OCD vs. OCPD: What’s the difference

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. 

Let’s take a look at these two disorders that sound the same but are actually quite different. First let’s break down the definition one-by-one. 

What is OCD?

OCD is a treatable mental health condition where people experience obsessions which are repetitive and intrusive thoughts, images, urges, or feelings. These obsessions are ego-dystonic, meaning that they do not align with a person’s actual values or desires.

What is OCPD?

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, a licensed therapist with NOCD and clinical training specialist. 

Despite standing for obsessive-compulsive personality disorder, OCPD is a personality disorder emphasizing rigid characteristics, striving for perfection, and over-devotion to work. 

Dr. Patrick McGrath, NOCD’s Chief Clinical Officer, says 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,” he says. 

Obsessions in OCD: 

• Disturbing or taboo thoughts that might involve self-harm of self or others 
• Fear of germs or contamination
• Struggle with uncertainty
• Unwanted ideas that are religious or sexual in nature 
• Desire for symmetry and order 

Hallmarks of OCPD: 

• Struggle to throw items away
• Preoccupation with details, rules, and lists 
• General rigidness
• Extreme devotion to work 
• Unwillingness to delegate tasks to others 
• Intense frugality 

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: 

• Frequent checking in with people to confirm their safety
• Checking locks, stoves, and light switches repeatedly
• Repeatedly counting or saying a word in your head
• Checking trash repeatedly to make sure you aren’t throwing something valuable out
• Excessive hand-washing
• Looking for mistakes over and over when writing an essay or paying taxes
• Looping back while driving to see if you’ve hit someone
• Google searching
• Mentally replaying situations to make sure you remember them completely
• Getting reassurance about things from other people
• Visiting different doctors to see if you have an illness
• Repeatedly apologizing to someone or asking if they’re okay
• Keeping yourself away from kitchen knives because you get thoughts about stabbing someone
• Staying away from kids because you get sexual thoughts about them
• Refusing to visit public places because you’re afraid you’ll catch an illness
• Avoiding crowded areas
• Replaying a past situation over and over in order to “solve” it
• Neutralizing a “bad” thought with a “good” thought

Potential life outcomes of OCPD: 

• Relationship friction
• Conflict at work 
• Family members of people with OCPD may feel highly controlled and heavily criticized
• May feel reluctant to seeking treatment since people with OCPD tend to believe everything will be okay if everyone around them complied with their demands 

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 thoughts outside of their value system whereas someone with OCPD tends to have ego-syntonic ideas that are compatible with one’s values and beliefs. 

Folks with OCPD don’t see their ideas about how the way things should be as an issue. Kildruff 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.” 

On the other hand, someone with OCD experiences their thoughts as a problem, so much so that they often perform actions out of fear something bad will happen whereas 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 going to be 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. 

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 or DSM, yet they can overlap. 

How can I tell if I have OCD or OCPD?

Yes. McGrath says, “They 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.” 

Kildruff 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. When people are in recovery they have a more relaxed presentation rather than the usual very intense presentation of OCPD.” 

Are OCD and OCPD treated differently?

The treatments for OCD and OCPD are related but do have some differences. One of the main differences is openness to treatment in general. Kildruff 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. 

While an internal conflict like experiencing unwanted thoughts might bring someone with OCD into treatment, an external conflict like problems in a marriage might bring someone with OCPD into treatment. 

To treat OCD and OCPD, exposure and prevention response prevention therapy, or ERP,  is a great place to start. ERP is a type of behavioral therapy that exposes people to situations that provoke their obsessions and the resulting distress while helping them prevent their compulsive responses.

NOCD has over 300 therapists who specialize in treating OCD, and we’ll work to match you with someone skilled and experienced. You can also find support and compassion in dozens of support groups, which are free to join for members working with a NOCD Therapist.

For someone with both OCD and OCPD or just one of those conditions, sample exposures may include the following: 

Exploring flexibility 

Let’s take 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. 

Trying the “dimmer switch” approach 

Kildruff likens adjusting one’s level of involvement in a particular task to a dimmer switch. She says, “It’s about learning how to better identify with a reasonable level of effort you need to give something relative to the importance of the task at hand. People with OCPD tend to view tasks as all or nothing. Instead of treating yourself like an on-off switch, what would it be like to try being a dimmer switch?” 

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

Acceptance Commitment Therapy: Part of acceptance and commitment therapy, or ACT, is having someone identify their personal core values. If someone says they value family but spends the bulk of their time working as a result of their disorder, ACT therapy might help them live more in line with their actual values. 

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 be 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 therapy would be accepting that there are a number of ways to fold clothing.  

Healing takes time and energy but it’s possible with the right education and support.