Obsessive Compulsive Personality Disorder (OCPD)

Obsessive–Compulsive Personality Disorder (OCPD)

Obsessive–Compulsive Personality Disorder (OCPD)

People with obsessive–compulsive PD (OCPD) are perfectionistic and preoccupied with orderliness; they need to exert interpersonal and mental control. These traits exist on a lifelong basis, at the expense of efficiency, flexibility, and candor. However, OCPD is not just obsessive–compulsive disorder (OCD) in miniature. Many patients with OCPD have no actual obsessions or compulsions at all, though some do eventually develop OCD.

The rigid perfectionism of these patients often results in indecisiveness, preoccupation with detail, scrupulosity, and insistence that others do things their way. These behaviors can interfere with their effectiveness in work or social situations. Often they seem depressed, and this depression may wax and wane, perhaps to the point that it drives them into treatment. Sometimes these people are stingy; they may be savers, refusing to throw away even worthless objects they no longer need. They may have trouble expressing affection.

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Patients with OCPD are list makers who allocate their own time poorly, workaholics who must meticulously plan even their own pleasure. They may plan their own vacations only to postpone them. They resist the authority of others, but insist on their own. They may be perceived as stilted, stiff, or moralistic.

This condition is probably fairly common; prevalence in various studies centers around 5%. It is diagnosed more often in males than in females, and it probably runs in families.

Essential Features of Obsessive–Compulsive Personality Disorder

These people are intensely focused on control, orderliness, and perfection. They can become so absorbed with details, organization, and rules of an activity that they lose sight of its purpose. They tend to be rigid and stubborn, perhaps so perfectionistic that it interferes with the completion of tasks. They can be overly conscientious, inflexible, or scrupulous about ethics, morals, and values. Some are workaholics; others won’t work unless others agree to do things the patients’ way. Some may save worthless items; others are stingy with themselves and with other people.

The Fine Print

The D’s: • Duration (begins in teens or early 20s and endures) • Diffuse contexts • Differential diagnosis (physical and substance use disorders, OCD, hoarding disorder, other PDs)

Robin Chatterjee

“I admit it—I’m over the top in neatness.” Robin Chatterjee straightened a fold in her sari. Born in Mumbai and educated in London, Robin was a graduate student in biology. Now she spent part of her time as a teaching assistant in biology, and the rest struggling through her own coursework at a major U.S. university. She gazed steadily at the interviewer.

According to her preceptor, a slightly dour Scot named MacLeish who had asked her to come for the interview, the problem wasn’t neatness. It was completing the work. Every paper she turned in was wonderful—every fact was there, every conclusion correct, not even a misspelling. He had asked her why she couldn’t learn to let go of them a little sooner, “before the rats die of old age?” She had thought it funny at the time, but it made her think.

Robin had always been orderly. Her mother had made her keep neat little lists of her chores, and the habit stuck. Robin admitted that she became so “lost in lists” that sometimes she hardly had time to finish her work. Her students seemed fond of her, but several had said they wished she’d give them more responsibility. One had told Dr. MacLeish that Robin seemed afraid even to let them do their own dissections; their methods weren’t as compulsively correct as hers were, so she’d try to do them herself. Finally, she also admitted that nearly every night, her work habits kept her in the lab until late. It had been weeks since she’d had a date—or any social life at all. This realization was what spurred her to follow Dr. MacLeish’s advice and come in for a mental health evaluation.

Evaluation of Robin Chatterjee

Although the prototype for OCPD seems a pretty good fit for Robin, she would just barely meet the official criteria. She was workaholic and perfectionistic (OCPD criteria A3 and A2), to the point that these traits interfered with the learning of her students. She had a great deal of difficulty delegating work—even the students’ own dissections (A6)! And she concentrated so fiercely on her lists of tasks that she sometimes didn’t accomplish the tasks themselves (A1). She had had these tendencies throughout her young adult life.

Depressed mood is common in these people. The common disorders that should be looked for in a patient with OCPD include OCD itself, major depressive disorder, and dysthymia. Robin was not depressed and, unlike so many patients with OCPD, seemed to have no other disorder. Because she barely met the criteria and was functioning well overall, I would place her GAF score at a relatively high 70.