Current thinking regarding the etiology of OCPD can be traced to the theories of Sigmund Freud. He postulated that obsessional defenses function to control unacceptable sexual and hostile feelings. Regression from the oedipal phase of development to the anal period is driven by castration anxiety. Character traits of orderliness, parsimony, and obstinacy are related to early conflicts and struggles with parental figures. A strong punitive superego dominates. The defense mechanisms of displacement, reaction formation, isolation of affect, intellectualization, symbolization, and undoing are used by the patient with OCPD.

Subsequent theorists have stressed the desire for security and caretaking and the avoidance of being seen in a shameful light as significant in the development of OCPD. Patients with OCPD are seen as experiencing inadequate love from their parents, leading to rage and intense desires for care and nurturance. Their attempts at being better to the point of perfectionism represent an attempt to be deserving of a more caring response. Dynamic theories of etiology continue to predominate. DSM-IV criteria for OCPD are presented in

Table 87-1.