Preface:

Personality, whether in the field of positive psychology (where its purpose is development and
flourishing) or in psychopathology, is of great importance. There is a hypothesis in clinical
psychology that emphasizes on the relationship between normal personality traits and
psychological disorders. The general idea is that psychological disorders and their symptoms, are
actually the result of exaggerated extension and exposure of the very same normal
characteristics (Claridge & Davis, 2013). In addition, if we take a brief look at the synchronicity of
personality disorders and the various psychopathologies, we have found another evidence
supporting the importance of personality in clinical psychology (Widiger & Smith, 2008). As a
result, it is essential to take a deeper look on different personality types and disorders. If we could
develop a model of personality and how it changes, we’d be able to monitor different personality
profiles and thus benefit from a roadmap which can be utilized in diagnosis, prevention, etiology
and psychotherapy of different psychological disorders. As for our part, in this article, we have
focused on obsessive-compulsive personality disorder which I think is very common in Iran. In
our country, control and authority, with a long history of oppression and insecurity, are strongly
integrated in our culture and minds and thus very difficult to change. Emotional invalidation,
which might be a result of a judgmental, anti-natural and self-alienated (here the self is
specifically the animal self) culture with its related values, is another important aspect of Iran’s
society. As a result, it seems that these underlying constructs unconsciously play an important
role in the formation of obsessive-compulsive personality in Iran. thus, there is no doubt that this
type of personality needs to be investigated and understood more if we want to develop a
collective consciousness about it or in another words, about ourselves!
Introduction (Lingiardi, 2017):
Personality is defined by psychodynamic diagnostic manual (PDM) as relatively stable ways of
thinking, feeling, behaving, and relating to others (although the personality can change, it does
imply a sense of stability). In the manual, “thinking” has a broad meaning including one’s belief
systems, ways of making sense of self and others, one’s moral values and personal ideals. In other
words, personality can be considered as a type of adaptation and lifestyle: behavioral, emotional
and cognitive patterns that are resulted from the contribution of constitutional factors,
development and social and cultural experiences. In the literature, it is popular to consider some
of these processes explicit (conscious and voluntary) and some implicit (unconscious and
automatic). A model of personality is ultimately a form of map. Its purpose is to help users find
their bearings, orient themselves with respect to recognizable landmarks, and navigate.
The importance of personality is not just in clinical psychology – it is the very essence of our
being. Behaviors are just a small part of it as it implies a wide range of other phenomena including
motives, fantasies, characteristic patterns of thought and feeling, ways of experiencing self and
others, ways of coping and defending, etc. Symptoms, categories and criteria may be useful in
addressing psychological problems, but they all need to be understood in the context of the
whole person in the larger relational and sociocultural background. Especially in psychotherapy
where its goal is reshaping the personality, understanding a person’s overall psychological
makeup and developmental trajectories may ultimately be more important than classifying
symptoms or mastering specific techniques.
One may not distinguish between a personality style or type and a personality disorder so fast.
The word “disorder” used frequently by clinicians implies a degree of extremity or rigidity that
causes significant dysfunction, suffering, or impairment. What we are trying to say is that one
can have for example an obsessive-compulsive personality without having an OCPD.
After this brief introduction, in the next section, we’d like to focus our attention specifically on
OCPD and describe it with more detail.
Obsessive–Compulsive Personalities (Lingiardi, 2017):
The main factor in this type of personality is emotion. These individuals tend to avoid and
constrict their emotion as if they are irrelevant and dangerous. So, they try to defend against
them through rigidity, regimentation and intellectualization. They are so obsessed with rules,
procedures, order, organization, schedules, etc. and tend to commit themselves to work and
achievements to the point that they totally forget about other aspects of being a human, that
is, leisure and relationships. Thinking and analyzing a subject is a way to avoid feeling the real
experience of it (for example, they may analyze every aspect of interpersonal relationships
while having few intimate relationships in their lives). When it comes to choose between
emotions and rationality, their choice is of course the latter as if they want to be untouched by
emotions. They may even intellectualize how they feel at the moment by talking rationally
about their feelings instead of for instance, saying simply “I feel blue”. their abstract thinking is
very well, and they pay too much attention to details. In contrast to neat, ordered and
regimented appearance, deep down they are obsessed with issues of control caught in an
unconscious conflict between submission and defiance, between rage and shame and anxiety
and fear of retaliation. As we said earlier rigidity, order and intellectualization help them avoid
this unconscious underlying conflict and the feelings accompanying it.
