Obsessive-compulsive personality disorder (OCPD), also referred to as anankastic personality disorder, is a personality disorder marked by a need for orderliness, perfectionism, and control. Someone with OCPD is often rigid and critical of both themselves and others. OCPD may lead to workaholism, burnout, and depression, or to procrastination that leaves the person 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.
What Is OCPD?
OCPD is a mental disorder characterized by a need for control and orderliness. OCPD is one of ten diagnosable personality disorders,1 which are long-standing, inflexible patterns of behavior and inner experience that cause significant distress to the individual.
As much as 7.9% of the general population has OCPD,2 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).
Can OCPD Be a Good Thing?
People with OCPD can be conscientious, dependable, and hardworking. When effectively managed, those with OCPD can harness these qualities to help heal themselves, their families, and their communities.
What Is OCPD Like for the Person Who Has It?
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
Here’s what OCPD can look like:
- Rigid 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 may have trouble navigating family and workplace relationships because they are critical and perfectionistic.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 at least as much by what the individual doesn’t do, as much as what they actually do—relationships, self-care, and leisure are sacrificed in the interest of productivity.
What Are the Symptoms of OCPD?
Symptoms of OCPD may include perfectionism, inflexibility and stubbornness, and a preoccupation with work. OCPD can manifest differently in different individuals, depending on which symptoms are present. Left untreated, OCPD can become worse with age.
Symptoms of OCPD include:1
- Preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
- Perfectionism that interferes with task completion (e.g., unable to complete a project because their overly strict standards are not met)
- Excessive devotion to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
- Overconscientious, scrupulousness, and inflexibility about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
- 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 miserly spending style toward both self and others
- Rigidity and stubbornness
OCPD Diagnosis
In order to be diagnosed with OCPD, individuals must have four of the eight symptoms listed above to meet the full criteria for the diagnosis.1 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 specifically structured interviews such as the Compulsive Personality Assessment Scale (CPAS) to determine whether the client meets OCPD criteria.5
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 symptoms are the result of a particular situation or developmental phase. However, when symptoms are pervasive and persistent for a year or more, people under the age of 18 may be diagnosed with OCPD.
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 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.6 Their capacity for order, organization, planning, conscientiousness, and high standards can be used to achieve a fulfilling life and benefit those around them.
What Is the Difference Between OCPD & OCD?
Obsessive Compulsive Disorder (OCD) is an anxiety disorder that’s characterized by having specific compulsions and obsessions, a tendency for the individual to doubt and second-guess themselves, and a dislike of the conditions by those who have it. OCPD differs from OCD in that it is characterized by an effect on someone’s entire personality, not just specific obsessions or compulsions, as well as a greater emphasis on work and productivity, conscientiousness, and a generally rigid approach to life.7,8
OCPD occurs three times more frequently than OCD, with rates as high as 7.8%, versus 2.3% for OCD.9,10
Can Someone Have Both OCD & OCPD?
Some individuals have both conditions: 20% of the individuals with OCPD also have OCD, and 25% of those with OCD also have OCPD.11 Having both OCD and OCPD tends to magnify the symptoms of both conditions.12 Many individuals with OCD have insight about the disruptions that the symptoms create in their lives. This is often not the case for people with OCPD.
Other Common Comorbidities
OCPD often co-occurs with other disorders, the most common being:13
- Other personality disorders
- Anxiety
- Depression
- Eating disorders
What Causes OCPD?
As with most mental health conditions, whether an individual develops that condition is due to a number of factors, both genetic and environmental.
OCPD & Genetics
Genetic factors clearly play a role in the origins of OCPD.14,15 Characteristics such as perfectionism, goal-directed behavior, self-restraint, determination, and concentration all have genetic components and can be adaptive.16,17
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.
OCPD Environmental Factors
Environmental factors will shape whether those inborn characteristics are healthy or unhealthy.11 These character traits 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
- Overprotective
- Demanding & Critical
- Rigid
- Neglectful
- Chaotic
- Undependable
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 are enthusiastically complementary may feel that they must meet extremely high expectations in order to be loved.
OCPD Triggers
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. When their sense of security or identity feels threatened their symptoms may get worse.
How Is OCPD Treated?
Treatment for OCPD usually involves a form of talk therapy, such as psychodynamic therapy or cognitive behavioral therapy.18 Individuals 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 as a primary treatment.
Therapy types typically used to treat OCPD 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 identifies specific symptoms and targets them in the sessions, usually in a more structured way, and often for a limited number of sessions.
- Schema therapy: Schema therapy aims to use CBT techniques in order to work on the 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):19 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.
- Family and couples therapy: May be helpful when the symptoms of the partner with OCPD are causing conflict within the couple or family.
Medication
The Food and Drug Administration has not approved any medications for the treatment of OCPD. 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 psychopharmacological treatment should consult a psychiatrist or psychopharmacologist about their options, and clarify the possible side effects of any medication they consider taking.
How to Get Help for OCPD
It’s important to find a therapist you feel comfortable working with. See our guide on finding a therapist, and consult our directory to get started on your journey toward healing.
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.
4 Tips for Coping 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.
Here are four ways to manage OCPD:
- Align your values and actions: Because individuals with OCPD 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 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 obligation—is an important lifestyle change for individuals with OCPD.
- Develop healthy coping strategies: This may include progressive muscle relaxation, a consistent exercise routine, or mindfulness meditation.
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, appreciating what their partner has to offer, and remembering that underneath their control and criticism is anxiety. Finally, they need to set boundaries and build a wide network of support.
How to Get Help for a Partner or 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.
Do I Have OCPD?
You should always reach out to a professional if you suspect any mental health issues.
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 1976.20 You can access it online at OCPD Online.
For Further Reading
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:
Websites:
Support Groups and Forums:
OCPD Infographics
