On a recent vacation to Florida with her family, Mollie Albanese found herself double-checking her bags to make sure her family had absolutely everything they needed.
“Everyone checks to make sure they haven’t forgotten anything, don’t they?” the 28-year-old from Virginia asked herself. “Or is this my OCD taking over again?”
Albanese has obsessive-compulsive disorder (OCD). Although she’s been through recovery, sometimes it can be hard to identify whether or not her behavior is another form of OCD popping up. “I was trying to figure out if I’m checking because I’m actually worried we forgot something, or if I am checking to make sure I feel safe, in terms of OCD,” she says.
Distinguishing non-compulsive perfectionism from OCD isn’t always easy. It can be challenging to distinguish these behaviors both before and after treating OCD, but experts say there are a few things to keep in mind that can help you distinguish perfectionism from OCD.
Perfectionism vs. OCD
Albanese says her perfectionism impacted her in several different ways. OCD made her avoid starting important tasks or personal hobbies because she was worried she wouldn’t do them exactly right. “The fear of not being perfect was enough to stop me from doing things entirely,” she says.
Adult coloring books, which had been a favorite hobby of hers, became a source of stress.
“I sometimes will literally just stare at the page and never start, because I didn’t know which color to start with or which part to start first,” she says. Over time, Albanese learned to identify this specific type of procrastination as perfectionism resulting from OCD.
It’s easy to think perfectionism is a desirable personality trait. In the professional world, it may be. But this makes it especially difficult to distinguish the instances where perfectionism results from OCD, which can interfere in many areas of a person’s life and overwhelm them entirely.
How can you tell the difference? “Simple perfectionism could be seen in someone who worries a lot about being perfect, wondering what other people think of them, and aiming for 100% perfection in various things they do,” April Kilduff, a licensed therapist who specializes in OCD, explains. “With OCD, or perfectionism OCD specifically, there exists the same fear of not being perfect, along with an uptick in behaviors that are done compulsively.”
A perfectionist might review their email once before they send it, but someone with perfectionism OCD—a subtype characterized by obsessions and compulsions centered around organization and perfection—might take 30 minutes to compose a short email, then review it repeatedly before sending, perhaps following rigid and complicated rules that become more and more time-consuming over time, Kilduff explains. “Or, in the case of school work, there’s often a lot of re-reading, re-reviewing, re-doing of assignments such that homework takes much more time than it would for a perfectionist who is just trying to do the best possible job,” she says.
In college, Albanese found that OCD made it difficult for her to start her assignments and submit them on time, even though she had always been someone to finish homework ahead of the deadlines. “School was a really big challenge for me personally for that reason,” she says. “I would put things off, and that’s very atypical for who I am. I really like to get things done ahead of time. And so when I noticed myself putting things off, I realized that my OCD was kind of creeping its way back in,” she tells me.
Like Albanese, Elise, an OCD advocate at The Ocdopus, found it was sometimes challenging to identify certain perfectionist behaviors that were a part of her OCD. “I was looking for a new job for a while and I would spend hours and hours looking at jobs, and trying to figure out what the best job would be, and I also would get job offers and turn them down if I didn’t feel like they were perfect,” says the New Jersey-based 24-year-old. Even though she’d learned to recognize other thoughts as part of OCD, those that dealt with perfectionism weren’t as obvious. “Taboo thoughts were very identifiable as OCD,” Elise says. “When I was having intrusive thoughts about my career and things like that, it was harder for me to catch because I thought I just cared a lot about my career.”
Over time, Albanese says, she found a way to ask herself the right questions to distinguish between perfectionism OCD and a desire to be detail-oriented. “Ruminating is a big compulsion for me, and so if I find myself ruminating on something, I will usually know that it’s OCD-related, and not just typical thoughts,” she explains. “If I’m putting it off because it scares me or because I’m worried about messing up, that is usually related to my OCD. If I’m putting it off because I’m not actually prepared to start it, then I think those are pretty normal or typical thoughts.”
When is perfectionism part of OCD?
There are many different ways perfectionist tendencies could show up as part of OCD. The most straightforward way is when it’s part of the subtype called perfectionism OCD. But that’s not the only way perfectionism can play a role in OCD. For Albanese, and many other people with OCD, perfectionism showed up as part of OCD even though it wasn’t what she’d identified as her main subtype.
