OCD vs. OCPD: What’s the difference?

I’m a therapist who treats obsessive-compulsive disorder, or OCD—a condition that you may have heard of. What not as many people know about is another mental health issue called obsessive-compulsive personality disorder (OCPD). As the Chief Clinical Officer at NOCD, I often hear patients say things like, OCDP sure sounds a lot like OCD. And that’s true. But while they may seem similar, they’re really not. Let’s take a look.

OCD vs. OCPD

OCD is a treatable mental health condition where you experience repetitive and intrusive thoughts, images, urges, or feelings (obsessions) that compel you to perform repetitive behaviors (compulsions). Examples of compulsions include tapping the keys on your laptop a certain number of times until it feels “right,” or repeatedly washing your hands until you feel clean.  

OCPD, on the other hand, has nothing to do with OCD in terms of obsessions or compulsions. Rather, it’s a personality disorder that’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. The two conditions can have similar symptoms—like a need for perfectionism or order. But I sometimes say that OCPD is a kind of anal retentiveness. In OCD, you may have an intrusive thought, image, or urge that you must neutralize 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, and we have a problem.

How can I tell if I have OCD or OCPD?

Another important distinguisher between OCD and OCPD is how you relate to the thoughts you have. If you have OCD, your thoughts can be ego-dystonic, which means that the things that distress you don’t align with your actual values or desires. Someone with OCPD tends to have ego-syntonic ideas—or upsetting thoughts that are compatible with their values and beliefs. 

People with OCPD don’t see their view of the way things “should be” as an issue that needs to be resolved. Rarely is their thinking considered a problem in their eyes; it’s everybody else not living up to their standards. So if you have OCPD, you might think, if everybody else just did it my way, everything would be fine.

This difference is key to how people with OCD and those with OCPD move about their everyday lives. If you have OCD, you will likely experience your thoughts as a problem, so much so that you’ll perform actions out of fear that something bad will happen. By contrast, if you’re living with OCPD, your actions are carried out with the personal conviction that how you do things is how things should be done. 

Another difference between OCD and OCPD is the disorder’s area of focus. OCD is very targeted to certain parts of your life—such as relationships or cleanliness. The rigid, controlling aspects of OCPD, on the other hand, can be across the board. It’s not just about the laundry, it’s also about the cooking, how the house is decorated, driving, work, and so on. 

A simple way to remember the difference between OCD and OCPD is to remember that the “P” in OCPD stands for personality—referring 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 subtypes of OCD, and the symptoms that patients experience:

Obsessions with OCD: 

• Harm OCD involves disturbing and/or intrusive thoughts about harming yourself or others. 
• Contamination OCD is a fear of germs or contamination.
• Religious OCD has to do with unwanted ideas that are religious in nature.
• Symmetry OCD is the need for things to be even, ordered, or “just so.”  
• Relationship OCD centers around obsessive worries about your relationships or partners.

Compulsions with OCD: 

With OCD, when your distress gets overwhelming, you will often engage in compulsions or repetitive activities, both behavioral and mental, aimed at getting rid of your discomfort and helping you regain a sense of control. Here are some examples: 

• Checking stoves, doors, locks, etc.
• Cleaning
• Repeating acts, like re-reading paragraphs over and over, or walking back and forth through a doorway multiple times
• Engaging in mental compulsions, like saying words or phrases that have to be repeated in a specific way
• Symmetry or making sure things are “just right”
• Hoarding 
• Counting
• Needing mental reassurance, such as replaying an incident in your mind countless times to soothe yourself from the belief that you did something wrong
• Avoiding particular places or situations 

Now let’s talk about OCPD, and some of the symptoms of this personality disorder:

Hallmarks of OCPD: 

• Struggling to throw items away (hoarding)
• Being preoccupied with details, rules, and lists 
• Having a general rigidness
• Being extremely devoted to work 
• Having an unwillingness to delegate tasks to others 
• Being intensely frugal

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, if you have OCPD, you may struggle to acknowledge alternatives to your ways of thinking, causing friction or conflict at work and in relationships. The people in your life may feel highly controlled and heavily criticized.

