Obsessive-Compulsive Personality Disorder

When you hear the term OCPD you may think you know what this means. A common insight of this disorder is a person who is extremely neat or simply a person who organizes his work. Throwaway phrases, such as “That’s so OCD”, can underestimate the disorder as a character quirk that anyone can exhibit on a whim.

It is important to learn that Obsessive-Compulsive Disorder and OCPD are different disorders. In this article, we are going to discuss the diagnoses of OCPD, the difference between OCD and OCPD, and the treatments that are currently available.

What is OCPD?

Obsessive-Compulsive Personality Disorder is defined by a persistent and rigid fixation with organisation, extreme perfectionism, and maintaining control in all situations. A person with OCPD will overlook the original goal of a task they are doing in favour of perfecting the details of the task. These personality traits typically hinder the individual in completing ordinary daily errands and sustaining interpersonal relationships.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), about 2% of us have OCPD. A 2018 report by SANE Australia also estimated that OCD is the most common of all personality disorders.

What is the difference between OCPD and OCD?

Obsessive-Compulsive Personality Disorder is often confused with the well-known anxiety disorder OCD. People with OCD have unwanted and irrational thoughts that drive them to repetitive behaviours i.e. compulsions such as counting numbers/actions, ritualised handwashing and repeatedly checking door locks/car locks. Completing these compulsions helps to dispel anxious feelings and thoughts, however, the person is likely aware that their compulsions are unrealistic and can feel distressed as a result. In contrast to this, a person with OCPD does not have these compulsions, but instead an inflexible view of life and adherence to extreme standards. This on its own is not a negative, and many people with OCPD may excel in their careers due to their level of focus; however, they will persist with their rigid routines even if it is negatively impacting their lives. They are not known to be described as approachable or relaxed, and their inflexibility and obsession with details tend to lead to difficulty in maintaining relationships and a display of perceived antisocial behaviour. People with OCPD are steadfast in their beliefs and fully resolved that their actions are “right”. They are often quick to anger when someone disagrees with them and may feel the need to impose their views on those around them. They have no awareness that their habits may be negatively impacting their efficiency in work or engagement in relationships. There is currently no known cause of OCPD, however, it is suspected to be a combination of cultural norms, childhood experiences and genetics.

What are personality disorders?

Briefly, personality disorders are long-standing behaviours, ways of operating and seeing and understanding the world around us which are different from most other people. Generally, these ways of thinking and functioning are quite rigid and cause problems in various ways for the person and those around them. OCPD is considered to be one type of personality disorder.

What are the signs and symptoms of OCPD?

A person with Obsessive-Compulsive Personality Disorder may present with behaviours such as:
  • Excessive list-making and schedule planning
  • Rigid adherence to rules that others would consider insignificant
  • An extreme need to be punctual
  • Formal or stiff mannerisms that may appear as antisocial
  • Obsessing over minor details of a task so much so that it is left unfinished
  • Hoarding or an unwillingness to throw out ruined and worthless objects
  • A refusal to delegate tasks as others may not do the task the “right way”
  • An excessive devotion to work in place of engaging in social relationships
  • A belief that everything will be fine if things are done the way they perceive they should be
You do not need to present with all the symptoms listed above to be diagnosed but will likely exhibit a consistent pattern of three or four of the behaviours. The typical onset of these symptoms is late adolescence to early adulthood.

How is OCPD diagnosed?

A clinical diagnosis of OCPD can be made when a pattern of certain behaviours results in a substantial negative impact on the person’s work life, social life, and familial relationships. While there isn’t a specific physical test, such as taking a blood sample, a doctor can speak to a person about their behaviour and how they feel this is affecting their life. The doctor may also need to speak to the person’s close relatives or friends to accurately assess their day-to-day actions. Counselling sessions may also prove useful to the diagnosis of OCPD. After a few counselling sessions, a referral to the doctor may be recommended if there is a presenting suspicion of OCPD.

How does Obsessive-Compulsive Personality Disorder affect relationships?

How you interact with others on a regular basis and your social circle is a strong clinical indicator of OCPD. A relationship, whether it be familial, friendly, or romantic, is not a priority for someone with OCPD. They prefer to focus on getting things done the correct way and this often stands in the way of maintaining their relationships. Having a loved one with OCPD can be difficult. They may be overly critical, want to take control of every situation and be unwilling to hear other opinions on how things should be done. On the other hand, they can also be driven and hardworking, and this can help to repair the relationships when their strengths are focused on the right place. As someone with OCPD is so preoccupied with the minute details of daily life, they have little recognition of their own feelings and the feelings of others. This means open communication with their partners does not come naturally to them and they may not understand why their partner is upset with them or how to resolve it. They may appear to be indifferent at times, and neglectful of their loved ones. As the person with OCPD may not feel they need to change, improvements to their relationships can only be made through seeking and participating in treatments. At Epsychiatry, the benefits of family consultations will be discussed with you in order to involve your loved ones in your treatment of care.

