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 recognized1 and probably under-diagnosed—even though it occurs in the general population about three times as often as OCD.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.
Traits and Characteristics of OCD
According to Dr. Rego, “At its core, OCD involves the experiencing of obsessions (unwanted, intrusive thoughts/images/impulses, etc. that are very distressing) and/or compulsions (behaviors or mental rituals that one feels compelled to do to prevent something bad from happening or create relieve from distress) so frequently or intensely that it interferes with the individual’s ability to function.”
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.
These behaviors are attempts to prevent a dreaded event or situation, or to reduce more free-floating anxiety. The individual with OCD unrealistically imagines that actions he or she takes will lead to safety or disaster. In other words, they engage in magical thinking. For example, an individual may think that if he wears his brown shoes, his mother will not have a heart attack.
The obsessions and compulsions can range in severity from minor irritations to completely debilitating urges that prevent the individual from functioning.
Traits and Characteristics of OCPD
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
Dr. Rego states, “OCPD is classified as a personality disorder. As such, it involves operating in a particular style (excessive perfectionism, preoccupation with orderliness and details, the need for control over one’s environment, etc.) that is relatively stable across situations and over the years, and is often not experienced as intrusive to the individual (but is often problematic to other people in the individual’s life) and can make it difficult to function (e.g., being late with work or school reports due to perfectionism).”
To meet the full criteria for OCPD, individuals must have a least four of the following eight characteristics:
- 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
Particular traits and symptoms predominate in different individuals, leading to different kinds of obsessive-compulsive personalities. These types can manifest in healthy or unhealthy ways:7
- Leader/Dictator
- Worker/Workaholic
- Helper/Servant
- Thinker/Procrastinator
Key Differences
The similarity of the psychiatric terms is unfortunate, as those who suffer from either condition may misunderstand their situation and what they need to do for help.
Here are some of the key differences:8
While the two conditions are distinct, some researchers believe that the two are related genetically. Research does not show a definitive link, but some individuals have both conditions. Twenty percent of the individuals with OCPD also have OCD, and 25% of those with OCD also have OCPD.9
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 judgement, 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.
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.
Dr. Rego states, “Fortunately, both conditions appear to respond similarly to both psychotherapy and medications. With respect to psychotherapy, a specific form of cognitive behavioral therapy (CBT) called Exposure and Response Prevention (EX/RP) has received the strongest support from the research studies. With respect to medications, the current literature suggests that OCPD traits may also respond to the same medications (selective serotonin reuptake inhibitors (SSRIs)) that are often used to treat OCD. In some cases, the CBT and medications are combined in order to enhance the overall power of the treatment.”
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.
Psychotropic medications,11 specifically selective serotonin reuptake inhibitors (SSRIs), have been found to be helpful in treating OCD. 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 psychodynamic12 and cognitive behavioral forms.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.
