Obsessive–compulsive personality disorder

{{Short description|Personality disorder involving orderliness}} {{Hatnote group| {{redirect|OCPD}} {{Distinguish|Obsessive–compulsive disorder}} }} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Infobox medical condition (new) | name = Obsessive–compulsive personality disorder | caption = A symptom of OCPD is a great attention to detail. | field = Psychiatry | synonyms = Anankastic personality disorder<ref>{{cite book|last1= Samuels|first1=Jack|last2=Costa|first2=Paul T.|editor-last = Widiger | editor-first = Thomas |title=The Oxford Handbook of Personality Disorders|chapter-url= https://books.google.com/books?id=nqOBunfGoNgC&pg=PA568 |year= 2012 |publisher= Oxford University Press|isbn=978-0-19-973501-3|page= 568|chapter= Obsessive–Compulsive Personality Disorder}}</ref> | symptoms = Obsession with rules and order; perfectionism; excessive devotion to productivity; inability to delegate tasks; zealotry on matters of morality; rigidity and stubbornness | onset = Adolescence to early adulthood<ref name="American Psychiatric Association">{{cite book | title=Diagnostic and Statistical Manual of Mental Disorders (DSM-5)|date=May 18, 2013|publisher= American Psychiatric Association|isbn=978-0-89042-554-1|edition=5th|location= United States|pages=681–82}}</ref> | risks = Negative life experiences, genetics | differential = Obsessive–compulsive disorder, personality disorders, substance use disorder, personality disorder due to another medical condition<ref name="American Psychiatric Association" /> | treatment = Psychotherapy | frequency = 3%<ref name= Diedrich2015/> | alt = Sweets sorted by colour and aligned in rows and columns | image = Obsessive Compulsive Disorder (8970250666).jpg }}{{Personality disorders sidebar}}

'''Obsessive–compulsive personality disorder''' ('''OCPD''') is <noinclude>a personality disorder </noinclude>marked by a spectrum of obsessions with rules, lists, schedules, and order, among other things. Symptoms are usually present by the time a person reaches adulthood, and are visible in a variety of situations.<ref name=":0" /> The cause of OCPD is thought to involve a combination of genetic and environmental factors, namely problems with attachment,<ref name="Diedrich2015">{{cite journal | vauthors = Diedrich A, Voderholzer U | s2cid = 20999600 | title = Obsessive–compulsive personality disorder: a current review | journal = Current Psychiatry Reports | volume = 17 | issue = 2 | article-number = 2 | date = February 2015 | pmid = 25617042 | doi = 10.1007/s11920-014-0547-8 }}</ref> but in some individuals there may be a link to brain trauma or Parkinson's disease.<ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6340987/</ref><ref>https://jnnp.bmj.com/content/72/3/420</ref>

Obsessive–compulsive personality disorder is distinct from ''obsessive–compulsive disorder'' (OCD), and the relation between the two is contentious. Some studies have found high comorbidity rates between the two disorders but others have shown little comorbidity.<ref name="Samuels_2000">{{cite journal | vauthors = Samuels J, Nestadt G, Bienvenu OJ, Costa PT, Riddle MA, Liang KY, Hoehn-Saric R, Grados MA, Cullen BA | title = Personality disorders and normal personality dimensions in obsessive–compulsive disorder | journal = The British Journal of Psychiatry: The Journal of Mental Science | volume = 177 | issue = 5| pages = 457–62 | date = November 2000 | pmid = 11060001 | doi = 10.1192/bjp.177.5.457 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Thamby A, Khanna S | title = The role of personality disorders in obsessive–compulsive disorder | journal = Indian Journal of Psychiatry | volume = 61 | issue = Suppl 1 | pages = S114–18 | date = January 2019 | pmid = 30745684 | pmc = 6343421 | doi = 10.4103/psychiatry.IndianJPsychiatry_526_18 | doi-access = free }}</ref> Both disorders may share outside similarities, such as rigid and ritual-like behaviors. OCPD is highly comorbid with other personality disorders, autism spectrum,<ref name= "Gillberg&Billstedt2000" /><ref name="Hofvander2009" /> eating disorders,<ref>{{cite journal | vauthors = Young S, Rhodes P, Touyz S, Hay P | title = The relationship between obsessive–compulsive personality disorder traits, obsessive–compulsive disorder and excessive exercise in patients with anorexia nervosa: a systematic review | journal = Journal of Eating Disorders | volume = 1 | issue = 1 | article-number = 16 | date = 2013-05-02 | pmid = 24999397 | pmc = 4081792 | doi = 10.1186/2050-2974-1-16 | doi-access = free }}</ref> anxiety, mood disorders, and substance use disorders.<ref name="Diedrich2015" /> People with OCPD are seldom conscious of their actions, while people with OCD tend to be aware of how their condition affects the way they act.<ref>{{Cite web |title=Obsessive-Compulsive Personality Disorder (OCPD): Symptoms |url=https://my.clevelandclinic.org/health/diseases/24526-obsessive-compulsive-personality-disorder-ocpd |archive-url=https://web.archive.org/web/20250213084849/https://my.clevelandclinic.org/health/diseases/24526-obsessive-compulsive-personality-disorder-ocpd |archive-date=2025-02-13 |access-date=2025-03-02 |website=Cleveland Clinic |language=en |url-status=live }}</ref>

The disorder is the most common personality disorder in the United States,<ref>{{cite journal | vauthors = Sansone RA, Sansone LA | title = Personality disorders: a nation-based perspective on prevalence | journal = Innovations in Clinical Neuroscience | volume = 8 | issue = 4 | pages = 13–8 | date = April 2011 | pmid = 21637629 | pmc = 3105841 }}</ref> and is diagnosed twice as often in males than in females;<ref name=":0">{{cite book | title=Diagnostic and Statistical Manual of Mental Disorders (DSM-5)|date= May 18, 2013|publisher=American Psychiatric Association |isbn= 978-0-89042-554-1|edition=5th|location=United States|pages = 678–81}}</ref> however, there is evidence to suggest the prevalence between men and women is equal.<ref name="Diedrich2015" /> {{TOC limit}}

==Signs and symptoms== Obsessive–compulsive personality disorder (OCPD) is marked by an excessive obsession with rules, lists, schedules, and order; a need for perfection<ref>Rizvi, A. (2023, October 28). Obsessive-compulsive personality disorder. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK597372/ </ref> that interferes with efficiency and the ability to complete tasks; a devotion to productivity that hinders interpersonal relationships and leisure time; rigidity and zealousness on matters of morality and ethics; an inability to delegate responsibilities or work to others; restricted functioning in interpersonal relationships; restricted expression of emotion and affect; and a need for control over one's environment and self.<ref name=":0" /><ref name="Millon_2004" />

Some of OCPD's symptoms are persistent and stable, whilst others are unstable. The obsession with perfectionism, reluctance to delegate tasks to others, and rigidity and stubbornness are stable symptoms. On the other hand, the symptoms that were most likely to change over time were the miserly spending style and the excessive devotion to productivity.<ref>{{cite journal | vauthors = Fineberg NA, Reghunandanan S, Kolli S, Atmaca M | title = Obsessive-compulsive (anankastic) personality disorder: toward the ICD-11 classification | journal = Revista Brasileira de Psiquiatria | volume = 36 | pages = 40–50 | date = 2014 | issue = Suppl 1 | pmid = 25388611 | doi = 10.1590/1516-4446-2013-1282 | doi-access = free }}</ref> This discrepancy in the stability of symptoms may lead to mixed results in terms of the course of the disorder, with some studies showing a remission rate of 58% after a 12-month period, whilst others suggest that the symptoms are stable and may worsen with age.<ref name="Diedrich2015" />

===Attention to order and perfection=== People with OCPD tend to be obsessed with controlling their environments; to satisfy this need for control, they become preoccupied with trivial details, lists, procedures, rules, and schedules.<ref name=":0" />

This preoccupation with details and rules makes the person unable to delegate tasks and responsibilities to others unless they submit to their exact way of completing a task, because they believe there is only one correct way to do something. They stubbornly insist that a task or job must be completed their way, and only their way, and may micromanage people when they are assigned a group task. They are frustrated when other people suggest alternative methods. A person with this disorder may reject help even when they desperately need it, as they believe that only they can do something correctly.<ref name=":0" />

