OCD vs OCPD - What's the difference?

OCD vs OCPD

OCD and OCPD are similar in certain ways but are different conditions. OCD is characterized by intrusive thoughts which prompt sufferers to perform ritualized compulsions to alleviate feelings of anxiety and stress.

OCPD, however, is a personality disorder that causes sufferers to feel preoccupied with orderliness, perfectionism, and control. Their behavior is driven by a desire for order and efficiency, rather than obsessions and anxiety.

This article will explore the similarities and differences between OCP and OCPD by going over the symptoms, causes, and treatment options for both mental health conditions.

What is OCD?

Obsessive-compulsive disorder is a debilitating mental health condition which has two main components: obsessions and compulsions. ^[1]

Obsessions are unsolicited, intrusive thoughts, images, and urges that constantly plague people with OCD. An affected person might know that their obsessions are not rational, but they cannot control them from reoccurring. ^[1]

Compulsions are repeated behaviors that sufferers of OCD use to address their obsessions. They can be thought of as rituals adopted to alleviate the anxiety brought on by obsessions. ^[1] However, any relief is only temporary and in the long term, performing a compulsion heightens anxiety and does not cure an obsession.

How is OCD diagnosed?

The Diagnostic and Statistical Manual of Mental Disorders’ fifth edition (DSM-5) criteria for an OCD diagnosis is as follows: ^[2]

• A person must experience obsessions, compulsions, or both.
• Obsessions and compulsions must be present for one hour or longer per day OR cause clinically significant distress or deficiency in social, professional, or other important area of function.
• Obsessions and compulsions must not be a result of a medication, substance abuse or other medical condition.
• Symptoms must not be better explained by another mental disorder.

What is OCPD?

OCPD is a personality disorder characterized by a fixation on rules, orderliness, cleanliness, and organization at all costs. ^[3] People with OCPD will seek to maintain control over every detail of a situation, paying excessive attention to every rule and detail no matter how trivial. ^[3]

They are unaware of how often others are annoyed with their hairsplitting approach to life, the delays that accompany even the smallest of tasks, and their sense of moral superiority. ^[3]

OCPD is one of the most widely diagnosed personality disorders across the USA, with prevalence estimated to be between 2% and 8%.

How is OCPD diagnosed?

According to the DSM-5, OCPD is diagnosed when there exists a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood. This is deemed to exist when four or more of the following symptoms are presented: ^[4]

• Preoccupation with rules, details, schedules, lists, and organization
• Perfectionism that prevents tasks being completed due to unreasonably high standards
• Excessive devotion to one’s professional life and productivity to the detriment of familial relationships and friendships
• Excessively conscientious and morally rigid
• Hoarding objects irrespective of their sentimental value
• Inability to delegate tasks unless they are completed exactly as the person with OCPD wants
• Miserly with money as they see it as something that must be stashed away in case of emergencies
• Excessive stubbornness and rigidity

OCD vs OCPD: Symptoms

Despite being distinct mental health conditions with separate diagnostic criteria, there is some overlap between OCD and OCPD:

• Desire for control over symptoms – People with OCD strive to control their intrusive thoughts and urges with compulsions, while in OCPD, the emphasis is on controlling one’s environment by enforcing rules to achieve perfection and orderliness.
• Anxiety and distress – In OCD, the distress stems from intrusive thoughts and the need to perform compulsions. OCPD individuals may experience distress due to their high, self-imposed standards, fear of making mistakes, and the need to maintain control.
• Rigid mindset – Both disorders cause sufferers to think rigidly when tackling their symptoms. ^[5] People with OCD will rigidly perform rituals in the face of their obsessions, while those with OCPD are typically inflexible in their adherence to routines, rules, and procedures.

While the above similarities can be noted, there are core differences between the symptoms of OCD and OCPD.

Obsessions and Compulsions

OCD is marked by the presence of obsessions, which are distressing thoughts or urges, and compulsions, which are irrational, repeated behaviors intended to soothe the obsessions. Patients can get into cycles of obsessions and compulsions, leaving them consumed by tackling these anxiety-inducing behaviors. ^[2]

On the other hand, OCPD is not characterized by repeated rituals performed to soothe obsessive thoughts. Instead of obsessions and compulsions, people with OCPD demonstrate a need for orderliness, perfectionism, and control at the cost of anything else. ^[3]

Self-awareness

People with OCD often recognize their behavior is irrational, misaligned with reality, and potentially disrupting others around them. Whilst this doesn’t make the disorder any easier to contend with, they retain a sense of self-awareness. ^[6]

