Despite their similar names, obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are dramatically different in nearly every way, from their definitions to their treatments.
We spoke with in-house experts here at NOCD to better understand both conditions, how they are related, and how they are distinct.
What is OCD?
OCD is a mental health condition characterized by two primary symptoms: obsessions and compulsions.
Obsessions
Obsessions are persistent and recurring thoughts, images, or urges that are experienced as unpleasant and intrusive. Some common examples of intrusive thoughts include:
- Disturbing or taboo thoughts that might involve harming oneself or others
- Fear of germs or contamination
- Persistent feelings of uncertainty
- Unwanted ideas that are religious or sexual in nature
- A desire for symmetry and order
Compulsions
Compulsions are mental or physical acts performed in response to obsessions to alleviate distress or anxiety or to prevent an unwanted outcome associated with obsessions from occurring. Some common examples of compulsions include:
- Repeatedly counting or saying a word in your head
- Excessive hand-washing
- Mentally replaying situations to make sure you remember them completely
- Seeking reassurance about things from other people
- Repeatedly apologizing to someone or asking if they’re okay
- Refusing to visit public places because you’re afraid you’ll catch an illness
- Neutralizing a “bad” thought with a “good” thought
What is OCPD?
When you ask a clinician about OCPD, the first thing they may emphasize is how misleading the name can be.
“It has nothing to do with OCD in terms of obsessions or compulsions,” says April Kilduff, MA, LCPC, LMHC, a licensed therapist with NOCD and clinical training specialist.
What, then, defines OCPD? As the name implies, OCPD is a type of personality disorder. According to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DMS-V-TR), OCPD is characterized by “a pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency,”
As summed up by Dr. Patrick McGrath, NOCD’s Chief Clinical Officer, OCPD is an extreme form of the old psychoanalytical idea of anal retentiveness. “In OCD, you have an intrusive thought, image, or urge, and you neutralize that with a compulsion. In OCPD, your way of being is, ‘I’m right, you’re not. Do what I say, and everything will go fine. Don’t do what I say, and we’ll have a problem,’” he says.
Symptoms of OCPD
Some of the main symptoms or hallmark features of OCPD include:
- Preoccupation with rules, lists, or orderliness
- Extreme devotion to work
- Excessive frugality
- A desire for control in one’s relationships with others
- Unwillingness to delegate tasks to others
How is OCD different from OCPD?
Because they are similar in name and may even involve similar themes, such as perfectionism or morality, one might confuse OCD with OCPD or assume that they are similar conditions at their cores.
The reality is they are very different mental illnesses and can be easily distinguished. Here are four key factors that separate OCD from OCPD.
#1 Presence of genuine obsessions and compulsions
At first glance, it might seem like OCPD involves both obsessions and compulsions, just like OCD. After all, individuals with OCPD can become preoccupied with similar topics and appear compelled to act in particular ways as a result.
While there may be some sense of obsessiveness or compulsiveness in the behaviors of people with OCPD, it is entirely distinct from the type of obsessions and compulsions that characterize OCD. As was noted above, OCD-related obsessions involve persistent and recurring thoughts that are unwanted and distressing. Individuals with OCPD do not experience this type of obsession, and their thoughts generally align with their own identity and values.
Similarly, genuine compulsions are done in response to OCD-related obsessions, which are not present in OCPD. Since these are not present in OCPD, any behaviors that seem compulsive in OCPD are not done to relieve distress or anxiety in the same way as in OCD. Additionally, OCD compulsions are most often done to prevent harm to oneself or others. OCPD behaviors“compulsions” are performed out of a sense of rigidity and a need to control one’s environment.
#2 Attitudes toward their unusual thoughts and behaviors
The thoughts and behaviors that characterize OCD are ego-dystonic, meaning they don’t represent the individual’s genuine beliefs and values. Moreover, people with OCD typically have some degree of insight, which means that they recognize that their thoughts, beliefs, and behaviors are irrational or inappropriate.
“Folks with OCPD don’t see their ideas about the way things should be as an issue,” says Kilduff. “Rarely is their thinking considered a problem in their eyes; it’s everybody else not living up to their standards. [They think] if everybody else just did it my way, everything would be fine.”
