Obsessive-Compulsive Personality Disorder (OCPD): Signs, Symptoms, & Treatments

What Is Obsessive-Compulsive Personality Disorder (OCPD)?

Obsessive-compulsive personality disorder (OCPD), also known as anankastic personality disorder, is a personality disorder characterized by a need for control and orderliness. OCPD includes long-standing, inflexible patterns of behavior and inner experience that cause significant distress to the person, and often the people surrounding them.¹

OCPD works to its own detriment, as it tends to slow down the completion of tasks and work.

OCPD Vs. OCD

OCPD and OCD are quite different. Those with OCD tend to have obsessions which lead to compulsions in their behaviors, rooted in anxiety. Those with OCPD tend to have an underlying need for control and their behaviors are dictated by the need to control their situation—it’s a personality disorder and not related to anxiety disorders.

How Common Is OCPD?

OCPD symptoms can be fairly common but the actual disorder requires diagnosis and treatment, so it is possible that there are unreported cases of OCPD. Less than 10% of the general population experiences OCPD and it is more common in men. It is possible that these symptoms overlap with other conditions which can make OCPD hard to diagnose.¹¹

Symptoms of OCPD

Symptoms of OCPD may include perfectionism, inflexibility, stubbornness, and preoccupation with work. OCPD can manifest differently in different people, depending on which symptoms are present. Typically, symptoms of OCPD are maladaptive versions of behaviors that might otherwise be quite helpful and adaptive. Left untreated, OCPD can become worse with age.

Common obsessive-compulsive personality disorder symptoms include:¹

• Preoccupation with details, lists, organization, and order to the extent that the point of an activity is lost
• Perfectionism that interferes with task completion (e.g., unable to complete a project because of overly strict standards)
• Excessive devotion to work and productivity to the exclusion of leisure activities and friendships
• Overconscientious, scrupulousness, and inflexibility about matters of morality, ethics, or values
• Inability to discard worn-out or worthless objects even when they have no sentimental value
• Reluctance to delegate tasks or to work with others unless they submit to their exact way of doing things
• Adopting a frugal spending style for both themselves and others
• An excessive need to be on time, follow a schedule, and be punctual
• Rigidity about following rules and regulations
• Believing that their way of doing things is the best way

Signs of OCPD

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.¹

Signs of an obsessive-compulsive personality disorder may include:

• Rigidity about schedules and rules: Individuals with OCPD tend to make lists, plan extensively, insist on particular ways of doing things, and meticulously organize objects and tasks.
• Difficulty in relationships: While they may work remarkably hard, people with OCPD often have trouble navigating relationships due to self-criticism and perfectionism.³
• Empathy and emotions are difficult: 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.
• Risk of depression and suicide: OCPD magnifies the effects of depression, leading to more suicidal ideation and suicide attempts, and a decrease in the sense that life is worth living.⁴
• Productivity at any cost: The disorder is characterized by at least as much of what the individual doesn’t do, as it is for what they actually do—relationships, self-care, and leisure are sacrificed in the interest of productivity.
• Anger outbursts: Anger outbursts can be common for those with OCPD as the sheer need for control can lead to anger when the person feels any lack of control.
• Social isolation: Due to the rigidity of the symptoms of those with OCPD, it can leave those with OCPD isolated from family and friends as most people do not thrive in environments that are so controlled and managed.

What Causes OCPD?

While there is no exact cause of OCPD, it is important to note that a person’s childhood experiences and history of trauma and abuse can play a role in the development of one’s cognition.

Genetics

While there is no direct genetic link for OCPD, we do know that mental health issues do have a genetic link and OCPD may be one condition that can be genetic.

Environmental Factors

Growing up in a very strict environment may lead one to become equally strict as an adult or adopt those same rituals in their home and be driven by control. The reverse may also be true: A lack of structure may create a deep need for structure and control and may develop into an unhealthy obsession with control.

Childhood Trauma

Those who grew up with childhood trauma tend to have experiences where they felt out of control in their environment and felt unsafe. Those with OCPD may be compensating for a need for safety by being fixated on controlling everything around them to prevent them from feeling hurt.

How Is OCPD Diagnosed?

OCPD and other personality disorders are diagnosed by a psychiatrist. Together with a therapist, the psychiatrist may evaluate and test the patient and review the patient’s work with a therapist over time to come to a diagnosis of OCPD. It is important to consider that the diagnosis process differs for those with OCD—to diagnose OCPD, the psychiatrist must rule out OCD, avoidant personality disorder, schizoid personality disorder, and other mood disorders.

OCPD Treatment Options

Treatment for OCPD usually involves a form of talk therapy, such as psychodynamic therapy or cognitive behavioral therapy.¹⁸ People who can use their determination and compulsive traits to push themselves to grow psychologically can be particularly successful. Medication may also be used to abate symptoms of anxiety or depression, though it is not considered a primary treatment.

Therapy

It’s important to find a therapist you feel comfortable working with. To get started on your journey toward healing, finding the right therapist can be done using an online therapist directory or by talking with your primary care physician. 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.

