Rosh Psychiatry Board Practice Exam

What is the most likely diagnosis for a man exhibiting perfectionism and difficulty delegating tasks?

1. Borderline personality disorder

2. Narcissistic personality disorder

3. Obsessive-compulsive disorder

4. Obsessive-compulsive personality disorder

The correct answer is: Obsessive-compulsive personality disorder

The man exhibiting perfectionism and difficulty delegating tasks is most likely diagnosed with obsessive-compulsive personality disorder (OCPD). OCPD is characterized by a pervasive pattern of preoccupation with orderliness, perfectionism, and control, which significantly influences interpersonal functioning and social interactions. Individuals with OCPD often have an overwhelming need to ensure that things are done their way and may struggle with delegating responsibilities to others due to a fear that others will not meet their exacting standards. This meticulous attention to detail and desire for control does not stem from the anxiety or intrusive thoughts associated with obsessive-compulsive disorder (OCD), which involves unwanted repetitive thoughts and behaviors aimed at reducing anxiety. This distinction is crucial; while OCD is characterized by specific obsessions and compulsions, OCPD reflects a broader personality style that deeply influences an individual’s approach to life. Perfectionism in OCPD is more about personal standards and control rather than the fear of catastrophic outcomes often seen in OCD. Difficulty in delegating tasks illustrates the rigidity and insistence on doing things according to one’s own set standards, which is a hallmark feature of OCPD. Thus, this diagnosis aligns closely with the described traits of perfectionism and difficulty in sharing responsibility with others