Making matters more complicated: Unlike OCD, where you may be more open to treatment, if you have OCPD you might feel reluctant to do so—instead, believing that everything will be OK if everyone around you complies with your demands. 

Is it possible to have both OCD and OCPD?

Yes. While OCD and OCPD are two different conditions, they can overlap. In fact, research shows that 52% of people with OCD also have another personality disorder, such as OCPD. 

Treatments for OCD and OCPD

The treatments for OCD and OCPD are related, but they do have some differences. 

To treat OCD and OCPD, the most successful treatment is a form of behavioral therapy called exposure and response prevention (ERP). Unlike traditional talk therapy, which can backfire and make these conditions worse, ERP is clinically proven to be highly effective in the majority of people with these conditions.

Here’s how it works: A trained therapist who specializes in ERP will take the time to understand your symptoms and create a custom therapy plan specifically for you. Then, your therapist will typically prompt you to face something that brings on only a mild amount of distress. 

For example, if you have OCD and/or OCPD, and you work every weekend to the point that your spouse is upset with you, your therapist may help you practice flexibility, by only working one day on the weekend, instead of two. Then you’ll move toward not working at all on the weekend. While you explore dialing down your work schedule, you’ll learn tools to help you tolerate the fear of disappointing the boss, or jeopardizing your reputation as someone who goes above and beyond. By making this conscious choice and seeing that nothing bad occurs, or realizing that you handled the discomfort better than you thought you could, your brain gets the message that there was nothing to fear in the first place.

As your therapy progresses, you’ll tackle triggers that elicit a bit more distress, to conquer bigger fears. With an ERP therapist guiding you, you’ll practice confronting your fears in your everyday life, too, instead of just the controlled setting of therapy. 

Ultimately, the goal of ERP is to free you from obsessive cycles and compulsions so you can live more comfortably, and it’s very effective, particularly for OCD. Most of the time something amazing happens as a result of this therapy: You won’t be riddled with distress from intrusive thoughts, images, or urges. Your need to engage in compulsions goes away. And the things that matter the most to you won’t feel like they’re at risk of slipping away. 

Working with an ERP specialist to address the thoughts and situations that cause you distress is more accessible than ever thanks to virtual ERP therapy. In fact, peer reviewed research shows live teletherapy sessions of ERP can be more effective for OCD, delivering results in less time than traditional outpatient ERP therapy, often in as little as 12 weeks. 

With OCPD, people can learn to be much more tolerant of other people and their beliefs. You may always have the thought in the back of your head that things should be done your way, but you won’t feel compelled to listen to them. With therapy, you can learn to let them go over time, and become more psychologically flexible. Progress looks like being able to roll with things, even when things don’t go exactly the way you’d like.

Want to begin your ERP therapist search? Browse the NOCD Therapist Directory. Every NOCD therapist is not only specialized in ERP but trained to deliver treatment online. Choose your therapist and we do the rest, including helping with scheduling and payment. Of course, if NOCD Therapists aren’t the right fit, you can also explore the International OCD Foundation Therapist Directory.

For people with OCPD, therapists might support ERP therapy with elements of the following two therapeutic approaches: 

Acceptance and Commitment Therapy, or ACT, can help you recognize that unpleasant feelings are an inevitable part of life. Your therapist will work with you on ways to accept and deal with these feelings, so you can act in a way that aligns with your larger life goals.

Cognitive Behavioral Therapy (CBT) can help you reframe how you think about certain tasks if you have OCD and/or OCPD. This type of therapy teaches you to become aware of your thinking so you can change your behavior. For example, someone with OCPD might think clothes need to be folded a certain way as a result of their black-and-white thinking. So 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.