Obsessive Compulsive Personality Disorder as an Autism Spectrum Disorder

Obsessive Compulsive Personality Disorder as an Autism Spectrum Disorder

Introduction

Obsessive compulsive personality disorder is a psychiatric disorder characterized by overly conscientious, rigid, disagreeable behavior, with intense anxiety, need for control, and social aloofness (Griffin et al. 2016). OcPD can be considered a disorder of excessive conscientiousness (Samuel & Widiger 2011), and some studies have suggested a relationship between OcPD and autism (Gadelkarim et al. 2019), there is still little research on their potential relationship. This post gives evidence for the hypothesis that obsessive compulsive personality disorder is a form of autism spectrum disorder, and is diametrically opposed to schizophrenia spectrum disorders consistent with the diametric model.

Overlap Between OcPD and Autism

Autism and OcPD seem to have many shared traits, many of which seem to be diametrical to schizotypy [Table 1]. OcPD and autism also appear to have a particularly high frequency of comorbidity with each other (Hofvander et al. 2009)(Gadelkarim et al. 2019). 

Table 1

Schizotypy	OcPD	Autism	Citation
Ambivalence, taking on multiple perspectives	Stubbornness	Stubbornness	APA (2013) Baron-Cohen (2005) Mann et al. (2008) Parnas & Handest (2003)
Impulsivity, sensation seeking	Increased risk aversion	Increased risk aversion	Griffin et al. (2016) South et al. (2014) Del Giudice et al. (2014)
Increased attention to emotion	Reduced emotionality	Alexithymia	Griffin et al. (2016) Kinnaird et al. (2019) Kerns (2005)
Increased extraversion when controlling for social difficulty	Social “coldness”	Reduced social warmth	Griffin et al. (2016) Wakabayashi et al. (2006) Del Giudice et al. (2014)
Novelty, excitement seeking	Behavioral inflexibility	Need for sameness, routine	Griffin et al. (2016) Crespi (2021) Daneluzzo et al. (2005)  Del Giudice et al. (2014)
Socially oriented perfectionism	Perfectionism	Perfectionism	Griffin et al. (2016) Riccioni et al. (2021) Stoeber (2014)
Reduced attention to detail	Attention to detail	Attention to detail	Griffin et al. (2016) Baron-Cohen et al. (2001) Russell-Smith et al. (2010)
Skepticism and non-conformity to normative rules	Excessive concern for following rules	Social interactions and morality based on normative rules	Griffin et al. (2016) Vignemont & Frith (2005) Stanghellini & Ballerini (2007)
Impulsivity, “jumping to conclusions” reasoning bias	Cautious, circumspect decision making	Circumspect reasoning bias	Griffin et al. (2016) Brosnan et al. (2013) Del Giudice et al. (2014)
Increased rumination	Excessive worry, rumination	Increased rumination	Griffin et al. (2016) Arwert & Sizoo (2020) Halari et al. (2009)

Study & Results

I used 8 items I had created for a previous study to measure obsessive compulsive personality traits, each item corresponding to a diagnostic criterion [Table 2]. Alongside these items, included scales to measure autistic traits, as reported in previous studies based on this same survey (Cloudfindings 2022a,b).

Table 2

Item	PC1 Loading
I care a lot the about details, rules, organization, and schedules surrounding an activity	0.67
I find it hard to feel satisfied with something if its not perfect	0.73
People often accuse me of being irrational when I know I’m not	0.56
I rather work on my own because others won’t do things the correct way.	0.49
I have a strong sense of justice and morality	0.41
I value hard work and productivity	0.51
It's important to save every penny you can	0.53
I like to keep things just incase I need them in the future	0.56

I then tested for correlations of the scale with autistic traits and the schizotypy-autism factor (see Cloudfindings 2022a,b). As predicted, the OcPD items correlated with autistic interests, literal language, autistic identity, and negatively with the schizotypy-autism factor, and imagination (this correlation was the weakest) [Table 3]. They also predicted suspected or diagnosed autism (spearman r=0.29) and negatively predicted suspected or diagnosed schizophrenia spectrum disorder (spearman r=-0.13).

