The impact of obsessive-compulsive personality disorder in perfectionism

Original Article

The Impact of Obsessive-Compulsive Personality Disorder in Perfectionism

Authors

  • Sarah A. Redden

  • Nora E. Mueller

  • Jesse R. Cougle

Affiliation

Department of Psychology, Florida State University, Tallahassee, FL, USA

Abstract
Objective

  • Investigate the relationship between perfectionism and Obsessive-Compulsive Personality Disorder (OCPD).

  • Explore clinical differences between individuals with and without OCPD among university students with elevated perfectionism.

Methods

  • Sample: 74 university students exhibiting high levels of perfectionism.

  • Utilized diagnostic assessments and self-report measures of clinical characteristics.

  • Participants randomly assigned to either exposure-based treatment for perfectionism or a waitlist control group.

  • 34 participants (45.95%) met the DSM-IV criteria for OCPD.

Results

  • Individuals with OCPD exhibited significantly higher levels of both general and specific perfectionism domains, along with greater levels of social anxiety.

  • OCPD diagnosis linked to higher rates of current anxiety disorders.

  • Both groups showed comparable benefits from the treatment.

Conclusions

  • Findings reveal the influential role of OCPD in perfectionism and affirm the treatment's effectiveness for both OCPD and non-OCPD individuals.

Key Points

  • Study evaluates OCPD's influence in individuals with high perfectionism.

  • OCPD correlated with increases in perfectionism and personal standards, along with heightened social anxiety and current anxiety disorders.

  • Treatment results were similarly beneficial for those with and without OCPD.

Article History

  • Received: January 5, 2022

  • Revised: March 18, 2022

  • Accepted: April 19, 2022

Keywords

  • Perfectionism

  • Obsessive-Compulsive Personality Disorder (OCPD)

  • Concern over mistakes

  • Treatment

Introduction

  • Definition of Perfectionism:

    • Desire for flawlessness.

    • Associated with self-criticism, distress, and functional impairment (Shafran et al., 2002).

    • According to Hewitt and Flett (1991):

    • High personal standards, belief in high standards expected by others, and unrealistically high standards for others characterize perfectionism.

  • Dimensional Model of Perfectionism:

    • Perfectionism can be characterized by excessive concern over mistakes, high personal standards, exaggerated emphasis on precision and organization, and doubts regarding actions (Frost et al., 1990).

    • Concern over mistakes recognized as a key aspect of perfectionism (Shafran et al., 2017).

  • Psychopathological Implications:

    • Perfectionism is related to various disorders: obsessive-compulsive disorder, social anxiety disorder, personality disorders, and depression.

    • High levels of perfectionism increase the likelihood of developing chronic psychopathology (Dimaggio et al., 2015; Egan et al., 2011; Limburg et al., 2017).

    • Treatment interventions targeting perfectionism reduce symptoms of anxiety, depression, and eating disorders (Egan et al., 2011).

OCPD Overview

  • Definition of OCPD:

    • Characterized by a preoccupation with details, perfectionism, and stubbornness (APA, 2013).

    • Common traits:

    • Difficulty terminating tasks due to unmet standards.

    • Work devotion impacting other areas of life.

    • Inflexibility and frugality.

    • Linked to negative emotional experiences and interpersonal difficulties (Mike et al., 2018).

    • Estimated 7.9% prevalence in Western countries (Grant et al., 2012).

  • Relation to Perfectionism:

    • Strong correlation established between perfectionism and OCPD, particularly among those with eating disorders (Halmi et al., 2005).

    • Perfectionism characterized as a stable trait within OCPD (McGlashan et al., 2005).

Limited Research on Clinical Differences

  • Minimal focus on clinical differences of perfectionists with and without OCPD, particularly possible differential comorbidity and treatment outcomes.

  • Previous studies demonstrated interventions that mitigate perfectionism concurrently alleviate anxiety/depression (Egan et al., 2011).

  • OCPD traits remain consistent over time, suggesting it exacerbates perfectionistic traits (Dimaggio et al., 2018; McGlashan et al., 2005).

Current Study Objectives

  • Aim 1: Compare perfectionism levels and clinical variables in perfectionistic individuals with vs. without OCPD.

  • Aim 2: Investigate the moderating role of OCPD in the effectiveness of internet-based perfectionism treatments involving repeated exposure to mistakes.

Hypotheses

  • Individuals with OCPD will exhibit higher perfectionism levels, increased symptomatology (depression, anxiety, eating disorders), and greater psychiatric comorbidity than those without OCPD.

Materials and Methods

Participants

  • Sample Composition: 74 (94.6% female) university students from a psychology subject pool.

    • Participants received class credits for study involvement.

  • Inclusion Criteria: Participants demonstrating high perfectionism defined as scoring ≥ 29 on the Concern Over Mistakes (CM) subscale of the Frost Multidimensional Perfectionism Scale (FMPS).

  • Exclusion Criteria: Participants with current or past psychosis, bipolar disorder, substance abuse (moderate or severe), imminent suicide risk, or changes in psychotropic medications in past four weeks.

  • Demographics: Average age of participants was 19.51 (SD = 4.53).

    • Ethnic Demographics:

    • 5.4% Black, 70.3% White, 18.9% Hispanic, 4.1% Asian/Pacific Islander, 1.4% Other.

  • Study Format: 38 participants in-person, 36 virtual sessions via Zoom due to COVID-19.

Measures

MINI International Neuropsychiatric Interview

  • Valid and reliable diagnostic interview assessing DSM-IV disorders, including exclusion criteria and comorbidity (Sheehan et al., 1998).

  • Adequate reliability metrics: test-retest and inter-rater (Lecrubier et al., 1997).