People with OCPD are obsessed with maintaining perfection. Perfectionism and the extremely high standards they set are detrimental and may cause delays and failures in completing objectives and tasks. Mistakes are generally exaggerated. For example, a person may write an essay and, believing it falls short of perfection, continue rewriting it, missing the deadline or even failing to complete the task. The subject may remain unaware that others become frustrated and annoyed by repeated delay and inconvenience so caused. Work relationships may then become a source of tension.<ref name=":0" />

===Rigidity=== Individuals with OCPD are overconscientious, scrupulous, and rigid, and inflexible on matters of morality, ethics, and other areas of life. They may force themselves and others to follow rigid moral principles and strict standards of performance. They are self-critical and harsh about their mistakes. These symptoms should not be accounted for or caused by a person's culture or religion.<ref name=":0" /> Their view of the world is polarised and dichotomous; there is no grey area between what is right and what is wrong. Whenever this dichotomous view of the world cannot be applied to a situation, this causes internal conflict as the person's perfectionist tendencies are challenged.<ref>{{cite journal | vauthors = Rowland TA, Jainer AK, Panchal R | title = Living with obsessional personality | journal = BJPsych Bulletin | volume = 41 | issue = 6 | pages = 366–367 | date = December 2017 | pmid = 29234518 | pmc = 5709690 | doi = 10.1192/pb.41.6.366a }}</ref>

People with this disorder are so obsessed with doing everything the "right and correct" way that they have a hard time understanding and appreciating the ideas, beliefs, and values of other people, and are reluctant to change their views, especially on matters of morality and politics.<ref name=":0" />

===Devotion to productivity=== Individuals with OCPD devote themselves to work and productivity at the expense of interpersonal relationships and recreation. Economic necessity, such as poverty, cannot account for this behavior.<ref name=":0" /> They may believe that they do not have sufficient time to relax because they have to prioritize their work above all. They may refuse to spend time with friends and family because of that. They may find it difficult to go on a vacation, and even if they book one, they may keep postponing it so it never happens.<ref>{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/obsessive-compulsive-disorder/research |title=Diagnosis and Management of Obsessive Compulsive Disorders in Children |last1=Steele |first1=Dale W. |last2=Caputo |first2=Eduardo L. |last3=Kanaan |first3=Ghid |last4=Zahradnik |first4=Michael L. |last5=Brannon |first5=Elizabeth |last6=Freeman |first6=Jennifer B. |last7=Balk |first7=Ethan M. |last8=Trikalinos |first8=Thomas A. |last9=Adam |first9=Gaelen P. |date=2024-12-06 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer276|url-access=subscription }}</ref> They may feel uncomfortable when they do go on a vacation and will take something along with them so they can work. They choose hobbies that are organized and structured, and they approach them as serious tasks requiring effort to perfect. The devotion to productivity in OCPD, however, is distinct from work addiction. OCPD is controlled and egosyntonic, whereas work addiction is uncontrolled and egodystonic, and the affected person may display signs of withdrawal.<ref>{{cite journal | vauthors = Atroszko PA, Demetrovics Z, Griffiths MD | title = Work Addiction, Obsessive-Compulsive Personality Disorder, Burn-Out, and Global Burden of Disease: Implications from the ICD-11 | journal = International Journal of Environmental Research and Public Health | volume = 17 | issue = 2 | date = January 2020 | page = 660 | pmid = 31968540 | pmc = 7014139 | doi = 10.3390/ijerph17020660| doi-access = free }}</ref>

===Restricted emotions and interpersonal functioning=== Individuals with this disorder may display little affection and warmth; their relationships and speech tend to be formal and professional, and they express little affection even to loved ones, such as greeting or hugging a significant other at an airport or train station.<ref name=":0" />

They are extremely careful in their interpersonal interactions. They have little spontaneity when interacting with others and ensure that their speech follows rigid, austere standards by excessively scrutinising it. They filter their speech to avoid embarrassing or imperfect articulation, while maintaining a high bar for what they consider acceptable. They raise their bar even higher when they are communicating with their superiors or with a person of high status. Communication becomes a time-consuming and exhausting effort, and they start avoiding it altogether. Others regard them as cold and detached as a result.<ref name="Millon_2004" />

Their need for restricting affection is a defense mechanism used to control their emotions. They may expunge emotions from their memories and organize them as a library of facts and data; the memories are intellectualized and rationalized, not experiences that they can feel. This helps them avoid unexpected emotions and feelings, allowing them to remain in control. They can view self-exploration as a waste of time and have a patronising attitude towards emotional people.<ref name="Millon_2004" />

===Interpersonal control=== Individuals with OCPD are at one extreme of the conscientiousness continuum. While conscientiousness is a desirable trait generally, its extreme presentation for those with OCPD leads to interpersonal problems. OCPD individuals present as over-controlled, and this extends to the relationships they have with other people. Individuals with OCPD are reverential to authority and rules. OCPD individuals may therefore punish those who violate their strict standards. The inability to accept differences in beliefs or behaviors from others often leads to high conflict and controlling relationships with coworkers, spouses, and children.<ref name="Hertler 2014">{{cite journal |last1=Hertler |first1=Steven C. |title=The Continuum of Conscientiousness: The Antagonistic Interests among Obsessive and Antisocial Personalities |journal=Polish Psychological Bulletin|date=June 1, 2014 |volume=45 |issue=2 |pages=167–178 |doi=10.2478/ppb-2014-0022|s2cid=220468464 |doi-access=free }}</ref>

==Causes== The cause of OCPD is thought to involve a combination of genetic and environmental factors.<ref name= Diedrich2015/> There is clear evidence to support the theory that OCPD is genetically inherited; however, the relevance and impact of genetic factors vary with studies placing it somewhere between 27% and 78%.<ref name="Diedrich2015" />

A twin study on the influence of genetics on the development of personality disorders over multiple personality disorders found that OCPD had a 0.78 heritability correlation, thus demonstrating that the development of OCPD can be strongly linked to genetics.<ref>{{Cite journal |last1=Torgersen |first1=Svenn |last2=Lygren |first2=Sissel |last3=Øien |first3=Per Anders |last4=Skre |first4=Ingunn |last5=Onstad |first5=Sidsel |last6=Edvardsen |first6=Jack |last7=Tambs |first7=Kristian |last8=Kringlen |first8=Einar |date=2000-11-01 |title=A twin study of personality disorders |url=https://www.sciencedirect.com/science/article/pii/S0010440X00982841 |journal=Comprehensive Psychiatry |language=en |volume=41 |issue=6 |pages=416–425 |doi=10.1053/comp.2000.16560 |pmid=11086146 |issn=0010-440X|url-access=subscription }}</ref>

Other studies have found links{{vague|date=August 2021}} between attachment theory and the development of OCPD. According to this hypothesis, those with OCPD have never developed a secure attachment style, had overbearing parents, were shown little care, and/or were unable to develop empathetically and emotionally.<ref name="Diedrich2015" />

