A 36-year-old accountant is brought by his wife. He works late daily, rewrites reports repeatedly over minor imperfections, refuses to delegate tasks to juniors because 'no one does it correctly', cannot discard worn-out clothing he may 'need later', and insists the family follow his fixed routines. He sees nothing wrong with his behaviour. He has no intrusive thoughts or rituals performed to reduce anxiety. The most likely diagnosis is:

• A Obsessive-compulsive disorder
• B Obsessive-compulsive personality disorder ✓
• C Narcissistic personality disorder
• D Avoidant personality disorder

Explanation

Perfectionism, inflexibility, inability to delegate, miserliness, inability to discard worthless objects, and over-devotion to work define obsessive-compulsive personality disorder (OCPD, anankastic personality in ICD terms). The absence of true obsessions and compulsions, plus the ego-syntonic attitude (he sees nothing wrong), separates OCPD from OCD, which is ego-dystonic and anxiety driven. Narcissistic grandiosity and avoidant fear of criticism are absent here.

Reference: DSM-5-TR, 2022 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.