Obsessive-Compulsive Personality Disorder (OCPD)
OVERVIEW
Obsessive-Compulsive Personality Disorder (OCPD) is a chronic psychological condition characterized by maladaptive patterns of excessive perfectionism, preoccupation with orderliness and details and the continual need for control over one’s environment;[1] these behaviors lead to significant distress or impairment.[2] One of the most common personality disorders, DSM-5 reports that OCPD’s estimated prevalence ranges from 2.1 to 7.9% in the general population,[3,4] with a higher incidence among men.[5]
OCPD is defined as a characterological disturbance which involves one's generalized style and beliefs in the way they relate to themselves and the world. Persons with OCPD are typically deeply consumed in dysfunctional beliefs and genuinely see their way of functioning as the only "correct" way, where the world needs to conform to their own strict standards. Blame for one’s internal strife is commonly placed on external circumstances or the environment around them.[6] Commonly characterized as being rigid and controlling, individuals with OCPD generally find it difficult to relax as they feel obligated to plan out their activities with minute details, as unstructured time is intolerable.[7] Further, they are often unable to deal with any deviance from their self-imposed rules, timelines, or schedules. As these rules/requirements may not make sense to anyone but them, they can cause difficulty in interactions with others.[8] The need for interpersonal control in OCPD is apt to lead to hostility as well as occasional explosive outbursts of anger and frustration at those around them.[9] Individuals with OCPD are typically seen as overly rigid and controlling since they often expect their coworkers, friends, and family to conform to their “right” way of doing things. They may also be inflexible about matters of morality and ethics and may attempt to impose their views on others.[10] The high standards individuals with OCPD have, which originate from dysfunctional beliefs, are thought to be established in early adolescence.[11] Lack of adherence to these rigid beliefs causes inner cognitive dissonance, leading them to push their beliefs onto others, creating difficulties in social interactions[12] as well as high levels of internal distress.[13] Inflexible cognitions (e.g. that their way is the only correct way) become so deeply ingrained they resist acknowledging alternatives to their own ways of thinking.[14] Those with OCPD do not question themselves, only seeing inadequacies in others and their external environment.[15]
OCPD traits often lead to significant functional impairment. The pursuit of perfection becomes problematic as inordinate amounts of time are spent on relatively trivial tasks; deadlines are often missed[16] as people tend to have difficulty finalizing projects, getting caught up in completing every detail perfectly.[17] While people with this personality disorder have a pervasive preoccupation with orderliness, perfectionism, and control with no room for flexibility that ultimately slows or interferes with completing a task,[18] they may achieve at a high level as they tend to be very good at detailed and complex work.[19] In fact, on the surface, people with OCPD can appear confident, warm, organized and high-achieving, with their meticulous standards benefitting them in certain professions. However, as with any personality disorder, overexpressed traits will cause dysfunction, and OPCD frequently occurs with psychiatric comorbidities.[20]
OCPD DIFFERS FROM OCD
OCPD and Obsessive-Compulsive Disorder (OCD) are often confused for each other as they are perceived as being similar. There is, however, a great difference between these two conditions, as OCPD is a personality disorder while OCD is an anxiety disorder; it is possible to have both of these disorders.[21,22]
While individuals with OCD and OCPD both experience anxiety, they do for differing reasons. Those with OCD experience tremendous anxiety related to specific preoccupations, which they perceived as threatening. Persons with OCD perform elaborate/time-consuming rituals to avoid or escape anxiety. Further, their overall genuine nature tends not to be affected by this condition and in the vast majority of the cases they recognize that the concerns are irrational. Within OCPD, however, it is one's dysfunctional philosophy which produces anxiety, anguish and frustration. Further, this personality style often has devastating effects on one's emotional wellbeing, work productivity and interpersonal relationships. However, since there is a moderate overlap between OCPD and OCD in regard to similarity of rituals, there requires vast training and clinical experience to distinguish the subtle but drastic contrast between these two conditions.[23]
SIGNS AND SYMPTOMS
OCPD presents itself with three primary associated features and three accompanying rituals, setting it apart from other personality disorders.
