Cluster C: Obsessive-Compulsive PD

Question 1

Cluster C

Answer 1

Anxious, fearful

Question 2

Main preoccupations

Answer 2

• orderliness
• perfectionism
• control

Question 3

Criteria

Answer 3

• A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and inpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
  1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
  2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project bc his or her own overly strict standards are not met)
  3. Is excessively devoted to work and productivity to the exclusion of leisures activities and friendships (not accounted for by obvious economic necessity)
  4. is overconscientious, scrupulous, and ineflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
  5. Is unable to discard worn-out or worthless objects even when they have no sentimental value
  6. is reluctant to delegate or to work with others unless they submit to exactly his or her way of doing things
  7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
  8. Shows rigidity and stubborness

Question 4

Individual characteristics

Answer 4

• Preoccupied with rules, order, lists, schedules, and organization, often to the point when they overall purpose is lost
• Exhibits perfectionism that interferes with task completion - project are delayed or never completed because they don’t meet high personal standards
• Excessively devoted to work and productivity, often at the expense of leisures and relationships
• Overly conscientious, scrupulous, and inflexible regarding matters of morality, ethics, and values
• Inability to discard worn-out or worthless items even wthout sentimental value
• Reluctant to delegate unless others conform to exact standards
• miserly spending style, hoards money for future catastrophe
• Stubborn and rigid in thinking and behavior
• Expersses emotions in a controlled, formal, or stiff manner
• Decision-making can be paralyzed due to overthinking and fear of imperfection

Question 5

Diagnostic features

Answer 5

• Core features: a pervasive pattern of perfectionism, orderliness, and need for control
• This pattern interferes with the ability to be flexible, efficient, or open to others’ perspective
• Planning is meticulous, changes are resisted
• tend to be rigid and often alienate others due to their inflexibility
• Even when compromise is beneficial, they often refuse due to rigid adherence to “principle”

Question 5

Differential Diagnoses

Answer 5

• Obsessive-Compulsive Disorder (OCD): OCPD lacks true obsessions and compulsions that are distressing and ego-dystonic.
• Hoarding Disorder: If hoarding is extreme, consider hoarding disorder.
• Narcissistic PD: Both may involve perfectionism, but narcissists believe they have achieved it; OCPD individuals are self-critical.
• Antisocial or Narcissistic PDs: May also be ungenerous, but still indulge themselves—unlike the frugality of OCPD.
• Schizoid PD: Social detachment in OCPD is from discomfort with emotions and overwork, not a fundamental lack of interest in intimacy.
• Medical Conditions or Substance Use Disorders: Must rule out personality change due to a medical condition or substances.

Question 6

Associated features

Answer 6

• Rigid in relationships, controlling, and overly formal.
• Difficulty expressing affection or emotions; may appear cold or stiff.
• Prone to ruminating rather than outwardly expressing anger.
• Sensitive to hierarchy; deferential to respected authority, oppositional to others.
• Frequently have co-occurring anxiety disorders, depressive disorders, bipolar disorder, or eating disorders.

Question 7

Gender and prevalence

Answer 7

• Diagnosed about twice as often in males
• Prevalence: 2.1-7.9% of the general population
• One of the most common personality disorders

Question 8

Cultural consideration

Answer 8

In cultures with a strong emphasis on work and productivity, behaviors may appear OCPD-like but are culturally normative.

A diagnosis should only be made if behaviors are excessive relative to cultural norms and cause impairment.

Question 9

Early signs

Answer 9

• Signs may be evident in adolescence or earlier
  
  • Excessive attention to homework
  • Overly rigid behaviors at school or home
  • Discomfort with unstructured play or spontaneity
• Perfectionism and rigidity in early environments (E.g., demanding parenting, strict environments) may contribute to development