How Is Obsessive-Compulsive Personality Disorder (OCPD) Treated Today?

Understanding Modern Approaches to Healing and Growth

In Part 1 of our series on Obsessive-Compulsive Personality Disorder (OCPD), we explored the historical development of the diagnosis, from Freud’s early theories to its inclusion in the DSM. In Part 2, we shift our focus to understanding what causes OCPD and how treatment has evolved—offering hope and direction to those living with the condition.

What Causes OCPD? Nature, Nurture, and Environment

OCPD appears to derive from the confluence of genetic and environmental factors (nature and nurture). People with a family history of personality disorders, including OCPD, may be genetically predisposed to develop similar traits. However, genetics alone do not determine the condition.

Environmental factors—particularly early childhood experiences—can play an important role. Children raised in rigid, highly structured homes or in environments where approval is contingent on achievement may internalize a belief system centered around perfection, control, and order. Conversely, children who grow up in chaotic or traumatic environments may develop coping strategies that over-rely on control. While these traits may begin as adaptive strategies, they can eventually evolve into rigid personality patterns that limit emotional expression and interpersonal connection.

To learn more about the underlying causes and clinical profile of OCPD, visit Psychology Today’s guide to OCPD, which provides a clear overview of its symptoms, contributing factors, and treatment options.

Modern Treatment Approaches for OCPD

Though OCPD is deeply rooted in personality structure, effective treatment options are available. Therapy remains the cornerstone of care, offering tools to challenge rigid thinking, improve flexibility, and foster healthier relationships.

Cognitive Behavioral Therapy (CBT)

CBT is widely used in the treatment of OCPD. It helps individuals identify and reframe perfectionistic beliefs, black-and-white thinking, and unrealistic standards. Through structured sessions, clients learn to recognize how their thought patterns drive behaviors and begin practicing more balanced, flexible ways of thinking.

Radically Open Dialectical Behavior Therapy (RO DBT)

An emerging and highly effective approach for individuals with OCPD is Radically Open Dialectical Behavior Therapy (RO DBT). Unlike standard DBT, which is often used for emotional undercontrol (e.g., borderline personality disorder), RO DBT is specifically designed for those with excessive self-control and emotional inhibition. This treatment helps clients embrace vulnerability, enhance emotional openness, and build deeper social connections. RO DBT directly targets the perfectionism, rigidity, and interpersonal difficulties that are central to OCPD—supporting increased openness and well-being.

Schema Therapy

Multiple clinical trials have shown strong evidence for Schema Therapy being effective in working with OCPD and there is strong data reflecting benefits continuing for years after treatment ends. It was developed by Jeffrey Young in the 1990s to help people with chronic emotional and relationship difficulties, particularly those with personality disorders, complex trauma, or long-standing mental health problems that don't respond well to traditional CBT. It involves working with schemas which are deeply ingrained negative patterns or themes about oneself and relationships, usually formed in childhood or adolescence when emotional needs aren’t met. The goal of schema therapy are to identify schemas, as well as how we respond to them (modes) and strengthen healthier responses to situations that trigger them. 

Medication Support

In some cases, medications like selective serotonin reuptake inhibitors (SSRIs) may be used to manage co-occurring symptoms such as anxiety or depression. While not a primary treatment for OCPD itself, medication can offer relief from secondary symptoms and support progress in therapy. Still, psychotherapy remains the most effective long-term approach for meaningful change.

Moving Forward: Building a Life Beyond Perfectionism

OCPD is more than just being detail-oriented or neat—it’s a complicated and serious mental health condition that can disrupt relationships, limit emotional expression, and cause significant internal distress. However, with the right treatment and support, individuals can learn to shift from rigid patterns toward a more flexible, fulfilling way of life.

At Neil Howell Psychotherapy, I specialize in helping clients recognize and transform the perfectionistic patterns and emotional overcontrol that often accompany OCPD. Using evidence-based approaches like RO DBT, CBT and Schema Therapy, therapy becomes a safe space to explore, understand, and rebuild healthier ways of being.

Ready to Begin Your Healing Journey?

If you’re struggling with perfectionism, control, or emotional rigidity, you don’t have to face it alone. Contact me today to learn more about how therapy can support your growth, improve your relationships, and help you rediscover emotional freedom.