OCPD: Signs & Symptoms & 7 Tips to Overcome Obsessive-Compulsive Personality Disorder

What is OCPD? Explained with an Example

Close your eyes and imagine the God of Perfectionism, In fact, perfectionism to the power of infinity! If you happen to come across this God, then you will know that they want everything to be just right, and the slightest deviation from the plan is not only unwelcome but highly intolerable. 

These Gods just don’t exhibit ‘self-oriented perfectionism’ i.e. “my rules aren’t just for me”, but they also exhibit ‘other-oriented perfectionism’ i.e. “my rules are also meant for others”. Please don’t misunderstand this with Narcissism. 

Unlike Narcissism, they are not full of themselves or manipulate others, they are obsessive and hyper-aware, observing minute details and the slightest change, driven by rules, and having a sense of certainty of what's best.

Medically such people may be diagnosed with Obsessive Compulsive Personality Disorder (OCPD).OCPD is a mental health condition characterized by a chronic and pervasive preoccupation with rules, orderliness, and control, at the expense of efficiency, openness, and flexibility.

People with OCPD are often seen to have significant distress in their socio-occupational functioning, and interpersonal relationships and can be tough for loved ones to deal with. Just like other personality disorders this maladaptive pattern of behavior often has its onset in adolescents or early adulthood and solidifies in personality over time. 

Although OCPD traits are seen among 2–7% of the healthy population and 23–26% of clinical populations, it still remains a relatively underdiagnosed and under-researched mental health condition.

It’s important to understand here that Obsessive-Compulsive Personality Disorder (OCPD) is not the same as obsessive-compulsive disorder (OCD). While OCD involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at reducing anxiety, OCPD is characterized by a chronic preoccupation with order aimed at perfectionism.

Unlike individuals with OCD, individuals with OCPD may not have insight into their personality issues and believe their way of thinking and behaving is the correct and best way, often leading to inflexibility and control issues. 

This perfectionistic approach to life can impair their interpersonal relationships and daily functioning. In contrast to OCD, people with OCPD may not see their behavior as problematic. In fact, they might even take pride in their meticulousness and expect others to do the same.

This confusion of OCD versus OCPD is not something new. If you are confused and would like to know which of the ones you or a loved one may be having, it’s recommended to ask your psychiatrist and get evaluated. 

Let’s explore the various facets of OCPD in this article including its types, signs & symptoms, causes, diagnostic criteria, tests, treatment options, and symptomatic management

4 Types of OCPD[Obsessive-Compulsive Personality Disorder]

OCPD can manifest in different forms and is often categorized based on the following predominant traits:

1. The Controlling: Characterized by a strong need to control their environment and the people in it.
2. The Perfectionist: Driven by an overwhelming need for perfection in all tasks.
3. The Hoarding: Exhibits hoarding behaviors, accumulating items of little or no value.
4. The Workaholic: Excessive devotion to work, often at the expense of personal relationships and leisure activities. Learn more about how OCPD affect relationships and marriage.

It is also possible that OCPD can manifest as a combination of the above types and a clear differentiation of specific types may not be evident.

Understanding the Signs and Symptoms of OCPD: The Case of Anushka

Anushka (name changed) is a 29-year-old aeronautical engineer who describes herself as hardworking and driven by purpose. 

In her words “I hate leisure, I don’t even know why people seek that? If you love your work, you love every moment you spend on your work and there is no space for complaints” she added further. "It's tough when people around me overlook their responsibilities. If a work is not done at its best then it’s better not done”.  

Anushka was diagnosed with OCPD. Here is what her history, psychiatric evaluation, detailed personality assessment, and information taken from family members revealed:

• Anushka has an extreme preoccupation with order, rules, and perfectionism. She values discipline over everything else. She always wants to be in control of herself and her environment. This trait of hers interferes with being flexible, effective, and open to changes. She comes up as Rigid and stubborn in her activities and insists that everything be done in a specific way.
• Anushka focuses on rules, minute details, procedures, schedules, and lists to maintain a sense of control. As a result, the main point of a project or activity is lost. She checks repeatedly for mistakes and pays extraordinary attention to detail. History from her family members indicates she is not able to make good use of her time, often leaving the most important tasks until the end. This preoccupation with perfectionism endlessly delays her completion of the task at hand. She is not aware that this affects her coworkers as when focused on one task, she tends to neglect all other aspects of her work and life.
• Since Anushka wants everything to be done in a specific way, she has difficulty delegating tasks and working with others. When working with others, she makes detailed lists about how a task should be done and gets upset if a coworker suggests an alternative way. This disables her in the form of micromanagement. She also rejects help even when she is behind schedule.
• Anushka is extremely dedicated to work and productivity. Her history supports that there is no financial necessity for such dedication. She neglects leisure activities and relationships and thinks she has no time to relax or go out with friends. She often postpones a vacation or takes work with her to vacation, so that she does not waste time. She considers hobbies and recreational activities as important tasks requiring organization and hard work to master, as in this as well, the goal is perfection.
• She likes to plan in great detail and does not want to consider changes in her plans. Her relentless rigidity often frustrates coworkers, friends, and family members.
• Her family members informed her that she is not expressive. She tightly controls her expression of affection. She comes up as someone who is formal, stiff, or serious in social settings. Often, she speaks only after she has thought of the perfect thing to say. She tends to focus more on logic and intellect and is intolerant of emotional or expressive behavior.
• She often behaves in a way where she comes up as overzealous, picky, and rigid about issues of morality, ethics, and values. She has high unattainable moral standards and often is harshly self-critical. She is rigidly deferential to authorities and insists on exact compliance with rules, with no consideration for exceptional circumstances.

What are the 4 Causes of Obsessive-Compulsive Personality Disorder[OCPD]?

The exact cause of OCPD is unknown, but it is believed to result from a combination of various factors like genetic, biological, environmental, and psychological.

1.Factors of Genetic Disposition: 

Research suggests that OCPD may run in families, indicating a potential genetic predisposition. Individuals with a family history of personality disorders or mental illness may be at higher risk.

2.Factors of Biological Disposition:

Research says individuals with OCPD exhibit altered spontaneous neural activity as compared to healthy controls in more than many brain regions, which may reflect different characteristic symptoms like cognitive inflexibility, excessive self-control, lower empathy, and visual attention bias. Neurobiological studies also indicate imbalances in neurotransmitters, such as serotonin, might contribute to the development of OCPD. These chemical messengers play a critical role in regulating mood and behavior.

3.Factors of the Environment:

Childhood experiences and upbringing significantly influence personality development. Children raised in highly controlling or overprotective environments may develop perfectionistic tendencies and an excessive need for control.

4.Factors of the Mind:

Early experiences of strict discipline, high parental expectations, and lack of emotional warmth can contribute to the development of OCPD. Individuals might develop rigid thinking patterns and an excessive need for order to cope with their environment.

We've covered Impacts of Obsessive-Compulsive Personality Disorder on Relationships and Daily Life

How is OCPD Diagnosed and tested?

Evaluation of OCPD: A Categorical & Dimensional Approach

Since OCPD is a clinical condition, a detailed clinical assessment is essential to differentiate OCPD from OCD and other personality disorders. 

The DSM-5 diagnostic criteria, released in 2022 in the DSM-5-TR, presents two separate methods for diagnosing OCPD: 

1. The categorical approach and 
2. The dimensional approach. 

While the categorical approach has been much criticized in recent times, due to its rigid categories and lack of flexibility, the dimensional approach provides more flexibility and consideration for overlap between various personality disorders.

The Categorical Approach

As per this approach, OCPD includes a pervasive pattern of preoccupation with orderliness, perfectionism, and control, at the expense of flexibility, openness, and efficiency.

Diagnosis requires at least four of the following criteria:

1. Preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Perfectionism that interferes with task completion.
3. Excessive devotion to work and productivity to the exclusion of leisure activities and friendships.
4. Over-conscientiousness, scrupulousness, and inflexibility about matters of morality, ethics, or values.
5. Inability to discard worn-out or worthless objects even when they have no sentimental value.
6. Reluctance to delegate tasks or to work with others unless they submit to exactly their way of doing things.
7. Miserliness in spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Rigidity and stubbornness.

The Dimensional Approach

The dimensional approach is an alternative model for diagnosing OCPD. This approach perceives personality disorders as a spectrum of personality dysfunctions across various domains and seeks to measure the extent of these dysfunctions by offering a more detailed understanding of the functions of a particular personality. 