What treatments are available?

It is common for a person with OCPD to be unaware that they require treatment and it can take a significant life change or perhaps, the encouragement of a loved one to motivate them to seek help Once appropriately motivated, there is a range of treatments for OCPD:

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy (CBT) is a practical approach to treating a wide range of mental health disorders. The premise for this therapy is that strong emotions can be challenging to change direction, so the therapy works on changing the negative thoughts and actions that lead to these emotions. CBT relies on the mind-body connection, meaning that a person’s thoughts, emotions, actions, and physical experiences are all interlinked. The aim is to interrupt the negative thought cycle, which in turn leads to negative feelings and physical symptoms. In comparison to traditional talk therapy, CBT concentrates on specific problems and uses a goal-orientated approach over a short period to combat these concerns. CBT is usually structured over 6-8 weeks, although this can vary from patient to patient, and will be decided between the individual and their therapist in the initial session. A typical CBT session involves:
  1. Identifying a current problem that is causing stress
  2. Recognising the thoughts and feelings that relate to this problem
  3. Identifying unreasonable and inaccurate perceptions
  4. Reshaping this perception
CBT can be particularly effective for Obsessive-Compulsive Personality Disorder because the person likely has inflexible and stubborn beliefs that can take much longer to overcome through talking therapy. Think of CBT as a high-intensity treatment over a short period, with clear goals to be reached at the end. This approach can be attractive to people with OCPD as they are generally extremely focused and enjoy detailed plans. Contact us at Epsychiatry to avail of our telehealth online services and treatments. Our psychologists have years of experience in delivering CBT and you can access this now. Traditional Talk Therapy Talk therapy is an industry standard when it comes to the treatment of mental health disorders. Studies have shown that this form of therapy can help alleviate negative thoughts and feelings through expressing your worries about distressing life events or general mental health concerns you may have. Talk therapy involves seeking out or being referred to a licenced professional therapist. You will meet with your chosen therapist for an initial session where they will guide you to discuss the underlying reason why you are seeking therapy and what outcome you would like to achieve. Professional therapists are trained active listeners, and this helps the patient to feel that what they are saying is important and that they are valued as a person. Talk therapy gives each patient the opportunity to explore the root of their negative thoughts and how this can have a knock-on effect on a person’s mood and behaviour. A therapist can also give gentle advice on techniques that can combat the negative thought-action cycle that may be occurring. This can be invaluable to patients with Obsessive-Compulsive Personality Disorder if they are willing to fully commit to the therapy by being open and honest and accepting the advice that is given. Talk therapy can also be advised in combination with a variety of other treatments. Prescribed Medications Your doctor may discuss with you the possibility of trailing prescribed medications to treat Obsessive-Compulsive Personality Disorder. They are more likely to prescribe medication if there is also a co-occurring depression or anxiety disorder along with OCPD. SSRIs treat the symptoms of OCPD by increasing the levels of serotonin in the brain. Serotonin often called the “happy hormone”, is known to naturally stabilize your mood and help you feel happier, calmer, and less anxious. Many studies have shown that a deficiency in serotonin is associated with depression, anxiety, and a variety of personality disorders. Medication is not the first line of treatment for Obsessive-Compulsive Personality Disorder, and doctors typically prefer to advise this in cases where other therapies have proved ineffective or there is a co-occurring depressive or anxiety disorder. You should discuss all your options with your doctor in order to make an informed decision. Relaxation Techniques  Specific relaxation techniques have also proved useful in treating the symptoms of Obsessive-Compulsive Personality Disorder. The most universal technique that is suggested by healthcare providers is called Progressive Muscle Relaxation (PMR). This technique guides you to tighten and relax your muscles in a particular order so that you may recognise where you are holding tension in the body and work to release this tension. The idea is that you can relax your body gradually by tensing and releasing the muscle groups. When performed regularly, PMR has been shown to relieve the physical symptoms of OCPD, as well as many other benefits such as regulating blood pressure and an improved sleep cycle.


What is the prognosis of Obsessive-Compulsive Personality Disorder?

At present, there few studies of adequate scale to adequately assess the prognosis of a person with Obsessive-Compulsive Personality Disorder who is receiving treatment. The treatments are promising; however, a lack of self-awareness and the presence of co-morbidities can act as a barrier to treatment.

While the treatments appear effective, it is evident that it may take significant time to see results. Therefore, the sooner treatment is prescribed, the better the prognosis.

If you suspect that you or a loved one may have Obsessive-Compulsive Personality Disorder, you should arrange to speak to a medical professional as soon as possible to discuss the treatment options.

You can be referred to a psychiatrist or psychologist at Epsychiatry for an assessment and possible treatment. Speak with your GP for a referral.