There is evidence linking the development of obsessive-compulsive spectrum symptoms, including OCPD, to traumatic brain injuries and Parkinson's disease.<ref>{{cite journal | last1=Rydon-Grange | first1=M. | last2=Coetzer | first2=R. | title=Association between cognitive impairments and obsessive-compulsive spectrum presentations following traumatic brain injury | journal=Neuropsychological Rehabilitation | date=2019 | volume=29 | issue=2 | pages=214–231 | doi=10.1080/09602011.2016.1272469 | pmid=28043199 }}</ref> Traumatic brain injury can cause new-onset or worsened OCPD traits, often due to frontal lobe or basal ganglia damage.<ref>{{cite journal | last1=Rydon-Grange | first1=Michelle | last2=Coetzer | first2=Rudi | title=Association between cognitive impairments and obsessive-compulsive spectrum presentations following traumatic brain injury | journal=Neuropsychological Rehabilitation | date=2019 | volume=29 | issue=2 | pages=214–231 | doi=10.1080/09602011.2016.1272469 | pmid=28043199 | url=https://www.tandfonline.com/doi/pdf/10.1080/09602011.2016.1272469#:~:text=Within%20the%20DSM%2D5%20(Diagnostic,intervention%2C%20leading%20to%20improved%20prognosis }}</ref> OCPD symptoms, such as extreme rigidity and perfectionism, can emerge or worsen following these injuries. While OCD (specific obsessions/compulsions) is possible as well following TBI,<ref>{{cite journal | last1=Yoshioka | first1=Daisuke | last2=Yamanashi | first2=Takehiko | last3=Hayashi | first3=Teruaki | last4=Iwata | first4=Masaaki | title=Obsessive–compulsive disorder after traumatic injury to the right frontal and left temporal lobes: A case report | journal=Psychiatry and Clinical Neurosciences Reports | date=2024 | volume=3 | issue=2 | article-number=e199 | doi=10.1002/pcn5.199 | pmid=38883324 | pmc=11177174 }}</ref> OCPD is more common, affecting up to 28% of TBI cases.<ref>{{cite journal | last1=Sousa | first1=R. M. | last2=Cunha | first2=N. | last3=Morgado | first3=P. | title=Obsessive-compulsive disorder after traumatic brain injury: Case report | journal=European Psychiatry | date=2023 | volume=66 | issue=Suppl 1 | pages=S929 | doi=10.1192/j.eurpsy.2023.1966 | pmc=10479246 }}</ref>

==Diagnosis==

=== Classification === Classification of personality disorders differs significantly between the two most prominent frameworks for classification of mental disorders, namely: the ''Diagnostic and Statistical Manual of Mental Disorders'' and the International Classification of Diseases, the most recent editions of which are the DSM-5-TR and ICD-11, respectively. While personality disorders, including OCPD, are diagnosed as separate entities in the DSM-5; in the ICD-11 classification of personality disorders, they are assessed in terms of severity levels, with trait and pattern specifiers serving to characterize the particular style of pathology.<ref name=":72">{{Cite journal |last=Clark |first=Lee Anna |author-link=Lee Anna Clark |date=2025-05-01 |title=Wherefrom and Whither PD? Recent Developments and Future Possibilities in DSM-5 and ICD-11 Personality Disorder Diagnosis |url=https://doi.org/10.1007/s11920-025-01602-y |journal=Current Psychiatry Reports |language=en |volume=27 |issue=5 |pages=267–277 |doi=10.1007/s11920-025-01602-y |issn=1535-1645 |pmc=12003573 |pmid=40108080}} {{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref> There is also a hybrid model,<ref name=":7">{{Cite journal |last1=Rodriguez-Seijas |first1=Craig |last2=Ruggero |first2=Camilo |last3=Eaton |first3=Nicholas R. |last4=Krueger |first4=Robert F. |date=2019 |title=The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review |url=https://link.springer.com/10.1007/s40501-019-00187-7 |journal=Current Treatment Options in Psychiatry |language=en |volume=6 |issue=4 |pages=284–298 |doi=10.1007/s40501-019-00187-7 |issn=2196-3061|url-access=subscription }}</ref> called the ''Alternative DSM-5 model for personality disorders'' (AMPD), which defines OCPD and five other PDs through disorder-specific combinations of pathological traits and areas of overall impairment.<ref name=":72" />

==== DSM-5 ==== {{Further|Classification of personality disorders#DSM-5}}The ''DSM-5'' includes two distinct diagnostic models for personality disorder. The ''DSM-5''’s main body (Section II) retains a traditional, categorical model of 10 putatively distinct personality disorders,<ref name=":72" /> grouped into three clusters. Contained within cluster C,<ref>{{Cite journal |last=Schulte Holthausen |first=Barbara |last2=Habel |first2=Ute |date=2018-10-11 |title=Sex Differences in Personality Disorders |url=https://doi.org/10.1007/s11920-018-0975-y |journal=Current Psychiatry Reports |language=en |volume=20 |issue=12 |pages=107 |doi=10.1007/s11920-018-0975-y |issn=1535-1645|url-access=subscription }}</ref> OCPD is defined as: "a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts". A diagnosis of OCPD is only received when four out of the eight criteria are met.<ref>{{Cite book|title=Psychiatry Online|url=https://dsm.psychiatryonline.org/doi/abs/10.1176/appi.books.9780890425596|access-date=2021-10-16|via=DSM Library|year=2013|doi=10.1176/appi.books.9780890425596|publisher=American Psychiatric Association|isbn=978-0-89042-555-8|last1=American Psychiatric Association}}</ref>

Located within Section III of both the DSM-5 and DSM-5-TR,<ref name=":72" /> the AMPD defines six specific personality disorders – one of them being OCPD<ref>{{Cite journal |last1=Christopher Fowler |first1=J. |last2=Sharp |first2=Carla |last3=Kalpakci |first3=Allison |last4=Madan |first4=Alok |last5=Clapp |first5=Joshua |last6=Allen |first6=Jon G. |last7=Christopher Frueh |first7=B. |last8=Oldham |first8=John M. |date=2015-01-01 |title=A dimensional approach to assessing personality functioning: examining personality trait domains utilizing DSM-IV personality disorder criteria |url=https://www.sciencedirect.com/science/article/pii/S0010440X14002521 |journal=Comprehensive Psychiatry |volume=56 |pages=75–84 |doi=10.1016/j.comppsych.2014.09.001 |pmid=25261890 |issn=0010-440X |quote=The number of specific PDs was reduced from 10 to 6 (antisocial, avoidant, borderline, narcissistic, obsessive–compulsive, and schizotypal) as well as a diagnosis of "personality disorder—trait specified" that can be made when criteria for a specific disorder are not met, but a personality disorder is assessed as present [23].|url-access=subscription }}</ref> – in terms of a description of the disorder, along with disorder-specific configurations of criteria A and B. Criterion A describes the characteristic manner in which the disorder impacts personality functioning, i.e. identity, self-direction, empathy and intimacy (criterion A);<ref name=":15" /> of these, at least two must be impaired to at least a moderate level.<ref name=":9">{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5|date=2013|publisher=American Psychiatric Association|isbn=978-0-89042-554-1|editor-last=American Psychiatric Association|edition=5th|location=Washington, D.C|pages=768–769|editor-last2=American Psychiatric Association}}</ref> For example, characteristic impairment in the intimacy domain is described as follows: "Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others." The overall impairment must be at least moderate across criterion A.<ref name=":9" />

Listing and describing the pathological personality traits associated with the disorder,<ref name=":15">{{Cite journal |last1=Zimmermann |first1=Johannes |last2=Kerber |first2=André |last3=Rek |first3=Katharina |last4=Hopwood |first4=Christopher J. |last5=Krueger |first5=Robert F. |date=2019-08-13 |title=A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders |journal=Current Psychiatry Reports |language=en |volume=21 |issue=9 |page=92 |doi=10.1007/s11920-019-1079-z |issn=1535-1645}}</ref> the criterion B section requires that at least three of the following four pathological traits are present: rigid perfectionism, perseveration, intimacy avoidance, and restricted affectivity,<ref name=":72" /> with rigid perfectionism being required. The AMPD specifiers allow for additional traits to be specified.<ref name=":9" /> The AMPD in the DSM-5, in its description of rigid perfectionism in the case of OCPD, erroneously<ref name=":10">{{Cite web |title=Supplement to DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, FIFTH EDITION |url=https://psychiatryonline.org/pb-assets/dsm/update/DSM5Update2016.pdf#page=10.00 |access-date=22 April 2025 |page=6}}</ref> states that it is "an aspect of extreme Conscientiousness [the opposite pole of Detachment]".<ref name=":9" /><ref name=":10" /> This has subsequently been updated to say that it is "the opposite pole of Disinhibition";<ref name=":10" /> the updated version exits in the DSM-5-TR.<ref>{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5-TR |date=2022 |publisher=American Psychiatric Association Publishing |isbn=978-0-89042-575-6 |editor-last=American Psychiatric Association |edition=Fifth edition, text revision |location=Washington, DC |pages=888–889 |quote=Rigid perfectionism (an aspect of extreme Conscientiousness [the opposite pole of Disinhibition]): Rigid insistence on everything being flawless, perfect, and without errors or faults, including one's own and others' performance; sacrificing of timeliness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organization, and order.}}</ref> Further requirements, for example relating to differential diagnosis, are embodied in criteria C–G.<ref name=":7" />