As per this approach, there is moderate or severe impairment in personality functioning if there is the presence of characteristic difficulties in 2 or more of the following areas:

• Identity: The sense of self is derived predominantly from work or productivity; there is a constricted experience of strong emotions.
• Self-direction: There are difficulties completing tasks and realizing goals associated with rigid and unreasonably high and inflexible internal standards of behavior; individuals are overly conscientious and have moralistic attitudes.
• Empathy: There is difficulty understanding and appreciating the ideas, feelings, or behaviors of others.
• Intimacy: Relationships are seen as secondary to work and productivity and interpersonal relationships are negatively affected by rigidity and stubbornness.

This approach also states the individual must exhibit rigid perfectionism characterized by the following:

• A demand for perfection and flawlessness in all tasks resulting in missed deadlines
• A pervasive belief in one correct method 
• A reluctance to adopt the views of others
• A focus on detail and order

 In addition to rigid perfectionism, the individual must exhibit 2 of the following 3 traits:

• Perseveration: characterized as persistence at tasks long after the behavior has ceased to be functional or practical.
• Intimacy avoidance:  characterized by avoiding close or romantic relationships, interpersonal attachments, and intimate sexual relationships.
• Restricted affectivity: exhibited as demonstrating little reaction to emotionally arousing situations, a constricted emotional experience and expression, and indifference or coldness.

OCPD Test and Assessment Tools

Mental health professionals use standardized assessments and diagnostic criteria, such as the DSM-5 or ICD-11, to evaluate symptoms and determine the presence of the disorder. Some of these assessment tools include:

• Minnesota Multiphasic Personality Inventory (MMPI-3)
• Millon Clinical Multiaxial Inventory (MCMI-IV)
• Personality Inventory for DSM-5 (PID-5) 

Treatment for OCPD and Clinical Management of Symptoms

OCPD treatment typically requires a combination of psychotherapy, medication, and self-help strategies as discussed below:

1.Medications for OCPD

There are no OCPD medications particularly or for that matter any personality disorders. In most cases, personality disorders may have associated symptoms of depression, anxiety, or aggression.

In that case, medications, such as selective serotonin reuptake inhibitors (SSRIs), are commonly administered to manage symptoms of anxiety and depression that often accompany OCPD. While medication alone is not a cure, it can be a valuable component of a comprehensive treatment plan.

2.Psychotherapy for OCPD

OCPD therapy can include various therapeutic approaches or a combination of therapeutic approaches as below:

• Psychodynamic therapy: This form of therapy aims to help individuals uncover the underlying defense mechanisms and emotional insecurities that manifest as a need for perfectionism and rigid behaviors. This facilitates gaining self-awareness and individuals can adopt more flexible behavioural patterns.
• Cognitive-behavioral therapy (CBT): This form of therapy employs cognitive and behavioral strategies to modify dysfunctional thought patterns and behaviors in individuals with OCPD. CBT helps individuals recognize and change maladaptive thought patterns and behaviors and focuses on developing flexibility, improving emotional regulation, and reducing perfectionistic tendencies.
• Trauma-focused Psychotherapy: Trauma-focused therapy can be beneficial for individuals with OCPD, particularly if past traumas have contributed to the development of rigid thinking and control issues. By addressing and processing these underlying traumas, therapy can help reduce perfectionistic tendencies and improve emotional flexibility, leading to better overall management of OCPD symptoms.
• Interpersonal therapy (IPT): This form of therapy focuses on improving communication skills and resolving interpersonal conflicts. By enhancing relational dynamics and addressing the rigid thinking patterns that strain relationships, IPT can help individuals with OCPD build healthier, more flexible social connections.

Check our article on Mental Health and Therapy, Know What Happens in Therapy Session and explore alternative Mental health therapies.

7 Self-Help Tips for Overcoming OCPD

Overcoming Obsessive-Compulsive Personality Disorder (OCPD) involves awareness and insight into maladaptive personality traits, recognizing the problem, seeking professional help, and adopting strategies to manage symptoms and enhance quality of life. 

Here are 7 effective strategies to help manage and overcome OCPD:

1.Manage Stress Effectively: 

Stress is the beginning of all mental health issues. Recognizing any deviations in sleep, appetite and mood is important to manage stress. Make use of relaxation techniques such as meditation, yoga, and deep breathing exercises to reduce stress and increase awareness of your thoughts and feelings.

Regular practice can improve emotional regulation, reduce anxiety, and promote a sense of calm. Lifestyle modification around sleep, diet, and exercise can go a long way to help manage stress better.

2.Practice Self-Compassion: 

Self-care is not complete without kindness for self. It’s important to accommodate flaws and shortcomings of self, as they form the very essence of being human. Cultivate self-compassion by treating yourself with kindness and understanding. Mindfulness-based practices can help you stay present and reduce the tendency to be overly critical of yourself and accept flaws.

3.Set Small, Achievable Goals: 

Individuals with OCPD often set unrealistically high standards. Learning to set realistic, achievable goals can reduce feelings of inadequacy and frustration. Break tasks into smaller, manageable steps and celebrate progress, even if it’s not perfect.

Seeking perfection is a hypothetical concept, the more perfectly you do it, the more scope it has to be perfected and it can feel like an unending process beyond the point of necessity. 

4.Engage in Productive Self-Talk: 

Words have a direct correlation with our subconscious mind. What others tell you is not as important as what you tell yourself. Make sure the words you tell yourself are kind and full of compassion. Labeling yourself, blaming, and criticizing yourself can have a deep impact on your mind, where your mind starts identifying the way you describe yourself.

Develop a habit of positive and productive self-talk. Challenge negative thoughts and replace them with affirming and encouraging statements to boost your confidence and motivation.

5.Volunteer for Unstructured Activities: 

Volunteering in roles that require flexibility and adaptability can help you practice letting go of control. Consider participating in Community Services, choose volunteer opportunities that involve working with diverse groups of people or unpredictable environments, where you develop the flexibility to accommodate imperfections and flaws in the process. You can also participate in planning community events to learn to adapt to last-minute changes and collaborate with others.

6.Participate in Adventure and Outdoor Activities: 

Engaging in adventure sports or outdoor activities can push you out of your comfort zone and help you embrace uncertainty. For example, you may consider Rock Climbing. This sport requires trust in your partner and equipment, helping you build resilience and confidence in unpredictable situations.

Another example is Orienteering or Trekking. This involves navigating unfamiliar terrain with a map and compass and can help you develop problem-solving skills and adaptability.

Developing flexibility in thinking and behavior is crucial for managing OCPD. Practice being open to new ideas and different ways of doing things. Challenge rigid beliefs and try to adapt to changes more comfortably, allowing some tasks to be completed imperfectly.

7.Seek Professional Help: 

If nothing works for you and you have tried everything. Then the first step in managing OCPD is to seek professional help from a mental health professional. Psychotherapy, particularly cognitive-behavioral therapy (CBT), is effective in treating OCPD.

A therapist can help you recognize and change maladaptive thought patterns and behaviors. Medications, such as selective serotonin reuptake inhibitors (SSRIs), may also be prescribed by your Psychiatrist to help manage symptoms of depression and anxiety if present and pose a barrier to you overcoming OCPD.

Do check we've covered How to overcome OCD?

Conclusion

Life is all about balance. Mental health conditions often result when we engage excessively in the extremes without awareness. Obsessive-Compulsive Personality Disorder is a challenging condition that requires understanding, patience, and effort to manage. By insight, awareness, and the right treatment individuals can take proactive steps toward recovery, lead fulfilling lives, and maintain a healthy balance between order and spontaneity. 

At Mave Health, we embark on a journey to deepen our understanding of mental health through a comprehensive approach. Our dedication lies in empowering individuals by creating a space where they find meaningful solutions to their existing mental health concerns, offering a transformative experience in mental health care. 

If you're seeking solutions, Mave Health backed by a team of specialized experts has been enhancing lives for over the past few years. Utilizing evidence-based, holistic, personalized, gold-standard treatment methods, we help individuals manage psychiatric disorders effectively. Reach out to us today to book a consultancy. Let’s aim to get comfortable with the uncomfortable!

Reference: 

Obsessive-Compulsive (Anankastic) Personality Disorder in the ICD-11: A Scoping Review

Obsessive-Compulsive Personality Disorder (OCPD) ByMark Zimmerman, MD, South County Psychiatry

Altered spontaneous brain activity in obsessive-compulsive personality disorder

Obsessive-Compulsive Personality Disorder Abid Rizvi; Tyler J. Torrico