You may need to clarify what you want help with (e.g. rigidity, control, perfectionism), as some clinicians may be unaware of the diagnosis. If this is the case and you have other options, you may want to try speaking with another therapist before setting up a consultation in person.

Therapy for OCPD may include:

• Psychodynamic therapy: In psychodynamic therapy, the therapist and patient work together to understand motivations that may have been unconscious and to remove the root causes of disturbances.
• Cognitive behavioral therapy (CBT): CBT identifies specific symptoms and targets them in sessions, usually in a structured way and often for a limited number of sessions.
• Schema therapy: Schema therapy uses CBT techniques in order to work on one’s personality as a whole, not just specific symptoms. Underlying schemas, or themes, that dominate the individual’s personality are identified and targeted. These schemas include defectiveness, isolation, self-sacrifice, unrelenting standards, and failure.
• Radically open dialectical behavior therapy (RO DBT): RO DBT is a treatment program developed from DBT designed to help individuals whose personality is characterized by over-control, including those who have anorexia, autism spectrum disorders, and OCPD.¹⁹
• Family and couples therapy: Family therapy or couples counseling may be helpful when the symptoms of the partner with OCPD are causing conflict within the couple or family.

Medication

The FDA has not approved any medications for the treatment of obsessive-compulsive personality disorder. While some people with OCPD obtain relief from anxiety, hoarding, or depression by taking medications, medications are usually not considered to be a primary treatment for OCPD.

Those seeking medication should consult a psychiatrist or psychopharmacologist about their options, and clarify the possible side effects of any medication they consider taking.

Can OCPD Be Prevented?

While OCPD can’t be prevented, there are things you can do to help you learn how to regulate your emotions and expectations in a way to make room for things that are out of your control. Learning to accept what you can control and focusing on those is key to maintaining emotional wellbeing; letting go of the things you can’t control can lighten the load mentally and emotionally.

What Are The Long-Term Impacts of OCPD?

Long-term impacts of OCPD can be dire and lead to overall deterioration of one’s mental health, work life, relationships, and friendship. Poorly managed OCPD can trigger or worsen depression, eating disorders, and physical health issues due to the stress related to being unable to control everything.

If left untreated, OCPD may lead to difficulties such as:

• Poor relationships: OCPD can lead to disconnection from family and friends who do not want to be around someone who is very controlling and rigid.
• Work and academic-related complications: At work it can be hard to work with someone with OCPD as they are unwilling to be flexible and consider another person’s point of view.
• Poor social functioning: OCPD makes it hard to relate to others as people are not perfect yet the one with OCPD strives for perfection in a healthy way.
• Poor physical health: We know that there is a direct link with heart health and mental health and stress. The stress one takes on with OCPD can worsen mental health so profoundly that it can manifest into physical symptoms and create true physical issues when there were once no physical issues.

How to Cope With OCPD

While professional help is usually recommended for individuals with OCPD, they can also benefit from working on their own to shift their priorities toward self-care and relationships. This will involve a combination of reflection and change of behavior.

Below are tips for managing OCPD:

• Align your values and actions: Because individuals with OCPD often lose track of what is most meaningful to them, they should carefully identify their values and evaluate whether they are actually living in accordance with those values.
• Engage in community service: Individuals with compulsive tendencies may find gratification and more balance by enlisting their skills in projects other than work, and creative activities that use their desire to be productive can help them achieve a greater sense of balance.
• Do what you love: Choosing to spend time in activities motivated by desire—rather than an obligation—is an important lifestyle change for individuals with OCPD.
• Develop healthy coping strategies: This may include progressive muscle relaxation, a consistent exercise routine, mindfulness, or meditation.

How to Help Someone With OCPD

OCPD relationships can be extremely challenging to navigate. In cases of very severe OCPD in which the individual is unwilling to change or enter treatment, there may be little that a person can do other than to set boundaries and protect themselves.

However, some individuals with OCPD can use their determination and perfectionism to improve their role in the relationship. You may be able to do so by changing your perspective, appreciating what your OCPD loved one has to offer, and recognizing that their control and criticism are driven by anxiety.

Below are some tips for helping someone with OCPD:

• Encourage treatment: Help someone feel seen and encourage treatment, pointing out that we all have room for improvement but that they could greatly reduce their anxiety, anger, or other symptoms by talking with a professional.
• Be understanding and empathetic: Compassion is key as living with OCPD makes one highly critical of themselves and they likely struggle with giving themselves compassion.
• Stay patient: Patience may be challenging but it is important in healing as it takes a lot of self-patience to come around to the idea that one doesn’t need to be perfect in order to be accepted.
• Seek therapy for yourself: It can be hard to always separate your feelings and the feelings coming from your loved one with OCPD, so having a safe space for yourself to process everything is key.
• Build a support network: Having a support system is important for everyone involved and gives you a lot of cushion to fall back on when things get too hard.

Final Thoughts

Working with a therapist to uncover how to manage this long term is really important and can be incredibly healing and bring huge relief to everyone. Remember, no one is perfect and we are never in control of everything—that is all part of the human experience. Working with a professional is a great way to learn how to step out of that and learn how to step into self acceptance with compassion, grace and self-love.