by Joye C. Anestis
As a graduate student in clinical psychology, I have come to understand, appreciate, and maybe even respect the construct of obsessive-compulsive personality disorder (OCPD). All because I wonder if a little bit of OCPD is adaptive on some level! Certainly, many of the successful people I have come across in upper-level academia have at least a few prominent symptoms of the disorder and they have often managed to make it work to their advantage, spurring them on to greater and greater success (although perhaps at the cost of some interpersonal relationships). However, in the case of OCPD, a little bit goes a long way - once an individual crosses over into the full disorder, it can wreak havoc on one's interpersonal and professional life.
My hope for this article is to provide up-to-date scientific information on OCPD - unfortunately, that does not leave me with much to write about. Just like almost all the other PDs (borderline and antisocial are exceptions to this), OCPD has received very little research attention...luckily, my own perfectionism will not prevent me from forging ahead and summing up what we know!
What is it: OCPD is one of the Cluster C personality disorders, grouped with avoidant and dependent personality disorders. These disorders were lumped together due to their supposed shared tendency toward anxiety and fear (but keep in mind that the validity of this grouping has been questioned; APA, 2000). According to the DSM-IV (APA, 2000), an individual must have at least 4 of the following symptoms to obtain the diagnosis:
- "is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost"
- perfectionism which prohibits task completion (e.g., can't complete a project because your standards are so high that they cannot be met)
- leisure activities and friendships are ignored due to excessive devotion to work and productivity (this does not apply if the devotion to work is out of economic necessity)
- "is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)"
- inability to get rid of worn-out or worthless objects even if they have no sentimental value
- "is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things"
- "adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes"
- is rigid and stubborn
First of all, can you see how a moderate amount of these symptoms might be professionally helpful? But, is it also apparent that once these symptoms become inflexible and persistent they could cause significant impairment and subjective distress? Individuals with this disorder are so rigid and perfectionistic that they seldom complete tasks and have a hard time maintaining friendships, as other people have a hard time living up to the OCPD individual's high standards. For a fictional (and admittedly exaggerated) example of OCPD, check out this Saturday Night Live skit...
How common is it?: Prevalence estimates vary but generally suggest that OCPD occurs in 1% of community samples (although higher community prevalence rates have been observed, e.g., Grant et al., 2005) and 3-10% in clinical samples (APA, 2000). There is some evidence toward differential prevalence rates by race/ethnicity, with Grant et al. (2004) observing that OCPD is more common in Whites than in Asians or Hispanics.
Diagnostic Problems and Comorbidity: By looking at the criteria, you probably noticed how problematic this particular symptom set can be diagnostically. First of all, there is considerable symptom overlap with other personality disorders. For example, one must differentiate between OCPD perfectionism and the perfectionism often seen in narcissistic personality disorder. Both OCPD and schizoid personality disorder share a tendency toward social detachment, although the function of the detachment differs between disorders. Of course, the biggest diagnostic confusion arises from the name of the disorder itself and begs the questions, what is the relationship between OCPD and obsessive-compulsive disorder (OCD). A future PBB article will be devoted to differentiating between them but for now it is sufficient to say that individuals with OCPD do not have the true obsessions and compulsions seen in OCD; however, there is a bit of symptoms overlap (e.g., hoarding) and a good amount of comorbidity between OCPD and OCD. Other disorders that commonly co-occur with OCPD include anorexia nervosa, major depressive disorder, and the anxiety disorders (Lilenfeld et al., 2006; McGlashan et al., 2000). And of course, OCPD is often comorbid with other personality disorders, not only within Cluster C but across clusters as well (Grant et al., 2005).
Treatment: Currently, no empirically-supported treatment (EST) exists for OCPD. Several researchers have suggested cognitive-behavioral techniques are effective for this disorder (and it makes conceptual sense, as such techniques would help in relaxing perfectionistic standards and softening cognitive inflexibility; e.g., Beck et al., 2003) but no randomized clinical trials have been conducted. Some have suggested that dialectical behavior therapy (DBT), a specific type of cognitive-behavioral therapy originally designed for suicidal behavior and borderline personality disorder, may be beneficial in treating OCPD. Two case studies discuss treatment (Lynch & Cheavens, 2008; Miller & Kraus, 2007) but again no randomized controlled trials exist. It should be noted here, however, that an individual rarely presents with only OCPD, the norm is for OCPD to be comorbid with another mental health condition. Several studies have suggested that a comorbid personality disorder attenuates treatment of an Axis I condition (e.g., depression, anxiety disorders, anorexia nervosa; Crane et al., 2007; Newton-Howes et al., 2006).
Joye Anestis is a doctoral candidate in clinical psychology at Florida State University.
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