Different Yet the Same: OCD & OCPD

For many, OCD (obsessive-compulsive disorder) means avid hand-washing, excessive organizing, color-coding and deep cleaning. Though associating OCD with these habits isn’t exactly wrong, it leaves out an important part of the picture.

You may be familiar with Jack Nicholson in As Good As It Gets who plays the part of an author with OCD. Throughout the film, he engages in ritualistic behaviors (also known as compulsions) that disrupt his interpersonal and professional life.  To avoid contaminants outside of his apartment, he wears gloves in public and warns pedestrians not to touch him. He refuses to use restaurant silverware and instead brings his own plastic utensils wrapped inside a protective bag. And upon returning to his orderly apartment, he immediately disposes of the gloves and commences a multi-step cleansing ritual by washing with scalding hot water and multiple new bars of soap.

This is a common portrayal of obsessive-compulsive disorder. You are likely familiar with this disorder, especially because it is common to joke about yourself or others being, “so OCD,” or overly tidy. In this post, I will delve deeper into OCD and explain the differences between this disorder and its closely named counterpart, OCPD.

Obsessive-compulsive Disorder

Obsessive-compulsive disorder (OCD) is an anxiety disorder defined by the presence of obsessive and compulsive behaviors. These behaviors occur together and interfere with a person’s quality of life and ability to function. Individuals with OCD have frequent, upsetting thoughts (obsessions) that they try to control by repeating particular behaviors (compulsions). This cycle sparks a great deal of anxiety because it is not only intrusive and unwanted, but also recurrent. All else gets paused until the compulsion is appeased.

OCD is a genetic predisposition and it usually makes its first appearance in childhood or adolescence. It is often triggered by a stressful or traumatic experience. The behaviors of individuals with OCD are driven by fear, anxiety, and uncertainty. They are aware their thoughts are irrational, but their fear and anxiety is the reason behind their compulsions. Many individuals suffering from OCD seek treatment to alleviate their anxiety.

Obsessive-compulsive Personality Disorder

Obsessive-compulsive personality disorder (OCPD) is a personality disorder defined by strict orderliness and control over of one’s environment at the expense of all else. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) describes OCPD as “a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.” Individuals with OCPD tend to think their way of doing things is the only way, and they are unlikely to delegate unless they know people will do things as well as they do. Their perfectionism keeps them at a high standard, so though they succeed at work, they are difficult to work with. They show unhealthy perfectionism and want to be in control of what is going on around them. They are judgmental, controlling, and stubborn. People with OCPD are difficult to live with and relationships suffer. They often feel paralyzed and unable to make decisions because they fear making the wrong one. They even struggle getting rid of items that no longer have value, which often leads to hoarding.

This disorder is usually diagnosed in late adolescence or young adulthood. It is approximated that men are twice as likely as women to be diagnosed with OCPD.

Juxtaposition

These two disorders have a few shared traits that connect them–a fear of contamination, a preoccupation with symmetry, and a nagging sense of doubt. If you are still unsure of the difference between these two disorders, allow me to further compare and contrast them:

  1. OCD is an anxiety disorder while OCPD is a personality disorder.
  2. Studies indicate that those with OCD are continually in search of immediate gratification, while those with OCPD can delay immediate reward.
  3. The symptoms of OCD tend to fluctuate in association with the underlying anxiety. Because OCPD is defined by inflexibility, the behaviors tend to be persistent and unchanging over time.
  4. Persons with OCD will often seek professional help to overcome the irrational nature of their behavior and the persistent state of anxiety they live under. Persons with OCPD will usually not seek help because they do not see that anything they are doing is abnormal or irrational.
  5. Individuals with OCPD do not experience an OCD cycle.

I want to elaborate on that final point, because it is the best way to differentiate OCD from OCPD. The key difference between the two is the cycle that sufferers experience, or the trigger. Those with OCD may constantly notice things out of place (trigger), and they will obsess over “fixing” the problem (compulsion) to the point that they are unable to focus on other tasks. If they do not appease their compulsions, anxiety will mount. Once the time is taken to “fix” things, they feel relief…until the next trigger appears. With OCPD, the behaviors are not directed by uncontrollable thoughts or irrational behaviors that are repeated over and over again. These individuals fully believe that their actions have an aim and purpose, and they consistently act this way, independent of their circumstances or surroundings. In other words, their actions are not triggered by anything, but are instead simply they way they operate.