==== ICD ==== {{Further|ICD-11 classification of personality disorders|Classification of personality disorders#ICD-10}} [[File:12888 2018 1908 Fig5.png|thumb|377x377px|A presentation aligning with the ICD-10 diagnoses of ''anankastic'' and ''other specific'' (narcissistic) personality disorder could have a presentation classified like this in accordance with the ICD-11.<ref name=":14" />]] The World Health Organization's ICD-11 has replaced the categorical classification of personality disorders in the ICD-10 – in which ''{{visible anchor|anankastic personality disorder}}'' ({{ICD10|F|60|5|f|60}}) is a diagnostic category<ref name=":13" /> – with a dimensional model containing a unified ''personality disorder'' ({{ICD11|6D10}}) with severity specifiers, along with specifiers for ''prominent personality traits or patterns'' ({{ICD11|6D11}}).<ref name=":14">{{Cite journal |last1=Bach |first1=Bo |last2=First |first2=Michael B. |date=2018-10-29 |title=Application of the ICD-11 classification of personality disorders |journal=BMC Psychiatry |volume=18 |issue=1 |page=351 |doi=10.1186/s12888-018-1908-3 |issn=1471-244X |pmc=6206910 |pmid=30373564 |doi-access=free}}</ref> Severity is assessed based on the pervasiveness of impairment in several areas of functioning, as well as on the level of distress and harm caused by the disorder,<ref>{{Cite journal |last=Swales |first=Michaela A. |date=2022-12-15 |title=Personality Disorder Diagnoses in ICD-11: Transforming Conceptualisations and Practice |url=https://cpe.psychopen.eu/index.php/cpe/article/view/9635 |journal=Clinical Psychology in Europe |language=en |volume=4 |issue=Spec Issue |article-number=e9635 |doi=10.32872/cpe.9635 |pmid=36760321 |issn=2625-3410 |pmc=9881116}}</ref> while trait and pattern specifiers are used for recording the manner in which the disturbance is manifested.<ref>{{Cite journal |last1=Bach |first1=Bo |last2=Kramer |first2=Ueli |last3=Doering |first3=Stephan |last4=di Giacomo |first4=Ester |last5=Hutsebaut |first5=Joost |last6=Kaera |first6=Andres |last7=De Panfilis |first7=Chiara |last8=Schmahl |first8=Christian |last9=Swales |first9=Michaela |last10=Taubner |first10=Svenja |last11=Renneberg |first11=Babette |date=2022-04-01 |title=The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities |journal=Borderline Personality Disorder and Emotion Dysregulation |volume=9 |issue=1 |page=12 |doi=10.1186/s40479-022-00182-0 |doi-access=free |pmid=35361271 |issn=2051-6673 |pmc=8973542}}</ref>

Research has found a significant relationship between OCPD and the ICD-11 domain ''Anankastia'' ({{ICD11|6D11.4}}),<ref name=":13">{{Cite journal |last1=Gecaite-Stonciene |first1=Julija |last2=Lochner |first2=Christine |last3=Marincowitz |first3=Clara |last4=Fineberg |first4=Naomi A. |last5=Stein |first5=Dan J. |date=2021-03-16 |title=Obsessive-Compulsive (Anankastic) Personality Disorder in the ICD-11: A Scoping Review |journal=Frontiers in Psychiatry |language=English |volume=12 |article-number=646030 |doi=10.3389/fpsyt.2021.646030 |doi-access=free |issn=1664-0640 |pmc=8007778 |pmid=33796036}}</ref><ref name=":11">{{Cite journal |last1=Simon |first1=Jonatan |last2=Lambrecht |first2=Bastian |last3=Bach |first3=Bo |date=2023-04-06 |title=Cross-walking personality disorder types to ICD-11 trait domains: An overview of current findings |journal=Frontiers in Psychiatry |language=English |volume=14 |article-number=1175425 |doi=10.3389/fpsyt.2023.1175425 |doi-access=free |issn=1664-0640 |pmc=10116048 |pmid=37091704}}</ref> reflecting rigid perfectionism, orderliness, and behavioral control.<ref name=":11" /> It also shows secondary associations with ''Negative Affectivity'', due to features like excessive caution and doubt. Some studies have found additional links to ''Dissociality'', suggesting a controlling or domineering interpersonal style, and to ''Detachment'', possibly reflecting prioritization of productivity over relationships.<ref name=":11" />

The list of criteria for the ICD-10 is similar to the one in the DSM-5, but does not include the last three criteria of the DSM-5, and additionally includes the symptoms "intrusive thoughts" and "excessive doubt and caution" as criteria for diagnosis.<ref name=":02">{{Cite journal |last1=Thamby|first1=Abel|last2=Khanna|first2=Sumant|date=January 2019|title=The role of personality disorders in obsessive-compulsive disorder|journal=Indian Journal of Psychiatry|volume=61|issue=Suppl 1|pages=S114–18|doi=10.4103/psychiatry.IndianJPsychiatry_526_18|issn=0019-5545|pmc=6343421|pmid=30745684|doi-access=free}}</ref>

=== Differential diagnosis === In order to find the most accurate diagnosis, a procedure of differential diagnosis is conducted.<ref>{{Cite journal |last=Cook |first=Chad E. |last2=Décary |first2=Simon |date=2020-01-01 |title=Higher order thinking about differential diagnosis |url=https://www.sciencedirect.com/science/article/pii/S1413355518310669 |journal=Brazilian Journal of Physical Therapy |volume=24 |issue=1 |pages=1–7 |doi=10.1016/j.bjpt.2019.01.010 |issn=1413-3555 |pmc=6994315 |pmid=30723033}}</ref> When the clinical picture raises suspicion of the presence of OCPD, there are several conditions that may also be considered, with differences between them and OCPD taken into account. Examples include other personality disorder diagnoses as well as obsessive–compulsive disorder. In case hoarding is a major problem, hoarding disorder is also supposed to be considered; it can be diagnosed alongside OCPD. Personality change due to another medical condition and substance use disorders are alternative diagnoses to be considered.<ref name=":16" />{{Reference page|pages=681–682}} Furthermore, the diagnosis should only be made when the condition exceeds the threshold of impairment required for it to be considered clinically significant; when not pathological, obsessive–compulsive personality traits may be beneficial, especially in productive environments.<ref name=":16" />{{Reference page|page=682}}

==== Obsessive–compulsive disorder ==== While the similar name of obsessive–compulsive disorder (OCD) may cause it to be confused with OCPD, a noticeable difference between the two is that OCD encompasses true obsessions or compulsions.<ref name=":16">{{Cite book |title=Diagnostic and statistical manual of mental disorders, fifth edition |title-link=DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |location=Washington, D.C}}</ref>{{Reference page|page=681}}Despite similarities between these and the criteria of OCPD, there are discrete qualitative dissimilarities between these disorders, predominantly in the functional part of symptoms. Unlike OCPD, OCD is described as invasive, and stressful. Individuals with OCD have avoidance behaviors, compulsive routines, and other methods to alleviate obsessive triggers.<ref>{{Cite report |url=https://effectivehealthcare.ahrq.gov/products/obsessive-compulsive-disorder/research |title=Diagnosis and Management of Obsessive Compulsive Disorders in Children |last1=Steele |first1=Dale W. |last2=Caputo |first2=Eduardo L. |last3=Kanaan |first3=Ghid |last4=Zahradnik |first4=Michael L. |last5=Brannon |first5=Elizabeth |last6=Freeman |first6=Jennifer B. |last7=Balk |first7=Ethan M. |last8=Trikalinos |first8=Thomas A. |last9=Adam |first9=Gaelen P. |date=2024-12-06 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer276|url-access=subscription }}</ref> Time-consuming obsessions and habits are aimed at reducing obsession-related stress. OCD symptoms are at times regarded as egodystonic because they are experienced as alien and repulsive to the person. Therefore, there is a greater mental anxiety associated with OCD.<ref name="Pinto 2008" />

