What is the Difference Between OCD and OCPD?

May 9, 2023   •  Posted in: 

You may have heard of OCD. But there is another, lesser-known mental health condition that shares a very similar name: obsessive-compulsive personality disorder.

Although these two conditions sound alike, they are, in reality, very different from one another. Because people can and do live with both, it’s important to distinguish between them so you can get the right treatment.

The good news is both of these conditions can successfully be treated. Here are important differences between OCD and OCPD, and how you can tell the difference between the two.

 

What is OCD?

First, let’s talk about what OCD is. OCD, or obsessive-compulsive disorder, is an often misunderstood mental health condition that can become debilitating if left untreated. Around 1% to 2% of the population lives with OCD[1].

The two core symptoms of OCD are obsessions and compulsions.

  • Obsessions are intrusive and unwanted thoughts, images, or sensations that cause the person with OCD a great deal of anxiety and distress. While most people experience intrusive thoughts, people with OCD ruminate over them to an often debilitating extent.
  • Compulsions are rituals or repetitive behaviors the person with OCD uses to try to reduce the anxiety that obsessions bring.

For example, someone with OCD may have an obsession about contamination. They might have thoughts like,

  • “What if that doorknob has germs that will infect me and I die?”
  • “What if I get my whole family sick?”
  • “What if there are still some germs left on my hands after I’ve washed them?”

These thoughts cause a lot of anxiety and fear for the person with OCD. No matter how hard they try, they cannot move on from these thoughts. In an attempt to rid themselves of this anxiety, the person engages in compulsive behaviors.

For example, they might wash their hands over and over again, even until their skin is raw and cracked, in an effort to be 100% sure there are no germs left behind. Or they might compulsively ask for reassurance from others, like asking their family members repeatedly whether they feel sick.

Some compulsions are mental and not visible to other people. For example, the person might repeat certain phrases in their head to “prevent” anything bad from happening, or review their memories over and over again to try to remember what and who they’ve touched (and may have contaminated).

Both obsessions and compulsions are obviously not based on logic, and most people with OCD realize this. But OCD is called “the doubting disease” for a reason; although the person with OCD may know their thoughts and behaviors are illogical, they feel the need to perform compulsions “just in case.” They may know their obsessions aren’t likely to be true, but they aren’t 100% sure – and have an extremely difficult time tolerating any level of uncertainty.

OCD and perfectionism

In media messaging, people with OCD are often depicted as perfectionists who like order and cleanliness. They may be shown as someone who likes their bookshelf to be alphabetized or their home to be perfectly neat, for example. Neatness, order, and perfection makes them happy.

In reality, people with OCD don’t “like” anything about their disorder. And although perfectionism is sometimes associated with OCD, they are two very different things.

Perfectionism is a personality trait, not a disorder. Perfectionists tend to strive for excellence to an often harmful degree. Their expectation of perfection from themselves and others may lead to negative consequences like low self-esteem and strained interpersonal relationships.

Some studies have found a link between perfectionism and OCD[2]. But, unlike perfectionists, people with OCD don’t want to need things to be perfect. They may have a compulsion to make something perfect because they have an obsession about it. For example, they may think that if their pencils aren’t perfectly lined up in a way that’s “just right,” then harm will come to them or someone they love.

For people with OCD, their behaviors are compulsive. They aren’t performing these compulsions to strive for perfection. They are performing them to make the intolerable anxiety of their obsessions go away.

 

What is OCPD?

OCPD, or obsessive-compulsive personality disorder, is often confused for OCD since they have such similar names. But, in reality, these two conditions are very different. Although someone can present with both OCD and OCPD, it’s important to know the difference between the two because treatment approaches highly differ.

OCPD is a condition that is closely related to perfectionism. People who live with this condition are overly preoccupied with making themselves and others follow a rigid set of rules, schedules, or moral code.

OCPD is categorized in the Diagnostic Statistical Manual (DSM-V-TR) as a personality disorder. Personality refers to the patterns in which you think, feel, behave, and interact with others. Like other personality disorders (like borderline personality disorder or narcissistic personality disorder), OCPD affects people’s entire worldview and personality, and how they move through life.

According to the DSM-V-TR, the symptoms of OCPD include[3]:

  • Showing a pattern of being preoccupied with order, cleanliness, rules, organization, lists, and having control over themselves and others
  • Being perfectionistic to the extent where standards of perfection get in the way of completing tasks
  • Having an excessive commitment to work and productivity (not for financial reasons), even when it gets in the way of friendships, leisure time, and other important life aspects
  • Hoarding unnecessary objects and being unwilling to throw things away
  • Being overconscientious and inflexible about morals, values, and rules
  • Being unnecessarily frugal or miserly about both their time and money
  • Being unwilling to delegate tasks to other people, or expect others to complete tasks to excessive standards of perfectionism
  • Displaying rigidity and stubbornness

In addition, people with OCPD often have a cold or disconnected manner and struggle with showing affection to others. Because of these symptoms, people with OCPD often have difficulties in their interpersonal relationships.

