Obsessive-compulsive personality disorder (OCPD): signs and support

The NHS describes a personality disorder as a condition in which a person thinks, feels, behaves or relates to others very differently from the average person. There are several types. OCD-UK explains that OCPD is the type characterised by perfectionism, orderliness and control, and that the World Health Organization’s classification uses the term anankastic personality disorder, from the Greek word for compulsion.

OCD-UK says the main features of OCPD are a preoccupation with orderliness and perfectionism, from cleanliness to order, at the expense of flexibility, openness and efficiency, regardless of the impact on others. People try to maintain control through painstaking attention to rules, trivial details, lists and procedures, to the extent that the major point of the activity is often lost.

The charity says OCPD is one of the most prevalent personality disorders in the general population, with estimated prevalence ranging from 2% to 8%, and that some studies suggest it is more common in males.

The examples below are drawn from OCD-UK’s description. Most people have some perfectionist traits, so the difference is how rigid and pervasive they become and whether they cause difficulties in work, home and relationships.

• Perfectionism and a need for everything to be in order and done a particular way.

• Inflexibility around rules, and sometimes around morality, ethics and values, expecting others to follow very rigid principles.

• Becoming absorbed in lists, procedures and detail so that the main point of a task is lost.

• Not realising that others may be annoyed by the time a task takes, and believing the other person may be wrong for not working to the same standard.

• Strain in relationships: co-workers or employers may find set rules hard, and family members can feel criticised and controlled, which can lead to conflict.

OCD-UK states that OCD is usually easily distinguished from OCPD by the presence of true obsessions and compulsions in OCD. In OCD the thoughts, beliefs and behaviours arise because of feared consequences that feel very real and often interfere with work, social and family life. With OCPD the problem is much more about rigidity around rules rather than perceived consequences, and it usually interferes with certain tasks.

The charity quotes the diagnostic manual DSM-5 in saying that when criteria for both conditions are met, both diagnoses should be recorded. It also notes that people with anxiety disorders such as OCD may be more likely to have a personality that meets some OCPD criteria, but people with OCD do not usually have a pattern of behaviour that would meet the full criteria for OCPD.

The NHS’s general page on personality disorders says it is not clear exactly what causes them, but they are thought to result from a combination of the genes a person inherits and early environmental influences, such as a distressing childhood experience like abuse or neglect. The sources read do not give an OCPD-specific explanation beyond this general picture.

Someone with a personality disorder may also have other mental health problems, such as depression and drug addiction, according to the NHS. For this reason, a thorough assessment looks at the whole picture rather than a single label.

The NHS says a mental health professional can talk to you about what a diagnosis means, and its page suggests asking a GP about support groups. Because people with OCPD often feel that their way of doing things is right, they may seek help only when relationships, work or another problem such as depression or anxiety come to a head.

If you are worried about a partner, family member or colleague, OCD-UK notes that those living with someone with OCPD can feel criticised and controlled. Family members can also look for support for themselves, and the NHS page points to Mind, Rethink Mental Illness and the Royal College of Psychiatrists for further information.

OCD-UK says OCPD is not easy to treat even when the person is prepared to seek help, but if they are willing to accept help, treatment can be effective. It suggests that people with OCPD may sometimes respond well because of their rigid adherence to therapy tasks set by a therapist. Treatments are similar to those for OCD, with cognitive behavioural therapy (CBT) found to be the most effective, and some people need additional support from medicines.

The NHS says treatment for personality disorders usually involves a talking therapy and can include other therapies and medicine. Treatment can last several months or years depending on severity and any other problems. Medicine is used for associated problems such as depression, anxiety or psychotic symptoms. The NHS adds that many people with a personality disorder recover over time and that treatment should be tailored to the individual.

On the NHS the first step is usually the GP, who may refer to a community mental health team or a psychological therapies service. Access to specialist personality disorder services may vary by area.

Some people choose private therapy with a psychologist, psychiatrist or accredited CBT therapist, usually for quicker access or a particular approach. It is sensible to check the therapist’s accreditation and experience of personality difficulties, and to ask how progress will be reviewed. Private and NHS care can be combined, with your GP kept informed.