In contrast, the symptoms seen in OCPD, although repetitive, are not linked with repulsive thoughts, images, or urges. OCPD characteristics and behaviors are known as egosyntonic, as people with this disorder view them as suitable and correct. On the other hand, the main features of perfectionism and inflexibility can result in considerable suffering in an individual with OCPD as a result of the associated need for control.<ref name="Pinto 2008" />

Similarity in the symptoms of OCD and OCPD can lead to complexity in distinguishing them clinically. For example, perfectionism is an OCPD criterion and a symptom of OCD if it involves the need for tidiness, symmetry, and organization. Hoarding is also considered both a compulsion found in OCD and a criterion for OCPD in the DSM-5. Even though OCD and OCPD are seemingly separate disorders there are obvious redundancies between the two concerning several symptoms.<ref name="Pinto 2008">{{cite book |last1=Pinto |first1=Anthon y |title=Obsessive–Compulsive Disorder: Subtypes and Spectrum Conditions |last2=Eisen |first2=Jane L. |last3=Mancebo |first3=Maria C. |last4=Rasmussen |first4=Steven A. |publisher=Elsevier |year=2008 |isbn=978-0-08-044701-8 |editor-last1=Abramowitz |editor-first1=Jonathan S. |pages=246–263 |chapter=Obsessive–Compulsive Personality Disorder |editor-last2=McKay |editor-first2=Dean |editor-last3=Taylor |editor-first3=Steven |chapter-url=http://ac.els-cdn.com/B9780080447018500164/3-s2.0-B9780080447018500164-main.pdf?_tid=5e5920c6-6e10-11e6-8885-00000aab0f02&acdnat=1472492906_7d594e8d9e99c696b9336666dab25769}}</ref>

==== Personality disorders ==== Schizoid personality disorder and obsessive–compulsive personality disorder may both display restricted affectivity and coldness; however, in OCPD, this is usually due to a controlling attitude, whereas, in SPD, it occurs due to a lack of ability to experience emotion and display affection.

Individuals with a narcissistic personality disorder usually believe that they have achieved perfection (especially compared to other people) and cannot get better, whereas those with OCPD do not believe that they have achieved perfection, and are self-critical. Those with NPD tend to be stingy and lack generosity; however, they are usually generous when spending on themselves, unlike those with OCPD who hoard money and are miserly on themselves and others. Similarly, individuals with antisocial personality disorder are not generous, but miserly around others, although they usually over-indulge themselves and are sometimes reckless in spending.

===Millon's subtypes=== In his book, ''Personality Disorders in Modern Life'', Theodore Millon describes five types of obsessive–compulsive personality disorder, which he shortened to compulsive personality disorder.<ref name = "Millon_2004">{{cite book | vauthors = Millon T, Millon CM, Meagher M, Grossman S, Ramnath R |title=Personality disorders in modern life |date= 2004 |publisher=Wiley |isbn=978-0-471-23734-1 |pages=223–58 |edition= 2nd. }}</ref> {| class="wikitable" |+ !Subtype !Features !Traits |- |'''Conscientious compulsive''' |Including dependent features |Those with conscientious compulsivity view themselves as helpful, co-operative, and compromising. They downplay their achievements and abilities and base their confidence on the opinions and expectations of others; this compensates for their feelings of insecurity and instability. They assume that devotion to work and striving for perfection will lead to them receiving love and reassurance. They believe that making a mistake or not achieving perfection will lead to abandonment and criticism. This mindset causes perpetual feelings of anxiety and an inability to appreciate their work.<ref name="Millon_2004" /> |- |'''Puritanical compulsive''' |Including paranoid features |They have strong internal impulses that are countered vociferously through the use of religion. They are constantly battling their impulses and sexual drives, which they view as irrational. They attempt to purify and pacify the urges by adopting a cold and detached lifestyle. They create an enemy which they use to vent their hostility, such as "non-believers", or "lazy people". They are patronizing, bigoted, and zealous in their attitude toward others. Their beliefs are polarized into "good" and "evil".<ref name="Millon_2004" />{{rp|231}} |- |'''Bureaucratic compulsive''' |Including narcissistic features |The bureaucratic compulsive displays signs of narcissistic traits alongside the compulsivity. They are champions of tradition, values, and bureaucracy. They cherish organizations that follow hierarchies and feel comforted by definitive roles between subordinates and superiors, and the known expectations and responsibilities. They derive their identity from work and project an image of diligence, reliability, and commitment to their institution. They view work and productivity in a polarized manner; either done or not. They may use their power and status to inflict fear and obedience in their subordinates if they do not strictly follow their rules and procedures, and derive pleasure from the sense of control and power that they acquire by doing so.<ref name="Millon_2004" />{{rp|232–3}} |- |'''Parsimonious compulsive''' |Including schizoid features |The parsimonious compulsive is hoarding and possessive in nature; they behave in a manner congruent with schizoid traits. They are selfish, miserly, and are suspicious of others' intentions, believing that others may take away their possessions. This attitude may be caused by parents who deprived their child of wants or wishes but provided necessities, causing the child to develop an extreme protective approach to their belongings, often being self-sufficient and distant from others. They use this shielding behavior to prevent having their urges, desires, and imperfections discovered.<ref name="Millon_2004" />{{rp|233}} |- |'''Bedevilled compulsive''' |Including negativistic features |This form of compulsive personality is a mixture of negativistic and compulsive behavior. When faced with dilemmas, they procrastinate and attempt to stall the decision through any means. They are in a constant battle between their desires and will, and may engage in self-defeating behavior and self-torture in order to resolve the internal conflict. Their identity is unstable, and they are indecisive.<ref name="Millon_2004" />{{rp|235}} |}

==Treatment== The best-validated treatment for OCPD is cognitive therapy (CT) or cognitive behavioral therapy (CBT), with studies showing an improvement in areas of personality impairment, and reduced levels of anxiety and depression. Group CBT is also associated with an increase in extraversion and agreeableness and reduced neuroticism.<ref name="Diedrich2015" /> Interpersonal psychotherapy has been linked to even better results when it came to reducing depressive symptoms.<ref>{{cite web |url= https://www.lecturio.com/concepts/cluster-c-personality-disorders/|title= Obsessive-Compulsive Personality Disorder |website= The Lecturio Medical Concept Library |date= 10 August 2020 |access-date=2021-06-24}}</ref> Treatment with Exposure and Response Prevention (ERP) combined with an SSRI is as effective as ERP alone for OCD symptoms. However, combination therapy is a reasonable initial approach for those with more severe symptoms.<ref name=":6">{{Cite journal |title=Diagnosis and Management of Obsessive Compulsive Disorders in Children |url=https://effectivehealthcare.ahrq.gov/products/obsessive-compulsive-disorder/research |access-date=2025-03-05 |website=effectivehealthcare.ahrq.gov |date=2024 |language=en |doi=10.23970/ahrqepccer276 |pmid=39836793 | vauthors = Steele DW, Caputo EL, Kanaan G, Zahradnik ML, Brannon E, Freeman JB, Balk EM, Trikalinos TA, Adam GP |url-access=subscription }}</ref> Additionally, a recent review<ref>{{Cite journal |last1=Bayer |first1=Andressa Sevéro |last2=Wiethan |first2=Ana Paula |last3=Brondani |first3=Danielle Vedoin |last4=Oliveira |first4=Clarissa Tochetto de |date=2025-08-18 |title=INTERVENÇÕES PARA O TRATAMENTO DO TRANSTORNO DA PERSONALIDADE OBSESSIVO-COMPULSIVA |url=https://revistas.ceeinter.com.br/praxisemsaude/article/view/2619 |journal=Práxis Em Saúde |language=pt |volume=3 |issue=2 |pages=01–08 |doi=10.56579/prxis.v3i2.2619 |issn=2966-1056|doi-access=free }}</ref> also indicates pilot studies - to be confirmed in clinical trials on large samples - on the use of Radically Open Dialectical Behavior Therapy and Evolutionary Systems Therapy for OCPD.

