A patient presenting for assessment of a separate mood disorder is noted, incidentally, to keep an extremely detailed and rigid daily schedule going back over a decade, to become visibly agitated by minor changes to it, and to have caused repeated arguments by insisting his family follow his exact standards for household organisation. He does not raise this pattern himself as a concern. Before revealing the answer: is the fact that he did not raise it himself unusual for this presentation?
No, this is entirely typical, not unusual. As the phenomenon's own text notes, anankastic personality disorder is usually identified incidentally, during assessment for a separate mental state disorder, rather than being the reason someone presents for treatment in its own right — exactly the pattern in this vignette. The rigidity, discomfort with change, and friction caused by insisting others conform to his standards, reaching a genuine threshold of impact on his relationships, are what support the diagnosis, even though it was not what brought him to assessment.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 10, 'Personality Disorders'.