Treatment

Living with OCD or OCPD can be difficult and even debilitating. Symptoms can wax and wane, getting better at times and worse at others. The good news for individuals who have either one (or both!) is that help is available. With appropriate treatment, these disorders can be managed to the point that the disruption to their lives is minimized. Treatment may involve a combination of psychotherapy, medication, and mindfulness techniques. To come to an informed diagnosis and find appropriate treatment, it is important to seek the care of a qualified mental health professional, such as a psychiatrist or psychologist. My door is always open to answer questions or offer therapy sessions. Click here to schedule with me today!

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

Resources:

When Addiction Raises Your Child

When Addiction Raises Your Child - Cluff Counseling - Lewisville TherapistAccording to The US Department of Health and Human Services, more than 8.3 million children currently live in a household where at least one parent is addicted to alcohol or drugs. Do those children notice their parents’ addiction? How does it affect them?

Addiction comes in all sizes and severities. There are addictions to substances like alcohol, tobacco, prescription drugs and illegal drugs (heroin, cocaine, methamphetamine, PCP/angel dust, hallucinogens, etc); there are impulse control disorders like kleptomania, pyromania, and gambling; and then there are behavioral addictions to food, sex, pornography, video games, smartphones, working, exercising, spirituality, cutting, shopping, etc. Because addictive behaviors are often done in isolation, the impacts of the behaviors, to loved ones, are often thought to be minimal.

Due to the many faces of addiction, its impacts can vary greatly. For example, a mother may physically leave her home to frequent bars, clubs, hotels, casinos; as a result, her children may suffer from neglect or abuse by her or others. Other addictions can take place at home and do not require a physical absence–like the father who abuses substances or gets involved in pornography/sex addiction from home. In such cases, his children may inadvertently experience psychological or emotional absence that can cause relational issues later in life. Depending on the age(s) of the child(ren), they may miss out on/not learn important things like how to brush their teeth or take care of their personal hygiene, table manners, stress management, problem solving, communication, how to make/keep friends, conflict resolution, etc. One woman, a new mom, recently told me she is not familiar with any nursery songs to sing to her daughter because she was never sung to herself.

This same woman shared with me the consequences she experienced of having a mother who was addicted to prescription pain medications. She said, “It was terrifying. Every day I dreaded coming home from school because I was afraid my mom would be passed out or dead on the bathroom floor. I was young–maybe third or fourth grade?–but I knew something was seriously wrong. I felt powerless. In order to feel like I had some semblance of control over my life, I formed OCD behaviors; I started pulling out all my eyelashes and even patches of hair off the top of my head. I even resorted to bullying a nice girl in my neighborhood! Eventually, the girl’s mother told my mom and I was put in therapy.” My heart goes out to this woman, as well as the other adult children of addicts whose stories I hear.

The real-life example above illustrates how children–even when they do not fully understand their parent’s addiction–feel its effects, and behaviorally act out their confusion and pain. They may wind up bullying, self-harming, or practicing OCD behaviors (obsessive-compulsive disorders) like cutting, eating disorders, etc. Many of these children go on to distrust authority figures, have commitment issues, and may wind up facing addiction themselves. Although these behaviors are often maladaptive, they are simply the way the child copes and tries to take care of him/herself. It is important that teachers, mentors and other adult family members recognize these as such, instead of punishing the child, and help them learn adaptive ways of coping (watch for a future blog post on specific ways you can help!).

If you are battling addiction, please remember–there is help! Just recently, I posted about the possibility of relying on a support animal through addiction and/or trauma. Not long before that I went into detail on support groups and group therapy which is accessible nationwide. And last summer, I posted about the benefits of therapy in general. The truth is, help is out there. In fact, it is readily available if you make (and follow through with) your decision to get help. So please, I urge you to contact me or schedule a session–not just for your own sake, but also for your family’s.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

Resources:

Obsessive-Compulsive Disorder at a Glance

Obsessive-Compulsive Disorder - Cluff Counseling - Denton TherapistWhat was once thought to be a rare mental disorder is now known to be quite common. Approximately 2.3% of the population or 3.3 million people between ages 18- 54 suffer from obsessive-compulsive disorder (OCD), which outranks mental disorders like schizophrenia, bipolar disorder, or panic disorder. Help is readily available for those facing this disorder to live a healthy, balanced life.

Chances are that you have heard about or know someone with obsessive-compulsive disorder (OCD). OCD manifests itself in so many different ways and varies from person to person. Here is the basic information of what obsessive-compulsive disorder is, how it manifests itself, who and when it affects, and how it can be treated.

Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable and recurring thoughts and/or behaviors that he or she feels the urge to repeat over and over. This mental health disorder is manifested by a swinging pendulum between obsessions and compulsions. The International Obsessive Compulsive Disorder Foundation defines the two sides as the following:

  1. Obsessions: Unwanted, intrusive thoughts, images or urges that trigger intensely distressing feelings.
  2. Compulsions: Behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease his or her distress. These are repetitive behaviors or thoughts that a person uses with the intention of neutralizing, counteracting, or making their obsessions go away. People with OCD realize this is only a temporary solution but without a better way to cope they rely on the compulsion as a temporary escape. (Compulsions can also include avoiding situations that trigger obsessions.)

Most people have obsessive or compulsive thoughts and/or behaviors at some point in their lives, but that does not mean OCD is present. There has been some confusion about the difference between obsessive compulsive disorder (OCD) and obsessive compulsive personality disorder (OCPD). While there appears to be some overlap between these two disorders, the biggest difference between OCD and OCPD is the presence of true obsessions and compulsions. Obsessions and compulsions are not present in OCPD; rather, OCPD is the ongoing presence of an obsessive personality trait–which, summed up simply, is a long-enduring personality trait commonly manifested through perfectionism (ie. preoccupation in details, inflexibility to schedules, being rule-bound, or needing order and symmetry). The way to distinguish OCD from this personality trait is that, with OCD, the cycle of obsessions and compulsions will become so extreme that it will consume significant amounts of time and will get in the way of daily activities that the person values.

The following are a few examples of obsessive behaviors:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, and harm
  • Aggressive thoughts towards others or self
  • Having things symmetrical or in a perfect order

Here are a few examples of compulsive behavior:

  • Excessive cleaning and/or handwashing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting

The compulsive behaviors of OCD often follow the obsessive thoughts. It is very important to note that not all rituals or habits are compulsions. Everyone double checks things sometimes–like making sure you turned the oven off or locked your car door. OCD is much more than that, though. A person with OCD generally cannot control his or her thoughts or behaviors, spends at least one hour a day on these thoughts/behaviors, does not get pleasure when performing the behaviors or rituals (but may feel brief relief from the anxiety the thoughts cause), and experiences significant problems in their daily life due to these thoughts or behaviors. Obsessive-compulsive disorder is disruptive to normal life patterns.

OCD does not discriminate; it is found in all ethnic groups and both men and women can be diagnosed with the disorder, although in children OCD is more prevalent in boys. Typically emergence or evidence of obsessive-compulsive behavior occurs around the age of six (the linguistic abilities of the child make it easier to find out the existence of OCD). The age of onset is typically reported around ages 6-15 for males, and ages 20-29 for females. Additionally, it has been found that many patients with OCD have other psychiatric comorbid (co-occurring or additional) disorders, such as: Mood and anxiety disorders, somatoform disorders (especially hypochondriasis and body dysmorphic disorder), eating disorders, impulse control disorders (especially kleptomania and trichotillomania), attention deficit–hyperactivity disorder (ADHD), obsessive-compulsive personality disorder, tic disorder, suicidal thoughts and behaviors.

Obsessive-compulsive disorder is treatable. Symptoms may ebb and flow depending on life stressors, but, if left untreated, they can greatly worsen and impact all areas of life with time. As mentioned above, the compulsive behaviors of OCD often follow the obsessive thoughts. This is why the focus of therapy is to address and distinguish the power of the obsessive thoughts, thus eliminating the need for the behaviors. Treatment approaches also focus on recognizing what triggers the behavior or thought and then making a plan for how to avoid and/or confront said triggers. This will lead to increased self-awareness and control, and freedom from the enslavement of obsessive-compulsive behaviors. In some cases, medical attention may be necessary.

If you or a loved one is suffering from OCD, now is the time to seek help and treatment from a trained, qualified counselor. I have helped many patients make individualized plans to avoid and overcome their obsessive-compulsive behaviors and I can help you, too. Contact me today to schedule your first session.

Melissa Cluff is a licensed marriage and family therapist based in Lewisville, Texas, personally seeing clients in the North Dallas area.

Resources:
Cluff Counseling: “Choosing the Right Therapist for You”
Cluff Counseling: “Taking the Stigma Out of Mental Illness”
International OCD Foundation: “What is OCD?”
MedScape: “Obsessive-Compulsive Disorder”
National Institute on Mental Health: “Obsessive-Compulsive Disorder”
Understanding Obsessive Compulsive Disorder: “Some OCD Facts and Figures”
Very Well: “OCD vs. Obsessive Compulsive Personality Disorder”
Wikipedia: “Obsessive-compulsive personality disorder”