==Epidemiology== Estimates for the prevalence of OCPD in the general population are 3%,<ref name=":1">{{Cite journal |last1=Grant |first1=Jon E. |last2=Mooney |first2=Marc E. |last3=Kushner |first3=Matt G. |date=April 2012 |title=Prevalence, correlates, and comorbidity of DSM-IV obsessive-compulsive personality disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions |journal=Journal of Psychiatric Research |volume=46 |issue=4 |pages=469–475 |doi=10.1016/j.jpsychires.2012.01.009 |pmid=22257387 |issn=0022-3956}}</ref> making it the most common personality disorder. Current evidence is inconclusive as to whether OCPD is more common in men than women, or in equal rates among sexes.<ref name=":1" /> It is estimated to occur in 8.7% of psychiatric outpatient settings.<ref name="Diedrich2015" />

A study of data collected in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions looked specifically for seven personality disorders as defined by the DSM-IV. The study concluded the most prevalent personality disorder of the survey's population to be OCPD, at 7.88%.<ref name=":22">{{Cite journal |last1=Grant |first1=Bridget F. |last2=Hasin |first2=Deborah S. |last3=Stinson |first3=Frederick S. |last4=Dawson |first4=Deborah A. |last5=Chou |first5=S. Patricia |last6=Ruan |first6=W. June |last7=Pickering |first7=Roger P. |date=2004-07-15 |title=Prevalence, Correlates, and Disability of Personality Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions |url=http://article.psychiatrist.com/?ContentType=START&ID=10000967 |journal=The Journal of Clinical Psychiatry |volume=65 |issue=7 |pages=948–958 |doi=10.4088/JCP.v65n0711 |pmid=15291684 |issn=0160-6689|url-access=subscription }}</ref> This study also concluded there were no gender differences in prevalence and that OCPD was not a predictor of disability.<ref name=":22" />

=== Comorbidity ===

==== Obsessive–compulsive disorder ==== The rate of comorbidity of OCPD in patients with OCD is estimated to be around 15–28%.<ref name=":5">{{Cite journal |last1=Thamby |first1=Abel |last2=Khanna |first2=Sumant |date=January 2019 |title=The role of personality disorders in obsessive–compulsive disorder |journal=Indian Journal of Psychiatry |volume=61 |issue=Suppl 1 |pages=S114–S118 |doi=10.4103/psychiatry.IndianJPsychiatry_526_18 |issn=0019-5545 |pmc=6343421 |pmid=30745684 |doi-access=free}}</ref> However, due to the addition of the hoarding disorder diagnosis in the DSM-5, and studies showing that hoarding may not be a symptom of OCPD, the true rate of comorbidity may be much lower.<ref name=":5" /> The two can be found in the same family,<ref name="Samuels_2000" /> sometimes along with eating disorders.<ref name="Halmi 2">{{cite journal | vauthors = Halmi KA, Tozzi F, Thornton LM, Crow S, Fichter MM, Kaplan AS, Keel P, Klump KL, Lilenfeld LR, Mitchell JE, Plotnicov KH, Pollice C, Rotondo A, Strober M, Woodside DB, Berrettini WH, Kaye WH, Bulik CM | title = The relation among perfectionism, obsessive–compulsive personality disorder and obsessive–compulsive disorder in individuals with eating disorders | journal = The International Journal of Eating Disorders | volume = 38 | issue = 4 | pages = 371–4 | date = December 2005 | pmid = 16231356 | doi = 10.1002/eat.20190 | doi-access = free }}</ref>

The presence of OCPD in patients with OCD has been linked to a worse prognosis of OCD, especially when cognitive behavioral therapy was used. This may be due to the egosyntonic nature of OCPD which may lead to the obsessions becoming aligned with one's personal values. In contrast, the trait of perfectionism may improve the outcome of treatment as patients are likely to complete homework assigned to them with determination. The findings with regards to pharmacological treatment has also been mixed, with some studies showing a lower reception to SRIs in OCD patients with comorbid OCPD, with others showing no relationship.<ref name=":5" />

Comorbidity between OCD and OCPD has been linked to a more severe presentation of symptoms,<ref name=":3">{{cite journal | vauthors = Starcevic V, Brakoulias V | s2cid = 6364483 | title = New diagnostic perspectives on obsessive–compulsive personality disorder and its links with other conditions | language = en-US | journal = Current Opinion in Psychiatry | volume = 27 | issue = 1 | pages = 62–7 | date = January 2014 | pmid = 24257122 | doi = 10.1097/YCO.0000000000000030 }}</ref> a younger age of onset,<ref name=":5" /> more significant impairment in functioning, poorer insight, and higher comorbidity of depression and anxiety.<ref name=":8">{{cite journal | vauthors = Fineberg NA, Day GA, de Koenigswarter N, Reghunandanan S, Kolli S, Jefferies-Sewell K, Hranov G, Laws KR | title = The neuropsychology of obsessive–compulsive personality disorder: a new analysis | journal = CNS Spectrums | volume = 20 | issue = 5 | pages = 490–9 | date = October 2015 | pmid = 25776273 | doi = 10.1017/S1092852914000662 | hdl = 2299/16555 | s2cid = 25043174 | hdl-access = free}}</ref>

==== Parkinson's disease ====

Individuals with Parkinson's disease are diagnosed with OCPD at a much higher rate than the general population. OCPD is the hallmark of the so-called "parkinsonsim personality" profile, a pattern of behavior characterized by rigid perfectionism, orderliness, and a cautious or industrious nature that can appear years before motor symptoms like tremors begin.<ref>https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054822#:~:text=According%20to%20the%20DSM%2DIV%20classification%20obsessive%2Dcompulsive%20PeD%20(,Depressive%20PeD%20and%20clinical%20characteristics.&text=OCPeD%20was%20present%20in%208,=%20Obsessive%2Dcompulsive%20Personality%20Disorder.</ref> Approximately 40-55% of those diagnosed with Parkinson's also have OCPD.<ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6340987/</ref><ref>https://jnnp.bmj.com/content/72/3/420</ref> It has not been shown that having an obsessive-compulsive personality predicts Parkinson's disease, but rather is thought that the personality profile is the result of similar neurological circuitry (rooted in the brain's fronto-basal ganglia circuits, which regulate both motor control and repetitive behaviors), rather than genetic predisposition to Parkinson’s.<ref>https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.01191/full</ref> OCPD symptoms in Parkinson’s disease patients often begin years before the traditional motor symptoms like tremors or rigidity appear. Because these traits can precede a diagnosis, researchers frequently categorize them as an early non-motor manifestation or "premotor" sign of the disease.<ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC6340987/#:~:text=In%20particular%2C%20we%20have%20carried,executive%20function%20deficit%20(21).</ref>

====Eating disorders==== Perfectionism has been linked with anorexia nervosa in research for decades. A researcher in 1949 described the behavior of the average "anorexic girl" as being "rigid" and "hyperconscious", observing a tendency to "[n]eatness, meticulosity, and a mulish stubbornness not amenable to reason [which] make her a rank perfectionist."<ref name="cachexia">{{cite journal | vauthors = DuBOIS FS | title = Compulsion neurosis with cachexia (anorexia nervosa) | journal = The American Journal of Psychiatry | volume = 106 | issue = 2 | pages = 107–15 | date = August 1949 | pmid = 18135398 | doi = 10.1176/ajp.106.2.107 }}</ref> So common are such traits as perfectionism and rigidity among anorectics, that they have been referred to in clinical literature as "classical childhood features of patients with anorexia nervosa" or "classical premorbid personality descriptors of anorexia nervosa".<ref>{{cite journal |title=Bulimia: Its Incidence and Clinical Importance in Patients With Anorexia Nervosa |author=Regina C. Casper |display-authors=etal |year=1980 |journal=Archives of General Psychiatry |pages=1030–1035 |volume=37 |doi=10.1001/archpsyc.1980.01780220068007 |issue=9 |pmid=6932187 }}</ref><ref>{{cite journal|title=The Significance of Bulimia in Juvenile Anorexia Nervosa: An Exploration of Possible Etiologic Factors|year=1981|author=Michael Strober|journal=International Journal of Eating Disorders|volume=1|issue=1|pages=28–43|doi=10.1002/1098-108X(198123)1:1<28::AID-EAT2260010104>3.0.CO;2-9}}</ref>

