Obsessive-compulsive personality disorder
- A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency
- Four (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:
- Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
- Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
- Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
- Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
- Is unable to discard worn-out or worthless objects even when they have no sentimental value.
- Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
- Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
- Shows rigidity and stubbornness.
- Obsessive-compulsive disorder
- Hoarding disorder
- Other personality disorders
- Personality change due to another medical condition
- Substance use disorders
- Clinical diagnosis; however if entertaining other organic causes may initiate workup below
- Point-of-care glucose
- Chem 7
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- Urine pregnancy/beta-hCG (if female of childbearing age)
- May need lots of reassurance
- May avoid giving decisive answers
- Try a low-key, casual tone
- Respond with empathy for emotions, but be firm and set boundaries regarding requests for excessive reassurances (e.g. emphasize what is already reassuring about presentation and that additional tests cannot be performed at this time)
- Emphasize follow-up plan and that patient can always return if deteriorates or not getting better
- Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.