Table 3

Variable	r with OcPD traits
Schizotypy-autism	-0.23
Autistic interests	0.43
Literal language	0.40
Imagination	-0.17
Autistic identity	0.36
ASD	0.29
SSD	-0.13

I then used factor analysis to investigate whether OcPD fit into the two factor structure of autistic traits (as in Cloudfindings 2022b). OcPD was able to be explained by the two factor autism phenotype, and was largely part of the repetitive domain [Table 4]. This supports the hypothesis that OcPD is a form of autism spectrum disorder.

Table 4

Variable	Repetitive	Social
Autistic Identity	0.82	-0.06
Autistic interests	0.79	0.24
OcPD Traits	0.69	0.20
Imagination	-0.01	0.93
Literal language	0.50	0.70

1. Griffin et al. (2016) Development and Examination of the Five-Factor Obsessive-Compulsive Inventory–Short Form

2. Samuel & Widiger (2011) Conscientiousness and Obsessive-Compulsive Personality Disorder

3. Gadelkarim et al. (2019) Overlap of obsessive-compulsive personality disorder and autism spectrum disorder traits among OCD outpatients: An exploratory study.

4. Guilera et al. (2019) Empathy and big five personality model in medical students and its relationship to gender and specialty preference: a cross-sectional study

5. APA (2013) Diagnostic and Statistical Manual of Mental Disorders 5

6. Baron-Cohen (2005) Autism «Autos»: Literally

7. South et al. (2014) Enhanced decision making and risk avoidance in high-functioning autism spectrum disorder.

8. Kinnaird et al. (2019) Investigating alexithymia in autism: A systematic review and meta-analysis

9. Wakabayashi et al. (2006) Are autistic traits an independent personality dimension? A study of the Autism-Spectrum Quotient (AQ) and the NEO-PI-R

10. Crespi (2021) Pattern Unifies Autism

11. Riccioni et al. (2021) High Intellectual Potential and High Functioning Autism: Clinical and Neurophysiological Features in a Pediatric Sample

12. Baron-Cohen et al. (2001) The Autism-Spectrum Quotient (AQ): Evidence from Asperger Syndrome/High-Functioning Autism, Males and Females, Scientists and Mathematicians

13. Vignemont & Frith (2005) Autism, Morality and Empathy

14. Brosnan et al. (2013) Adolescents with Autism Spectrum Disorder Show a Circumspect Reasoning Bias Rather than ‘Jumping-to-Conclusions’

15. Arwert & Sizoo (2020) Self‑reported Suicidality in Male and Female Adults with Autism Spectrum Disorders: Rumination and Self‑esteem

16. Del Giudice et al. (2014) Autistic-like and schizotypal traits in a life history perspective: diametrical associations with impulsivity, sensation seeking, and sociosexual behavior

17. Kerns (2005) Positive schizotypy and emotion processing.

18. Daneluzzo et al. (2005) The contribution of temperament and character to schizotypy multidimensionality

19. Stoeber (2014) Multidimensional Perfectionism and the DSM-5 Personality Traits

20. Russell-Smith et al. (2010) Are the autism and positive schizotypy spectra diametrically opposed in local versus global processing?

21. Stanghellini & Ballerini (2007) Values in Persons With Schizophrenia

22. Mann et al. (2008) The Schizotypal Ambivalence Scale as a Marker of Schizotypy

23. Parnas & Handest (2003) Phenomenology of Anomalous Self-Experience in Early Schizophrenia

24. Halari et al. (2009) Rumination and negative symptoms in schizophrenia

25. Hofvander et al. (2009) Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders

26. Cloudfindings (2022a) Characterizing Repetitive Behaviors & Interests Specific to Autism: The Autistic Interests Scale

27. Cloudfindings (2022b) Identity in Autism