In assessing an individual for obsessive-compulsive personality disorder, the clinician should not include those behaviors that reﬂect habits, customs, or interpersonal styles that are culturally sanctioned by the individual’s reference group. Certain cultures place sub- stantial emphasis on work and productivity; the resulting behaviors in members of those societies need not be considered indications of obsessive-compulsive personality disorder.
In systematic studies, obsessive—compulsive personality disorder appears to be diagnosed about twice as often among males.
Obsessive-compulsive disorder. Despite the similarity in names, 0CD is usually easily distinguished from obsessive-compulsive personality disorder by the presence of true ob- sessions and compulsions in OCD. When criteria for both obsessive-compulsive person- ality disorder and 0CD are met, both diagnoses should be recorded.
Hoarding disorder. A diagnosis of hoarding disorder should be considered especially when hoarding is extreme (e.g., accumulated stacks of worthless objects present a fire haz- ard and make it difficult for others to walk through the house). When criteria for both ob- sessive-compulsive personality disorder and hoarding disorder are met, both diagnoses should be recorded.
Other personality disorders and personality traits. Other personality disorders may be confused with obsessive-compulsive personality disorder because they have certain features in common. It is, therefore, important to distinguish among these disorders based on differences in their characteristic features. However, if an individual has personality features that meet criteria for one or more personality disorders in addition to obsessive- compulsive personality disorder, all can be diagnosed. Individuals with narcissistic per- sonality disorder may also profess a commitment to perfectionism and believe that others cannot do things as well, but these individuals are more likely to believe that they have achieved perfection, whereas those with obsessive-compulsive personality disorder are usually self-critical. Individuals with narcissistic or antisocial personality disorder lack generosity but will indulge themselves, whereas those with obsessive-compulsive person- ality disorder adopt a miserly spending style toward both self and others. Both schizoid by an apparent formality and social detachment. In obsessive—compulsive personality dis— order, this stems from discomfort with emotions and excessive devotion to work, whereas in schizoid personality disorder there is a fundamental lack of capacity for intimacy.
Obsessive—compulsive personality traits in moderation may be especially adaptive, par- ticularly in situations that reward high performance. Only when these traits are inﬂexible, maladaptive, and persisting and cause significant functional impairment or subjective dis- tress do they constitute obsessive-compulsive personality disorder.
Personality change due to another medical condition. Obsessive-compulsive person- ality disorder must be distinguished from personality change due to another medical con- dition, in which the traits emerge attributable to the effects of another medical condition on the central nervous system.
Substance use disorders. Obsessive-compulsive personality disorder must also be dis- tinguished from symptoms that may develop in association with persistent substance use.
Due to Another Medical Condition
Diagnostic Criteria 310.1 (F07.0)
A. A persistent personality disturbance that represents a change from the individual’s pre- vious characteristic personality pattern.
Note: In children. the disturbance involves a marked deviation from normal devel- opment or a significant change in the child’s usual behavior patterns, lasting at least 1 year.
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
C. The disturbance is not better explained by another mental disorder (including another mental disorder due to another medical condition).
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning.
Specify whether:
Labile type: If the predominant feature is affective lability.