Which diagnosis best fits duration, episodicity, and exclusions?
A
Obsessive-compulsive personality disorder (OCPD)
Pervasive pattern of preoccupation with orderliness, perfectionism, and mental/interpersonal control (at the expense of flexibility, openness, and efficiency), beginning by early adulthood; ≥4 of 8: preoccupation with details/rules/order; perfectionism interfering with task completion; excessively devoted to work; overconscientious about morality/ethics; unable to discard worthless objects; reluctant to delegate; miserly; rigidity/stubbornness
AA. Pervasive pattern of preoccupation with orderliness, perfectionism, and mental/interpersonal control (at the expense of flexibility, openness, and efficiency), beginning by early adulthood; ≥4 of 8: preoccupation with details/rules/order; perfectionism interfering with task completion; excessively devoted to work; overconscientious about morality/ethics; unable to discard worthless objects; reluctant to delegate; miserly; rigidity/stubbornness
BA. Persistent difficulty discarding or parting with possessions, regardless of their actual value B. Difficulty is due to perceived need to save items and distress associated with discarding them C. Accumulation of possessions results in congestion and clutter of living areas, compromising their intended use
Common specifiers
AMild / Moderate / Severe
BWith excessive acquisition; With good or fair insight; With poor insight; With absent insight / delusional beliefs
Differential flags
AOCD (ego-dystonic intrusive obsessions + compulsions; not a personality style); Narcissistic PD (perfectionism driven by need for admiration); ASD (rigidity is neurodevelopmental; different onset and profile)
BOCD with hoarding compulsions (in OCD, hoarding is driven by specific obsessions; hoarding disorder does not require obsessions); OCPD (excessive sentimentality about items; not true difficulty discarding); Major NCD (cognitive decline causing inability to manage possessions)