People with OCPD, however, typically have a lack of insight into how their behavior is perceived by others and often do not consider it to be problematic. ^[1] They believe their behavior is correct and justified, are far less self-aware, and are thus more susceptible to hurting other peoples’ feelings. Conflict is common for people with OCPD, with family members, for example, often feeling heavily criticized and controlled. ^[6]

Impact on daily life

OCD typically impacts several different areas of a person’s life, including their ability to focus at work, desire to socialize, and ability to carry out daily tasks. ^[6]

OCPD usually impairs people’s interpersonal relationships, which can have negative consequences for all areas of life. However, it doesn’t necessarily detract from a person’s ability to work or complete tasks. In many cases, it can make people more efficient. Commonly, it’s not the job that’s hurt by a person’s OCPD, it’s the relationships with co-workers or other people involved in an organization. ^[6]

OCD vs OCPD: Causes

The causes of both OCD and OCPD are not explicitly known, but there are several factors that are thought to contribute to a person’s risk of contracting either disorder.

OCD Risk Factors

Genetic Factors - There is evidence that OCD can run in families, suggesting a genetic component. Having a close family member with OCD increases the risk of developing the disorder. ^[7]

Neurological functioning - Certain brain areas and neurotransmitters are impacted in the development of OCD. The brain circuits involving the frontal cortex, basal ganglia, and limbic system (particularly the amygdala) are believed to be involved in the development of OCD, but that connection is unclear. ^[7] Serotonin deficiencies in the brain have also been linked with OCD.

Environmental factors – Certain environmental factors, such as childhood trauma, abuse, or neglect, have been reported to play a part in the development of OCD. ^[7] Brain injury, infection, pregnancy complications, and the occurrence of stressful events are all factors that have been shown to contribute to a person’s OCD. ^[8]

OCPD risk factors

Negative early life experiences - Adverse childhood experiences, such as neglect, abuse, or inconsistent parenting, may contribute to the development of OCPD. Traumatic events or a highly controlled or over-protective upbringing may increase the risk of developing perfectionistic and controlling tendencies associated with OCPD. ^[6]

Genetic factors – Some studies suggest that there is a genetic component to the development of OCPD, however this hasn’t been well studied.

Environmental factors - Cultural or societal influences that emphasize strict rules, order, and perfectionism may contribute to the formation of OCPD traits. ^[6] Children bound by strict rules may struggle with personality development and expression. ^[6]

OCD vs OCPD: Treatment Similarities and differences

The treatment options for OCD and OCPD are similar, with medication, talk therapy, or a combination of both being frontline options. 

Below we’ll discuss the ways each disorder can be treated:

OCD treatment

Medication – Selective serotonin reuptake inhibitors (SSRIs) are the type of medication used to treat OCD.  ^[7] Examples include fluoxetine, fluvoxamine, or sertraline, can help reduce the frequency and intensity of obsessions and compulsions.

Psychotherapy – Cognitive behavior therapy (CBT) is the primary therapy used to treat OCD, with patients encouraged to recognize negative thought patterns and learn coping strategies to avoid performing compulsions.

A particularly effective from of CBT is exposure and response prevention (ERP), which involves gradual and systematic exposure to the feared obsessions while preventing the associated compulsive behaviors. Over time, patients learn to tolerate their obsessions without performing compulsions. ^[7]

Self-care - Establishing a structured routine, maintaining a balanced lifestyle, and prioritizing self-care can contribute to overall well-being and symptom management.

OCPD treatment

Medication – Similarly to OCD, people with OCPD may be prescribed SSRIs to lessen how rigid they are and relax their fixation on orderliness. ^[6]

Psychotherapy – Talk therapy focused on improving a person’s insight such as psychodynamic therapy, can be helpful for some people with OCPD. ^[6] It can help a person explore the underlying reasons behind their pursuit of perfection, control issues, and rigidity.

Relaxation techniques – Individuals with OCPD can benefit from relaxation exercises to manage stress and reduce the sense of urgency that accompanies OCPD ^[6].

It must be noted that patient’s attitudes towards treatment can vary. People with OCD often see the need for treatment, while those with OCPD aren’t often aware there is any fault in their behavior. As such, it can be more challenging to initiate treatment in people with OCPD than OCD.

Can you have OCD and OCPD?

Yes, it is possible for both conditions to exist comorbidly, with research suggesting that OCPD occurs in individuals with OCD 15% to 28% of the time. ^[5]