Though there are many different OCD subtypes, the condition generally follows the same cycle: an intrusive thought, image or urge leads to anxiety or distress, which leads to compulsive behaviors done in an attempt to feel better. Someone with relationship OCD might be continually worried they are with the wrong partner, and will inadvertently focus on how a specific feature of their partner seems imperfect, like their nose or their laugh, becoming highly worried that their thoughts mean they’re a bad fit for their partner. This fixation on its own could appear to be a perfectionist fixation, but is a part of OCD.
People often find that OCD fixates on different subjects or topics depending on what is most relevant to them at the time. Because OCD can latch onto new themes, topics, or fears, it can make it challenging to spot new presentations and symptoms.
“[OCD] is sneaky in that it can come into places that you didn’t expect. So even in recovery, a lot of people talk about wanting to recover perfectly and wanting to be the perfect patient, and perfection doesn’t really exist—that’s OCD sneaking back in,” Albanese says.
The emotional impact of perfectionism and OCD
One of the challenging and less-discussed aspects of perfectionism as a part of OCD is the emotional toll it can take on people. It can feel demoralizing for people to find themselves struggling to complete task and not know why. “A lot of times it looks like laziness or apathy, but it’s more of that fear of starting and messing up,” Albanese explains. Perfectionism can lead to procrastination, which can make people feel like they are lazy, when in reality they are struggling with a mental health condition.
Elise describes how it was especially confusing for her when she didn’t know her fixation on the ideal job was part of OCD. “I just felt like I was trying to make my life as good as possible, but really I was falling down a rabbit hole of researching and trying to make everything the best, so I became unable to do things that I wanted,” she says.
Signs of perfectionism OCD
As a personality trait, perfectionism usually gives the person pleasure, satisfaction, or motivation. Someone might simply prefer things to be organized in a certain way because it’s the way they best enjoy it. For people with OCD, on the other hand, compulsions do not give them pleasure, but rather feel like the only avenue they have to alleviate distress. These compulsions, however, only provide temporary relief, as perfection is impossible, and imperfection persists everywhere; it’s only a matter of time before the obsessions and accompanying anxieties return.
As opposed to a personality trait of perfectionism, perfectionist obsessions and compulsions that are a part of OCD are often ritualized. For example, a person might have a compulsion to check their bags seven times before traveling in order to feel “just right” and relieve their anxiety. Or they might have a compulsion to make sure their emails contain an even number of words. They might have an urge to fix their hair until it’s “just right,” even if that means they’ll be late to an important meeting, worrying that they will lose control entirely if they fail to do so. These obsessions and compulsions are not driven by a sense of pleasure or preference, but by anxiety that something bad will happen if they do not complete their compulsions.
How to treat perfectionism OCD
The most effective way to treat any subtype of OCD, including perfectionism OCD, is through exposure and response prevention (ERP) therapy.
ERP addresses obsessions and compulsions through a personalized, targeted approach. The basis of ERP therapy is that by being exposed to triggers, obsessions, and resulting anxiety, without responding with compulsions, can help a person habituate to the fear and anxiety caused by obsessions, while increasing their tolerance for uncertainty.
For example, let’s say every time you want to play guitar, you feel an overwhelming sense that you need to play perfectly or else there’s no point in playing at all. Because this anxiety is so overwhelming, you’ve decided to simply stop playing guitar, even though it’s your favorite hobby. A therapist would work with you to expose yourself to the source of your distress. In therapy, you would face your fear and play guitar knowing that it’s not going to be perfect, resisting the urge to start over or quit when you make a mistake.
When you prevent yourself from engaging in your compulsions (in this case, avoiding playing guitar), you teach yourself a new way to respond to obsessions and provide yourself with the opportunity to habituate to anxiety and learn that your feared outcome won’t occur, or that you can handle it if it does. Over time, this allows you to experience a significant reduction in anxiety when obsessions are triggered.
ERP therapy has been proven by decades of clinical research to be effective in helping people with OCD. It has been found effective for 80% of OCD patients, and the majority of patients experience results within 12 to 20 sessions.
If you’re interested in learning about ERP, you can schedule a free call with the NOCD Care Team to find out how treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is.