Resistance to feel “out of control” is the cornerstone of this type of psychology which may have
originated in their early experiences with their caregivers or authority figures. Freud (1913)
when he first coined the term “anal” was actually describing OC psychology by emphasizing the
relationship between stubborn, punctilious and hoarding tendencies of an OC adult and a
child’s resistance to toilet training. In his idea, toilet training was just a symbol of something
bigger: exerting control over impulses and desires which can have many cases in life such as
eating, sex, general obedience, etc. it is thought that controlling parents may contribute to this
type of psychology and its characteristic conflicts like giving versus withholding, generosity
versus selfishness, and compliant submission versus oppositional defiance.
Rationality, rules, procedures, non-emotionality all bring the idea of a “living machine” when
it comes to obsessive-compulsive personalities, a term previously used by Reich (1933/1972) to
describe this type of psychology. These individuals seem to have identified with their caregivers
who expected them to be older than their age. As a result, they regard the expressions of most
affects as “immature”, overvalue rationality and suffer humiliation when acting childishly.
Most scholars in the field of psychoanalysis believe that an OCP’s main fear is not being able to
control their impulses such as anger, greed and messiness and indeed most of their obsessive
thoughts or compulsions are considered as actions trying to counteract or undo these impulses.
When OCPs get pathological, their guilt over unaccepted wishes gets so strong that they may
suffer from their over rigid and punitive conscience. These individuals tend to have harsh self-
criticisms and view themselves and others through ideal standards. They follow rules literally,
get lost in detail, and postpone making decisions because they want to make the perfect one.
 They are scrupulous to a fault, but may have trouble relaxing, joking, and being intimate.
Obsessions and compulsions may be balanced or not in different individuals with obsessive
people weighing towards obsessions and compulsive souls towards compulsions. The first
group are chronically “in their heads”: thinking, reasoning, judging, doubting. The latter is
chronically “doing and undoing”: cleaning, collecting, perfecting. Obsessive patients are
ruminative and cerebral; their self-esteem May depend on thinking. Compulsive individuals
tend to be busy, meticulous, perfectionistic; their self-esteem depends on doing. In therapy, an
individual with an obsessive–compulsive personality may try hard to be cooperative but
covertly resist the therapist’s efforts to explore the patient’s affective world. The patient may
become subtly oppositional, expressing unconscious opposition by coming late, forgetting to
pay, and prefacing responses to the therapist’s comments with “Yes, but . . .” The person may
interrupt and talk over the therapist. To the clinician, the relationship may feel subtly (or not so
subtly) like an ongoing power struggle. As the patient insists on tendentious argument rather
than more authentic emotional engagement, the therapist may become impatient and
exasperated. Effective therapy requires sustained and patient exploration of those aspects of
personality that individuals with obsessive–compulsive personalities otherwise spend
inordinate energy trying to subdue.
Some of the key feature of OCPs are summarized in table 1.
Table 1 – Key Features of OCPs

Contributing constitutional–maturational patterns: Possible aggressivity, irritability, orderliness.

Central tension/preoccupation: Submission to versus rebellion against controlling authority.
Central affects: Anger, guilt, shame, fear.
Characteristic pathogenic belief about self: “Most feelings are dangerous and must be controlled.”
Characteristic pathogenic belief about others: “Others are less precise and in control than I am, so I
have to control what they do and resist being controlled by them.”
Central ways of defending: Isolation of affect, reaction formation, intellectualizing, moralizing, undoing.
