Patients with OCPD tend to be constricted in many aspects of their lives. Relationships may be stiff, formal, and distant, and affects are shallow. Although often slavishly devoted to their work, these patients have doubts about their performance and are perfectionist and indecisive, which limits the amount of satisfaction they may derive from their endeavors. They experience significant anxiety when confronted with situations marked by uncertainty or unpredictability.

Because these traits are experienced by the patient as chronic and ego-syntonic, individuals often present for treatment when they face a disruptive crisis in their lives. At such critical periods of change, these patients lack flexibility and decisiveness, so they feel overwhelmed. Individuals with OCPD appear to be prone to the development of depressive symptoms as they grow older. In a study of 2,322 hospitalized patients older than 65 with major depression, 46% of the patients with Axis II diagnoses had compulsive personality disorder. Recent studies of outpatients also demonstrated significant comorbidity with major depression and OCD. Further study of the relation between OCPD and depression is indicated and may imply a biological substrate for OCPD.