Obsessive-compulsive personality disorder. Although obsessive-compulsive person- ality disorder and 0CD have similar names, the clinical manifestations of these disorders are quite different. Obsessive-compulsive personality disorder is not characterized by in- trusive thoughts, images, or urges or by repetitive behaviors that are performed in re- sponse to these intrusions; instead, it involves an enduring and pervasive maladaptive pattern of excessive perfectionism and rigid control. If an individual manifests symptoms of both OCD and obsessive-compulsive personality disorder, both diagnoses can be given.
Individuals with OCD often have other psychopathology. Many adults with the disorder have a lifetime diagnosis of an anxiety disorder (76%; e.g., panic disorder, social anxiety disorder, generalized anxiety disorder, specific phobia) or a depressive or bipolar disorder (63% for any depressive or bipolar disorder, with the most common being major depres- sive disorder [41%]). Onset of OCD is usually later than for most comorbid anxiety disor- ders (with the exception of separation anxiety disorder) and PTSD but often precedes that of depressive disorders. Comorbid obsessive-compulsive personality disorder is also common in individuals with OCD (e.g., ranging from 23% to 32%).
Up to 30% of individuals with OCD also have a lifetime tic disorder. A comorbid tic disorder is most common in males with onset of 0CD in childhood. These individuals tend to differ from those without a history of tic disorders in the themes of their OCD symptoms, comorbidity, course, and pattern of familial transmission. A triad of OCD, tic disorder, and attention-deficit/hyperactivity disorder can also be seen in children.
Disorders that occur more frequently in individuals with OCD than in those without the disorder include several obsessive-compulsive and related disorders such as body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin—pick- ing) disorder. Finally, an association between OCD and some disorders characterized by impulsivity, such as oppositional defiant disorder, has been reported.
OCD is also much more common in individuals with certain other disorders than would be expected based on its prevalence in the general population; when one of those other disorders is diagnosed, the individual should be assessed for 0CD as well. For ex- ample, in individuals with schizophrenia or schizoaffective disorder, the prevalence of 0CD is approximately 12%. Rates of 0CD are also elevated in bipolar disorder; eating dis- orders, such as anorexia nervosa and bulimia nervosa; and Tourette’s disorder.
Diagnostic Criteria 300.7 (F45.22)
A. Preoccupation with one or more perceived defects or ﬂaws in physical appearance that are not observable or appear slight to others.
B. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seek- ing) or mental acts (e.g., comparing his or her appearance with that of others) in re- sponse to the appearance concerns.
C. The preoccupation causes clinically significant distress or impairment in social, occu- pational, or other important areas of functioning.
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
Specify it:
With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the indi- vidual is preoccupied with other body areas, which is often the case.
Specify it:
Indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., “I look ugly" or “I look deformed").