Obsessive-Compulsive personality Disorder:
We have mentioned earlier that there is a difference between a personality style and a
personality disorder (Lingiardi, 2017). The fifth edition of the Diagnostic and Statistical Manual
of Mental Disorders-fifth edition (“DSM-5”), defines the conditions in which a normal
psychology leads to a personality disorder (PD). Two factors are obviously important in
developing a PD: Persistence and inflexibility of the personality, deviation from the norms of
the individual culture and more importantly clinically significant suffering and impairment in
the individual’s social, professional, educational, etc. functioning. We know that personality
includes a wide range of psychological phenomena and thus This inflexibility must occur in at
least two of the following domains: cognition, affectivity, interpersonal functioning and
impulse control. the onset of a PD is usually in adolescence or adulthood. While different
studies in epidemiology announce 4% to 15% prevalence rate for personality disorders,
research shows that the occurrence of OCPD is different based on age and the population
varying from 0.5% in elderly to 71.5% in internet users. Despite this heterogeneity, Marina
Junqueira Clemente et al, in their metanalysis, showed that there is no significant variability in
OCPD prevalence rate worldwide, affecting almost 1 over 15 adult individuals. They also
showed that more research is needed in the epidemiology of OCPD which is based on
standardized data (Clemente et al., 2022).
OCPD has a twin brother, i.e., obsessive compulsive disorder. Finding a neat distinction
between these two disorders has long been the goal of many researchers. The symptoms of the
two disorders overlap with each other which makes it difficult to differentiate the two based on
phenotype alone. As a result, a deeper examination of the subjective experience of the patient
is considered in clinical examinations. persons affected with OCD regard their symptoms as
intrusive and distressing and thus ego-dystonic while individuals with OCPD think of their
symptoms and behaviors as appropriate or an advantage over others (ego-syntonic or poor
insight). As a results, insight is one of the criteria that can be useful in clinical diagnosis. Self-
control or impulsivity (as a continuum) can be another factor. Impulsivity plays a crucial role in
many disorders such as substance use disorders, pathological gambling, attention
deficit/hyperactivity disorder, and borderline personality disorder. Excessive self-control is
also linked with many undesirable symptoms and behaviors including social isolation, poor
interpersonal functioning, perfectionism, rigidity, and lack of emotional expression. As
mentioned earlier, research shows the correlation of these phenomena with OCPD and thus we
can conclude that excessive self-control is one of the main players in individuals affected with
OCPD. Based on this fact, Anthony Pinto et al, investigated the capacity to delay reward in
individuals with OCPD. In their research they found significant relationship between excessive
capacity to delay reward and OCPD. Furthermore, functional neuroimaging studies show
higher activations of the dorsolateral prefrontal cortex (DLPFC) and parietal cortex in
individuals who can exert more control over their desires and thus select larger, delayed
rewards instead of smaller immediate ones. As a result, they suggested that this excessive
capacity to delay rewards, with its neuroscientific biomarkers can be used as a valid way of
diagnosing OCPD (Pinto et al., 2014).
In another study, MARIA C. MANCEBO et al, used national library of medicine (MEDLINE)
database in order to conduct a systematic research of the literature concerning OCD and OCPD
published between 1991 and 2004. Relying on DSM-4 criteria, they found out that, as opposed
to the common belief about the relation of the two psychological conditions, the evidence
shows that 75% of individuals affected with OCD, do not have OCPD and 80% of individuals
affected with OCPD, do not have OCD. As a result, they concluded that these two disorders are
almost independent (as far as the literature goes) (Mancebo et al., 2005).
Although, OCPD is one of the most common PDs in the general population, there is still a lack of
evidence that can guide clinicians for treating this psychological disorder. Currently, a
combination of psychotherapy and pharmacotherapy is used in the treatment. For instance,
Julija Gecaite-Stonciene et al, reviewed the evidence and evaluated the efficacy and tolerability
of pharmacotherapy for OCPD. In their systematic review, they found that Citalopram and
fluvoxamine are efficient in treating this illness and can be tolerated by the patients.
