Classification & Assessment in Psychiatry · Paper A
Anankastic (obsessive-compulsive) personality disorder
Anankastic personality disorder matters because the person sees their own rigid perfectionism as correct and reasonable, unlike obsessive-compulsive disorder (OCDObsessive-compulsive disorder, a condition of unwanted repeated thoughts and the actions done to relieve them.Read more →), where the sufferer recognises their intrusive thoughts as unwanted. It is a Cluster C ('anxious/fearful') personality disorder marked by preoccupation with orderliness, perfectionism and control, often at the expense of efficiency. For example, imagine a manager who rewrites a finished report five times over trivial formatting, convinced each version is still not good enough. In practice, that comfort with the standard, rather than distress about it, is the key clue that this is a personality disorder, not OCD.
Core features include excessive doubt and caution, preoccupation with details, rules and order, perfectionism that interferes with completing tasks, and excessive conscientiousness. Rigidity, stubbornness, and an unreasonable insistence that others submit to the person's own way of doing things are also typical. Crucially, these traits are ego-syntonic, meaning the person experiences them as a natural, justified part of who they are, unlike OCD's ego-dystonic obsessionsAn unwanted, intrusive thought, image, or urge that keeps returning and causes distress.Read more → and compulsionsA repetitive action or mental act carried out to relieve the anxiety caused by an obsession.Read more →, which the sufferer finds unwanted and distressing. Picture a patient content with spending hours colour-coding files, seeing it as simply doing the job properly. In practice, that lack of internal distress about the behaviour is what separates a personality trait from an anxiety disorder.