OCD Vs. OCPD: Understanding the Differences

Key Differences Between OCD & OCPD

While obsessive-compulsive disorder (OCD) has become a household term and is often applied liberally, obsessive-compulsive personality disorder (OCPD) is little known, little recognized, and under-diagnosed—despite affecting 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 receive treatment that is less effective.¹ 

Differences between OCD and OCPD include:

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 intrusive thoughts and repetitive behaviors. Though people with OCPD will engage in rigid behaviors, they will not possess these same beliefs and rituals.

Additionally, individuals with OCPD may lack empathy and become hostile or domineering in relationships.⁵ Their emotions, other than frustration and anger, are often masked, as they are reluctant to show vulnerability.⁶

“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.” says Dr. Simon Rego, Chief of Psychology at Montefiore Medical Center/Albert Einstein College of Medicine.

Distress About Symptoms

Those with OCD tend to have a fair understanding of their symptoms and the pain it adds to their life. In contrast, a person with OCPD usually sees their actions as completely justified and often complains 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 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 loved ones. OCPD tends to motivate people to selfishly strive for rewards or personal accomplishments.

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 it is possible to develop both comorbidly. Research suggests that twenty percent of individuals with OCPD also have OCD and 25% of those with OCD have OCPD.⁹

According to Dr. Rego,”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.”

Causes of OCD & OCPD

A combination of environmental and biological factors seems to influence the presentation of both OCD and OCPD. Although triggers may seem similar, they are not identical.

Possible causes and risk factors of OCD include:

• Premature birth
• Parent smoking during pregnancy
• Childhood trauma
• Having a first-degree relative with OCD

Possible causes and risk factors of OCPD include:¹⁵

• High value on perfectionism
• Childhood trauma
• Having family members with anxiety disorders

Diagnosing OCD Vs. OCPD

Because 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 of an assessment while diagnosing 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.

When diagnosing OCD, a clinician will look for the presence of:

• Obsessions: 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: 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.

Diagnosing OCPD

It could take several sessions to gain the needed information to make an OCPD diagnosis.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.

Examples of OCD Vs. OCPD

To demonstrate the differences between OCD and OCPD, consider these two examples. Odetta has OCD and Pedro has OCPD. Both are paralegals at the same law firm.

OCD Example

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 home, she washes her hands every chance she gets as she worries about germs a lot. She often has intrusive thoughts that she will harm her children which she tries to alleviate by twisting off and on the top of the water bottle five times.

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.

OCPD Example

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. However, he does think constantly about right and wrong. If a coworker gets preferential treatment in vacation schedules, he will turn it over in his mind 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, 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. Additionally, 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 grump. He has difficulty delegating and doesn’t have many friends.

Treatment of OCD Vs. OCPD

The diagnosis of OCD or OCPD and recommendations for treatment can be offered by a mental health practitioner 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 therapies for OCD will help lessen the distress of intrusive thoughts by paradoxically welcoming them, rather than trying to avoid or repress them. Cognitive behavioral therapy (CBT) for OCD has been shown an effective approach, and exposure and response prevention (ERP) can help someone progressively expose themself to the things that they fear the most. 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.

*This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

Treatment for OCPD

Personality disorders such as OCPD are known to be difficult to treat, but there is evidence that psychotherapy can be effective, including both psychodynamic therapy and cognitive behavioral forms.^12,13 Medications are not usually considered to be a primary treatment for OCPD but may help reduce additional symptoms of depression or anxiety.

Psychodynamic therapy can help to understand how environmental factors have shaped a client’s core personality in ways they are unaware of in order to understand unconscious conflicts that led to maladaptive compulsivity. Put slightly differently, this approach can help one identify these aspects of themselves so that one can express meticulous aspects of their personality in a healthy way.¹⁴

For those seeking help with their relationships, marriage counseling and family therapy may be helpful in addressing problems that develop as a result of OCPD.