Furthermore they emphasized that their finding has a high level of uncertainty and more
research needs to be done In this field (Gecaite-Stonciene et al., 2022). In another study, Ellen
F. Finch et al, addressed the lack of treatment guidelines for OCPD and proposed a pragmatic
and accessible treatment model: Good Psychiatric Management (GPM) for OCPD. The model
consists of eight principles. First, it emphasizes the assessment of perfectionism and rigidity on
occupational and social functioning for diagnosis. Second, it educates the patient about the
core factor of an OCPD psychology that is relying on overcontrolling others and the
environment to gain internal stability and rigidity of the psyche instead of being flexible and
open. Third, it focuses of personal life outside of treatment as a grounds for developing the
personality. Fourth, it uses practical experiences as a way to challenge and correct rigidly held
beliefs and behaviors. Fifth, it focuses on comorbidities like anxiety and mood disruptions to be
able to manage the disorder better. Sixth, it uses multimodal treatments. Seventh, manages the
safety of the patient by using general suicide risk assessment and eighth, conservative
pharmacological management (Finch et al., 2021).
Pinto tried to categorize OCPD and introduced two subtypes for this phenomenon: the
controlling and anxious presentation styles. The controlling style has deficits in emotion
regulation and chronically feels distressed and annoyed when others can’t live up to his/her
high standards. As a result, they tend to be verbally hostile, judgmental and controlling in their
interpersonal relationships. In contrast, the anxious style, is more worried, submissive and
emotionally avoidant. Their high standards lead to self-criticism and over attention to the
expectation of others (Finch et al., 2021).
As far as neurobiology is concerned, little has been known about the etiology of OCPD. Previous
research shows a significant association between striatal surface area localized to the caudate
tail, smaller ventral striatum volumes, and greater cortical thickness in the right prefrontal
cortex and cluster C (Avoidant, Dependent and obsessive-compulsive) personality disorder
symptoms compared to healthy control. another study suggests the relationship between
intolerance of uncertainty (a common trait in OCPs) and striatal volume, particularly the
putamen. Mehmet Gurkan Gurok et al, also reports hippocampal and amygdalar structural
abnormalities related to the neuroanatomy of OCPD. In their study, they found that these
areas have smaller volumes compared to healthy control individuals (Gurok et al., 2019).

The need to control the environment in OCPs as well as viewing others through their
perfectionistic standards, often leads to interpersonal difficulties. The interpersonal circumplex
(IPC; Leary, 1957) is a way to assess the quality of interpersonal relationships among
individuals. IPC is grounded in interpersonal theory which conceptualizes interpersonal
relationships by two orthogonal dimensions: dominance and warmth. IPS claim that all
interpersonal relationships (or at least some aspects of all interpersonal relationships) can be
understood as positioning along these two dimensions (see figure one for an example of
interpersonal functioning in OCPD). These dimensions can have two limit points, that is,
domineering-submissive and overly warm-cold. Plus, one can have four other points and thus
two other dimensions by averaging every two limits: intrusive, exploitable, socially avoidant
and vindictive. The result is eight areas or styles by which we can categorize interpersonal
relationships. Grounded in IPC, NICOLE M. CAIN et al, investigated interpersonal functioning in
OCPD. In their study, they found that that OCPD individuals have hostile-dominant style when
in a relationship with others who have warm-dominant style. Furthermore, OCPD+OCD
individuals reported to be submissive in a relationship with warm-submissive individuals. The
encounter of both of these two groups accompanied relational problems and sensitivities.
additionally, OCPD individuals showed deficits in empathetic perspective taking compared to
healthy control (Cain et al., 2015).
 Fig 1. Dimensions of IPC and interpersonal functioning in OCPD

It’s been a while since the majority of scientific communities in psychology favored dimensional
models of psychological phenomena compared to the former categorical conceptualization.
The reason of this shift is very clear. Almost everyone agrees that most of the variables in
psychology, happen along a continuum with different intensities. So, by having a dimensional
mindset, they can be better understood and modeled. Taking a brief look at the most popular
diagnostic manuals, shows that this movement is supported by ICD-11 and DSM-5 and PDM-2.
This fact also holds for personality disorders (as reflected in Alternative Model of Personality
Disorders-AMPD of DSM-5). Currently, pathological traits in different personality disorders can
be assessed by measures like the Personality Inventory for DSM-5, the Computerized Adaptive
Test of Personality Disorder and the Personality Inventory for ICD-11. This includes
overcontrolled behavior in OCPD which is related to pathological traits like rigid perfectionism,
workaholism and compulsivity. The Five Factor Model (FFM) also describes these traits as
maladaptive conscientiousness (a trait characteristic of individuals affected with OCPD).
