Despite their similar names, Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD) are significantly different conditions. OCD is marked by specific obsessions (unwanted, intrusive and persistent thoughts) and compulsions, such as checking the oven or washing hands repeatedly. OCPD, in contrast, affects the entire personality with the need for control and perfectionism.
While OCD has become a household term and is applied liberally, OCPD is little known, little recognized and probably under-diagnosed—even though it occurs in the general population about three times as often as OCD.1,2,3 Unfortunately, the two are often confused, and individual sufferers may pursue or get treatment that is less effective than if they were properly diagnosed and treated.
“It’s important to note that while there is evidence that suggests OCD and OCPD are linked, studies suggest that the majority of individuals with OCD do not have OCPD and similarly, the majority of individuals with OCPD do not have OCD,” says Dr. Simon Rego, Chief of Psychology at Montefiore Medical Center/Albert Einstein College of Medicine.
While there is wide variation in how both of these conditions can manifest, and their severity can differ significantly, there are certain core traits that define each of them.
Key Differences Between OCD and OCPD
The similarity of the psychiatric terms is unfortunate as there are significant differences, but those who suffer from either condition may misunderstand their situation and what they need to do for help.1
The Presence of Obsessions & Compulsions
The most obvious way that OCD differs from OCPD is the presence of obsessions and compulsions. People with OCD will have these intrusive thoughts and repetitive behaviors, and though people with OCPD will engage in rigid behaviors, they will not have obsessions or compulsions.
Distress About Symptoms
Those with OCD tend to have a fair understanding of their symptoms and the pain it adds to their life. People with OCPD usually see their actions as completely justified and often complain that other people are the problem.
Consistency of Symptoms
OCD symptoms will largely be consistent with time. In many cases, symptoms will gradually build and increase over the course of months or years. OCPD symptoms may seem to wax and wane, but this is typically due to the projects and planning with which the person is engaged.
Difficulties in Daily Life
The person with OCPD may appear to be a high-functioning, well-established individual because they are so focused on achieving their goals. When symptoms are intense, the person with OCD will overtly struggle to complete even the most basic activities of daily living.
Motivating Factors
People with OCD are usually driven to avoid some type of real or imagined threat to themselves or people they care about. OCPD tends to motivate people to selfishly achieve some rewards or personal accomplishments.
| OCD | OCPD |
|---|---|
| Anxiety Disorder | Personality Disorder |
| Do not like their symptoms | Take pride in their personality |
| Have specific obsessions and compulsions | Entire personality is affected |
| Anxiety Disorder | Personality Disorder |
| Do not like their symptoms | Take pride in their personality |
| Motivated by need to prevent catastrophes | Motivated by perfectionism and conscientiousness |
| Willingly seek professional help | Resist seeking professional help |
| Seek help for relief from symptoms | Seek help mostly to selvage relationships |
| Spend time on compulsive rituals (e.g. cleaning & checking) | Spend time on work projects and planning |
| Symptoms are generally maladaptive (except regarding hygiene) | Traits may be adaptive if used consciously |
| Emotions are not necessarily suppressed | Emotions are controlled and gratification is delayed |
| Often feel insecure in regard to others | May Become domineering |
OCD Symptoms Vs. OCPD Symptoms
According to Dr. Rego, “At its core, OCD involves the experiencing of obsessions and/or compulsions so frequently or intensely that it interferes with the individual’s ability to function. OCPD is classified as a personality disorder. As such, it involves operating in a particular style that is relatively stable across situations and over the years, and is often not experienced as intrusive to the individual and can make it difficult to function.”
OCD Symptoms
Individuals with OCD experience obsessions or compulsions, or both:
- Obsessions are recurrent and persistent thoughts that are disturbing and cause the individual anxiety or distress. Individuals with OCD usually try to ignore or suppress these thoughts. They may also try to disperse them by trying to focus on another thought, or by engaging in a compulsive action.
- Compulsions are repetitive behaviors such as hand-washing, ordering, checking, or mental acts such as praying, counting, or repeating words silently that the individual feels an urgent need to do in order to make disturbing thoughts go away.
The obsessions and compulsions can range in severity from minor irritations to completely debilitating urges that prevent the individual from functioning.
OCPD Symptoms
The American Psychiatric Association’s Diagnostic and Statistical Manual Fifth Edition (DSM-5) describes OCPD as, “A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.”4
To meet the full criteria for OCPD, individuals must have a least four of the following eight characteristics:4
- Is preoccupied with details, to the extent that the major point of the activity is lost.
- Shows perfectionism that interferes with task completion.
- Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships.
- Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values.
- Is unable to discard worn-out or worthless objects even when they have no sentimental value.
- Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
- Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
- Shows rigidity and stubbornness.
People with OCPD can be very difficult to get along with. This accounts for much of the human cost of OCPD, as they often lack empathy and may become hostile and domineering in relationships.5
Their emotions, other than frustration and anger, are often masked, as they are reluctant to show vulnerability.6
Can Someone Have Both OCD & OCPD?
While the two conditions are distinct, some researchers believe that the two are related genetically. Research does not show a definitive link, but some people have both conditions. Twenty percent of the individuals with OCPD also have OCD, and 25% of those with OCD also have OCPD.9
Causes of OCD & OCPD
A combination of environmental and biological factors seem to influence the presentation of both OCD and OCPD. Although triggers may seem similar, they are not identical.
