Evolutionary Psychopathology by Marco Del Giudice

Author:Marco Del Giudice
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2018-12-07T16:00:00+00:00

Obsessive-Compulsive Personality Disorder

OCPD is a condition defined by a pervasive pattern of orderliness, perfectionism, and self-control. People with OCPD tend to have detailed and exacting standards, behave in an overly scrupulous and inflexible manner with regard to ethics and morality, and focus on work at the expense of leisure, friendships, and intimate relationships. Their preoccupation with details, rules, lists, and schedules may become so prominent that it interferes with the main point of the task; indeed, obsessive perfectionism can make it hard to actually complete tasks and projects. The cognitive and behavioral rigidity of people with this condition is reflected in their interpersonal style, which is often controlling and lacking in spontaneous emotional expression. Rigidity and need for control frequently lead to frustration and anger, which then have to be suppressed or restrained. Finally, OCPD patients can be extremely parsimonious—saving money without spending it and accumulating objects they have trouble discarding. The profile of OCPD in the alternative DSM-5 system is marked by extreme conscientiousness (the opposite of disinhibition) combined with facets of detachment and negative affectivity (American Psychiatric Association, 2013; Carter et al., 2016; Samuels & Costa, 2012; Steenkamp et al., 2015).

While the symptoms of OCPD are rooted in self-regulation and self-control, they also have significant motivational components. For example, orderliness is tightly linked to heightened disgust sensitivity (Haslam, 2011); research on OCPD has focused on pathogen and contamination stimuli, but moral and sexual disgust are also likely to be upregulated. The marked tendency of OCPD patients to experience shame and guilt (Schoenleber & Berenbaum, 2010, 2012) may stem from a number of possible motivational states (see Table 2.1), whereas thriftiness and hoarding point to a specific role of the acquisition system.

The risk of OCPD has a heritable component; estimates from the few available studies range from about 30% to more than 70% (Hopwood & Thomas, 2014; Kendler et al., 2008). The latter estimate is more plausible, given that conscientiousness itself is about 50% heritable. The sex distribution for this condition is approximately balanced, although some studies have found a somewhat higher prevalence in males (less than 2:1; Coid, 1999; Grant et al., 2004; Jackson & Burgess, 2000; Torgersen, 2001).

The comorbidity network of OCPD includes other personality disorders, especially in the DSM-IV cluster A (paranoid and schizoid), but also APD, NPD, and others (Diedrich & Voderholzer, 2015; Hummelen et al., 2008; Lenzenweger et al., 2007; Rossi et al., 2000). However, OCPD shows the lowest rates of comorbidity and the smallest genetic correlations with other personality disorders; shared genetic effects between OCPD and other personality conditions seem to operate mainly via neuroticism/negative emotionality (Kendler et al., 2008; Westen et al., 2003). Eating disorders—mainly with anorexic symptoms—are frequent in OCPD patients and their relatives; other commonly co-occurring conditions include GAD, social anxiety disorder (SAD), panic disorder, and OCD (De Reus & Emmelkamp, 2012; Samuels & Costa, 2012). The overlap between OCPD and OCD is especially interesting, considering that the two disorders are sometimes grouped into a unitary “obsessive-compulsive spectrum.” While OCPD

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