Previous research shows the correlation of the above-mentioned scales. But one cannot
understand if all these concepts are totally independent or not. For instance, can maladaptive
conscientious be considered as intensified conscientious or in other words, an extension along
a dimension? or is maladaptive conscientious independent from neuroticism (another scale of
FFM), workaholism, perfectionism, compulsivity? To address these questions, Douglas B.
Samuel et al, developed the Five Factor Obsessive Compulsive Inventory (FFOCI). In their study
they found that maladaptive conscientiousness is independent from neuroticism and FFOGI
can be considered as a valid instrument which is capable of assessing conscientious across a
dimension that spans traditional boundaries of normal and pathological measures (Samuel et
al., 2023).
It is more than 100 years ago when OCPD was first described. It has been included in all DSMs
(1 to 5) since 1952 as a diagnosable mental disorder. Central to OCPD are eight personality
traits: preoccupation with details, perfectionism, excessive devotion to work and
productivity, over-conscientiousness, inability to discard worthless objects, inability to
delegate tasks, miserliness, and rigidity and stubbornness. it imposes significant burden on
public health and economy as it can impair the individuals’ psychosocial functioning and reduce
their quality of life.
Alice Diedrich and Ulrich Voderholzer have provided an overview of the state of the art
concerning various aspects of OCPD including diagnostics, epidemiology, co-occurrences,
etiology and treatment of the disorder (Diedrich & Voderholzer, 2015). Below, there is a brief
discussion of all these subjects
Diagnostics:
Former versions of DSM had problems of specificity and sensitivity concerning this disorder. To
address these problems, DSM-5 has developed the following criteria:
1- moderate to high level of impairment in personality functioning expressed at least by
difficulties in two of the following areas: identity, self-direction, empathy and intimacy.
2- rigid perfectionism plus the presence of at least two of the following maladaptive personality
traits: perseveration, intimacy avoidance and restricted affectivity.
These two criteria are alternative and one of them is enough for diagnosing OCPD in an
individual.
Epidemiology:
Despite the inconsistency of evidence, OCPD may be considered as the most prevalent disorder
in general population with lifetime prevalence rate of 3 to 8 percent. Based om DSM-3-R
criteria, sex distribution may be considered the same and considering age and the level of
education, OCPD is higher among adults and less educated persons.
Course of Illness:
Although both personality and personality disorders imply a sense of stability over time, there
are some studies that suggest OCPD may not be so stable and can recover with remission rate
of 38% over a 24-month follow up. Nevertheless, the evidence concerning the course of OCPD
is inconsistent and debatable as some studies show that it worsens over time
Comorbidities:
There are many mental and medical conditions associated with OCPD. the psychological
problems include anxiety disorders (panic disorder, generalized anxiety disorder, social phobia
and specific phobia), affective disorders (unipolar and bipolar) and substance-related disorders
(alcohol or drug dependance). Furthermore, many studies suggest the relationship between
OCPD and cluster A personality disorders, specifically paranoid and schizotypal. Among medical
disorders, the relationship between OCPD and hypermobility syndrome, Ehlers–Danlos
syndrome hypermobility type, and Parkinson’s disease is very strong.
OCPD and OCD:
The relationship between OCPD and OCD has long been a source of controversy. some clinicians
consider these two disorders as distinct relying on ego-syntonic characteristics of OCPD as well
as the absence of compulsions and obsessions. However, this criteria for distinguishing the two
disorders are not very accurate as we can see that perfectionism in OCPD is ego-dystonic and
contamination pre-occupation in OCD is ego-syntonic. As there are some exceptions, one must
find other criteria to distinguish between the two. and yet, some clinicians believe the two
disorders are indeed related by introducing a new subtype of individuals affected by both OCPD
and OCD or considering the occurrence of OCPD as a severity marker of OCD.
