Individuals with obsessive-compulsive personality disorder (OCPD) are preoccupied with orderliness, perfectionism, and control. Their perfectionism often makes them rigid and critical of both themselves and others. OCPD may lead to over-working, burn-out, and depression, or to procrastination that leaves the individual paralyzed and unable to accomplish anything of value to themselves.
While OCPD can have a very negative impact on individuals and their families, there are good options for treatment, including Psychodynamic Therapy, Cognitive and Behavioral Therapies, and Radically Open Dialectical Behavior Therapy. Perhaps more importantly, individuals with OCPD have personal qualities that may be enlisted in service of healing themselves, their families, and their communities.
What Is OCPD?
As much as 7.8 percent of the general population has OCPD, making it the most frequently occurring personality disorder in our culture. Yet clinicians may fail to recognize and diagnose it, and may misdiagnose it as another condition such as obsessive-compulsive disorder (OCD).
Personality disorders such as OCPD are long-standing, inflexible patterns of behavior and inner experience that cause significant distress to the individual. OCPD is one of ten such personality disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual.1
Signs of OCPD: What It Looks Like
Individuals with OCPD tend to make lists, plan extensively, insist on particular ways of doing things, and meticulously organize objects and tasks. They are usually very rigid about schedules and rules.
OCPD can lead to severe difficulties in maintaining relationships,2 and, while they may work remarkably hard, they may have trouble navigating the workplace because they are critical and perfectionistic.
They attempt to control not only their behavior, but also their emotions. Emotions that may leave them feeling vulnerable, such as sadness and desire, may be repressed. Emotions that they can justify, and that make them feel stronger, such as anger, are more easily experienced. Empathy may be difficult for them to attain.
OCPD may be characterized by extreme efforts to comply and appease others, or by authoritarianism, a domineering style that makes relationships very painful.
OCPD magnifies the effects of depression, leading to more suicidal ideation and suicide attempts, and a decrease in a sense that life is worth living.3
The disorder is characterized at least as much by what the individual doesn’t do, as much as what they do do: relationships, self-care, and leisure are sacrificed in the interest of productivity.
OCPD in Children
While children may show some traits of OCPD, the diagnosis is usually not made until late adolescence or early adulthood. The diagnosis should also not be made if their symptoms are the result of a particular situation or developmental phase. However, when their symptoms are pervasive and persistent for a year or more, people under the age of 18 may be diagnosed with OCPD.
Left untreated, OCPD can become worse with age.
OCPD vs OCD
OCPD is often confused with, and misdiagnosed as, OCD (obsessive-compulsive disorder).
OCPD occurs three times more frequently in the general population than OCD, with rates as high as 7.8 percent, versus that of 2.3 percent for OCD.4,5
OCD is characterized by:
- Specific compulsions: Repetitive rituals such as excessive hand-washing and checking ovens and doors
- Specific obsessions: Persistent and intrusive thoughts and images that the individual can’t dismiss, sometimes of a very disturbing nature
- Fear of germs
- A need to have things in perfect order or at right angles
- A tendency for the individual to doubt themselves, second-guessing so much that they are unable to complete tasks
- A dislike of the condition by those who have it
OCPD, in contrast, is characterized by:
- Its effect on the entire personality, not just specific obsessions or compulsions
- A greater capacity to delay gratification6
- A greater emphasis on conscientiousness7
- Excessive emphasis on work and productivity
- Uncritical acceptance of a rigid approach to life
Some individuals have both conditions: 20% of the individuals with OCPD also have OCD, and 25% of those with OCD also have OCPD.8
Who Is Most at Risk for OCPD?
Symptoms of OCPD
According to the DSM-5,9 individuals must have four of the following eight symptoms to meet the full criteria for the diagnosis:
- Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
- Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
- Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
- Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
- Is unable to discard worn-out or worthless objects even when 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.
- Shows rigidity and stubbornness.
OCPD manifests differently in different individuals, depending upon which symptoms predominate.
Individuals with OCPD can be:
- bossy and authoritarian
- appeasing and conflict avoidant; disappointing others is frightening to them
- workaholic (more compulsive)
- procrastinating (more obsessive)
Perfectionism and a need to control are the common denominators among all four of these. At least as important, however, is the loss of meaning of the original intention. As the DSM-5 points out, individuals with OCPD lose the major point of the activities they become engaged in. For instance, while they may intend to help people, they may end up hurting them with control or criticism.
