Diagnosing Obsessive-Compulsive Personality Disorder
Disorder of Openness: Authoritarian Personality Disorder aka OCPD
Originally published by: Psychology Today
Obsessive-Compulsive Personality Disorder (OCPD) is not Obsessive-Compulsive Disorder (OCD) - light. It is a qualitatively and categorically different syndrome. It is a personality disorder (PD). It is often overlooked by clinicians and researchers alike. However, OCPD is a very recognizable, and familiar type of character.
Narrative Description of Prototypical OCPD
The OCPD type of person is very systematic. They carefully plan everything down to the smallest detail. They often get lost in the details and forget their overall purpose. However, they are constantly scheduling tasks, events, etc, and organizing their environment. Individuals with OCPD are very rule-bound and are drawn to routine.
They are rigid in their experiences and character. Individuals with OCPD also are antagonistic.
Individuals with OCPD experience distress or have difficulty completing tasks because of their need to prepare, for example cleaning or organizing before starting the task. Individuals with OCPD will show impairment in functioning, for example being late or missing a deadline because of time spent prepping.
These individuals have a proclivity for hoarding their belongings even when no sentimental value is attached. They are penny-pinchers and could be described as miserly. Personality traits include perfectionism, rigidity, and orderliness. Interpersonally, individuals with OCPD can come off as stiff, controlling, or domineering.
General Criteria for the Diagnosis of Personality Disorders
In order to diagnose OCPD, the general criteria for personality disorders must be met. These criteria include the specific OCPD pattern as displayed in the table here. The OCPD pattern is present when at least four of nine symptoms are present. Furthermore, the pattern must be enduring (present for at least the past 5 years), rigid, as well as date back to at least adolescence and manifest itself in a variety of intrapersonal and interpersonal situations.
A longstanding PD pattern must lead to clinically significant subjective distress or deficits in social, occupational, and other areas of functioning. Lastly, the enduring pattern cannot be due to the effects of a drug or general medical condition nor can they be due to the presence of schizophrenia, mood disorder with psychotic features, or other psychotic disorders.
Diagnostic Criterion
The DSM-IV provides a content definition for OCPD as follows: "an extensive pattern of preoccupation with perfectionism, orderliness, and interpersonal and mental control, at the cost of efficiency, flexibility, and openness." The OCPD pattern is operationalized by the criterion/symptom list here. Theoretically, OCPD criteria should correspond to functioning in different domains: (a) cognition, (b) affectivity, (c) interpersonal functioning, and (d) impulse control.
As can be seen in the OCPD diagnostic criterion table, its symptoms include Orderliness, perfectionism, workaholism, excessive conscientiousness, hoarding behavior, resistance to delegating tasks because tasks need to be done in a specific way, miserly, and stubbornness. The presence of these symptoms can be assessed with explicit self-report screening questionnaires which can identify diagnoses for further evaluation. Following the screening, a structured interview should be conducted to diagnose personality disorders. Collaterall (peer, parent, etc.) reports are a valuable data source. An example of impairment in functioning due to a longstanding pattern of OCPD would be missing a deadline because an individual spent too much time organizing a binder or PowerPoint, unable to complete the actual project. Another example is being late due to following a preparation routine.
Conceptualizations of OCPD
OCPD can probably be traced back to one of Theophrastus’ "Characters" from antiquity. In modern history, Sigmund Freud provided the first formal conception of OCPD. Freud’s theory of psychosexual development posited a stage theory of emotional growth in children in which they pass through different phases, each with its unique conflict, including “the anal phase.” During the anal phase, the toddler is struggling to master toilet training which taps inner conflicts in connection to control and aggression. Freud theorized that adults can be stuck in a psychosexual stage. Therefore, there could exist an “anal character type.” Individuals with an "anal" character could be described as preoccupied with control: self-control and controlling others.
They are focused on following rules, drawn to structure and order. Many of their behaviors are motivated by a fear of loss of control. OCPD was classified in the DSM-IV as an anxious personality disorder i.e., the central underlying affect and/or emotional experience of individuals with OCPD is anxiety. Their pattern of behavior functions to manage their excessive anxiety.
The Authoritarian Personality Type
OCPD traits are also shared by Allport and Adorno’s construct of the authoritarian personality, respectively. Authoritarians, like individuals with OCPD, display rigidity, concrete thinking, orderliness, and a preoccupation with routine as well as a need to follow rules. These individuals are generally emotionally cut-off, selfish, and antagonistic. Both authoritarianism and OCPD can be conceptualized as a disorder of the Five-Factor Model openness i.e., markedly low levels of openness characterize both authoritarian and OCPD types. Individuals in close relationships with individuals with OCPD/authoritarian traits may feel a loss of autonomy, sink into passivity and submission, as well as, experience what it feels like to be controlled.
Clinical Implications
Individuals with OCPD are often high achievers and may not present for psychotherapy. However, it happens. Psychodynamic therapy or Cognitive therapy has been recommended in the literature to help people with OCPD increase their flexibility and openness.
References available in original article on Psychology Today.