Etiology:
Currently, the literature on etiology of most psychological disorders is heterogeneous and
sometimes contradictory. Every etiological theory tries to explain the cause of an illness by
developing a model which captures a limited amount of data and utilizes a limited power of
computation. And OCPD of course is no exception. Parental dominance, over-control and
intrusiveness or in Freud’s words, rigid toilet training, are the main factors that play an
important role in the formation of such a psychology according to Psychoanalytic etiological
models. Some studies try to explain the cause of OCPD through attachment issues. These
researches provide some support that claims OCPD psychological structure is correlated to
insecure attachment style, less care and more overprotection during childhood. Attachment
etiological theories thus state that these factors result in undeveloped emotion and empathy
in individuals affected with OCPD.
In contrast to OCD, few studies have investigated the neurological and biological correlates of
OCPD. the studies available have found associations between OCPD and the dopamine D3
receptor, Gly/Gly genotype, the serotonin transporter 5HTTLPR polymorphism and a blunted
prolactin response to fenfluramine indicating a potential serotonergic dysfunction.
Nevertheless, these findings are inconsistent and lack enough replication by other researchers.
Furthermore, there are some neurological studies that link OCPD to dense and well-branched
limbic system. However, the evidence here again is controversial as some other studies have
found reduced gray matter volume in the limbic cingulate.
Some other theories also state that OCPD psychological formation may be a compensatory
tactic in response to preexisting cognitive deficits. There are also some evolutionary theories
that have found the correlation of OCPD with decreased empathizing ability and increased
systemizing capabilities (that enables comprehension for lawful and intentional events).
Treatment seeking:
Some studies suggest decreased treatment seeking in individuals affected with OCPD. this
finding make sense and is consistent with ego-syntonic characteristic of OCPD as well as the
need for control and independence in this psychological structure.
Psychotherapy:
Frontline treatment for OCPD includes pharmacotherapy and psychotherapy. There are few
studies that suggest the efficacy of carbamazepine and fluvoxamine for reducing symptoms in
individuals affected only with OCPD and citalopram in individuals suffering from OCPD and
depressive symptoms. However, these finding lack enough empirical and reliable data.
Psychological treatments of OCPD also include cognitive therapy (CT), cognitive behavioral
therapy (CBT), group CBT combined with escitalopram, interpersonal psychotherapy,
metacognitive interpersonal therapy, schema therapy, dialectical behavior therapy and
supportive-expressive dynamic psychotherapy. The evidence supports the reduction of OCPD
traits as well as depressive and anxiety symptom by these mental treatments in individuals
suffering from with OCPD. table 2 summarizes several studies investigating psychotherapy in
OCPD.
 Table 2- summary of studies investigating psychotherapy in OCPD

Study Sample Assessme Design Intervention Summary of results

nt
Fiore, Dimaggio, 1 outpatient SCID-II for Case study 31 weekly Patient no longer met full
Nicolo, with DSM-IV individual criteria for any
Semerari, and APD + OCPD sessions and 36 personality disorder, but some
Carcione (2008) weekly group traits
sessions of MIT were still present.
Dimaggio et al. 1 outpatient SCID-II, Case study 3 years of MIT There was a significant drop in
(2011) [ with not depression, personality
OCPD + MDD specified disorder
whether psychopathology, general
DSM-III-R distress level
or as well as alexithymic
IV symptoms from
pre to post therapy.
Lynch and 1 outpatient SCID-II for Case study 9 months of The patient no longer met
Cheavens with DSM-IV weekly criteria for
(2008) OCPD + PPD + individual DBT OCPD or PPD and his Hamilton
MDD and Rating Scale for Depression
6 months of score
weekly decreased from 21 at baseline
DBT group to 6 at
skills follow-up.
training
Montazeri, 1 inpatient SCID-I and Case study 16 weekly Schema therapy was effective
Neshatdoos, with II for sessions of in reducing
Abedi, and OCPD DSMIV ST OCPD symptoms.
Abedi (2014)
Ng (2005) 20 outpatients SCID-I and Pre–post ∼22 sessions of There was a significant drop in
with II for CT depression and anxiety from
OCPD + DSMIV pre to
chronic post therapy. Nine patients no
depression longer
fulfilled the DSM-IV diagnosis of
OCPD. Eight patients were also
free
from axis I disorders.
