Obsessive compulsive personality disorder
Synonyms and keywords: Anankastic personality disorder; obsession; OCPD; ritual

# Overview
Obsessive compulsive personality disorder is a personality disorder that is characterized by a general psychological inflexibility, rigid conformity to rules and procedures, perfectionism, moral code, and/or excessive orderliness. Obsessive compulsive personality disorder (OCPD) is often confused with obsessive-compulsive disorder (OCD). This could be due to the more commonly known OCD and the similarities in name of the two disorders, however the mindsets are typically different and unrelated. Those who are suffering from OCPD do not generally feel the need to repeatedly perform ritualistic actions, a common symptom of OCD. Instead, people with OCPD tend to stress perfectionism above all else, and feel anxious when they perceive that things are not "right".  People with OCPD may hoard money for future use, keep their home perfectly organized, or be anxious about delegating tasks for fear that they won't be completed correctly. There are four primary areas that cause anxiety for OCPD personalities: time, relationship, uncleanliness, and money. There are few moral gray areas for a person with fully developed OCPD; actions and beliefs are either completely right, or absolutely wrong. As might be expected, interpersonal relationships are difficult because of the excessive demands placed on friends, romantic partners and children.

# Historical Perspective
Sigmund Freud was the first person to characterize what is now known as obsessive-compulsive or anankastic personality disorder as the anal-retentive character. This fixation fit into his theory of psychosexual development.

# Differential Diagnosis
- Anxiety disorder
- Body dysmorphic disorder
- Eating disorders
- Gambling
- Major depressive disorder
- Paraphilias
- Schizophrenia
- Substance abuse
- Tics and stereotyped movements

# Epidemiology and Demographics

## Prevalence
The prevalence of obsessive-compulsive personality disorder is 1200 per 100,000 (1.2%) of the overall population.

# Risk Factors
- Internalizing symptoms
- Negative emotions
- Behavioral inhibition in children
- Stressful/traumatic events in childhood
- Infections
- Post-infectious autoimmune syndrome
- First degree parents with OCD
- Dysfunction in the orbitofrontal cortex
- Dysfunction in the anterior cingulate cortex
- Dysfunction in the striatum

# Natural History, Prognosis and Complications

## Prognosis
Poor prognostic factors include:
- Internalizing symptoms
- Physical or sexual abuse in childhood
- Parents with OCD
- Cerebral dysfunction
- Male gender
- Tics syndrome

# Diagnostic Criteria

## DSM-V Diagnostic Criteria for Obsessive Compulsive Personality Disorder

## Mnemonic
A mnemonic that can be used to remember the criteria for OCPD is LAW FIRMS.
- L  Loses point of activity (due to preoccupation with detail)
- A  Ability to complete tasks is gone (compromised by perfectionism)
- W  Worthless objects (unable to discard)
- F  Friendships (and leisure activities) excluded (due to a preoccupation with work)
- I  Inflexible, overconscientious (on ethics, values, or morality, not accounted for by religion or culture)
- R  Reluctant to delegate (unless others submit to exact guidelines)
- M  Miserly (toward self and others)
- S  Stubbornness (and rigidity)

# Treatment
Treatment for OCPD normally involves psychotherapy and self help. Medication is generally not indicated for this personality disorder in isolation, but Fluoxetine has been prescribed with success.  Anti-anxiety medication will reduce the feeling of fear and SSRIs can replace the chronic frustration with a sense of well-being, as well as reducing stubbornness and negative rumination.  A mild tranquilizer can reduce alcohol dependence, if present. ADD medication can improve task completion by improving mental focus, which will provide visible success and improve outlook for recovery.  Caffeine sensitivity may be an exacerbating factor.

## Psychotherapy
- Behavior therapy  Talking with a psychotherapist about ways to change compulsions into healthier, productive actions.
- Psychotherapy  Talking with a trained counselor or psychotherapist who understands the condition.
- Pharmacotherapy - A psychiatrist can prescribe medications which may make self-management and participation in other therapies possible and/or more productive.

## Self Help
- Educating family and friends about the condition will help them to manage behavioral problems more sympathetically, and to watch out for the warning signs.
- Support groups may also be helpful in accepting and changing obsessive-compulsive behaviors.
- Relaxation, meditation, exercise, regular sleep, and a balanced diet are all important factors in maintaining this focus.
- Consult your healthcare provider if you are having difficulty sleeping and/or you are experiencing problems that prevent you from exercising regularly.
- Keeping a diary may help the individual to identify those stressful situations that help to trigger compulsive reactions, enabling them to focus on more constructive activities.
- Retained items, the result of hoarding, should be released, simultaneously reducing the shame associated with hoarding. Having an assistant to cull hoarded, collected, and stored items will facilitate the process.