Abstract
With the ultimate goal of better understanding Obsessive-Compulsive Personality Disorder (OCPD), the present work is a review and critique of Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) diagnostic criteria at the end of their 18 years of use. Problems of specificity (polythetic criteria and failure to employ a hallmark feature) make OCPD an indistinct diagnostic category that consequently contains a plurality of types. Problems of sensitivity (missing elements and concrete expression of signs) make it more difficult to cull OCPD persons from the population at large. Collectively, these problems of specificity and sensitivity have undermined the efficiency of the DSM-IV criteria set; but more importantly, these problems continue to distort the clinical understanding of OCPD generally.
Highlights
Egosyntonic and enduring, Obsessive-Compulsive Personality Disorder (OCPD) is an axiomatic Axis II pattern producing a marked behavioral, cognitive, and affective signature
As currently formulated in DSM-IV (APA, 1994), conscientiousness is not directed at a particular end, perfectionism does not interfere with a particular task, rigidity and stubbornness are not centered on a particular circumstance—so what makes parsimony any different; why should this disposition be constrained to the expression of hoarding worthless objects and spending money like a miser? because parsimony is not reliably expressed within such confines says nothing about its archetypal importance and diagnostic potential
Lessons of specificity suggest that polythetic criteria sets have proved divisive and distracting, creating contention between clinicians and confusion in diagnosis
Summary
Egosyntonic and enduring, Obsessive-Compulsive Personality Disorder (OCPD) is an axiomatic Axis II pattern producing a marked behavioral, cognitive, and affective signature. As the OCPD criteria list is currently formulated, there is no hallmark symptom, no trait, feature, or quality that hierarchically organizes all others; no psychological, interpersonal, behavioral, or cognitive pattern that is invariably and essentially true of the obsessive personality.
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