Structured Clinical Interview for DSM-IV

  • Focused on enforcing OCPD diagnosis (SCID-II; First et al., 1997). Internal consistency for OCPD = 0.70 (Blais & Norman, 1997).

Frost Multidimensional Perfectionism Scale (FMPS)

  • 35-item self-report measure assessing six perfectionism domains (Frost et al., 1990).

    1. Excessive concern over mistakes,

    2. Excessively high personal standards,

    3. High parental expectations,

    4. Parental criticism,

    5. Emphasis on precision/order/organization,

    6. Doubts about actions.

  • Internal consistency = 0.88 (present study). Concern over mistakes subscale indicated correlation with other perfectionism measures (r = 0.57-0.85).

Centre for Epidemiologic Studies Depression Scale (CES-D)

  • 20-item self-report measuring depressive symptoms over the prior week (Radloff, 1977).

  • Total score range = 0 to 60 (higher scores reflect severe depressive symptoms). Internal consistency = 0.90 in this study.

State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA)

  • 20-item self-report questionnaire assessing cognitive and somatic anxiety symptoms; trait version utilized (Ree et al., 2008). Internal consistency = 0.90.

Eating Attitudes Test (EAT-26)

  • 26-item measure for eating disorder symptoms (Garner et al., 1982).

  • Cut-off score of 20+ signifies risk for eating disorders; internal consistency = 0.89.

Social Phobia Inventory (SPIN)

  • 17-item questionnaire assessing social anxiety disorder (Connor et al., 2000). A total score of 19+ indicates social anxiety disorder. Internal consistency = 0.94.

Intervention

Exposure-based Treatment

  • Participants assigned to treatment focusing on making mistakes or to the waitlist control group.

  • Treatment executed over two weeks, five exposure sessions.

    • Task 1: Purposefully spelling three words incorrectly in sentences, followed by repeating tasks.

    • Task 2: Recall series of shapes shown for short intervals, increasing in number over time.

    • Task 3: Simple mathematics task with choices that included both correct and incorrect answers to induce mistakes.

Procedure

  • Approved by Florida State University Institutional Review Board.

  • Participants completed informed consent, followed by the FMPS-CM. Those scoring ≥ 29 underwent a clinical interview to meet exclusion criteria. Participants then completed surveys.

  • Randomly assigned to either intervention or waitlist.

  • Post-treatment measures were collected after intervention completion or while in the waitlist group.

Data Analysis

  • Comparisons made between OCPD and non-OCPD groups using chi-square analyses and ANOVA.

  • Outliers found in EAT-26 were Windsorized prior to analysis.

  • Multiple regression analyses assessed treatment condition interactions with OCPD.

  • Missing data handled through multiple imputations (20 iterations).

Results

Participant Demographics

  • 34 participants (45.95%) met criteria for OCPD; comparisons were made with 40 participants (54.05%) without OCPD.

Perfectionism Results

  • ANOVA results revealed individuals with OCPD displayed significantly greater perfectionism levels (p < 0.001) and higher self-set personal standards (p = 0.002).

  • Other perfectionism dimensions showed non-significant differences:

    • Concern over mistakes (p = 0.029), parental expectations (p = 0.237), parental criticism (p = 0.042), order and organization (p = 0.027), doubts about actions (p = 0.028).

Symptom Severity

  • OCPD individuals exhibited higher social anxiety (SPIN Total, p = 0.011).

  • No significant differences noted for depression, trait anxiety, or eating disorder symptoms.

Comorbidity Results

  • Higher rates of any current disorder noted in OCPD group (p = 0.037), predominately attributable to increased rates of current anxiety disorders (p = 0.014).

    • Specific to GAD: 50% of OCPD individuals had GAD vs. 15% in non-OCPD group (p = 0.001).

Setting Impact

  • Two-way ANOVA indicated no significant interaction between study completion setting (in-person vs. online) and OCPD diagnosis regarding perfectionism levels or other measures (p > 0.05).

Treatment Response

  • Intent-to-treat multiple regression showed no significant interactions between treatment condition and OCPD diagnoses across various symptom measures (p > 0.05).

  • Both OCPD and non-OCPD groups demonstrated equivalent treatment benefits from exposure-based intervention.

Discussion

Key Findings

  • First evaluation of OCPD in high perfectionism sample elucidates higher perfectionism in OCPD individuals.

  • Results align with prior findings highlighting OCPD's link to more extreme perfectionism with consequential impairments in multiple life domains.

  • OCPD associated with increased social anxiety, consistent with prior research on comorbid symptomatology (Diedrich & Voderholzer, 2015).

  • Exposure-based treatment effectively reduced perfectionism and social anxiety symptoms irrespective of OCPD diagnosis (p = 0.006 for social anxiety).

  • No significant differences were found in eating pathology, trait anxiety, or depression between OCPD groups.

Implications for Treatment

  • Reductions in perfectionism may enhance the quality of life for those with OCPD.

  • Further investigation is warranted to examine the treatment impacts on various facets of OCPD beyond perfectionism.

  • Study limitations highlight participant gender bias (94.6% female), necessitating more diverse samples for further research.

  • Consideration of active controls in future research may be necessary to compare treatments effectively.

Conclusions

  • Study contributes to the understanding of perfectionism and its association with OCPD, indicating that effective treatment can target perfectionism in both populations.

  • Insights gained may inform clinical practices surrounding perfectionism intervention strategies, providing a pathway for individuals with OCPD to express symptom relief through targeted treatment.

References

  • Reference citations throughout the document provide credibility and context to statements made, ensuring proper support exists for study methodologies and claims made.

Ethical Guidelines

  • No conflicts of interest declared; research conducted without specific outside funding.