Associated Features:
Indecisiveness – For those with OCPD, nearly all decisions can seem to take on utmost importance, while being correct is imperative; therefore, making even simple choices can become a nightmare. The inability to establish with certainty which choice is the correct one can cause a person great suffering. For example, it is not uncommon for someone to spend ten minutes on relatively trivial decisions such as which route to drive somewhere or which pair of shoes would be correct for an outfit. Placing a great deal of pressure on themselves and on others to not make mistakes, the driving force behind OCPD is to avoid being wrong in any accounts. Since it is nearly impossible to continuously make correct choices in life, those with OCPD regularly feel discontent.[24]
The impacts of indecisiveness can have devastating effects on academic, professional and interpersonal relationships. Through their educational career, students who should be earning top marks will often do poorly due to incomplete assignments, as they have an extremely difficult time getting assignments perfect. Procrastination often contributes to one’s difficulties as making decisions becomes increasingly difficult. Further, the commencement of a project can be problematic as one struggles to sort priorities correctly. Choosing a college major and career path further debilitate one with OCPD due to the long-term investment that accompanies such a decision. Aspirations for perfection can play themselves out in interpersonal relationships as well. For someone with OCPD, choosing a partner who lives up to their unreasonably high standards is very difficult, if not impossible, as even relatively minor flaws in their partner appear substantial and difficult to overlook and accept. Relationships over the long haul are often filled with chronic discord and volatility.[25] Conversely, persons with OCPD tend to have a low threshold for feeling hurt and humiliation. This becomes one of the major issues to work on, as one easily feels hurt and cannot cope with criticism. Any criticism is perceived as an attack on one’s already perfect standards leading to them feeling out of control. To avoid criticism, individuals spend an inordinate amount time making the correct decision - or exercise extreme caution and remain indecisive to avoid failure.[26] Unfortunately, this attempt at avoiding suffering results in rumination and fixation, which can lead to deep hatred, anger and sadness.[27]
Emotional Rigidity - Due to their quest for perfectionism, those with OCPD tend to be rigid and stubborn in their activities, insisting that everything be done in specific ways. The need to be in control often leads to persons with OCPD acting solitary in their endeavors as they tend to mistrust the help of others. Planning ahead in great detail without considering any changes, this relentless rigidity may frustrate co-workers and friends.[28] The compelling need to do things in a particular way is often based on little evidence or logic. Objections to both banal and significant decisions may lead to long arguments; although one with OCPD may be unable to fully justify their position, they vehemently maintain their beliefs.[29]
Within interpersonal relationships, the rigidity of OCPD can become problematic. Expression of one’s affection is usually highly controlled, with interactions presenting in a formal, stiff, or serious way. Often, one speaks only after thinking of the perfect thing to say. Possibly appearing cold, they tend to focus on logic and intellect while being intolerant of others’ emotional or expressive behavior.[30] Since emotionality is associated with spontaneity as well as potential loss of control, responding to one’s emotions effectively and appropriately places an abundance of pressure on them to keep emotions constricted. They further contain themselves as vulnerability is viewed as a way to negatively expose themselves to the possibility of rejection. Exerting effort to contain any type of out-bursts of emotion becomes an everyday phenomenon. However, one emotion exists in abundance in those with OCPD: the expression of anger tends to come out naturally and in excess. Additionally, the projected emotional flatness of persons with OCPD often leads to their humor being mistaken for seriousness, with jokes or sarcasm mistaken by others as insults and political incorrectness.[31] These attitudes can have detrimental consequences on relationships, causing distress, oppression and exhaustion for the partners. Since the need of individuals with OCPD to remain firm in their perspective becomes more important than compromising in a situation, they become at risk of losing a job or severely damaging relationships.[32]
Rigidity further presents in one’s morals, ethics, and values. Applying rigid moral principles to themselves and to others, they are harshly self-critical. Further, they are rigidly deferential to authorities and those in position of power, insisting on exact compliance to rules, with no exceptions for any extenuating circumstances.[33]
