MHM Magazine

Issue 3 | 2022 | MENTAL HEALTH MATTERS | 29 MHM distress, personal inner conflicts, and suffering typical of individuals with OCPD. WHAT IS OCPD? Obsessive-compulsive personality traits are present in many of us and can be quite adaptive. Nevertheless, taken to the extreme, it can become debilitating and cause significant suffering for the person and significant others. OCPD in DSM-5 or anankastic personality disorder in ICD-10, has traditionally been characterised as an excessive preoccupation with orderliness, mental and interpersonal control, and perfectionism at the expense to efficiency, openness, and flexibility. The maladaptive patterns of OCPD usually have an onset in late adolescence or early adulthood. The traits of OCPD are usually stable over time, significantly impair functioning, and cause significant distress. Even though it’s quite common, OCPD is still a relatively under-diagnosed disorder lacking empirical research. Notably, with the introduction of ICD-11, there was a dramatic shift in conceptualisation of personality disorders. In the new dimensional approach of the ICD-11, the anankastia domain overlaps with DSM-5 OCPD traits as well as the low disinhibition (low levels of impulsivity) domain. Anankastia is described as a narrow focus to an individual’s rigid standards of perfection, right or wrong categorisation, and a high need to control oneself, others, and/ or the environment to meet those high standards. In a clinical sense, the individuals that will present with the highest anankastia and/ or lowest disinhibition traits will most likely have the highest OCPD symptoms as well. Furthermore, egosyntonicity, or compatibility with the conscious self-concept, is one of the most important aspects in personality-related disorders. Individuals with OCPD may see their symptoms as valuable assets of their personality, which they would have difficulty changing, and which give them a sense of self-identity and structure in life. OCPD EPIDEMIOLOGY AND COMORBIDITY WITH OTHER MENTAL DISORDERS Most of us are more familiar with the other personality disorders, such as borderline, antisocial, or narcissistic personality disorder, due to the increased attention by the scientific community, clinicians, and even popular media, as they usually manifest as extremely maladaptive and socially undesirable. Nevertheless, the arguably somewhat lesser known OCPD is considered one of the most common personality disorders in the general population, with lifetime prevalence rates ranging from 2.1 % to 7.9 %. The prevalence of OCPD tends to rise in psychiatric populations, increasing up to 25 %. Considering comorbidity with other mental health disorders, OCPD is often comorbid with OCD, mood and anxiety disorders, eating disorders, and substance-related disorders. OCPD is also often comorbid with other personality disorders, including avoidant, paranoid, schizotypal, borderline, and narcissistic personality disorder. OCPD VS. OCD According to DSM-5/DSM-5-TR, to meet the criteria for OCPD, the patient must have at least four out of eight symptoms associated with significant distress and impairment, including preoccupation with details, perfectionism, workaholism, over-conscientiousness, hoarding, need for control, miserliness, and rigidity. In contrast, to meet the diagnostic criteria for OCD, the person must have obsessions and/or compulsions that are time consuming (at least one hour/day) and/or cause significant distress in daily functioning, while the symptoms should not be better explained by other mental disorder, substance abuse or medical condition. Some parallels and overlapping features between OCPD and OCD can be drawn that present a diagnostic challenge. First, in both OCPD and OCD, there may be a preoccupation with detail. Moreover, while someone with OCPD may tend to be overly rigid in terms of order and cleanliness, a person with OCD may manifest similar behaviors as part of their contamination obsessions and cleaning compulsions. Secondly, both OCPD and OCD may tend to overestimate threat and find it difficult to tolerate uncertainty. Thirdly, even though perfectionism is not a core feature of OCD, it may be a contributing factor to OCD symptomatology, resulting in repetitive ordering and arranging behaviours. Fourthly, in both OCPD and OCD, the importance of “right” vs. taboo thoughts may be emphasised to a great extent. Two key aspects may help to differentiate OCPD from OCD. First, even though both OCPD and OCD may vary in terms of the degree of insight, individuals with OCPD may be fixated on the belief that their behaviour is appropriate and a core part of their personality (egosyntonic), whereas most OCD patients have egodystonic symptoms, meaning that they see their symptoms as upsetting and unwanted. Secondly, as DSM-5 suggest, the clinical manifestations between OCPD and OCD are rather different in that OCPD is not primarily characterised by intrusive thoughts (obsessions) or repetitive behaviours (compulsions) as in the case of OCD. Instead, its core feature is a pervasive maladaptive pattern of pathological perfectionism and rigid control. Of note is that these two disorders can co-exist, with DSM-5 suggesting that in such a case, both diagnoses should be assigned. THE KEY CHARACTERISTICS OF OCPD: • Preoccupation with details • Perfectionism • Workaholism • Over-conscientiousness • Hoarding • Need for control • Miserliness • Rigidity