What is Obsessive-Compulsive Personality Disorder?
Obsessive-compulsive personality disorder (OCPD) is an illness characterized by a strong need for order, perfection, and control. People with OCPD are typically inflexible, and they are reluctant to give up control of tasks to other people. As a result, they may neglect other parts of their lives in their quest for perfection in specific tasks, and their unwillingness to be flexible may get in the way of successful completion of the tasks.
OCPD is one of a group of conditions called Cluster C personality disorders. This group also includes avoidant personality disorder and dependent personality disorder.
Symptoms of Obsessive-Compulsive Personality Disorder
Common symptoms of OCPD include:
- Perfectionism that causes distress or the inability to complete tasks
- Distrust of the abilities of others
- Unwillingness to delegate
- Neglect of relationships or other aspects of life in favor of pursuing perfection
- Fixation on rules, details, and principles
- Need to be in control
- General inflexibility or stubbornness
- Need for firm control over money
OCPD vs. OCD
OCPD differs from obsessive-compulsive disorder. OCPD is a personality disorder characterized by consistent behavior over a long period. OCD is an anxiety disorder with symptoms that may fluctuate.
Differences between the two disorders include:
- People with OCD are troubled by intrusive, repetitive thoughts (obsessions) and irresistible, repetitive behaviors (compulsions). People with OCPD do not experience true obsessions or compulsions.
- People with OCD recognize that their symptoms are atypical and may be distressed by them. However, people with OCPD usually believe that their behaviors are justified and they do not have a problem.
- OCD symptoms may come and go depending on the person’s anxiety level. People with OCPD exhibit consistent symptoms.
What Causes Obsessive-Compulsive Personality Disorder?
The exact cause of OCPD has not been discovered. Several factors, however, seem to put an individual at increased risk of OCPD.
- Family history and genetics. People with OCPD often have a family history of the same disorder. Therefore, scientists suspect a genetic component to OCPD, but no definite association with any gene or group of genes has been discovered.
- Childhood experiences. Some researchers believe that extremes of parental attachment during childhood, either overprotectiveness or lack of emotional attachment, may increase a person’s risk of OCPD.
Is Obsessive-Compulsive Personality Disorder Hereditary?
Scientists have not yet been able to identify a specific genetic component that increases the risk of OCPD. Inherited genes may increase an individual’s susceptibility to OCPD, but the disorder’s actual development may result from external triggering circumstances.
How Is Obsessive-Compulsive Personality Disorder Detected?
People with OCPD exhibit many different behaviors related to their need for order and perfection. However, some other traits are not as clearly associated with the core behaviors and may also be signs of the disorder, including:
- Avoidance of close relationships
- Unusually restrained expressions of emotion
- Lack of empathy or generosity
- Unwillingness to dispose of items, even if they have no monetary or sentimental value
- Rigidity about morality or values
How Is Obsessive-Compulsive Personality Disorder Diagnosed?
Diagnosis of OCPD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that OCPD or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.
Diagnostic steps may include:
- A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.
The results of the psychological assessments will be compared to the diagnostic criteria for OCPD in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for OCPD include:
- Persistent need for perfection, order, and control (of self, others, and situations).
- At least four symptoms are present.
- The symptoms begin by early adulthood.
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How Is Obsessive-Compulsive Personality Disorder Treated?
There is no cure for AVPD, and no medications are commonly used to treat the core disorder itself. Instead, the most common treatment course involves psychotherapy, with drugs sometimes used to treat other co-existing mental illnesses.
People with OCPD usually believe that their need for control and perfection is rational and justified. Unfortunately, this makes it unlikely that they will seek treatment independently, and their inflexibility may make it difficult for a therapist to make progress with them.
Research has not yet shown which therapeutic approaches are the most effective treatments for OCPD. However, both psychotherapy and medications may be helpful in some cases.
Commonly used therapeutic approaches include:
- Cognitive-behavioral therapy (CBT). This type of treatment focuses on teaching the patient to recognize inaccurate perceptions about themselves and others and develop strategies for dealing with these misperceptions when they occur.
- Psychodynamic therapy. This type of therapy helps the patient to identify their patterns of behavior. The therapist is likely to encourage examining the patient’s emotions, beliefs, and early childhood experiences.
In some cases, medications may help to control the symptoms of OCPD. The drugs used to treat these symptoms include selective serotonin reuptake inhibitors (SSRIs).
How Does Obsessive-Compulsive Personality Disorder Progress?
People with OCPD believe that their behaviors are necessary, but their inflexibility and preoccupations can get in the way of their success in many different ways. Over time, the behaviors may cause significant problems with social and professional functioning.
Long-term adverse effects of OCPD can include:
- Difficulties at work caused by unwillingness to work with others or inability to finish tasks on time
- Social isolation because of time devoted to OCPD tasks rather than leisure
- Relationship difficulties because of lack of empathy or emotional connection
How Is Obsessive-Compulsive Personality Disorder Prevented?