Depressed Mood - Mindful to downplay and hide any emotions, the frequent inner turmoil of depression those with OCPD suffer is rarely observed by others. The expectations of high standards one applies to themselves can become debilitating. Feeling deeply entrenched that they are a "Good Person" can paradoxically lead to feelings of depression and disappointment. Unable to live up to their high standards, self-hatred along with tremendous disappointment can easily lead to depression. Understanding and acceptance that one is human and with occasional flaws is paramount to overcoming said depression.[34]
Dichotomous thinking is another contributor to depression within the OCPD population. This tendency to categorize all aspects of life into one of two perspectives (e.g. good or bad) places immense pressure on oneself. Since those with OCPD value what is good, pure and wholesome, it can take only one perceived fault or character stain to find complete justification in discarding anything which presents as a flaw. Further, these rigid standards relay onto oneself and can be devastating to one's self-image as finding fault in one's own world produces a regular source of conflict in maintaining perpetual high standards of life.[35]
Accompanying Rituals:
Perfectionism – In those with OCPD, a need for perfectionism leads to preoccupation with order, and control of themselves and situations. This drive leads to an interference with flexibility, effectiveness, and openness. In an attempt to maintain a sense of control, one focus on rules, minute details, procedures, schedules, and lists. The main point of a project or activity often becomes lost as persons repeatedly check for mistakes and pay extraordinary attention to detail. Making poor use of time, the most important tasks are often left until the end; further, preoccupation with details and attempting to perfect all aspects of the project can endlessly delay completion.[36] As a ritualistic aspect of this condition, perfectionism entails checking and rechecking "completed" tasks to be absolutely sure that there are no imperfections. As an example, it could take someone with OCPD upwards of 10 to 20 minutes to fill out a check or mail an envelope due to the rigid need to ensure that there are absolutely no mistakes.[37]
The need for perfectionism impacts those with OCPD in the workforce as they are often unaware of how their behavior affects co-workers. Wanting everything done in a specific way, one has difficulty delegating tasks and working with others, making detailed lists about how a task should be done and becoming upset if a coworker suggests an alternative way. Help may even be rejected when a project is behind schedule.[38]
Dichotomous thinking presents in obsessional personality as there is no “grey area” and everything is either black or white. If something cannot be categorized as such, inner turmoil develops as it undermines a perfectionist's view of the world.[39] In this cognitive distortion of “all or nothing,” the dismissal of those who fall short of such extreme standards occurs if one’s high standards are not met. This is one of the major social deficits in people with OCPD and leads to a lack of emotional connection with others. The immediate judgement of other people against one’s own gold standards are impossibly hard to consistently achieve. Once a person with OCPD recognizes a flaw in another, every aspect of the person's character becomes heavily scrutinized. Moreover, any perceived flaw, however insignificant, will outweigh any positive qualities of the other person, resulting in disapproval; the person with OCPD will be unable to focus on anything but the flaw, noting that as the other’s defining attribute.[40]
Hoarding – Hoarding presents as the excessive saving or collecting of items (which are typically regarded as worthless), to the point that it intrudes on the quality of life for the hoarder or those living with them. In the majority of these cases, people lack the insight that they are behaving in an unhealthy manner. When persons are not cognizant of the irrational nature of this condition it is referred to as overvalued ideation (ego-syntonic OCD). Typically, this form of OCD involves a poorer prognosis since the individual is rarely willing to confront the challenges offered by treatment. The lack of willingness to see their culpability has a very adverse impact on the quality of life for those around them. However, many hoarders are well aware of the adverse impact of this condition and suffer tremendously as a consequence of seeing their living environment filled with possessions.[41]
Where hoarding is a component of OCPD, the justification for saving items typically involves the following rationales:[42]
It is perceived as “wasteful” to throw out something that may be in good shape
Something may be useful/needed at some point in the future
Objects may be part of a project that has yet to be completed and is one of their endless projects on the "to do list."