Regardless of the prevalence of the full-fledged OCPD among eating disordered samples, the presence of this personality disorder or its traits, such as perfectionism, has been found to be positively correlated with a range of complications in eating disorders and a negative outcome, as opposed to impulsive features—those linked with histrionic personality disorder, for example—which predict a better outcome from treatment.<ref>{{cite journal | vauthors = Lilenfeld LR, Wonderlich S, Riso LP, Crosby R, Mitchell J | title = Eating disorders and personality: a methodological and empirical review | journal = Clinical Psychology Review | volume = 26 | issue = 3 | pages = 299–320 | date = May 2006 | pmid = 16330138 | doi = 10.1016/j.cpr.2005.10.003 }}</ref> OCPD predicts more severe symptoms of anorexia nervosa, and worse remission rates, however, OCPD and perfectionistic traits predicted a higher acceptance of treatment, which was defined as undergoing 5 weeks of treatment.<ref name="worse">{{cite journal | vauthors = Crane AM, Roberts ME, Treasure J | title = Are obsessive–compulsive personality traits associated with a poor outcome in anorexia nervosa? A systematic review of randomized controlled trials and naturalistic outcome studies | journal = The International Journal of Eating Disorders | volume = 40 | issue = 7 | pages = 581–8 | date = November 2007 | pmid = 17607713 | doi = 10.1002/eat.20419 | doi-access = free }}</ref>

People with anorexia nervosa who exercise excessively display a higher prevalence of several OCPD traits when compared to their counterparts who did not exercise excessively. The traits included self-imposed perfectionism, and the childhood OCPD traits of being rule-bound and cautious. It may be that people with OCPD traits are more likely to use exercise alongside restricting food intake in order to mitigate fears of increased weight, reduce anxiety, or reduce obsessions related to weight gain. Samples that had the childhood traits of rigidity, extreme cautiousness, and perfectionism endured more severe food restriction and higher levels of exercise and underwent longer periods of underweight status. It may be that OCPD traits are an indicator of a more severe manifestation of AN which is harder to treat.<ref name=":2">{{cite journal | vauthors = Young S, Rhodes P, Touyz S, Hay P | title = The relationship between obsessive-compulsive personality disorder traits, obsessive-compulsive disorder and excessive exercise in patients with anorexia nervosa: a systematic review | journal = Journal of Eating Disorders | volume = 1 | issue = 1 | article-number = 16 | date = May 2013 | pmid = 24999397 | pmc = 4081792 | doi = 10.1186/2050-2974-1-16 | doi-access = free }}</ref>

====Gambling disorder==== A majority of those with lifelong gambling disorder have some sort of personality disorder, and the most common personality disorder amongst them is obsessive compulsive personality disorder. OCPD has a strong comorbidity with individuals who have gambling disorder.<ref name=":12">{{Cite journal |last1=Medeiros |first1=Gustavo C. |last2=Grant |first2=Jon E. |date=2018-06-01 |title=Gambling disorder and obsessive-compulsive personality disorder: A frequent but understudied comorbidity |journal=Journal of Behavioral Addictions |volume=7 |issue=2 |pages=366–374 |doi=10.1556/2006.7.2018.50 |issn=2063-5303 |pmc=6174606 |pmid=29936850}}</ref> A study of data collected in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions looked at pathological gambling and psychiatric conditions as defined by the DSM-IV. Of the surveyed population consistent with gambling disorder, 60.8% also had a personality disorder, with OCPD appearing most frequently at 30%.<ref>{{Cite journal |last1=Petry |first1=Nancy M. |last2=Stinson |first2=Frederick S. |last3=Grant |first3=Bridget F. |date=2005-05-15 |title=Comorbidity of DSM-IV Pathological Gambling and Other Psychiatric Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions |url=http://article.psychiatrist.com/?ContentType=START&ID=10001305 |journal=The Journal of Clinical Psychiatry |volume=66 |issue=5 |pages=564–574 |doi=10.4088/JCP.v66n0504 |pmid=15889941 |issn=0160-6689|url-access=subscription }}</ref> About 300,000 U.S citizens have both a gambling disorder and obsessive compulsive personality disorder; and yet, there is little research on the comorbidity of the two disorders. Those with gambling disorders and OCPD do, indeed, exhibit different behavioral patterns than those with gambling disorders alone. More research on the relationship between the disorders is thought to help uncover causes and develop treatments for patients.<ref name=":12" />

====Mental fatigue==== Recently, in 2020, the connection between mental fatigue and OCPD was published for the first time, even though mental fatigue has been previously associated with identified characteristics of OCPD such as workaholic behavior and perfectionism.<ref>{{Cite journal |last1=Gecaite-Stonciene |first1=Julija |last2=Fineberg |first2=Naomi A. |last3=Podlipskyte |first3=Aurelija |last4=Neverauskas |first4=Julius |last5=Juskiene |first5=Alicja |last6=Mickuviene |first6=Narseta |last7=Burkauskas |first7=Julius |date=November 2020 |title=Mental Fatigue, But Not other Fatigue Characteristics, as a Candidate Feature of Obsessive Compulsive Personality Disorder in Patients with Anxiety and Mood Disorders—An Exploratory Study |journal=International Journal of Environmental Research and Public Health |volume=17 |issue=21 |page=8132 |doi=10.3390/ijerph17218132 |issn=1661-7827 |pmc=7662240 |pmid=33153220|doi-access=free }}</ref>

====Autism spectrum==== There are considerable similarities and overlap between autism spectrum disorder (ASD) and OCPD,<ref name="Gillberg&Billstedt2000">{{cite journal | vauthors = Gillberg C, Billstedt E | title = Autism and Asperger syndrome: coexistence with other clinical disorders | journal = Acta Psychiatrica Scandinavica | volume = 102 | issue = 5 | pages = 321–30 | date = November 2000 | pmid = 11098802 | doi = 10.1034/j.1600-0447.2000.102005321.x | s2cid = 40070782 }}</ref> such as list-making, inflexible adherence to rules, and obsessive aspects of ASD, although the latter may be distinguished from OCPD especially regarding affective behaviors, worse social skills, difficulties with theory of mind and intense intellectual interests, e.g. an ability to recall every aspect of a hobby.<ref name="Fitzgerald2001a">{{Cite journal | doi = 10.1192/apt.7.4.310 | issn = 1355-5146 | volume = 7 | issue = 4 | pages = 310–318 | last1 = Fitzgerald | first1 = Michael | first2 = Aiden | last2 = Corvin | title = Diagnosis and differential diagnosis of Asperger syndrome | journal = Advances in Psychiatric Treatment | date = 2001-07-01 | doi-access = free }}</ref> A 2009 study involving adult autistic people found that 32% of those diagnosed with ASD met the diagnostic requirements for a comorbid OCPD diagnosis.<ref name="Hofvander2009">{{cite journal | vauthors = Hofvander B, Delorme R, Chaste P, Nydén A, Wentz E, Ståhlberg O, Herbrecht E, Stopin A, Anckarsäter H, Gillberg C, Råstam M, Leboyer M | title = Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders | journal = BMC Psychiatry | volume = 9 | issue = 1 | article-number = 35 | date = June 2009 | pmid = 19515234 | pmc = 2705351 | doi = 10.1186/1471-244x-9-35 | doi-access = free }}</ref>

====Other disorders and conditions==== A diagnosis of OCPD is common with anxiety disorders, substance use disorders, and mood disorders.<ref name="Diedrich2015" /> OCPD is also highly comorbid with Cluster A personality disorders,<ref name="Diedrich2015" /> especially paranoid and schizotypal personality disorders.<ref name="Diedrich2015" /><ref name=":3" />

OCPD is also linked to hypochondriasis, with some studies estimating a rate of co-occurrence as high as 55.7%.<ref name=":3" />

