Obsessive-Compulsive Personality Disorder: OCPD Symptoms, Diagnosis & Treatment

August 8, 2023 Roberto Olivardia, PhD

Originally published by: ADDitude magazine

People with OCPD are preoccupied with perfectionism and stubborn about the way things “should be done” — sometimes to the detriment of relationships. Learn more about the symptoms and signs of obsessive-compulsive personality disorder, how it’s diagnosed, treatments, and more.

What is Obsessive-Compulsive Personality Disorder (OCPD)?

OCPD is characterized by an intense and pervasive preoccupation with orderliness, perfectionism, and control (both mental and interpersonal)1. Individuals with OCPD may be rigid and stubborn, insisting that others do things according to their strict standards. They may exhibit these behaviors at the expense of flexibility, openness, and efficiency.

OCPD is often mistaken for obsessive-compulsive disorder (OCD). While both disorders can co-exist (and have similar names), they are quite distinct.

OCPD: Symptoms and Diagnosis in Adults

OCPD is one of several personality disorders listed in the DSM-5. A personality disorder is characterized by rigid and unhealthy patterns of thinking, functioning, and behaving. A person with a personality disorder has trouble perceiving and relating to situations and people. This causes significant problems and limitations in relationships, social activities, work, and school.

To merit an OCPD diagnosis, an individual must exhibit at least four of the following symptoms, which typically begin in early adulthood:

Preoccupation or fixation with details, rules, schedules, organization, and lists — even to the extent that the prevailing point of the activity is lost.
Perfectionism that interferes with completion of the task. Individuals with OCPD often demonstrate a sense of righteousness about the way things “should be done.” It may include an overwhelming need for order.
Excessive devotion to work and productivity (not due to financial necessity), resulting in neglect of leisure activities and friends.
Excessive conscientiousness, fastidiousness, and inflexibility regarding ethical and moral issues and values.
Unwillingness to throw out worn-out or worthless objects, even those with no sentimental value.
Reluctance to delegate or work with other people unless those people agree to do things exactly “the right way.”
A miserly approach to spending for themselves and others because money is something to be saved for future disasters.
Rigidity and stubbornness. Such rigidity often manifests in a sense of hypermorality.

OCPD is one of the most prevalent personality disorders in the general population, with an estimated prevalence between 2.1 and 8%. The disorder is diagnosed in twice as many men as women.1 There is no single etiological factor that is responsible for the presence of OCPD.

OCPD: Other Signs

Individuals with OCPD are often excessively careful and prone to repetition, paying extraordinary attention to detail and repeatedly checking for mistakes. They are often oblivious to how their behaviors affect others.

Individuals with OCPD may feel like they don’t have time to take off from work. And when they do, they are very uncomfortable — unless they take some work along with them. If and when they do spend time with friends, it is often in the form of a sport or other organized activity. Even then, the game could be turned into a highly structured task.

Individuals with OCPD will often intellectualize their emotions and rely overly on logic to deal with situations and other people, forgetting the role emotion may play in interpersonal situations. They display restricted affect and a lack of empathy. The lack of empathy is less out of malice and more out of what they view as “the way it is” in a hyperlogical manner.

More possible signs of OCPD:

Trouble going along with anyone else’s ideas; may reject offers for help because they believe no one else can do it right
Difficulty with prioritizing, decision-making, and meeting deadlines especially in the absence of clearly defined rules and established procedures
Occupational difficulties and distress, particularly when facing new situations that require flexibility and compromise
Prone to anger in situations where they can’t maintain control of their physical or interpersonal environment
May display excessive deference to an authority they respect, and excessive resistant to one they don’t
Discomfort around emotionally expressive individuals

OCPD vs. OCD: What’s the Difference?

OCD is characterized by obsessions and/or compulsions. Obsessions are persistent thoughts, impulses, or images that are intrusive in nature and cause distress and anxiety. Often, a person will try to ignore an obsession or neutralize it by some thought or action. Even though logic may inform them that this is irrational, it is still very difficult to pass it off.

Compulsions are repetitive physical behaviors (such as hand washing or praying) or mental acts (such as saying words silently, counting, creating images) that a person feels compelled to do in order to undo or cope with an obsession.

OCPD is not characterized by intrusive thoughts, images or urges, or by repetitive behaviors performed in response. Instead, OCPD involves pervasive, extreme patterns of excessive perfectionism and control.

Other differences:

People with OCD see their thoughts as distressing and sometimes irrational. They wish to not have obsessive thoughts. People with OCPD think their way is the “right and best way” and don’t see a need to change. Other people feel distressed by the OCPD person’s rules.
Patients with OCD see their symptoms as disabling and unhelpful in managing their lives. People with OCPD see their symptoms as helpful, and are wedded to them
Many people with OCD are motivated to seek treatment. Typically, people with OCPD don’t believe they need treatment. They believe that everyone else around them should change, not themselves, to make things better.
Family members and co-workers of people with OCPD often feel controlled by the demands and rules of the person with the disorder. It can result in a lot of conflict. It is difficult to relate to or sympathize with the person with OCPD.

Though OCD and OCPD are distinct, the two disorders frequently co-occur.

OCPD and ADHD: Is There a Link?

Studies find that individuals with ADHD are generally at higher risk of development of any of the personality disorders, including OCPD. A 2017 study found in a sample of 439 undergraduate college students that four personality disorders were significant predictors of ADHD, one of which was OCPD.

Clinical experience has shown that patients with ADHD may develop highly perfectionistic standards and rules in reaction to their executive functioning deficits. The harsh and negative messaging that they received over the years has made them obsess about doing things “the right way.”

OCPD: Treatments

Treatment of OCPD usually comprises cognitive behavioral therapy (CBT)and psychotherapy, which aims to improve a person’s understanding of themselves. The goal is not to change the values of a person, per se, but to couch their values in a more adaptive way for living life. This includes promoting flexibility and lessening rigidity in all aspects of life. Acceptance and Commitment Therapy (ACT), which aims to align someone with a sense of balanced, valued living, can be helpful.

There are few large sample studies of people with OCPD. However, reports suggest that treatment can lead to greater insight and mindful awareness into how someone’s OCPD symptoms affect others.

In addition to psychotherapy, antidepressants, including selective serotonin reuptake inhibitors (SSRIs), may be helpful for managing some symptoms of OCPD.

OCPD often exists with other conditions, notably OCD, eating disorders, autism spectrum disorder, and, sometimes, ADHD. Therefore, treating OCPD traits can help in treating a comorbid disorder. Likewise, treating the comorbid disorder can help relax some of the rigidity that is associated with OCPD. In the end, the prognosis depends on a person’s willingness to change and their commitment to treatment.