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 | “You must do/be better to be worthwhile.” |
| Self-View | “I'm responsible if something goes wrong.” |
| World-View | “Life is unpredictable and expects too much. Therefore, be in control, be right and proper and don't make mistakes.” |
| Maladaptive Schemas |
|
| Optimal Diagnostic Criterion | Shows perfectionism that interferes with task completion. |
DSM diagnostic criteria
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood.
- Preoccupied with details, rules, lists, order, organization, or schedules to the extent the major point is lost.
- Shows perfectionism that interferes with task completion.
- Is excessively devoted to work and productivity to the exclusion of leisure and friendships.
- Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values.
- Is unable to discard worn-out or worthless objects even when they have no sentimental value.
- Is reluctant to delegate tasks unless others submit to exactly their way of doing things.
- Adopts a miserly spending style toward self and others; money hoarded for future catastrophes.
- Shows rigidity and stubbornness.
- 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.