OCD Risk Factors
Temperamental, physiological, and environment factors increase the risk of OCD and include:
- Premature birth
- Parent smoking during pregnancy
- Childhood trauma
- Having a first-degree relative with OCD
OCPD Risk Factors
Much less is known about the risk factors for OCPD, likely because it is less well-known and less frequently studied. Some likely risk factors for OCPD include:15
- High value on perfectionism
- Childhood trauma that leaves the impression that perfection is needed for survival
- Having family members with anxiety disorders
Diagnosing OCD Vs. OCPD
Since OCD and OCPD present very differently, diagnosing the two will be a much different process. For OCD, the diagnosis may be clear within a few minutes into the assessment, while OCPD may take much longer.
Diagnosing OCD
Typically, people with OCD will seek treatment for their clear obsessions and compulsions. If obsessions and compulsions are present, they consume a lot of time, and the person’s routine is disrupted, OCD is likely.
Diagnosing OCPD
People with OCPD are only likely to seek treatment when compelled to by others. They will only complain about others and even deny the need for them to receive treatment. It could take several sessions to gain the needed information to make a OCPD diagnosis.
Treatment of OCD Vs. OCPD
The diagnosis of OCD or OCPD, and recommendations for treatment, are best done by a mental health practitioner (psychiatrist, psychologist, or social worker) with knowledge of the distinction between the two conditions. There is more research regarding the treatment of OCD than for OCPD. But there is evidence that both conditions can be helped with psychotherapy.
Treatment for OCD
Cognitive and behavioral treatments (CBT) have been found to be effective for OCD.10
Behavioral therapies such as Exposure and Response Prevention (ERP) will help someone to progressively expose themself to the things that they fear the most, such as germs. Cognitive therapies will help lessen the distress of intrusive thoughts by, paradoxically, welcoming them, rather than trying to avoid or repress them.
OCD medications, specifically selective serotonin reuptake inhibitors (SSRIs), have been found to be helpful in treating OCD.11
Be sure to consult with the prescribing physician about possible side effects. Examples of SSRIs include sertraline (Zoloft), fluoxetine (Prozac), and citalopram (Celexa).
Treatment for OCPD
Personality disorders such as OCPD are known to be difficult to treat, but there is evidence that various forms of psychotherapy can be effective, including both psychodynamic and cognitive behavioral forms.12,13
OCPD is believed to result from a combination of genetic and environmental causes. Psychodynamic therapy can help to understand how environmental factors have shaped your core personality in ways that you have not been aware of, to understand unconscious conflicts that have led to maladaptive compulsivity.
Put slightly differently, dynamic therapy can help you become aware of the different aspects of your personality and help them operate more harmoniously so that you can express meticulous aspects of your personality in a healthy way.14
Marriage and family counseling may be helpful in improving relationship problems that develop as a result of OCPD.
Medications are not usually considered to be a primary treatment for OCPD, but may help reduce additional symptoms of depression or anxiety.
Examples of OCD Vs. OCPD
To demonstrate differences between the conditions, let’s take two individuals as examples; Odetta has OCD and Pedro has OCPD. Both are paralegals at the same law firm. Their personalities serve as illustrations of how the two conditions are expressed.
Odetta never leaves the house without checking three times to make sure that the iron, the oven, and the curling iron are all turned off. Once out of her house she washes her hands every chance she gets, since she worries about germs a lot. She often has thoughts that she will hurt her children, which she tries to get rid of by twisting off and back on the top of the water bottle she constantly carries with her five times.
Her friends know her as a very emotional person. She can burst out with joy as much as anxiety or grief. You always know what she’s thinking and feeling. Aside from her very specific obsessions (germs and hurting her kids) and compulsions (twisting and checking), she’s not one to worry about perfecting her documents at work, or her billing with clients. In fact, many would say she’s a little too casual.
Pedro, on the other hand, has no trouble getting out of the house without checking. He doesn’t obsess about the same sort of dangers that Odetta does. But he does think constantly about right and wrong. If a coworker gets preferential treatment in regard to vacation schedules, he will turn it over in his mind constantly and struggle with whether or not to complain to his boss, or to report it to human resources.
Not that he’s really interested in vacation, as he has weeks of vacation time stored up. Like many people with OCPD, he delays gratification, and neglects leisure. It’s the principle of the inequitable vacation schedule that disturbs him.
He’s a perfectionist regarding documents, and his performance reviews note this. But his managers caution him that he takes too long to complete projects. While Odetta isn’t meticulous in recording her billable hours, Pedro documents his hours to the minute rather than the quarter hour, even though his supervisor has suggested that he is being too precise, and has asked him on multiple occasions to round up the figures.
Odetta leaves the office consistently at 5 each day. Pedro stays until his work is done every day, even if it isn’t pressing.
While you always know what Odetta is feeling, the opposite is true with Pedro. You will probably sense his muted exasperation and judgment, but you will otherwise know little about what he is feeling. And neither does he. People with OCPD try to control their feelings, often to the point that they don’t even know what they are feeling themselves.
Odetta can’t stand her obsessions and compulsions and wishes she could get rid of them. Pedro is proud of the way he lives and would be dismissive and defensive if you told him that there was anything wrong with his personality.
Odetta gets along with others in her office and family. Pedro is well-respected, but he’s also known as a critical, controlling curmudgeon. He has difficulty delegating, and doesn’t have many friends.
With the exception of good hygiene, Odetta’s symptoms have little adaptive value. Pedro’s symptoms, on the other hand, could be harnessed and used constructively–if he were able to acknowledge that they are maladaptive as they now stand.
OCPD Vs. OCD Infographics
