, they have a hard time delegating tasks and working with others. When working with others, they can create detailed lists of how a task should be done, and if a coworker suggests an alternative way, annoyed. They may reject help even when they are late.
Patients with obsessive-compulsive personality disorder are overly dedicated to work and productivity; your dedication is not motivated by a financial need. As a result, leisure activities and relationships are neglected. They may think they don't have time to relax or hang out with friends; they might put off a vacation so long that it doesn't happen, or they might feel they should take work with them so they don't waste time. Time spent with friends, when it occurs, tends to be a formally organized activity (eg, a sport). Hobbies and recreational activities are considered important tasks that require organization and hard work to master; the goal is perfection.
These patients plan ahead and in great detail and do not want to consider changes. Your relentless rigidity can frustrate co-workers and friends.
Expression of affection is also tightly controlled. These patients may relate to others in a formal, rigid, or serious manner. Often, they only speak after thinking of the perfect thing to say. They may focus on logic and intellect and be intolerant of emotional or expressive behavior.
These patients can be fanatical, demanding, and rigid about issues of morality, ethics, and values. They apply strict moral principles to themselves and others and are harshly self-critical. They are rigidly deferential to the authorities and insist on strict compliance with the rules, with no exceptions for extenuating circumstances.
Diagnosis of obsessive-compulsive personality disorder
• Clinical criteria (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5])
For the diagnosis of obsessive-compulsive personality disorder, patients must have
• A persistent pattern of preoccupation with orderliness, perfectionism, and control over oneself, others, and situations
This pattern is characterized by the presence of ≥ 4 of the following:
• Concern about details, rules, schedules, organization and lists
• Effort to do something perfectly that interferes with task completion
• Excessive devotion to work and productivity (not because of a financial need), resulting in neglect of leisure activities and friends
• Excessive uprightness, meticulousness and inflexibility regarding ethical and moral issues and values
• Unwillingness to discard worn-out or worthless objects, even those with no sentimental value
• Reluctance to delegate or work with others unless those people agree to do things exactly as patients want
• A greedy approach to spending on themselves and others because they see money as something to be saved for future catastrophes
• Rigidity and stubbornness
In addition, symptoms must have occurred in early adulthood.
Differential diagnosis
Obsessive-compulsive personality disorder should be distinguished from these disorders:
• Obsessive-compulsive disorder (OCD): patients with OCD have real obsessions (repetitive, unwanted, intrusive thoughts that cause marked anxiety) and compulsions (ritualistic behaviors they feel they should do to reduce their anxiety-related obsessions). OCD patients are often distressed by their lack of control over compulsive impulses; in patients with obsessive-compulsive personality disorder, the need for control is driven by a preoccupation with order so that their behaviors, values, and feelings are acceptable and compatible with the sense of self.
• Avoidant Personality Disorder: Both Avoidant Personality Disorder and Obsessive-Compulsive Personality Disorder are characterized by social isolation; but in patients with obsessive-compulsive personality disorder, isolation results from prioritizing work and productivity over relationships, and these patients do not trust others solely because of its potential to interfere with patients' perfectionism.
• Schizoid personality disorder: Both schizoid personality disorders and obsessive-compulsive personality disorder are characterized by an apparent formality in interpersonal relationships and detachment. However, the reasons are different: a basic inability for intimacy in patients with schizoid personality disorder versus discomfort with emotions and dedication to work in patients with obsessive-compulsive personality disorder.
Treatment of obsessive-compulsive personality disorder
• Psychodynamic psychotherapy
• Cognitive behavioral therapy
• Selective serotonin reuptake inhibitors
The general treatment of obsessive-compulsive personality disorder is similar to that for all personality disorders.
There is little information about the treatment of obsessive-compulsive personality disorder. In addition, treatment is complicated by rigidity, obstinacy, and the patient's need for control, which can be frustrating for therapists.
Psychodynamic therapy and cognitive-behavioral therapy can help patients with obsessive-compulsive personality disorder. Sometimes, during therapy, an interesting, intellectual, and detailed conversation by the patient may seem psychologically oriented, but it is devoid of affection and does not lead to change.
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