Obsessive-Compulsive Personality Disorder (OCPD) And The Need For Order And Control

Obsessive-compulsive personality disorder (OCPD), not to be confused with obsessive-compulsive disorder (OCD), is a personality disorder characterized by rigid adherence to personal rules, difficulty with a loss of control, and fixation with tradition. It is recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association (APA)

This condition is not a common personality disorder and is believed to be present in around 1% to 2% of the general population, though it may be more due to a lack of research on the condition. According to the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), OCPD is considered the most common personality disorder in the US, followed by narcissistic and borderline personality disorder. Understanding OCPD and the nature of a person with an obsessive personality may help you know whether screening for this condition could benefit you and how to distinguish the symptoms from those of similar conditions like OCD.

Obsessive-compulsive personality disorder (OCPD): A type of "personality disorder"

Obsessive-compulsive personality disorder (OCPD) is a cluster C disorder within the DSM-5. Personality disorders, including schizoid personality disorder, borderline personality disorder, and OCPD, are all mental disorders or illnesses that impact one's personality. Due to the nature of these disorders, they may cause dysfunction in multiple areas of life, including interpersonal relationships, careers, education, organization, and others. Obsessive-compulsive personality disorder may begin as a child or in early adulthood and is associated with themes of control, rigidity, extreme caution, and obsession with hard work or self-sufficiency. It is different from obsessive-compulsive disorder (OCD).

Perfectionism, organization, and control: Symptoms OCPD

In the DSM-5, the criteria for OCPD involve a persistent pattern of perfectionism and a pervasive preoccupation with control and orderliness. These fixations must cause significant impairments in multiple areas of the person’s life and affect their sense of identity. 

For an accurate diagnosis, an individual must show at least four of the following symptoms on the DSM-5's criteria list for obsessive-compulsive personality disorder (OCPD): 

• A preoccupation with details, rules, lists, organization, or schedules 
• Rigid perfectionism that leads to an inability to complete tasks
• Excessive devotion to a career at the expense of romantic, platonic, or familial relationships, which may lead to social isolation 
• Inflexibility and rigid moral principles 
• Trouble throwing out old or worthless objects, such as clothes, appliances, and other items that may not have sentimental value
• Reluctance to work in a team due to excessive doubt or a lack of trust in the ability of others
• Embracing an overly frugal approach to spending on oneself and others
• Stubbornness, which may show as difficulty letting go of control or anger when a situation doesn't go as planned

The source of obsessive-compulsive personality disorder (OCPD) symptoms is important for a diagnosis

OCPD vs. OCD: Understanding the differences and similarities 

There are various related conditions that may be considered differential diagnoses for OCPD, the main one being OCD. Both OCD and OCPD are oriented around obsessive-compulsive behaviors. It can be helpful to know the psychological definitions of the words to differentiate the two. According to the American Psychological Association, obsessions are intrusive thoughts, images, or impulses that may be inappropriate and cause anxiety. The APA defines compulsions as behaviors intended to reduce the anxiety caused by these obsessions or to prevent a perceived threat. 

OCPD is a type of personality disorder, but are OCD and OCPD both personality disorders?

These behaviors can be present in both OCD and OCPD. However, obsessive-compulsive personality disorder (OCPD) is a personality disorder, whereas OCD is listed in the category of obsessive-compulsive and related disorders in the DMS-5. Personality disorders directly involve personality traits, including the ability to feel empathy, how one interacts in relationships, and the way people see themselves compared to the general population. 

Someone with OCPD may struggle more with separating their identity from their symptoms, believing that their way of life is a part of who they are and not a sign of a mental health concern. Contrarily, people with OCD often feel extreme distress from their symptoms, trying to separate themselves from them as much as possible. 

OCPD, perfectionism, organization, and control

Obsessive-compulsive personality disorder involves traits primarily related to seeking control, difficulty seeing a "grey area," and rigid beliefs about the world. These beliefs may be related to organization, cleanliness, or one’s career, among other challenges. OCD, on the other hand, can have many themes. Some people with OCD may struggle with relationship OCD, whereas others might struggle with harm OCD. Although they do not have the same fears, each person feels significant anxiety about their particular concern.

Obsessive-compulsive personality disorder is associated more with behavioral patterns than the causes behind them. For example, whether someone associates their identity with their career or with raising a family, both individuals may be experiencing the primary theme of difficulty forming an identity and an internal sense of responsibility over the occurrences encountered in these situations. With OCD, themes are more specific and oriented around compulsions and the topics within a person's thoughts, often related to fears surrounding immorality. 