Popa, Nirestian, 31 in. and SCID-II for Pre–post 40 sessions of There were significant
Ardelean, outpatients DSM-IV CBT + improvements in
Buicu, and Ile with escitalopram
(2013) OCPD + GAS anxiety, extroversion,
agreeableness
and emotional stability frompre
to post
therapy.
Strauss et al. 30 outpatients SCID-I and Longitudin ≤52 weekly Stronger early alliances and
(2006) with II for al sessions of rupture–
OCPD/APD DSMIII- CT repair episodes predicted more
R improvement in symptoms of
personality disorder and
depression.
Cummings, 27 inpatients SCID-I and Longitudin 52 weeks of CT More self-esteem variability
Hayes, with II for al during the
Cardaciotto, APD + OCPD DSMIII- first 10 weeks of treatment
and Newman (+ depressive R; predicted
(2012) disorder) confirmat more improvement in OCPD
ion and
with depression symptoms at the
SCID-II for end of the
DSM-IV treatment, beyond baseline and
average self-esteem.
Enero et al. (2012) 116 Met Longitudin 10 sessions of Distress level was identified as a
outpatients criteria al group significant predictor of
with OCPD for an CBT treatment
OCPD response.
according
to DSM-IV
Barber, Morse, 38 outpatients SCID-I and Longitudin 52 weekly Individuals with OCPD
Krakauer, with II for al sessions of improved
Chittams, and OCPD/APD + DSMIII- supportive– significantly across time on
Crits-Christoph depressive R, PDE expressive measures
(1997) and/ dynamic of personality disorder
or anxiety psychotherapy symptoms,
disorder depression, anxiety, general
functioning and interpersonal
problems. By the end of
treatment,
only 15 % of individuals with
OCPD
still retained their diagnosis.
Barber and Muenz 239 Met RCT ≥12 sessions Results revealed a superiority of
(1996) outpatients criteria and IPT over
with MDD and for MDD
 an elevated according 15 weeks of CT CT in depressed individuals
level to DSM- or suffering
of OCPD/APD IV; IPT from elevated OCPD levels
dimensio regarding
nal treatment-related reductions in
assessme depression
nt of PDs
with the
PAF
Bamelis, Evers, 323 SCID-I RCT Weekly ST led to significantly more
Spinhoven, and Arntz outpatients and II for sessions of ST, recoveries
(2014) with DSMIV; COT or TAU; than did COT and TAU. Dropout
personality DSM-IV different rates
disorders Personalit treatment were also lower compared to
including 89 y durations TAU. ST patients had higher
with OCPD Disorders general and social
Question functioning and lower rates of
naire depressive disorder at follow-
up.
OCPD = obsessive–compulsive personality disorder, APD = avoidant personality disorder, MDD
= major depressive disorder, PPD = paranoid personality disorder, GAS = generalized anxiety
disorder, SCID = Structured Clinical Interview for DSM Disorders, DSM = Diagnostic and
Statistical Manual for Mental Disorders, PD = personality disorder, PAF = Personality
Assessment Form, PDE = Personality Disorder Examination, RCT = randomized controlled trial,
CT = cognitive therapy, CBT = cognitive–behavioural therapy, IPT = interpersonal
psychotherapy, MIT = metacognitive interpersonal therapy, DBT = dialectical–behavioural
therapy, ST = Schema Therapy, COT = Clarification-Oriented Therapy, TAU = Treatment as Usual
Conclusion and discussion:
Here we provide an in-depth overview of Obsessive-Compulsive Personality Disorder (OCPD),
including its symptoms, diagnosis, epidemiology, etiology, and treatment options. The essay
discusses the criteria used to diagnose OCPD, which includes moderate to a high level of
impairment in personality functioning, and rigid perfectionism along with the presence of at least
two of the following maladaptive personality traits: perseveration, intimacy avoidance, and
restricted affectivity.