#3 More targeted symptoms
Another difference between OCD and OCPD is the disorder’s area of focus. As Kilduff notes, “OCD is more targeted to certain parts of people’s lives. The rigid, controlling aspects of OCPD are across the board and impact nearly every area of life. It’s not just about the laundry. It’s also about the cooking, how the house is decorated, driving, work, and so on.”
This is because OCPD is a personality disorder, meaning that the condition impacts how they view and interact with the world. OCD, on the other hand, is usually in conflict with someone’s identity or personality.
#4 Openness to treatment
One of the main differences between the two conditions is openness to treatment in general, says Kilduff. Most of the time, people with OCPD are reluctant to seek therapy, whereas people with OCD tend to really want help.
“[People with OCD] feel horrible. They hate their intrusive thoughts, they don’t like that they’re doing these behaviors, and they want out of the OCD trap. A person with OCPD, on the other hand, is not going to experience their behavior as intrusive, problematic, or personally bothersome,” she says.
Moreover, while an internal conflict, such as experiencing unwanted thoughts, might bring someone with OCD into treatment, an external conflict, like problems in a marriage, may be more likely to motivate someone with OCPD to begin treatment.
Can you have both OCD and OCPD?
Yes—people can have both conditions simultaneously. While OCD and OCPD are not even in the same section of the DSM-V, they can certainly co-occur. Moreover, comorbidity appears more common among individuals with OCD with particular traits. For example, studies have found that individuals with both conditions were more likely to suffer from higher rates of doubting, symmetry, and hoarding obsessions, as well as cleaning, ordering, and repeating compulsions. Whether having OCPD makes these OCD symptoms more defined or having these types of OCD traits makes one disposed to develop OCPD is unclear.
How do the treatments compare?
Just like their definitions and symptoms, the treatments for OCD and OCPD are notably different.
Therapy
The gold standard for OCD is exposure and response prevention (ERP) therapy. In ERP treatment, patients confront obsessive thoughts, images, or urges without engaging in compulsions for short-term relief. Over time, this helps them learn to sit with discomfort and uncertainty while reducing the frequency and intensity of their obsessions and compulsive urges.
ERP can help patients with OCPD, but the treatment may need to be modified. Moreover, the treatment goal is generally different. More specifically, with OCPD, the goal is to decrease how much they require organization, accomplishment, and efficiency while helping them feel more comfortable with uncertainty, flexibility, relaxation, and spontaneity.
For people with OCPD, therapists might support ERP therapy with elements of the following two therapeutic approaches:
Acceptance and Commitment Therapy: Part of acceptance and commitment therapy, or ACT, involves having someone identify their core values. If someone says they value family but spends the bulk of their time working due to their disorder, ACT therapy might help them live more in line with their actual values.
Cognitive Behavior Therapy: A therapist might help someone with OCD or OCPD reframe how they think about certain tasks using cognitive behavioral therapy (CBT), which can help individuals become aware of distorted and unhelpful thinking patterns. For example, someone with OCPD might feel that clothing needs to be folded a certain way due to a cognitive distortion known as all-or-nothing thinking. In that case, part of their therapy would involve working to accept that there are several ways to fold clothes.
Dialectical Behavioral Therapy: Dialectical behavior therapy (DBT) is a form of CBT adapted for people prone to feeling intense emotions. DBT focuses on helping them develop skills for accepting their circumstances, managing emotions, and navigating social relationships. A specific type of DBT, called Radically Open DBT (RO DBT), has been found effective for OCPD.
Medication
In more severe cases of OCD, medication can allow therapy members to be more receptive to ERP treatment. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline or fluoxetine, are some of the more commonly prescribed medications. They work by blocking the reuptake of serotonin, a chemical messenger in the brain associated with the symptoms of OCD.
There is no medication established to treat OCPD specifically. As a result, practitioners use a broader range of pharmacological tools, from SSRIs and benzodiazepines to anticonvulsants and other mood stabilizers, to treat OCPD.