Ordering – Excessive ordering is another prominent sign of OCPD. Someone with this condition tends to place items in exactly their proper spot and aligned how they “should be” (i.e. the “correct” way.) Cabinets, closets and drawers are often meticulously arranged, as persons with OCPD tend to ritualize ordering, often with a focus on patterns, symmetry, use of equivalent spacing and parallel formations; if an item were misaligned or shifted slightly from its proper space, a person with OCPD can typically note this discrepancy immediately and readjust it. If items are not put exactly in their proper spot the world might be a much more threatening place due to its unpredictability. With ordering as a manifestation of OCD and OCPD, it is common for someone to place and replace items over and over again until they feel they have gotten it exactly right. Ordering and symmetry also manifest in action, with some persons presenting with the need to touch both sides of an object, or, as an example, the left and right sides of their body.[43]
DIAGNOSIS
To qualify for a diagnosis of OCPD one does not need to present with all of the following manifestations. A combination of the following dispositions in the extreme form is generally basis for diagnosis. The primary manifestations of OCPD entail perfectionistic standards or righteous indignation. The second factor entails the rigid ownership of truth, which produces anger and conflict. Persons with OCPD generally lean toward one of these perspectives or another. However, in some cases both perspectives present equally. What is important to note is that people tend not to enter therapy for the express purpose of being treated for OCPD, as typically a diagnosis will be made by a clinician after other topics have been explored.[44]
For a diagnosis of Obsessive-Compulsive Personality Disorder, persons must have begun by early adulthood and have a persistent pattern of preoccupation with order, perfectionism, and control of self, others, and situations.[45]
This pattern is shown by the presence of ≥ 4 of the following:[46]
Preoccupation with details, rules, schedules, organization, and lists
A striving to do something perfectly that interferes with completion of the task
Excessive devotion to work and productivity (not due to financial necessity), resulting in neglect of leisure activities and friends
Excessive conscientiousness, fastidiousness, and inflexibility regarding ethical and moral issues and values
Unwillingness to throw out worn-out or worthless objects, even those with no sentimental value
Reluctance to delegate or work with other people unless those people agree to do things exactly as one wants
A miserly approach to spending for themselves and others because they see money as something to be saved for future disasters
Rigidity and stubbornness
Differential diagnosis
Obsessive-Compulsive Personality Disorder should be distinguished from the following disorders:[47]
Obsessive-Compulsive Disorder (OCD): Those with OCD have true obsessions (repetitive, unwanted, intrusive thoughts that cause marked anxiety) and compulsions (ritualistic behaviors that they feel they must do to control their obsessions). Persons with OCD are often distressed by their lack of control over compulsive drives; in those with Obsessive-Compulsive Personality Disorder, the need for control is driven by their preoccupation with order so their behavior, values, and feelings are acceptable and consistent with their sense of self.
Avoidant Personality Disorder (AVPD): Both Avoidant and Obsessive-Compulsive Personality Disorders are characterized by social isolation; however, in those with OCPD, isolation results from giving priority to work and productivity rather than relationships, and these persons mistrust others only because of their potential to intrude on the patients' perfectionism.
Schizoid Personality Disorder: Both Schizoid and Obsessive-Compulsive Personality Disorders are characterized by a seeming formality in interpersonal relationships and by detachment. However, the motives are different: a basic incapability for intimacy in patients with Schizoid Personality Disorder vs discomfort with emotions and dedication to work in those with OCPD.