We also highlight the difference between OCPD and Obsessive-Compulsive Disorder (OCD),
including how the ego-dystonic characteristics of perfectionism in OCPD and the ego-syntonic
characteristics of contamination pre-occupation in OCD can be used to differentiate the two
disorders. The epidemiology of OCPD is discussed, including its prevalence in the general
population and how it varies based on age and population. The essay also addresses the course
of illness, comorbidities, and the relationship between OCPD and OCD.

In addition to discussing the symptoms and diagnosis of OCPD, the essay provides insight into the
etiology of the disorder. Several etiological theories are presented, including psychoanalytic and
attachment theories, as well as neurological and biological correlates. we also discussed
treatment options for OCPD, including pharmacotherapy and psychotherapy, and highlights
several studies investigating psychotherapy in OCPD, which support the reduction of OCPD traits
as well as depressive and anxiety symptoms.

Overall, this essay provides a comprehensive and useful resource for those seeking to understand
OCPD. It highlights the importance of a dimensional model of psychological phenomena, which
allows for a better understanding and modeling of variables in psychology. We also emphasize
the need for further research in the epidemiology and treatment of OCPD, and how OCPD
imposes a significant burden on public health and the economy as it can impair the individual's
psycho-social functioning and reduce their quality of life.
References:

Cain, N. M., Ansell, E. B., Simpson, H. B., & Pinto, A. (2015). Interpersonal functioning in obsessive–
compulsive personality disorder. Journal of personality assessment, 97(1), 90-99.
Claridge, G., & Davis, C. (2013). Personality and psychological disorders. Personality and Psychological
Disorders, 1-266. https://doi.org/10.4324/9780203766309/PERSONALITY-PSYCHOLOGICAL-
DISORDERS-GORDON-CLARIDGE-CAROLINE-DAVIS
Clemente, M. J., Silva, A. S. M., Pedro, M. O. P., Paiva, H. S., Périco, C. d. A. M., Torales, J., Ventriglio, A.,
& Castaldelli-Maia, J. M. (2022). A meta-analysis and meta-regression analysis of the global
prevalence of obsessive-compulsive personality disorder. Heliyon, 8(7), e09912.
Diedrich, A., & Voderholzer, U. (2015). Obsessive–compulsive personality disorder: a current review.
Current psychiatry reports, 17, 1-10.
Finch, E. F., Choi-Kain, L. W., Iliakis, E. A., Eisen, J. L., & Pinto, A. (2021). Good Psychiatric Management
for Obsessive–Compulsive Personality Disorder. Current Behavioral Neuroscience Reports, 1-12.
Gecaite-Stonciene, J., Williams, T., Lochner, C., Hoffman, J., & Stein, D. J. (2022). Efficacy and tolerability
of pharmacotherapy for obsessive-compulsive personality disorder: a systematic review of
randomized controlled trials. Expert Opinion on Pharmacotherapy, 23(11), 1351-1358.
Gurok, M. G., Korucu, T., Kilic, M. C., Yildirim, H., & Atmaca, M. (2019). Hippocampus and amygdalar
volumes in patients with obsessive-compulsive personality disorder. Journal of Clinical
Neuroscience, 64, 259-263.
Lingiardi, V., & McWilliams, N. (2017). Psychodynamic diagnostic manual: PDM-2 (second ed.). Guilford
Publications.
Mancebo, M. C., Eisen, J. L., Grant, J. E., & Rasmussen, S. A. (2005). Obsessive compulsive personality
disorder and obsessive compulsive disorder: clinical characteristics, diagnostic difficulties, and
treatment. Annals of Clinical Psychiatry, 17(4), 197-204.
Pinto, A., Steinglass, J. E., Greene, A. L., Weber, E. U., & Simpson, H. B. (2014). Capacity to delay reward
differentiates obsessive-compulsive disorder and obsessive-compulsive personality disorder.
Biological psychiatry, 75(8), 653-659.
Samuel, D. B., Nagarajan, S., Balling, C. E., & Bucher, M. A. (2023). Maladaptive conscientiousness is still
conscientiousness. Journal of Research in Personality, 103, 104334.
Widiger, T. A., & Smith, G. T. (2008). Personality and psychopathology. In Handbook of personality:
Theory and research, 3rd ed. (pp. 743-769). The Guilford Press.