Obsessive-Compulsive Personality Disorder

Obsessive-Compulsive Personality Disordered individuals are described as inhibited, stubborn, perfectionistic, judgmental, overconscientious, rigid, and chronically anxious.

Characteristically, they are people who avoid intimacy and experience little pleasure from life. They may be successful, but at the same time are indecisive and demanding. Often they are perceived as cold and reserved. Unlike the Axis I Obsessive-Compulsive DisorderOpens in new window, ritualistic compulsions and obsessions do not characterize this personality disorder.

Clinical Presentation

The Obsessive-Compulsive Personality Disorder can be recognized by the following behavior and interpersonal styles, cognitive style, and emotional style. Behaviorally, this disorder is characterized by perfectionism. Individuals with this disorder are likely to be workaholics.

In addition to dependability, they tend to be stubborn and possessive. They, like passive-aggressive-disordered individualsOpens in new window, can be indecisive and procrastinating. Interpersonally, these individuals are exquisitely conscious of social rank and status and modify their behavior accordingly. That is, they tend to be deferential and obsequious to superiors, and haughty and autocratic to subordinates and peers. They can be doggedly insistent that others do things their way, without an appreciation or awareness of how others react to their insistence. At best, they are polite and loyal to the organizations and ideals they espouse.

Their thinking style can be characterized as constricted and rule based. They have difficulty establishing priorities and perspective. They are “detail” people and often lose sight of the larger project. In other words, they “can’t see the forest for the trees.” Their indecisiveness and doubts make decision-making difficult.

Their mental inflexibility is matched by their non-suggestible and unimaginative style, suggesting they have a restricted fantasy life. Like passive-aggressive individualsOpens in new window, the obsessive-compulsives have conflicts between assertiveness and defiance, and pleasing and obedience.

Their emotional style is characterized as grim and cheerless. They have difficulty with the expression of intimate feelings such as warmth and tenderness. They tend to avoid the “softer” feelings, although they may express anger, frustration, and irritability quite freely. This grim, feeling-avoidant demeanor shows itself in stilted, stiff relationship behaviors.

DSM-5 Characterization

Individuals with this personality disorder are characterized by an unremitting pattern of perfectionism, orderliness, and control, instead of flexibility, openness, and efficiency. They are overly preoccupied with details, rules, and schedules.

Their perfectionism interferes with completing tasks, due to their overly strict standards. They are overly devoted to work and productivity to the exclusion of leisure activities and friendships. When it comes to matters of values, morality, or ethics, these individuals are inflexible, scrupulousOpens in new window, and overconscientious.

Often, they are unable to discard worn-out or worthless objects that have no sentimental value. They will not delegate tasks or work with others unless it can be on their terms. Not surprisingly, these individuals are also rigid and stubborn. Finally, they are misers with money, and it is hoarded in the event of future catastrophes (American Psychiatric Association, 2013).

Case Example: Mr. O.

Mr. O. is a 37-year-old male business executive who wanted to begin a course of psychotherapy because his “whole world was closing in.” He gave a history of longstanding feelings of dissatisfaction with his marriage, which had worsened in the past two years. He described his wife’s increasing demands for time and affection from him, which he believed was a weakness she had.

His professional life also had become conflicted when his partner of ten years wanted to expand their accounting firm to another city. Mr. O. believed this proposal was fraught with dangers, and had come to the point of selling out his share of the business to his partner.

He knew he had to make some decisions about his marriage and his business but found himself unable to do so. He hoped therapy would help with these decisions. He presented as neatly dressed in a conservative three-piece gray suit. His posture was rigid and he spoke in a formal and controlled tone with constricted affect. His thinking was characterized by preoccupation with details and was somewhat circumstantial.

Biopsychosocial – Adlerian Conceptualization

The following biopsychosocial formulation may be helpful in understanding how the Obsessive-Compulsive Personality Disorder is likely to have developed. Biologically, these individuals were likely to have exhibited an anhedonic temperament as an infant (Millon, 2011). Interestingly, firstborn children have a greater propensity for developing a compulsive style than other siblings (Toman, 1961).

Psychologically, these individuals view themselves, others, the world, and life’s purpose in terms of the following themes. They tend to view themselves with some variant of the theme: “I’m responsible if something goes wrong, so I have to be reliable, competent, and righteous.” Their world-view is some variant of the theme: “Life is unpredictable and expects too much.” As such, they are likely to conclude, “Therefore, be in control, right, and proper at all times.”

Socially, predictable patterns of parenting and environmental conditioning are noted for this personality. The parenting style they experienced could be characterized as both consistent and overcontrolled.

As children they were trained to be overly responsible for their actions and to feel guilty and worthless if they were not obedient, achievement oriented, or “good,” The parental injunction to which they were most likely exposed was: “You must do and be better to be worthwhile.”

This obsessive-compulsive pattern is confirmed, reinforced, and perpetuated by the following individual and systems factors:

Exceedingly high expectations plus harshly rigid behavior and beliefs, along with a tendency to be self-critical, lead to rigid rule-based behavior and avoidance of social, professional, and moral unacceptability.

This in turn further reconfirms the harshly rigid behaviors and beliefs of this personality.

Treatment Considerations

The Obsessive-Compulsive Disorder (OCD)Opens in new window has a long tradition of treatment, dating back to Freud’s case of the “Rat Man” and Adler’s “Case of Mrs. A.” Note that OCD Opens in new windowis a symptom disorder, while the Obsessive-Compulsive Personality Disorder is a personality disorder.

Since the “Rat Man” exhibited both symptom and personality disorders, many who have read Freud’s account of this case and its treatment have incorrectly assumed that both disorders are the same and are treated the same.

They are not the same condition, but in about one-third of cases, both disorders have been shown to be present (Jenike, Baer, & Minichiello, 1990).

When both disorders are present together, treatment has been shown to be much more challenging than if only OCD is present.

The goals of treatment include increased cognitive constriction and increased feeling expression, so that a more reasonable balance can be obtained between thoughts and feelings.

Treatment strategies for the Obsessive-Compulsive Personality Disorder usually involve long-term, insight-oriented therapy. Unlike the Obsessive-Compulsive DisorderOpens in new window, where antidepressantsOpens in new window plus behavior therapy can result in amelioration of obsessionsOpens in new window and compulsionsOpens in new window in a relatively short period of time, the Obsessive Compulsive Personality Disorder does not lend itself to short-term treatment outcomes. However, Salzman (1968) and Turkat and Maisto (1985) offered dynamic and cognitive behavior intervention that has proved effective. Medication is usually not needed with this disorder but may be effective for treatable symptoms such as depression and anxiety.