CAUSES
While personality disorders such as OCPD do not have any one specific cause, some risk factors that may make one more susceptible to developing OCPD include:[48]
A family history of personality disorders, anxiety or depression
Childhood trauma, including child abuse that leaves one feeling like being “perfect” is the only way to survive
Having a preexisting mental health condition, especially an anxiety disorder
Familial traits of compulsivity, restricted range of emotion, and perfectionism are thought to contribute to this disorder.[49] Hummelen et al. proposed that OCPD develops out of one’s inborn tendency toward systemizing, as this leads to heightened rigidity, stubbornness, and perfectionism.[50] These thoughts, based on the systemizing mechanism, offer one possible explanation for the link between OCPD and interpersonal hostility which was noted in previous research.[51,52]
Additionally, a difficulty of understanding interpersonal functioning in OCPD is due to its high comorbidity with OCD. Gordon et al (2013) and Starcevic et al. (2012) note prevalence data supporting a relationship between these disorders, with elevated rates of OCPD (45-47.3%) in persons diagnosed with OCD.[53,54] Further, research by Przeworski & Cain (2012) on OCD using the interpersonal circumplex suggests that OCD exhibits interpersonal heterogeneity, with OCD individuals reporting “exploitable, nonassertive, and intrusive interpersonal problems.”[55]
COMPLICATIONS
Comorbidities may be present in those with OCPD. Persons often also have a depressive disorder (e.g. major depressive disorder or persistent depressive disorder) or an alcohol use disorder.[56]
Individuals with OCPD often report hostile dominant interpersonal problems and high interpersonal distress. Cain et al. (2015) suggest that interpersonal deficits are an important feature of OCPD pathology. Their results found OCPD individuals reported hostile-dominant interpersonal problems and sensitivities with warm-dominant behavior by others while OCPD+OCD individuals reported submissive interpersonal problems and sensitivities with warm-submissive behavior by others. Further, individuals with OCPD, with and without OCD, reported less perspective taking and more personal distress than healthy controls. Finally, their research indicates that interpersonal control may manifest differently in OCPD males as OCPD males in their study reported higher systemizing levels than OCPD females.[57]
TREATMENT AND THERAPEUTIC OPTIONS
Treatment specifically for OCPD typically includes:[58]
Psychodynamic Psychotherapy
Rowland et al. (2017) note that in a clinical setting, those with OCPD can appear to function well and are often high achieving, thus creating difficulty ascertaining what problems to target in treatment. However, family members and partners are often acutely aware of the difficulties of living with someone with OCPD and can provide valuable collateral information to mental health providers.[59]
It is important to note that treatment may be complicated by the individual's rigidity, obstinacy, and need for control. A further challenge to treatment is that those with OCPD may present during therapy sessions with interesting, detailed, intellectualized conversation that may seem psychologically oriented - but it is void of affect and does not typically lead to change.[60] Phillipson (2007) notes that one’s steadfast belief that their way is the only correct way makes them resistant to accepting the premise that it is in their best interest to let go of "truth owning;" yet letting go of truth is paramount in their recovery. Phillipson further remarks that as ~50% of OCPD clients remain in therapy long-term, many cease attending due to the overwhelming sense of outrage that the doctor/therapist has “made a mistake,” rather than acknowledge the actual conflict within the therapeutic relationship as the unavoidable manifestation of why they came into therapy in the first place.[61]
Cain et al., (2015) offer that interventions tailored to target the interpersonal profile of OCPD may be beneficial. Specifically, they note the importance of skills-based approaches to increase one’s perspective taking as well as the capacity for understanding and responding to emotion.[62]
If you find you are experiencing significant distress due to a need for excessive perfectionism, preoccupation with orderliness and details and continual control over your life/environment your doctor or mental health professional can provide a formal diagnosis and treatment options for relief of said symptoms.
Contributed by: Jennifer (Ghahari) Smith, Ph.D.
REFERENCES
1 Pinto, Anthony. “Treatment of Obsessive-Compulsive Personality Disorder.” Clinical Handbook of Obsessive-Compulsive and Related Disorders, edited by E.A. Storch and A.B. Lewin, 2016, pp. 415-429.
2 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version. (accessed 10-8-2020). www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/obsessive-compulsive-personality-disorder-ocpd
3 Pinto, Anthony. “Treatment of Obsessive-Compulsive Personality Disorder.”
4 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., DSM-5). Washington, DC: American Psychiatric.
5 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
6 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety,” OCPD Online, 28 May 2020, ocpd.org/published-articles/a-defect-of-philosophy-not-anxiety
7 Pinto A, Eisen JL, Mancebo MC, Rasmussen SA. Obsessive compulsive personality disorder. In: Abramowitz JS, McKay D, Taylor S, editors. Obsessive-compulsive disorder: Subtypes and spectrum conditions. New York: Elsevier; 2008.
8 “Obsessive-Compulsive Personality Disorder,” Sheppard Pratt. (accessed 10-7-2020). www.sheppardpratt.org/knowledge-center/condition/obsessive-compulsive-personality-disorder/
9 Villemarette-Pittman NR, Stanford MS, Greve KW, Houston RJ, Mathias CW. Obsessive-compulsive personality disorder and behavioral disinhibition. Journal of Psychology. 2004;138(1):5–22.
