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.

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