Moreover, OCPD has been found to be very common among some medical conditions, including Parkinson's disease and the hypermobile subtype of Ehler-Danlos syndrome. The latter may be explained by the need for control that arises from musculoskeletal problems and the associated features that arise early in life, whilst the former can be explained by dysfunctions in the fronto-basal ganglia circuitry.<ref name="Diedrich2015" />

{| class="wikitable sortable" style="text-align:center;" ! Psychiatric disorder ! Prevalence of OCPD in 12 month diagnosis<ref name="Diedrich2015" /> |- | Substance use disorder | 12–25% |- ! Mood disorders ! 24% |- | Major depressive disorder | 23–28% |- | Bipolar disorder | 26–39% |- ! Anxiety disorders ! 23–24% |- | Generalised anxiety disorder | 34% |- | Panic disorder | 23–38% |- | Social anxiety disorder | 33% |- | Specific phobia | 22% |}

==History== [[File:Sigmund Freud, by Max Halberstadt (cropped).jpg|thumb|Sigmund Freud, 1921]] In 1908, Sigmund Freud named what is now known as obsessive–compulsive or anankastic personality disorder "anal retentive character".<ref>{{Citation|last=Haslam|first=Nick|title=Anal Expulsive/Anal Retentive Personality |date=2016 |encyclopedia= Encyclopedia of Personality and Individual Differences|pages= 1–2|editor-last=Zeigler-Hill|editor-first=Virgil |editor2-last= Shackelford |editor2-first=Todd K.|place=Cham|publisher=Springer International Publishing |doi=10.1007/978-3-319-28099-8_1357-1|isbn= 978-3-319-28099-8 }}</ref><ref>{{Cite book |edition = Standard | volume = 9 | title = Jensen's 'Gradiva' and Other Works (1906-1908) | first = Sigmund | last = Freud |url= https://www.karnacbooks.com/product/standard-edition-vol-9-jensens-gradiva-and-other-works-1906-1908/6878/|access-date=2020-08-02| publisher = Karnac Books}}</ref> He identified the main strands of the personality type as a preoccupation with orderliness, parsimony (frugality), and obstinacy (rigidity and stubbornness). The concept fits his theory of psychosexual development. Freud believed that the anal retentive character faced difficulties regulating the control of defecation, leading to repercussions by the parents, and it is the latter that would cause the anal retentive character.<ref>{{Cite book | vauthors = Freud S | veditors = Gay P |date= September 1995 |title=The Freud Reader| publisher = W. W. Norton & Co | isbn = 978-0-393-31403-8 }}</ref>

Aubrey Lewis, in his 1936 book ''Problems of Obsessional Illness'',<ref>{{Cite journal|last=Lewis|first=Aubrey|date=February 1936|title=Problems of Obsessional Illness|journal=Proceedings of the Royal Society of Medicine|volume=29|issue=4|pages=325–36|doi= 10.1177/003591573602900418 |issn=0035-9157|pmc=2075767|pmid=19990606}}</ref> suggests that anal-erotic characteristics are found in patients without obsessive thoughts, and proposed two types of obsessional personality, one melancholy and stubborn, the other uncertain and indecisive.<ref name=":4">{{Cite book|title=Obsessive–compulsive personality disorder|editor1=Grant, Jon E. |editor2=Pinto, Anthony |editor3=Chamberlain, Samuel |publisher=American Psychiatric Association Publishing|date=October 2019|isbn=978-1-61537-280-5|location=Washington, DC |page =3|oclc=45375754}}</ref>

In the book ''Contributions to the theory of the anal character,'' Karl Abraham noted that the core feature of the anal character is being perfectionistic, and he believed that these traits will help an individual in becoming industrious and productive, whilst hindering their social and interpersonal functioning, such as working with others.<ref name=":4" />

OCPD was included in the first edition of the ''Diagnostic and Statistical Manual of Mental Disorders'' in 1952 by the American Psychiatric Association under the name "compulsive personality". It was defined as a chronic and excessive preoccupation with adherence to rules and standards of conscience. Other symptoms included rigidity, over-conscientiousness, and a reduced ability to relax.<ref>{{Cite book|title=Diagnostic and Statistical Manual of Mental Disorders|publisher= American Psychiatric Association|year=1952|page =57}}</ref>

The DSM-II (1968) changed the name to "obsessive–compulsive personality", and also suggested the term "anankastic personality" in order to reduce confusion between OCPD and OCD, but the proposed name was removed from later editions. The symptoms described in the DSM-II closely resembled those in the original DSM.<ref>{{Cite book|title=Diagnostic and Statistical Manual of Mental Disorders|publisher=American Psychiatric Association|year=1968|edition=2nd|page =43}}</ref>

In 1980, the DSM-III was released, and it renamed the disorder back to "compulsive personality disorder", and also included new symptoms of the disorder: a restricted expression of affect, and an inability to delegate tasks. Devotion to productivity, perfectionism, and indecisiveness were the other symptoms included.<ref>{{Cite book|title= Diagnostic and Statistical Manual of Mental Disorders|publisher =American Psychiatric Association|year=1980|edition=3rd|pages=326–28}}</ref> The DSM-III-R (1987) renamed the disorder again to "obsessive–compulsive personality disorder" and the name has remained since then. A diagnosis of OCPD was given when 5 of the 9 symptoms were met, and the 9 symptoms included perfectionism, preoccupation with details, an insistence that others submit to one's way, indecisiveness, devotion to work, restricted expression of affect, excessive conscientiousness, lack of generosity, and hoarding.<ref>{{Cite book|title=Diagnostic and statistical manual of mental disorders: DSM-III-R | publisher =American Psychiatric Association, Work Group to Revise DSM-III |year=1987 |isbn=0-89042-018-1|edition=3rd, rev. |location=Washington, DC|pages=354–56|oclc=16395933}}</ref>

With DSM-IV, OCPD was classified as a 'Cluster C' personality disorder. There was a dispute about the categorization of OCPD as an Axis II anxiety disorder. Although the DSM-IV attempted to distinguish between OCPD and OCD by focusing on the absence of obsessions and compulsions in OCPD, OC personality traits are easily mistaken for abnormal cognitions or values considered to underpin OCD. The disorder is a neglected and understudied area of research.<ref>{{cite journal | vauthors = Reddy MS, Vijay MS, Reddy S | title = Obsessive-compulsive (Anankastic) Personality Disorder: A Poorly Researched Landscape with Significant Clinical Relevance | journal = Indian Journal of Psychological Medicine | volume = 38 | issue = 1 | pages = 1–5 | date = 2016 | pmid = 27011394 | pmc = 4782437 | doi = 10.4103/0253-7176.175085 | doi-access = free }}</ref>

==See also== {{Portal|Psychology|Psychiatry }} {{Columns-list|colwidth=20em| * Anal retentiveness * Analysis paralysis * Authoritarian personality * Hoarding disorder * Idée fixe (psychology) * Jobsworth * Mysophobia * Pedantry * Perfection * Perfectionism * Scrupulosity * VUCA * Workaholic }}

==References== {{reflist}}

==Further reading== * Grant, John E., Obsessive-Compulsive Personality Disorder (2019). American Psychiatric Association Publishing. {{ISBN|978-1-61537-280-5}}

==External links== *{{MedlinePlusEncyclopedia|000942|Obsessive–compulsive personality disorder}} *[https://psychiatryonline.org/doi/pdf/10.1176/appi.focus.11.2.189 Alternative DSM-5 Model for Personality Disorders] (with AMPD definition of OCPD) {{Medical resources | DiseasesDB = | ICD10 = {{ICD10|F|60|5|f|60}} | ICD9 = {{ICD9|301.4}} | ICDO = | OMIM = | MedlinePlus = 000942 | eMedicineSubj = | eMedicineTopic = | MeshID = D003193 | GeneReviewsID = | GeneReviewsName = | ICD11 = {{ICD11|6D10}} + {{ICD11|6D11.4}} }}

{{DEFAULTSORT:Obsessive-compulsive personality disorder}} Category:Cluster C personality disorders