A 45-year-old man is referred for psychiatric evaluation. He is described as a perfectionist who is preoccupied with details, rules, and schedules. He has difficulty delegating tasks and is reluctant to spend money on himself or others. He maintains rigid control over his emotions and rarely expresses warmth. Which of the following is NOT typically associated with Obsessive-Compulsive Personality Disorder?

Explanation

## Distinguishing OCPD from Narcissistic Personality Disorder **Key Point:** A grandiose sense of self-importance and need for excessive admiration are **defining features of Narcissistic Personality Disorder (NPD)**, not Obsessive-Compulsive Personality Disorder (OCPD). This is a crucial distinction between two Cluster B/C personality disorders. ### Comparison of OCPD vs NPD | Feature | OCPD | NPD | |---------|------|-----| | Preoccupation with orderliness/perfectionism | ✓ | ✗ | | Reluctance to delegate | ✓ | ✗ | | Excessive devotion to work | ✓ | ✗ | | Emotional constriction/coldness | ✓ | ✗ | | Grandiosity and self-importance | ✗ | ✓ | | Need for excessive admiration | ✗ | ✓ | | Lack of empathy | ✓ | ✓ | | Interpersonal exploitativeness | ✗ | ✓ | **High-Yield:** **OCPD** is a Cluster C disorder (anxious/avoidant) driven by **fear of loss of control**, while **NPD** is a Cluster B disorder (dramatic/erratic) driven by **need for admiration and grandiosity**. OCPD patients are rigid and emotionally cold; NPD patients are charming but exploitative. **Mnemonic for OCPD (PERFECT):** - **P**erfectionism that interferes with task completion - **E**xcessive devotion to work - **R**eluctance to delegate - **F**ormality and emotional restriction - **E**xcessive scrupulosity about rules/details - **C**ontrol-oriented behavior - **T**hrift and reluctance to spend **Clinical Pearl:** OCPD patients often seek help because they recognize their perfectionism causes distress. NPD patients rarely seek help and do not see their behavior as problematic. This is a key diagnostic differentiator.