Pills for the perfectionist – Evidence for pharmacotherapy in obsessive–compulsive personality disorder: A review

Abstract Obsessive–compulsive personality disorder (OCPD) or anankastia is characterized by an excessive preoccupation with perfectionism, rigidity in thinking, and lack of openness. It is one of the most common personality disorders in the general population and shows a high degree of comorbidity with other psychiatric disorders. OCPD has a significant impact on patients’ quality of life and contributes to a significant economic burden. However, research on OCPD and its treatment is rather limited. The aim of this review is to provide an overview of the available pharmacological treatment for OCPD and the evidence for its effectiveness. A literature search was conducted in PubMed and Google Scholar databases from their conception to date for English-language articles related to OCPD. The initial search strategy yielded 200 results, of which 53 were analyzed including original research, reviews, and case reports. All references and sources were cross-checked. There is no Food and Drug Administration (FDA)-approved medication for the treatment of OCPD. There is some preliminary evidence for the efficacy of fluvoxamine, citalopram, and carbamazepine in reducing OCPD symptoms. However, studies have used self-report measures that are poorly validated, are of small sample size, have no placebo arm, and lack follow-up data. Selective serotonin reuptake inhibitors (SSRIs) and psychotherapy continue to be the treatment of choice, albeit with little robust evidence. There is a need for well-planned and sufficiently powered randomized controlled trials that assess the efficacy of medications for individuals with OCPD. These should include patients with OCPD with and without comorbidities, use reliable instruments for assessment, and cover both academic and clinical settings.