productive environments. only when these traits become extreme, maladaptive, and cause clinically significant impairment in several aspects of one's life should a diagnosis of ocpd be considered. personality change due to another medical condition. obsessive–compulsive personality disorder must be differentiated from a personality change due to a medical condition, which affects the central nervous system, and may cause changes in behavior and traits. substance use disorders. substance use may cause the advent of obsessive-compulsive traits. it is necessary that this is distinguished from underlying and persistent behavior, which must occur when a person is not under influence of a substance. icd-10 the world health organization's icd-10 uses the term anankastic personality disorder (f60.5). at least four of the following must be present: feelings of doubt perfectionism excessive conscientiousness checking and preoccupation with details stubbornness caution rigidity insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder. millon's subtypes in his book, personality disorders in modern life, theodore millon describes 5 types of obsessive–compulsive personality disorder, which he shortened to compulsive personality disorder. subtype description conscientious compulsive (including dependent features) those with conscientious compulsivity view themselves as helpful, co-operative, and compromising. they downplay their achievements and abilities and base their confidence on the opinions and expectations of others; this compensates for their feelings of insecurity and instability. they assume that devotion to work and striving for perfection will lead to them receiving love and reassurance. they believe that making a mistake or not achieving perfection will lead to abandonment and criticism. this mindset causes perpetual feelings of anxiety and an inability to appreciate their work. puritanical compulsive (including paranoid features) they have strong internal impulses that are countered vociferously through the use of religion. they are constantly battling their impulses and sexual drives, which they view as irrational. they attempt to purify and pacify the urges by adopting a cold and detached lifestyle. they create an enemy which they use to vent their hostility, such as "non-believers", or "lazy people". they are patronizing, bigoted, and zealous in their attitude toward others. their beliefs are polarized into "good" and "evil".: 231 bureaucratic compulsive (including narcissistic features) the bureaucratic compulsive displays signs of narcissistic traits alongside the compulsivity. they are champions of tradition, values, and bureaucracy. they cherish organizations that follow hierarchies and feel comforted by definitive roles between subordinates and superiors, and the known expectations and responsibilities. they derive their identity from work and project an image of diligence, reliability, and commitment to their institution. they view work and productivity in a polarized manner; either done or not. they may use their power and status to inflict fear and obedience in their subordinates if they do not strictly follow their rules and procedures, and derive pleasure from the sense of control and power that they acquire by doing so.: 232–233 parsimonious compulsive (including schizoid features) the parsimonious compulsive is hoarding and possessive in nature; they behave in a manner congruent with schizoid traits. they are selfish, miserly, and are suspicious of others' intentions, believing that others may take away their possessions. this attitude may be caused by parents who deprived their child of wants or wishes but provided necessities, causing the child to develop an extreme protective approach to their belongings, often being self-sufficient and distant from others. they use this shielding behavior to prevent having their urges, desires, and imperfections discovered.: 233 bedevilled compulsive (including negativistic features) this form of compulsive personality is a mixture of negativistic and compulsive behavior. when faced with dilemmas, they procrastinate and attempt to stall the decision through any means. they are in a constant battle between their desires and will, and may engage in self-defeating behavior and self-torture in order to resolve the internal conflict. their identity is unstable, and they are indecisive.: 235 comorbidity obsessive–compulsive disorder ocpd is often confused with obsessive-compulsive disorder (ocd). despite the similar names, they are two distinct disorders. some ocpd individuals do have ocd, and the two can be found in the same family, sometimes along with eating disorders. the rate of comorbidity of ocpd in patients with ocd is estimated to be around 15–28%. however, due to the addition of the hoarding disorder diagnosis in the dsm-5, and studies showing that hoarding may not be a symptom of ocpd, the true rate of comorbidity may be much lower. there is significant similarity in the symptoms of ocd and ocpd, which can lead to complexity in distinguishing them clinically. for example, perfectionism is an ocpd criterion and a symptom of ocd if it involves the need for tidiness, symmetry, and organization. hoarding is also considered both a compulsion found in ocd and a criterion for ocpd in the dsm-5. even though ocd and ocpd are seemingly separate disorders there are obvious redundancies between the two concerning several symptoms. regardless of similarities between the ocpd criteria and the obsessions and compulsions found in ocd, there are discrete qualitative dissimilarities between these disorders, predominantly in the functional part of symptoms. unlike ocpd, ocd is described as invasive, and stressful. time-consuming obsessions and habits are aimed at reducing obsession-related stress. ocd symptoms are at times regarded as egodystonic because they are experienced as alien and repulsive to the person. therefore, there is a greater mental anxiety associated with ocd. in contrast, the symptoms seen in ocpd, although repetitive, are not linked with repulsive thoughts, images, or urges. ocpd characteristics and behaviors are known as ego-syntonic, as people with this disorder view them as suitable and correct. on the other hand, the main features of perfectionism and inflexibility can result in considerable suffering in an individual with ocpd as a result of the associated need for control. the presence of ocpd in patients with ocd has been linked to a worse prognosis of ocd, especially when cognitive behavioral therapy was used. this may be due to the ego-syntonic nature of ocpd which may lead to the obsessions becoming aligned with one's personal values. in contrast, the trait of perfectionism may improve the outcome of treatment as patients are likely to complete homework assigned to them with determination. the findings with regards to pharmacological treatment has also been