The final personality disorder in the current diagnostic system is Obsessive-Compulsive Personality Disorder (OCPD). First, I’ll explain why OCPD is not the same as Obsessive-Compulsive Disorder (OCD).
In OCD, someone’s obsessions and compulsions are entirely subjective, and individual to them. While the person knows their obsessions and fears are irrational, they feel forced to listen to those fears. At the core of OCD are ingrained if-then loops: if the person does not listen to those fears, something bad will happen to them or people they care about. If the person carries out their compulsions – either activities or rituals of specific thoughts – then they have briefly stopped those negative things from happening
As a stereotypical example, consider a person with OCD whose particular obsession and compulsion centres on locking doors. The person may need to spend an hour checking that every door in their house is locked before leaving, to prevent the overwhelming consequences of leaving one unlocked. However, they will not think differently of their family members for being able to leave after checking once. They may envy their family for being free from that worry and may feel guilty over how the time spent checking intrudes upon other family members.
In OCPD, the person’s rules and beliefs are not subjective and personal. They see their rules and methods as “objectively” correct, regardless of how complex, rigid or time consuming their approach may appear to others. Someone with OCPD who had specific rules about the correct location of every item in their house would require everyone else to abide by those rules exactly. If a housemate wanted to do things differently, the person with OCPD would see them as incorrect, illogical, or even morally wrong.
The DSM-V describes OCPD as a pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal control, which comes at the expense of flexibility, openness, and efficiency. In the ICD, it is instead known as Anankastic PD (Anankastic is an older synonym for compulsive, which was most popular in the 1960s).
To be diagnosed with OCPD, a person must have at least 4 of these criteria:
- They are so preoccupied with details, rules, lists, organization, or schedules that they miss the main point of activities.
- They are so perfectionistic that it stops them completing tasks e.g. they can be unable to complete projects because they can’t meet their own overly strict standards
- They are devoted to working and productivity ahead of anything else including leisure activities and friendships. (Only if this is not caused by obvious financial need)
- They are overconscientious, scrupulous, and rigid about morality, ethics, or values. (Only if this is not better explained by their personal culture or religion)
- They struggle to discard worn-out or worthless objects, even when they have no sentimental value
- They refuse to delegate tasks or to work with others unless others work exactly as they would
- They are miserly, and hoard money in case of future catastrophes.
- They are rigid and stubborn
OCPD is rarely written deliberately into a character, perhaps as it’s a little-known condition. However, characters described as having OCD can often be shown to have the controlling nature of OCPD rather than the anxious nature of OCD. An example of this is Sheldon Cooper from The Big Bang Theory. Sheldon relies on a very rigid structure in his life and is unable to do anything which breaks this structure. He throws away an untouched breakfast made for him because it was made on the wrong day of the week. He also applies this structure to his friends and especially to his room-mate Leonard, who has to obey an incredibly detailed “room-mate agreement” in order to stay with him. Sheldon is not written as having OCPD, but his character does demonstrate how the rigidity of someone with OCPD can impact their lives and relationships.
Studies have found that between 1.7% and 7.8% of people will experience OCPD at some point in their life. As you would expect, it is correlated with having OCD- in one study, 27% of people with OCD also had OCPD. However, this estimate might be unrealistically high because of how similar their diagnostic criteria appear from the outside. The most-used treatment method for OCPD is long-term counselling, which aims to help the person understand why they fear change and imperfection and to help them understand that other people can’t be expected to conform to their rigid rules. People with both OCPD and OCD, or OCPD plus an anxiety disorder, can also take antidepressants to help reduce their anxiety.
Psychological Criticisms of OCPD
As many people with OCPD see their approach as justified and correct, OCPD is often identified only when it becomes a problem for others. Family members who become upset by the controlling atmosphere a person with OCPD creates may lay down an ultimatum, while employers may be confused by the person’s inefficiency and difficulty working with others.
Although personality disorders are ostensibly defined by behaviour which is significantly against cultural norms, OCPD conflicts with this definition. Western culture celebrates hard-working, always-busy perfectionists, and so socially rewards many traits of OCPD. Because people are often praised for working themselves too hard, OCPD may be undetected until it causes dysfunction in other ways. A person may need to experience a breakdown or crisis before the depths of their perfectionism are revealed.
Finally, previous studies on OCPD have discussed the lack of exact data about OCPD. Over time, people are more likely to stop fitting the diagnostic criteria for OCPD than they are for most other PDs (although DPD and NPD were even less stable). This could be because the diagnostic criteria for OCPD have changed significantly over time as psychiatrists have tried to get more information about the condition and its effects. Some researchers believe that OCPD may be a neurologically-based condition instead of a personality disorder, as many people with Parkinson’s disease experience personality changes that strongly resemble OCPD. Others believe there is not yet enough information to say what type of condition OCPD may be, or even to be sure it actually is a unique condition.
So, that completes the list of current PDs. I hope these explanations were useful, as I’ll probably return to discussing more aspects of PDs and psychiatric diagnoses in future posts.