The Spectrum of The Compulsive Personality
Many individuals have fewer than four of the eight symptoms described in the DSM-5. These individuals would be considered to have only traits of OCPD, or sub-clinical OCPD.
The symptoms of OCPD are maladaptive versions of behaviors that might otherwise be quite adaptive. Many individuals have some compulsive traits that are adaptive and healthy, along with other traits of OCPD that are maladaptive and unhealthy.
While those who meet the full criteria for OCPD are understood to be poorly adapted, many individuals use their compulsive temperament in a healthy way.10 Their capacity for order, organization, planning, conscientiousness and high standards can be used to achieve a fulfilling life and in service to those around them.
Causes & Triggers of OCPD
As with most mental health conditions, both environmental11 and genetic factors12 play a role in whether someone develops OCPD.13 Characteristics such as perfectionism,14 goal-directed behavior, self-restraint,15 determination, and concentration all have genetic components, and can be quite adaptive.
But these characteristics may become exaggerated and problematic when the individual feels a need to enlist them in order to feel safer. For example, when they do not feel a secure attachment to their parents, they may use otherwise healthy qualities to prove to themselves, and to those around them, that they have value and are worthy of love.
Parental traits that may lead a characteristically meticulous individual to develop OCPD include:
- Overinvolved or Intrusive
- Demanding & Critical
While these situations and others may contribute to the development of OCPD, some individuals with OCPD appear to have had a fairly secure childhood with appropriately attentive parents.
Symptoms of OCPD may develop if a child feels the need to become controlling or overachieving even with parents who are in the “good enough” range. For instance, a child whose parents who are enthusiastically complementary may feel that they must meet extremely high expectations in order to be loved.
While anxiety is commonly understood to be the underlying cause of OCPD, not all anxious individuals develop OCPD. OCPD appears to be a particular coping strategy to deal with anxiety used by those with certain predispositions, such as perfectionism and conscientiousness.
People with OCPD tend to become more rigid when circumstances lead them to feel in jeopardy of judgment or criticism, and of experiencing shame or guilt.
Treatment of OCPD
Research regarding the treatment of OCPD is limited. However, some studies indicate that various forms of therapy can be helpful.16 Individuals who can use their determination and compulsive traits in service of their psychological growth can be particularly successful.
Psychodynamic, Psychoanalytic, and Expressive Treatments
Psychodynamic, psychoanalytic, and expressive therapies, also known as traditional talk therapy, achieve change through insight and expression. Difficult childhood environments that have caused maladaptive coping strategies that have been carried into adulthood are identified. Therapist and patient work together to understand motivations that may have been unconscious, and to remove root causes of disturbances.
Psychodynamic therapy is designed to address more global personality issues, including compulsive personality, rather than targeting specific symptoms.
Sessions are not structured and invite a free flow of emotion and discussion.
While there are short-term forms of dynamic therapy,17 treatment is usually open-ended and long-term. Clients often experience some relief in the initial months, but deeper changes, such as greater access to a wider range of emotions, may take years. Some research indicates that psychodynamic treatments have a longer-lasting effect.18
Cognitive and Behavioral Therapy (CBT)
Cognitive and behavioral treatments question maladaptive ways of thinking, and replace them with more adaptive ways of thinking.19 For example, clients might be encouraged to look for shades of grey when in conflict with others, rather than seeing them as either black or white, or wrong or right.
CBT practitioners may also introduce specific behaviors to help clients gradually become accustomed to more adaptive ways of acting.
CBT identifies specific symptoms and targets them in the sessions, usually in a more structured way, and often for a limited number of sessions. Homework assignments to help learn techniques to better cope with problematic issues are often a part of the therapy.
Radically Open Dialectical Behavior Therapy (RO DBT)20
RO DBT is a treatment program designed to help individuals whose personality is characterized by over-control, including those who have anorexia, autism spectrum disorders, and OCPD. The approach is intended to improve poor social signaling (body language), a lack of openness, and limited flexibility that may have hindered over-controlled individuals from cultivating better relationships. The program includes weekly, structured psychotherapy sessions and weekly skills training classes.
Family and Couples Therapy
Family and couples therapy may be helpful when the symptoms of the partner with OCPD are causing conflict within the couple or family. Many people with OCPD feel more comfortable beginning therapy with their partner, and, if they have a good experience there, may feel more comfortable beginning individual therapy.
Partners should be aware, however, that successful couples therapy usually explores what each of the partners can do differently to improve the relationship, rather than holding one partner responsible.