OCPD statistics

Although obsessive-compulsive personality disorder (OCPD) is not as heavily studied as other personality disorders or mental health conditions, hundreds of thousands of people live with this condition in the US. Below are a few statistics to keep in mind about the condition:

• OCPD can be co-morbid with other mental illnesses, like OCD, depression, eating disorders, and anxiety disorders.
• Although no cause has been confirmed, genetics and environmental factors are often considered the leading causes of OCPD. 
• People with OCPD may experience hostile social behaviors and a lack of an empathetic perspective 
• Cognitive-behavioral therapy may be an effective form of treatment for distressing OCPD symptoms 

What are the most effective treatments?

Various options are available to treat OCPD, including talk therapy and medications like selective serotonin reuptake inhibitors (SSRIs). Treatments for obsessive-compulsive personality disorder (OCPD) can differ from those that might be suggested for obsessive-compulsive disorder. It’s important to consult a mental health professional for an appropriate diagnosis and treatment plan. Below are options you might consider if you or a loved one has been diagnosed. 

Radically open dialectical behavior therapy (RO-DBT) 

Inspired by dialectical behavior therapy (DBT), radically open dialectical behavior therapy (RO-DBT) was developed by Thomas R. Lynch to address symptoms of OCPD and other causes of control-oriented behaviors. According to 2020 research, RO-DBT is one of the most effective therapeutic modalities for OCPD and has been associated with reduced symptoms in those with treatment-resistant symptoms. 

RO-DBT takes place in a group format and may involve the client and their family members. It may help individuals with OCPD through social skills that may be difficult due to their condition. Relating with the symptoms of others may be favorable for those who try this type of group therapy, as they can have the perspective of people who may understand where they're coming from. 

How does an RO-DBT session work? 

In an RO-DBT session, each client receives a workbook with official RO-DBT worksheets, skills training, and lessons. The therapist of the session may teach each person in a structured format, slowly working with the group to help them take more risks, try new activities, or discuss uncertainty. The modules within the RO-DBT workbook include the following: 

• Interpersonal effectiveness
• Emotional control
• Mindfulness
• Distress tolerance
• Radical openness

RO-DBT workbook modules

• Lessening rigidity and rule governance 
• Restructuring ideas of "correctness" 
• Reducing compulsive behavior 
• Learning to socialize healthily 
• Coping with vulnerability
• Unmasking inner feelings
• Reducing comparison, envy, and bitterness
• Practicing self-care
• Rejecting structure and order
• Embracing openness 
• Embracing healthy risk and novelty
• Considering feedback
• Reducing distrust and suspicion 
• Increasing empathy 
• Practicing forgiveness and compassion 

RO-DBT may also be attractive to those who enjoy following rules because they often take place in a structured format, with prior agreement of which lessons you'll learn and the ability to take notes. You can also graduate from RO-DBT after finishing the workbook, which can offer a sense of success and accomplishment. 

Cognitive-behavioral therapy (CBT) 

Cognitive-behavioral therapy is a type of talk therapy that has been proven effective in treating multiple mental illnesses and symptoms, including depression, anxiety, OCD, post-traumatic stress disorder (PTSD), and some personality disorders. CBT may also be effective in treating obsessive-compulsive personality disorder, as it works with patterns of thought that can underline behaviors like those exhibited in this condition. 

How does a cognitive-behavioral therapy session work?

In CBT, clients with obsessive-compulsive disorders can work with their providers to develop a treatment plan based on their goals. The therapist can help them restructure their thoughts to serve their current circumstances. In addition, they can work together to develop a way that the individual can put the positive sides of their personality traits to use while still ensuring compassion, self-care, empathy, and rest. 

For example, average levels of determination, detail orientation, and ambition may be helpful and admirable. However, when these personality traits become someone's entire outlook and negatively impact relationships and personal life, they might benefit from moderation strategies. A CBT therapist might help individuals with self-reflection and self-awareness to improve their symptoms, setting realistic goals to treat the condition.

Different counseling options for personality disorders

You're not alone if you think you might be living with obsessive-compulsive personality disorder (OCPD) or have previously been diagnosed with any of the DSM-5 personality disorders. There are many options for treatment, and counseling can be a practical first step for addressing symptoms. If you believe your behavior has started to impact your life, even if you don't understand why, consider talking to a compassionate counselor in your area or over an online platform like BetterHelp. Through BetterHelp, you may find a therapist who specializes in CBT, RO-DBT, or other forms of counseling like psychodynamic therapy or exposure therapy.

Research support online therapy to treat personality disorders

Studies suggest that internet-based counseling is as effective as in-person therapy in treating symptoms of personality disorders. In one study, researchers found that client satisfaction with online personality disorder treatment was moderate to high and that they found the platforms over mobile apps more convenient than face-to-face therapy. In addition, an absence of adverse effects from symptoms was observed. 

If you're interested in trying therapy for obsessive-compulsive personality disorder but have a busy schedule due to your career, online therapy might be valuable to you. You can choose a session time outside of standard business hours and work with your therapist to find a plan that fits your needs at a cost-effective price.