Most people are somewhat familiar with obsessive-compulsive disorder or OCD. Yet not as many people are familiar with obsessive-compulsive personality disorder or OCPD.
I’m a therapist who treats OCD (and the Chief Clinical Officer for NOCD) and I often hear people say things like, “OCDP sure sounds like OCD.” That’s true, but once you take a closer look, you begin to understand that these two disorders are actually quite different. Let’s dig in.
OCD vs. OCPD
Obsessive-compulsive disorder (OCD) is a treatable mental health condition where people experience obsessions which are repetitive and intrusive thoughts, images, urges, or feelings.
So since the words sound almost the same, how does OCD differ from OCPD? Well, when you ask a clinician about OCPD, the first thing they usually say is how confusing the name of the condition is. “It has nothing to do with OCD in terms of obsessions or compulsions,” says April Kilduff, MA, LMHC, LCPC, a licensed therapist with NOCD and clinical training specialist. Rather, OCPD is a personality disorder. It’s characterized by extreme preoccupation with orderliness, perfectionism, and control. Rigidity and stubbornness are often exhibited, along with—in some cases—over-devotion to work.
I sometimes say that OCPD is a kind of anal retentiveness. In OCD, you have an intrusive thought, image, or urge and you “neutralize” that with a compulsion. In OCPD, your way of being is I’m right, you’re not, Do what I say, and everything will go fine. Don’t do what I say we have a problem.
How can I tell if I have OCD or OCPD?
One important distinguisher between OCD and OCPD is how someone relates to the thoughts they have. An OCD person’s thoughts can be ego-dystonic, which means they experience distressing intrusive thoughts that do not align with their actual values or desires. Someone with OCPD tends to have ego-syntonic ideas—meaning their thoughts are compatible with their values and beliefs.
People with OCPD don’t see their ideas about how things “should be” as an issue that needs to be resolved. Kilduff says, “Rarely is their thinking considered a problem in their eyes; it’s everybody else not living up to their standards. [They think] if everybody else just did it my way, everything would be fine.”
This difference is key to how people with OCD and how people with OCPD move about their everyday lives. Someone with OCD experiences their thoughts as a problem, so much so that they often perform actions out of fear something bad will happen. By contrast, the behavior of someone with OCPD is carried out with the personal conviction that how they do things is how things should be done.
Another difference between OCD and OCPD is the disorder’s area of focus. Kilruff says, “OCD is very targeted to certain parts of people’s lives. The rigid, controlling aspects of OCPD are across the board in their life. It’s not just about the laundry, it’s also about the cooking, how the house is decorated, driving, work, and so on and so forth.”
A simple way to remember the difference between OCD and OCPD is to acknowledge the ‘P’ that stands for “personality” in OCPD and refers to the set of characteristics the disorder encompasses rather than a focus on specific obsessions or compulsions which is only present in OCD.
OCD Symptoms vs. OCPD Symptoms
Let’s start with OCD symptoms, which include both obsessions and compulsions. While this is not an exhaustive list, here are some common obsessions in OCD patients:
Obsessions in OCD:
- Harm OCD: Disturbing/intrusive thoughts that might involve self-harm of self or others
- Contamination OCD: Fear of germs or contamination
- Religious OCD: Unwanted ideas that are religious
- Symmetry OCD: Desire for symmetry and order
- Relationship OCD: Obsessive worries about one’s relationship/partner
Compulsions in OCD:
When their distress gets overwhelming, people with OCD will often engage in compulsions or repetitive activities, both behavioral and mental, aimed at getting rid of distress and regaining a sense of control. Here are some examples:
Now let’s talk about OCPD, and some of the symptoms of this personality disorder:
Hallmarks of OCPD:
- Struggle to throw items away (hoarding)
- Preoccupation with details, rules, and lists
- General rigidness
- Extreme devotion to work
- Unwillingness to delegate tasks to others
- Intense frugality
How can OCPD affect your life?
Given that people with OCPD have rigid beliefs that they may impose on others, living with OCPD can lead to social and interpersonal difficulties. For instance, someone with OCPD may struggle to acknowledge alternatives to their ways of thinking, causing relationship friction or conflict at work. Likewise, family members of people with OCPD may feel highly controlled and heavily criticized.
Making matters more complicated is their resistance to help. Unlike OCD where people are more open to seeking treatment, people with OCPD may feel reluctant to do so. Instead, they believe everything will be okay if everyone around them complies with their demands.
Is it possible to have both OCD and OCPD?
Yes. While OCD and OCPD are not in the same section of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), yet they can overlap.
Is there help for people with OCPD?
Yes. People can learn to become much more tolerant of other people and their beliefs. They may, in the back of their head, always have their thoughts about how things should be done, but they don’t have to listen to them. They can let them go over time, instead of just believing everything to be true.
My colleague Kilduff views progress in recovering from OCPD in part as “a path to growing more psychological flexibility.” She says, “Progress is being able to roll with things, even when things don’t go exactly the way they’d like.”
Are OCD and OCPD treated differently?
The treatments for OCD and OCPD are related but do have some differences. As previously mentioned, one of the main differences is openness to treatment in general. Kilduff says, most of the time, people with OCPD are reluctant to seek treatment whereas people with OCD tend to really want help.
“People with OCD feel horrible, they hate these intrusive thoughts, they don’t like that they’re doing the behaviors, and they want out of the OCD trap. The OCPD person is not going to experience their behavior as intrusive, problematic, or annoying,” she says.
To treat OCD and OCPD, exposure and prevention response prevention therapy, or ERP, is a great place to start. ERP is a very specific type of therapy, so your traditional talk therapy can’t be viewed as a replacement. The process works by exposing patients to different types of situations in order to provoke their obsessions, creating the opportunity to practice the prevention of compulsive responses in a safe and controlled environment. Ultimately, the goal of ERP is to free individuals from obsessive cycles and compulsions so they can live more comfortably, and it’s very effective, particularly for OCD.
Let’s take, as an example, someone with OCD and/or OCPD who works every weekend to the point that their spouse becomes upset with them. To start, practicing flexibility might mean only working for one weekend day instead of two and then leading up to not working on the weekends at all. While they explore dialing down their work schedules, they learn to tolerate the fear of disappointing the boss or jeopardizing a reputation as someone who goes above and beyond.
For people with OCPD, therapists might support ERP therapy with elements of the following two therapeutic approaches:
Acceptance and Commitment Therapy: Acceptance and commitment therapy, or ACT, can help patients recognize unpleasant feelings are an inevitable part of life, and we can best deal with them by accepting them, and then acting in a way that aligns with our larger life goals.
Cognitive Behavioral Therapy: A therapist might help someone with OCD or OCPD reframe how they think about certain tasks using cognitive behavioral therapy, or CBT, a type of therapy that helps people become aware of their thinking so they can change their behavior. Someone with OCPD might think clothing needs to be folded a certain way as a result of their black-and-white thinking. In that case, part of their CBT therapy would be about accepting that there are a number of ways to fold clothing.
Where to get help for OCD or OCPD
Healing takes time and energy, but it’s possible with the right education and support. As the Chief Clinical Officer for NOCD, I can tell you that NOCD’s therapists have all received specialized, intensive training in OCD treatment, and are qualified to provide an accurate diagnosis if you think you may be struggling with OCD or OCPD. I encourage you to learn more about NOCD’s evidence-based approach to treatment.