There is no known way to prevent OCPD.
Obsessive-Compulsive Personality Disorder Caregiver Tips
Many people with obsessive-compulsive personality disorder also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with OCPD:
Obsessive-Compulsive Personality Disorder Brain Science
Researchers have identified differences in brain activity in people with OCPD compared to people without the disorder. For example, one study used functional magnetic resonance imaging (fMRI) to compare brain activity in OCPD patients to healthy control subjects. Differences were discovered in several different brain areas, including:
- Caudate nuclei. These structures deep inside the brain play a role in goal-directed action, memory, learning, and emotion. Study participants with OCPD showed increased activity in this area.
- Precuneus. This region near the rear of the brain has many functions, including the retrieval of memories. OCPD patients had higher activity in this area as well.
- Insular cortex. OCPD patients had an increased amount of activity in this part of the brain, which is involved in the process of self-awareness.
- Superior frontal gyrus. This area in the front of the brain is also involved in self-awareness, and OCPD patients had increased activity here, too.
- Fusiform gyrus. This area on the underside of the brain is involved in recognizing facial expressions. People with OCPD showed decreased activity in this area.
- Lingual gyrus. This part of the brain is involved in vision-related functions. People with OCPD had decreased activity here.
Obsessive-Compulsive Personality Disorder Research
Title: Effectiveness of PTSD-treatment Compared to Integrated PTSD-PD-treatment in Adult Patients With Comorbid PTSD and CPD (PROSPER-C)
Principal investigator: Kathleen Thomaes, MD, PhD
Post-traumatic stress disorder (PTSD) is highly comorbid with personality disorders (PD), mainly borderline (BPD) and cluster C personality disorders (CPD). It is not clear what treatment is most effective for those who suffer both PTSD and PD. There is a growing preference in clinicians for evidence-based PTSD treatments, such as Eye Movement Desensitization and Reprocessing (EMDR) or Imagination and Rescripting (ImRs), because these treatments are relatively short, and there is some evidence that comorbid PD symptoms might resolve as well. However, at least 30-44% of PTSD patients do not sufficiently respond to PTSD treatments or are excluded because of suicidality or self-harm. In addition, PD treatments are more intensive than PTSD treatments, e.g., Dialectical Behavior Therapy (DBT) and Schema-Focused Therapy (SFT). There is evidence that integrated PTSD-PD treatment is twice as effective as PD treatment alone, but integrated PTSD-PD treatment is not yet directly compared to PTSD treatment alone. This study will address this knowledge gap, including secondary outcome measures on functioning, quality of life, and cost-effectiveness.
For patients with comorbid PTSD and CPD, ImRs-only will be compared to integrated SFT-ImRs (PROSPER-C).
Psychological (cognitive, affective, and relational) and neurobiological candidate predictors and mediators of treatment outcome will be investigated through a machine-learning paradigm to develop a clinically useful and individual prediction instrument of treatment outcome. Examples of predictors and mediators are educational level, working memory, hyper- and hypo-arousal, therapeutic alliance and social support, resting-state fMRI, an emotional face task fMRI, cortisol levels from hair samples, and (epi)genetic markers.
For the neurobiological prediction, a subgroup of patients will undergo MRI scans, as will healthy controls as control subjects.
Risperidone in the Treatment of Psychotic-like and Deficit Symptoms of Schizotypal Personality Disorder
Principal Investigator: Harold Koenigsberg
Icahn School of Medicine at Mount Sinai
New York, NY
This study aims to determine the efficacy of risperidone compared to placebo in treating the psychotic-like and deficit symptoms of schizotypal personality disorder (SPD). Treatment with risperidone, a 5HT2 and dopamine D2 blocking agent, holds particular promise in the treatment of SPD. Unlike traditional antipsychotics, risperidone targets the deficit or negative symptoms of schizophrenia. The deficit-like symptoms of SPD are, therefore, also likely to respond to treatment with risperidone. One common complication in the present psychopharmacologic treatment of SPD with traditional neuroleptics is that many patients discontinue treatment due to medication-induced dysphoria. Given initial reports and the serotonergic component of the risperidone mechanism, risperidone is anticipated to produce little or no dysphoria.
Title: Compassion and Metacognition in Schizotypal Personality (CMBT)
Principal Investigator: Simone Cheli
The purpose of this study is to assess the safety and efficacy of a newly developed psychotherapy for schizotypal personality disorder. This new form of psychotherapy integrates compassion-focused therapy and metacognitively oriented psychotherapy.
After being informed about the study and potential risks, all patients giving written informed consent will undergo a psychological assessment to determine eligibility for study entry. Patients who meet the eligibility requirements will be randomized in a double-blind manner in a 1:1 ratio to new integrative psychotherapy or treatment as usual (cognitive behavioral therapy plus standard psychopharmacological treatment). One month after the conclusion of the two forms of treatment (both lasting six months), patients will have access to the final follow-up assessment.