When perfectionism becomes a problem: Purdue Psychological Sciences researcher seeks to help clinicians identify when OCPD-related symptoms become problematic

Written By: Rebecca Hoffa, rhoffa@purdue.edu

Perfectionism, conscientiousness and orderliness tend to be seen as positive traits of high-achieving individuals. But what happens when they start affecting that individual’s relationships or ability to function in life?

Obsessive compulsive personality disorder (OCPD) is exactly that: a mental health condition centered around extreme perfectionism, conscientiousness and control. Unlike obsessive compulsive disorder (OCD), which is a mental health condition that includes unwanted thoughts (obsessions) and actions to mitigate the perceived threat (compulsions), OCPD isn’t perceived as a nuisance to the person experiencing the condition; it’s often first identified by the people closest to them in their lives.

Doug Samuel, professor of psychological sciences in Purdue University’s College of Health and Human Sciences, has focused a significant portion of his research on OCPD. He has recently made strides in helping provide frameworks for clinicians to assess when these traits are becoming problematic to ultimately help their patients live happier, more functional lives.

“People will talk about keeping things organized, kind of being scheduled and things like that with OCD,” Samuel said. “And those are actually much more consistent with OCPD than they are with OCD. OCD is traditionally thought of as an anxiety-driven disorder where individuals have obsessions about things that could go wrong if they don’t do something. For individuals who experience OCD symptoms, they’re pretty impaired by those. They kind of recognize they’re not accurate, but they’re still worried that they might be.

“I’ll contrast that with OCPD, which as a personality disorder is more so that individuals think that’s the right way to be. They’re not necessarily troubled by it. Where that trouble would often come up is in relationships. This need for control, to be perfectionistic, to have really high moral standards, to be extremely deliberate in making decisions, those are things that the person experiences and they see as the correct approach to life.”

While individuals with OCPD may not identify that they have a problem, it’s often their spouses, children, parents or other important people in their life who are pointing out their extremes when it comes to these traits, which are often causing friction in their relationships.

“The impairment really is in the ability to function in life,” Samuel said. “Functioning in life is also a broad thing. This can include things like: Can you maintain a job? Can you maintain relationships? Can you keep your house organized and achieve the daily activities that one needs to do in life? That’s kind of the big place where I would say it tends to hit with OCPD.”

Samuel noted OCPD is much more common than people may guess. He said one of his most surprising findings from his recent work exploring the condition in a representative national sample is that the average person in the United States has higher levels of the traits involved with OCPD than the researchers originally expected.

“I think estimates are probably around 7% or 8% of the general population who have OCPD,” Samuel said. “Now, that is premised on where you draw a line. And that is of itself a tricky challenge, right? Because we know that certain amounts of these things as they increase on a slope is good. The way I think about this is that at some point that overall good thing becomes inflexible, and it tips down into being more problematic. So, it’s where you draw that line to tell you what the prevalence is.”

As a clinical psychologist, Samuel’s work is ultimately focused on helping clinicians better understand, diagnose and treat the disorder.

“So historically with personality disorders, if we go back 100 years up until about the 1990s, it was thought you really either had it or you didn’t,” Samuel said. “The field is moving toward thinking about it on a dimension. We’ve found a lot of leverage from using the basic personality traits that we use to understand all individuals. Those are called the Big Five. Within those, we have pretty good evidence that there’s clearly pathological ranges of most of those traits. The one that has been most interesting to me is conscientiousness.

“This is a trait that’s defined by organization, being on time, being deliberate in your decision-making. There are people who say, ‘No, you could never have too much conscientiousness,’ but I think we have reasonable evidence that that is probably true up to a certain extent. And at a certain point, being organized becomes perfectionism. Being deliberate becomes hyper-deliberate or over-deliberate. It’s an open question that the science is still trying to sort out. It’s always been interesting for me to try to figure out conceptually where we might draw that line between normal, helpful, adaptive levels of conscientiousness and where that becomes more maladaptive or pathological.”

Samuel and his research team developed a measure called the Five Factor Obsessive Compulsive Inventory, which is meant to measure the historical symptoms of OCPD and creates a scale to assess the maladaptive range for each of those traits to determine when a diagnosis might be needed. However, for many years, clinicians were often guessing where the percentiles fell on that scale that required a diagnosis. His recent study, “Investigating the Link Between Overcontrolled Traits and Functional Impairment: Determining Relations and Establishing Interpretive Guidelines,” is aiming to address that by developing guidelines for clinicians when assessing OCPD patients.

“That was the idea behind that study: to see if we could start to look at the lines of where the normal separates from the risk,” Samuel said. “I think we have a good start. I think these need to be, like anything else, validated against future studies. They worked reasonably in this sample. I think it remains to be seen how well it’s going to work in a true clinical setting. I hope this is at least a starting point. They can always be adjusted later, but it gives therapists and individuals an idea of where these lines might be drawn.”

Samuel said he hopes to build on the research in the future to go beyond self-report data and include surveys of the loved ones of those affected by OCPD to further refine guidelines for clinicians and translate the work into a clinical setting.

“I hope that we are able to more accurately assess those levels where the problem is likely to be, and if that requires a different measure or a more fine-grained kind of magnifying glass in certain levels, we may need those things,” Samuel said. “Ultimately, I’d like to be able to figure out how to characterize that line relating the trait to life functioning. Does that line kind of go up, up, up; hit a plateau; and start going down, or does it form more of an inverted U? I think those are the types of questions that we don’t yet have the ability to answer super well.”