While some people with OCPD obtain relief from anxiety or depression by taking medications, medications are usually not considered to be a primary treatment for OCPD. Those seeking psychopharmacological treatment should consult a psychiatrist or psychopharmacologist about their options, and clarify the possible side effects of any medication they consider taking.
While professional help is usually indicated for individuals with OCPD, they can also benefit from working on their own to shift their priorities to self-care and relationships. This will involve a combination of reflection and change of behavior.
Because individuals with this condition too often lose track of what is most meaningful to them, they should carefully identify their values and evaluate whether they are actually living in accord with those values. For example, they may need to commit to investing their time and energy in cultivating emotional health, better relationships, personal growth, or peace of mind, rather than making more money or achieving greater status.
Individuals with compulsive tendencies may find gratification and more balance by enlisting their skills in projects other than work. Activities that allow them to organize and plan, such as community service, may be satisfying. Creative activities that use their desire to be productive can help them achieve a greater sense of balance.
Choosing to spend time in activities motivated by desire—rather than obligation—is an important lifestyle change for individuals with OCPD.
Coping strategies that may be helpful for those with OCPD include:
- Progressive muscle relaxation
- Mindfulness meditation. The application Insight Timer can help you get started.
- Daily journaling to identify situations that increase anxiety, and observations about what has worked and what has not to decrease it
How to Get Help for OCPD
Individuals seeking therapy can find practical guidance for finding a therapist here.
Once you have identified a few potential therapists, research their credentials and experience. Call them in advance and ask if they have experience treating OCPD. Many will respond as if you asked them about OCD. You may need to clarify what you want help with (e.g. rigidity, control, perfectionism), as many clinicians are unaware of the diagnosis, even if they have worked with someone with the condition. If they seem to be unfamiliar with OCPD, and you have other options, you may want to try speaking with another therapist before setting up a time for a consultation in person.
How to Get Help for a Loved One
Individuals with OCPD are often resistant to entering therapy. Efforts to get them to go to therapy may be most successful if they feel they are not being criticized. Using less clinical terms such as “You’re driven, it’s a matter of being too strong rather than weak,” may help motivate them to try therapy.
Others with OCPD, however, are relieved to realize that they have an actual medical condition, and are then willing to get help. In either case, convey that you know they are trying to do the right thing, but that they are unintentionally hurting you.
It is best for the person who will be seeing the therapist to contact the therapist themselves, but it may be necessary for you to make an initial call. The sooner the contact is handed over to him or her, the better.
How to Get Help for a Child
While children are usually not diagnosed with OCPD, it is not unusual for them to develop compulsive behaviors, rigidity, and obsessive thinking. If these are beginning to affect their schoolwork or their relationships with other children, consult a therapist with extensive experience working with children. The child need not meet the full criteria for OCPD to benefit from psychotherapy.
For Partners of Those With OCPD
Living with someone with OCPD can be extremely challenging. Because of their inflexibility, insistence that they are correct, and need for rules and for order, partners may feel disrespected, drained, and hopeless. In cases of very severe OCPD, and cases in which the individual is unwilling to change or enter treatment, there may be little that the partner can do other than to set boundaries and protect themselves.
However, some partners with OCPD, upon realizing that they have a medical condition, and that they are negatively impacting their partner, can use their determination and perfectionism to improve their role in the relationship.
Partners may be able to improve their situation by changing their perspective on their partner, appreciating what he or she has to offer, and remembering that underneath their control and criticism is anxiety. Partners should communicate what they appreciate about their OCPD partner, and what they need from them. Finally, they need to set boundaries and build a wide network of support.
Tests for OCPD
You should always reach out to a professional if you suspect any mental health issues.
Tests performed by Professionals
The diagnosis of OCPD is usually made by a trained clinician after a thorough interview. There are no blood tests or genetic tests for the condition. Some psychologists are trained to administer specific structured interviews22 such as the Compulsive Personality Assessment Scale (CPAS) to determine whether the client meets the criteria for OCPD.
Quizzes and Self Diagnosis
Self-tests should not be used in place of an evaluation by a skilled clinician. But you may be able to use self-administered tests to get a rough sense of where you stand. The most common self-test is one published in the book Freedom from Compulsion by Leonard Cammer in 1976.23 You can access it online at OCPD Online.
Additional Resources for OCPD
There are currently no foundations or institutions promoting research, awareness, or treatment of OCPD. However, some websites and online forums provide resources, and opportunities for mutual support for those with OCPD and their loved ones:
Support Groups and Forums: