Obsessive-Compulsive Personality Disorder
Cluster C. Anxious / Fearful · Table 9.2 [1]
Pervasive preoccupation with orderliness, perfectionism, and control at the expense of flexibility, openness, and efficiency.
Characteristics (Table 9.2) [1]
| Triggering Event(s) | Demands of authority figures; unstructured situations, and/or demands of intimate and close relations |
|---|---|
| Behavioral Style |
|
| Interpersonal Style |
|
| Cognitive Style |
|
| Affective Style |
|
| Temperament | Irritable, difficult, or anxious |
| Attachment Style | Preoccupied |
| Parental Injunction | Grew up believing worth had to be earned by doing and being ever better. |
| Self-View | Holds the self accountable whenever anything goes wrong. |
| World-View | Views life as unpredictable and overly demanding, so aims to stay in control, do things correctly and properly, and avoid mistakes. |
| Maladaptive Schemas |
|
| Optimal Diagnostic Criterion | Perfectionism so exacting that it gets in the way of finishing tasks. |
DSM diagnostic criteria
A far-reaching preoccupation with order, perfectionism, and control over one's mind and relationships, at the cost of flexibility, openness, and efficiency, present from early adulthood.
- Fixates on details, rules, lists, order, organization, or schedules until the main purpose is lost.
- Sets standards so perfectionistic that tasks go unfinished.
- Over-invests in work and productivity, crowding out leisure and friendships.
- Is rigidly overconscientious and scrupulous about morals, ethics, or values.
- Cannot bring themselves to throw out worn or useless items even absent any sentimental attachment.
- Hesitates to hand off tasks unless others agree to do them exactly their way.
- Spends miserly on self and others, stockpiling money against imagined future disasters.
- Comes across as rigid and stubborn.
- Obsessive-compulsive disorder (true obsessions/compulsions, ego-dystonic)
- Narcissistic PD (perfectionism in service of grandiosity)
- Hoarding disorder
- Autism spectrum disorder (rigidity with social-communication deficits)
Treatment
- Increase cognitive and behavioral flexibility
- Improve access to and expression of emotion
- Reduce perfectionism, procrastination, and over-control
Engage the patient's competence and conscientiousness while loosening rigid rules and the 'mistakes are catastrophic' stance. Counter intellectualization by gently directing attention to affect and the relational costs of control; use experiments that make flexibility safe.
- Cognitive therapy (rigidity, unrelenting standards)
- Schema therapy (unrelenting standards, emotional inhibition)
- Emotion-focused / psychodynamic work on affect avoidance
- Behavioral experiments testing the cost of 'good enough' vs. perfect.
- Cognitive work on unrelenting-standards and punitiveness schemas.
- Scheduling leisure and connection as deliberate, valued tasks.
- Affect-labeling to counter feeling avoidance and intellectualization.
- Intellectualization and control enacted in the therapy itself
- Difficulty tolerating the ambiguity of emotion-focused work
- Perfectionism applied to 'being a good patient'
Good; conscientiousness and a strong work ethic support engagement once the patient experiences flexibility as safe.
Practise this presentation
For training only. Diagnostic criteria are summarised, consult the full sources [1,2] for the complete text; see References. Not a substitute for supervised clinical assessment.