The relationship between OCD and obsessive-compulsive personality disorder (OCPD) has been a focus of debate. This is due to the presence of certain similarities in the diagnosis of OCD, an Axis I disorder in DSM-IV, and of obsessive-compulsive personality disorder, an Axis II disorder in DSM-IV. Both disorders reveal a preoccupation with aggression and control, both use the defenses of reaction formation, undoing, intellectualization, denial and isolation of affect. The psychoanalytic formulation suggests that OCD develops when these defenses fail to contain the obsessional character’s anxiety. In this view, OCD is often considered to be on a continuum with OCPD pathology.

Epidemiologic evidence, however, reveals that a concurrent diagnosis of OCPD is neither necessary nor sufficient for the development of OCD on Axis I, in most OCD patients. Moreover, while prospective research is lacking, it appears that OCPDis not a risk factor for developing OCD, as the prevalence of OCPD among OCD patients is not that different from its prevalence in other psychiatric disorders . This observation raises an interesting theoretical perspective which is divergent from the continuum hypothesis for OCPD and OCD. Diagnostic confusion can be lessened if one remembers that OCD symptoms are usually egodystonic, while compulsive character traits are ego-syntonic and rarely provoke resistance. Moreover, OCPD does not have the degree of functional impairment characteristic of OCD.

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