Obsessive-compulsive personality disorder

Meet the patient

A 51-year-old finance partner is referred by occupational health after his third missed deadline this year. He has not taken annual leave since 2019. He arrives eleven minutes early with a typed agenda and asks whether you keep to fifty minutes exactly, because the last psychiatrist did not.^[1][2]

His analyses are the best in the department and none of them arrive on time. Two juniors have transferred out; his wife has stopped inviting people over because he re-stacks the dishwasher after her. He sees no problem: "I have standards. Other people are careless."^[1][2]

Then, almost in passing, he mentions he has not enjoyed anything for four months and has been looking up his life insurance terms. Two questions are now live. Is the rigidity a personality disorder, an anxiety disorder, or autism? And what is hiding behind that controlled affect?^[1][11]

References18ShowHide

1. [1]Pinto A, Teller J, Wheaton MG Obsessive-Compulsive Personality Disorder: A Review of Symptomatology, Impact on Functioning, and Treatment Focus (Am Psychiatr Publ), 2022.PMID 37200888
2. [2]Diedrich A, Voderholzer U Obsessive-compulsive personality disorder: a current review Curr Psychiatry Rep, 2015.PMID 25617042
3. [3]Pozza A, Starcevic V, Ferretti F, Pedani C, et al. Obsessive-Compulsive Personality Disorder Co-occurring in Individuals with Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis Harv Rev Psychiatry, 2021.PMID 33666394
4. [4]Mancebo MC, Eisen JL, Grant JE, Rasmussen SA Obsessive compulsive personality disorder and obsessive compulsive disorder: clinical characteristics, diagnostic difficulties, and treatment Ann Clin Psychiatry, 2005.PMID 16402751
5. [5]Bamelis LL, Evers SM, Spinhoven P, Arntz A Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders Am J Psychiatry, 2014.PMID 24322378
6. [6]Bamelis LL, Arntz A, Wetzelaer P, Verdoorn R, et al. Economic evaluation of schema therapy and clarification-oriented psychotherapy for personality disorders: a multicenter, randomized controlled trial J Clin Psychiatry, 2015.PMID 26579561
7. [7]Grant BF, Hasin DS, Stinson FS, Dawson DA, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions J Clin Psychiatry, 2004.PMID 15291684
8. [8]Lenzenweger MF, Lane MC, Loranger AW, Kessler RC DSM-IV personality disorders in the National Comorbidity Survey Replication Biol Psychiatry, 2007.PMID 17217923
9. [9]Torgersen S, Kringlen E, Cramer V The prevalence of personality disorders in a community sample Arch Gen Psychiatry, 2001.PMID 11386989
10. [10]Shadid J, Ferrari AJ, Bach B, Sellbom M, et al. The global epidemiology of personality disorder: a systematic review and meta-regression Lancet Psychiatry, 2025.PMID 41197646
11. [11]Lugnegård T, Hallerbäck MU, Gillberg C Personality disorders and autism spectrum disorders: what are the connections? Compr Psychiatry, 2012.PMID 21821235
12. [12]Kim YR, Tyrer P, Mulder R, King JD, et al. ICD-11 classification of personality disorder: there is no other way forward Br J Psychiatry, 2026.PMID 41906979
13. [13]Soomro GM, Altman D, Rajagopal S, Oakley-Browne M Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD) Cochrane Database Syst Rev, 2008.PMID 18253995
14. [14]Bloch MH, McGuire J, Landeros-Weisenberger A, Leckman JF, et al. Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder Mol Psychiatry, 2010.PMID 19468281
15. [15]Foa EB, Liebowitz MR, Kozak MJ, Davies S, et al. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder Am J Psychiatry, 2005.PMID 15625214
16. [16]Koran LM, Hanna GL, Hollander E, Nestadt G, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder Am J Psychiatry, 2007.PMID 17849776
17. [17]Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study Arch Gen Psychiatry, 2011.PMID 21464343
18. [18]Hirschtritt ME, Bloch MH, Mathews CA Obsessive-Compulsive Disorder: Advances in Diagnosis and Treatment JAMA, 2017.PMID 28384832