10 Cain NM, Ansell EB, Simpson HB, Pinto A. Interpersonal functioning in obsessive-compulsive personality disorder. J Pers Assess. 2015;97(1):90-99. doi:10.1080/00223891.2014.934376
11 Phillipson S. When the going gets tough … the Perfectionist takes control. OCD Online, 2016. Available at: https//www.ocdonline.com/going-gets-tough.
12 Rowland TA, Jainer AK, Panchal R. Living with obsessional personality. BJPsych Bull. 2017;41(6):366-367. doi:10.1192/pb.41.6.366a
13 Cain NM, Ansell EB, Simpson HB, Pinto A. Interpersonal functioning in obsessive-compulsive personality disorder.
14 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
15 Rowland TA, Jainer AK, Panchal R. Living with obsessional personality.
16 Cain NM, Ansell EB, Simpson HB, Pinto A. Interpersonal functioning in obsessive-compulsive personality disorder.
17 “Obsessive-Compulsive Personality Disorder,” Sheppard Pratt.
18 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
19 “Obsessive-Compulsive Personality Disorder,” Sheppard Pratt.
20 Reddy MS, Vijay MS, Reddy S. Obsessive-compulsive (anankastic) personality disorder: a poorly researched landscape with significant clinical relevance. Indian J Psychol Med 2016; 38: 1–5.
21 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
22 “Obsessive-Compulsive Personality Disorder,” Sheppard Pratt.
23 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
24 Ibid.
25 Ibid.
26 Ibid.
27 Rowland TA, Jainer AK, Panchal R. Living with obsessional personality.
28 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
29 Rowland TA, Jainer AK, Panchal R. Living with obsessional personality.
30 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
31 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
32 Rowland TA, Jainer AK, Panchal R. Living with obsessional personality.
33 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
34 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
35 Ibid.
36 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
37 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
38 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
39 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
40 Rowland TA, Jainer AK, Panchal R. Living with obsessional personality.
41 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
42 Ibid.
43 Ibid.
44 Ibid.
45 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
46 Ibid.
47 Ibid.
48 “Obsessive-Compulsive Personality Disorder,” Sheppard Pratt.
49 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
50 Hummelen B, Wilberg T, Pederen G, Sigmund K. The quality of the DSM-IV obsessive compulsive personality disorder construct as a prototype category. Journal of Nervous and Mental Disease. 2008;196:446–455.
51 Cain NM. Interpersonal problem profile of the Pathological Obsessive-Compulsive Personality Scale (POPS). 2011, March; Paper presented at the 2011 annual meeting of The Society for Personality Assessment; Boston, MA.
52 Villemarette-Pittman NR, Stanford MS, Greve KW, Houston RJ, Mathias CW. Obsessive-compulsive personality disorder and behavioral disinhibition.
53 Gordon OM, Salkovskis PM, Oldfield VB, Carter N. The association between obsessive-compulsive disorder and obsessive-compulsive personality disorder: Prevalence and clinical presentation. British Journal of Clinical Psychology. 2013
54 Starcevic V, Berle D, Brakoulias V, Sammut P, Moses K, Milicevic D, Hannan A. Obsessive-compulsive personality disorder co-occurring with obsessive-compulsive disorder: Conceptual and clinical implications. Australian and New Zealand Journal of Psychiatry. 2012
55 Przeworski A, Cain NM. Interpersonal problems in individuals with nonhoarding OCD and those with hoarding symptoms. 2012, November; Paper presented at the 2012 annual meeting of the Association for Behavior and Cognitive Therapies; National Harbor, MD.
56 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
57 Cain NM, Ansell EB, Simpson HB, Pinto A. Interpersonal functioning in obsessive-compulsive personality disorder.
58 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
59 Rowland TA, Jainer AK, Panchal R. Living with obsessional personality.
60 “Obsessive-Compulsive Personality Disorder,” Merck Manual: Professional Version.
61 Phillipson, Steven. “Obsessive Compulsive Personality Disorder: A Defect Other of Philosophy, Not Anxiety.”
62 Cain NM, Ansell EB, Simpson HB, Pinto A. Interpersonal functioning in obsessive-compulsive personality disorder.