You may have noticed that obsessions and compulsions are not mentioned in this list of symptoms. That’s because obsessions and compulsions, which are core symptoms of OCD, are not part of having OCPD. Although people can have both, OCD and OCPD are distinct conditions that have many important differences.

 

The differences between OCD and OCPD

OCD and OCPD are completely different conditions that have little-to-no symptom overlap. Here, we’ll go over some of the most notable differences between these two conditions.

DSM categorization

In the DSM-V-TR, which is the handbook that mental health professionals use to make psychiatric diagnoses, OCD is categorized under “obsessive-compulsive and related disorders.” Other disorders in this category include body dysmorphic disorder, hoarding disorder, and trichotillomania. This category includes conditions which revolve around intrusive thoughts or urges. For example, someone with trichotillomania has the intense urge to pull out their hair.

In contrast, OCPD is listed as a personality disorder. Other types of personality disorder include borderline personality disorder, antisocial personality disorder, schizoaffective personality disorder, and narcissistic personality disorder. As we explained earlier, personality disorders are lifelong conditions that affect the person’s worldview and way of relating to themselves and others.

Symptoms

The diagnostic criteria (symptoms) for each of these disorders is also distinct.

As we’ve already described, the main symptoms for OCD are obsessions and compulsions. You do not meet the criteria for a diagnosis of OCD if you don’t experience these symptoms.

People with OCPD do not experience obsessions or compulsions. Instead, their disorder causes them to be rigid and stubborn when it comes to organization, rules, lists, morals, and so on.

Level of self-awareness

In general, people with OCD tend to have a certain amount of self-awareness. They are able to reflect upon their behaviors and realize they are illogical. That isn’t usually enough for them to recover from OCD, but the insight is often there. People with OCD may seek treatment because they feel like something is “wrong.” They are in distress.

People with OCPD, on the other hand, tend to believe they are in the right – and that others are wrong for not going along with their rigid demands. People with personality disorders, in general, tend to have a lower level of self-reflection about the ways in which their condition affects them[4]. They might avoid seeking treatment even when their lives and relationships are being impacted by their behavior.

Motivation for behavior

Even if someone with OCD has perfectionistic tendencies, they have different motivating factors for these behaviors as someone with OCPD.

For example, people with a subtype of OCD called “just right OCD” have an obsessive need to rearrange things until it feels “right” or “complete.” For example, they may constantly rearrange items on their desk until this feeling of incompleteness goes away, or they may open a door over and over again until it feels “right.” For them, the motivating factor is fear and distress.

Someone with OCPD could behave in the same way. But for them, the motivation could be that they want to follow a certain rule, or they have a high expectation of organization and order.

 

Treatment for OCD and OCPD

Another important distinction in which OCD and OCPD differ is in the ways they’re treated.

OCPD is usually treated with some form of talk therapy, like psychodynamic therapy or cognitive-behavioral therapy (CBT). For people with OCD, a treatment plan that consists only of talk therapy is unlikely to be helpful – and might even make things worse.

The gold standard of treatment for OCD is something called exposure and response prevention therapy (ERP), which challenges you to intentionally trigger obsessions and refrain from responding to them with compulsions[5]. The more you practice this, the less important the obsessions become.

Whether you live with OCD or OCPD, it’s critical to your recovery to address all aspects of your health and well-being – mental, physical, spiritual, intellectual, financial, social, and more.

That’s why our experienced team at The Center • A Place of HOPE uses a unique and proven Whole-Person Approach to care. We understand you are a unique person with unique needs, strengths, and struggles – and we make sure to individualize your treatment plan to reflect that.

If you’re ready to start on your road to recovery, get in touch with us today.


[1] https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650182/
[3] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Publishing.
[4] https://pubmed.ncbi.nlm.nih.gov/31115349/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343408/

Dr. Gregory Jantz

Pioneering Whole Person Care over thirty years ago, Dr. Gregory Jantz is an innovator in the treatment of mental health. He is a best-selling author of over 45 books, and a go-to media authority on behavioral health afflictions, appearing on CBS, ABC, NBC, Fox, and CNN. Dr. Jantz leads a team of world-class, licensed, and...

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