Obsessive-compulsive disorder (OCD) and borderline personality disorder (BPD) are two distinct mental health conditions, but research shows they can sometimes occur together. While they share some surface-level similarities—such as intense emotions and rigid behaviors—their underlying mechanisms are distinct.
Keep reading to learn more about the similarities and differences between OCD and BPD, what happens when they co-occur, and how to get effective treatment.
What is OCD?
OCD is a condition marked by two main symptoms:
- Obsessions: Intrusive thoughts, images, urges, feelings, or sensations that cause significant distress.
- Compulsions: Physical or mental acts done to relieve distress from obsessions or to prevent something bad from occurring.
What is BPD?
BPD is a personality disorder that affects the way a person feels about themselves and others, making it difficult to function in everyday life.
BPD involves a range of symptoms, including:
- Fear of abandonment and efforts to avoid it
- Unstable relationships
- Distorted sense of self or self-image
- Impulsivity
- Intense and rapid mood swings
- Difficulty controlling anger
What’s the difference between OCD and BPD?
Although OCD and BPD can both cause intense distress, they differ in key ways.
Here’s a chart to see the differences:
| OCD | BPD |
| Driven by intrusive thoughts and compulsions | Driven by emotional dysregulation and relational instability |
| Compulsive behaviors that temporarily reduce anxiety | Impulsive behaviors often occur in response to strong emotions |
| Symptoms follow a cycle of obsessions → anxiety → compulsions → relief | Symptoms show up in unstable moods, self-image, and relationships |
| Fear of uncertainty is common | Fear of abandonment is common |
Can you have OCD and BPD at the same time?
Yes, it is possible to have both OCD and BPD. A study found that the prevalence of people with OCD and BPD is estimated to be about 5%. This is more than three times the overall rate of BPD, which is around 1.4% of the general population. When both conditions occur together, symptoms can feel more overwhelming and may complicate treatment.
How do symptoms overlap?
Although OCD and BPD are different, some symptoms may appear similar.
- OCD reassurance-seeking (asking for constant confirmation that an obsession isn’t true) can look like BPD fear of abandonment (seeking reassurance in relationships).
- Both can involve high levels of distress, difficulty tolerating uncertainty, and rigid coping strategies.
However, the underlying drivers differ: OCD behaviors are fueled by intrusive thoughts, while patterns of emotional dysregulation and relational sensitivity shape BPD reactions.
How are OCD and BPD treated?
OCD and BPD require different treatment approaches, though therapy can sometimes be combined when both are present.
OCD
The most effective treatment for OCD is exposure and response prevention (ERP) therapy. ERP is a specialized form of cognitive behavioral therapy (CBT) proven to be effective for OCD. General CBT, if not tailored for OCD, can sometimes be unhelpful or even worsen symptoms.
Studies show that ERP therapy is highly effective, with 80% of people with OCD experiencing a significant reduction in their symptoms.
Other approaches that may help include:
- Medication (typically SSRIs)
- Mindfulness-based strategies
- Acceptance and commitment therapy (ACT)
These are typically done in combination with ERP therapy, depending on the individual’s needs.
Severe or treatment-resistant OCD may benefit from the following therapies:
- Intensive outpatient programs (IOPs)
- Partial hospital programs (PHPs)
- Residential treatment centers (RTCs)
- Transcranial magnetic stimulation (TMS)
- Deep brain stimulation (DBS)
- Gamma knife radiosurgery (GKRS)
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
BPD
The most evidence-based treatment is dialectical behavior therapy (DBT), which helps with emotional regulation and relationship skills.
Other effective treatments include:
- Mentalization-based therapy (MBT)
- Transference-focused psychotherapy (TFP)
- Cognitive behavioral therapy (CBT)
- Schema therapy (ST)
- Group therapy
Currently, there are no medications approved to manage BPD.
If you have OCD and BPD, an integrated approach may be used, and medications may also play a role depending on your needs.
When to seek help
If you notice symptoms of OCD, BPD, or both, it’s important to seek an evaluation from a licensed mental health professional. Early diagnosis can provide clarity, reduce distress, and guide you toward effective treatment.
Bottom line
OCD and BPD are different conditions, but they can overlap in some people. Understanding the distinctions—and getting the right diagnosis—is the first step toward effective treatment and recovery.
Key takeaways
- OCD and BPD are separate conditions with distinct symptoms and diagnostic criteria.
- Research shows that 5% of people with OCD may also have BPD.
- While some symptoms look similar, OCD is driven by intrusive thoughts, and BPD is driven by emotional dysregulation.
- OCD is most effectively treated with exposure and response prevention (ERP) and adjunctive therapies, while BPD often responds to DBT, and integrated care may be needed when both occur together.