mixed, with some studies showing a lower reception to sris in ocd patients with comorbid ocpd, with others showing no relationship. comorbidity between ocd and ocpd has been linked to a more severe presentation of symptoms, a younger age of onset, more significant impairment in functioning, poorer insight, and higher comorbidity of depression and anxiety. autism spectrum disorder there are considerable similarities and overlap between autism spectrum disorder (asd) and ocpd, such as list-making, inflexible adherence to rules, and obsessive aspects of asd, although the latter may be distinguished from ocpd especially regarding affective behaviors, worse social skills, difficulties with theory of mind and intense intellectual interests, e.g. an ability to recall every aspect of a hobby. a 2009 study involving adult autistic people found that 32% of those diagnosed with asd met the diagnostic requirements for a comorbid ocpd diagnosis. eating disorders perfectionism has been linked with anorexia nervosa in research for decades. a researcher in 1949 described the behavior of the average "anorexic girl" as being "rigid" and "hyperconscious", observing a tendency to "eatness, meticulosity, and a mulish stubbornness not amenable to reason make her a rank perfectionist". so common are such traits as perfectionism and rigidity among anorectics, that they have been referred to in clinical literature as "classical childhood features of patients with anorexia nervosa" or classical premorbid personality descriptors of anorexia nervosa". regardless of the prevalence of the full-fledged ocpd among eating disordered samples, the presence of this personality disorder or its traits, such as perfectionism, has been found to be positively correlated with a range of complications in eating disorders and a negative outcome, as opposed to impulsive features—those linked with histrionic personality disorder, for example—which predict a better outcome from treatment. ocpd predicts more severe symptoms of anorexia nervosa, and worse remission rates, however, ocpd and perfectionistic traits predicted a higher acceptance of treatment, which was defined as undergoing 5 weeks of treatment. people with anorexia nervosa who exercise excessively display a higher prevalence of several ocpd traits when compared to their counterparts who did not exercise excessively. the traits included self-imposed perfectionism, and the childhood ocpd traits of being rule-bound and cautious. it may be that people with ocpd traits are more likely to use exercise alongside restricting food intake in order to mitigate fears of increased weight, reduce anxiety, or reduce obsessions related to weight gain. samples that had the childhood traits of rigidity, extreme cautiousness, and perfectionism endured more severe food restriction and higher levels of exercise and underwent longer periods of underweight status. it may be that ocpd traits are an indicator of a more severe manifestation of an which is harder to treat. gambling disorder a majority of those with lifelong gambling disorder have some sort of personality disorder, and the most common personality disorder amongst them is obsessive compulsive personality disorder. ocpd has a strong comorbidity with individuals who have gambling disorder. a study of data collected in the 2001-2002 national epidemiologic survey on alcohol and related conditions looked at pathological gambling and psychiatric conditions as defined by the dsm-iv. of the surveyed population consistent with gambling disorder, 60.8% also had a personality disorder, with ocpd appearing most frequently at 30%. about 300,000 u.s citizens have both a gambling disorder and obsessive compulsive personality disorder; and yet, there is little research on the comorbidity of the two disorders. those with gambling disorders and ocpd do, indeed, exhibit different behavioral patterns than those with gambling disorders alone. more research on the relationship between the disorders is thought to help uncover causes and develop treatments for patients. mental fatigue recently, in 2020, the connection between mental fatigue and ocpd was published for the first time, even though mental fatigue has been previously associated with identified characteristics of ocpd such as workaholic behavior and perfectionism. other disorders and conditions a diagnosis of ocpd is common with anxiety disorders, substance use disorders, and mood disorders. ocpd is also highly comorbid with cluster a personality disorders, especially paranoid and schizotypal personality disorders. ocpd is also linked to hypochondriasis, with some studies estimating a rate of co-occurrence as high as 55.7%. moreover, ocpd has been found to be very common among some medical conditions, including parkinson's disease and the hypermobile subtype of ehler-danlos syndrome. the latter may be explained by the need for control that arises from musculoskeletal problems and the associated features that arise early in life, whilst the former can be explained by dysfunctions in the fronto-basal ganglia circuitry. psychiatric disorder prevalence of ocpd in 12 month diagnosis substance use disorder 12–25% mood disorders 24% major depressive disorder 23–28% bipolar disorder 26–39% anxiety disorders 23–24% generalised anxiety disorder 34% panic disorder 23–38% social anxiety disorder 33% specific phobia 22% treatment the best-validated treatment for ocpd is cognitive therapy (ct) or cognitive behavioral therapy (cbt), with studies showing an improvement in areas of personality impairment, and reduced levels of anxiety and depression. group cbt is also associated with an increase in extraversion and agreeableness and reduced neuroticism. interpersonal psychotherapy has been linked to even better results when it came to reducing depressive symptoms. epidemiology estimates for the prevalence of ocpd in the general population are 3%, making it the most common personality disorder. current evidence is inconclusive as to whether ocpd is more common in men than women, or in equal rates among sexes. it is estimated to occur in 8.7% of psychiatric outpatient settings. a study of data collected in the 2001-2002 national epidemiologic survey on alcohol and related conditions looked specifically for seven personality disorders as defined by the dsm-iv. the study concluded the most prevalent personality disorder of the survey's population to be ocpd, at 7.88%. this study also concluded there were no gender differences in prevalence and that ocpd was not a predicter of disability. history sigmund freud, 1921 in 1908, sigmund freud named what is now known as obsessive–compulsive or anankastic personality disorder "anal retentive character". he identified the main strands of the personality type as a preoccupation with orderliness, parsimony (frugality), and obstinacy (rigidity and stubbornness). the concept fits his theory of psychosexual development.