OCD vs OCPD: Classifications and Differences

OCD vs OCPD – this article discusses the similarities and differences between both disorders, as well as treatment options and prognoses.

Most people have heard of obsessive-compulsive disorder (OCD). But what about obsessive-compulsive personality disorder (OCPD)? Whereas both disorders share similarities, they also have clear distinctions. Understanding these differences can help someone struggling with obsessive thoughts and compulsions and aid them in seeking support.

What Is OCD?

Obsessive-compulsive disorder is a mental health problem characterized by two main components: obsessions and compulsions.

Obsessions can come in the form of unwanted thoughts or fears, which result in the individual attempting to manage these obsessions through compulsive actions. This attempt to manage the stress associated with unwanted thoughts through ritualistic behaviors feeds into the vicious cycle of OCD: the individual feels driven to act in protective ways, but the thoughts always return. They, therefore, repeat actions and rituals until they interfere with day to day life and ultimately increase psychological distress [4].

OCD can cause high levels of shame and embarrassment around the disorder, especially if the compulsions and rituals associated with it are obvious to others.

What Is OCPD?

Whereas OCD is a mental health disorder, OCPD is a personality disorder. This means that while OCD may have a relatively short duration, OCPD can be lifelong and continue to affect patterns of thoughts, emotions, and behaviors. For this reason, OCPD can cause significant psychological distress for someone struggling with it. The causes of OCPD are somewhat unclear; there may be a genetic or situational predisposition – or potentially both.

OCPD as a personality disorder affects roughly 3-8% of the general population and is thought to be more common in older individuals than OCD [1]. This may be to do with how OCPD can be more difficult to treat than OCD. Furthermore, due to how significantly OCPD can impact people’s lives, the disorder is believed to have a considerable economic burden [2].

People with OCPD may not realize that their patterns of thinking and acting are problematic, possibly due to how ingrained their beliefs are. Additionally, it remains somewhat unclear whether comorbid OCPD and OPD represent a distinct subtype of OCD, or whether it is just a more severe type of OCD [3]. However, the current literature does not support either one as a necessary component of the other – they can exist independently [7].

OCD Symptoms vs OCPD Symptoms

The symptoms of OCD and OCPD often overlap. For this reason, we will cover the main symptoms of OCD and OCPD before discussing the similarities and distinctions between both disorders.

OCD Symptoms

OCD symptoms sometimes onset during puberty, but typically develop in early adulthood. As previously mentioned, there are two main components to OCD: compulsions and obsessions. However, there are also emotional symptoms associated with OCD.

The following are obsessive thoughts associated with OCD. These thoughts may warrant a diagnosis of OCD if they cause significant distress or interrupt your ability to lead a full life.

• A fear of causing deliberate harm to yourself or others. For example, fearing that you may physically attack yourself or a loved one.
• A fear of accidentally causing harm to yourself or others. For example, fearing that you may crash a car while driving.
• Worrying about making mistakes and feeling a need to be perfect.
• Unwanted mental images or thoughts
• Intensely needing order or symmetry. For example, insisting that all books on a shelf be organized by color to reduce anxiety
• A sense of urgency around completing an action
• Fearing infection or contamination

If someone attempts to ignore or suppress such obsessions or urges, they may indulge in actions to help alleviate anxiety – such as performing a compulsion. Compulsions associated with OCD may include:

• Feeling the need to wash yourself or items excessively
• Checking tasks or situations repeatedly to ensure that you will not accidentally harm others
• Repeating words or actions
• Arranging items to achieve order or symmetry
• Mentally or verbally counting while performing an action or task

In order to qualify for a diagnosis of OCD, these obsessions or compulsions need to be time-consuming, for example, taking more than one hour per day. Furthermore, they need to cause significant psychological and emotional distress, or impact abilities to function socially or occupationally.

OCPD Symptoms

OCPD consists of similar symptoms to OCD, including obsessive thoughts and compulsions. Furthermore, people with either OCPD or OCD may exhibit perfectionism and require strict routines and order.

However, there are some distinctive OCPD symptoms that are not typically present in OCD. These include:

• A difficulty completing tasks due to rigid perfectionism
• Inabilities discarding items, even if these values have no worth
• Obsessions with moral or ethical codes
• Attempting to control the actions of others
• Hyperfocus on work
• A lack of flexibility
• Difficulties being affectionate or intimate
• Withdrawing emotionally when a situation is out of their control
• Problem-solving difficulties
• Interpersonal relationship problems

What Are the Similarities Between OCD and OCPD?

As is evident, there are many similarities between OCD and OCPD. These include obsessive, unwanted thoughts and compulsive actions intended to alleviate stress associated with these thoughts. These thoughts and actions can lead to complex emotions and psychological distress, and can significantly interfere with an individual’s quality of life.

Furthermore, OCPD and OCD can be highly comorbid – people with OCD may be at higher risk of having obsessive compulsive personality disorder than people with other anxiety issues such as panic disorder or social phobias [3].

However, despite the obvious similarities between OCD and OCPD, as well as the risk of comorbidity, there are some clear and important differences between both disorders.

The Differences Between OCD and OCPD

One of the main distinctions between OCD and OCPD is that people may develop OCD due to life experiences, whereas people are likely born with OCPD, possibly due to genetic predisposition. For this reason, there are differences between the age of onset of both disorders – OCD may start to show later in life, whereas OCPD may present in childhood.

People with OCD may attempt to control specific factors of a situation which triggers their anxiety. However, in contrast, people with OCPD may attempt to control the overall situation or people in their environment.

Another distinction between both disorders lies in how people regard their obsessive thoughts. Meaning, while people with OCD regard these obsessions as unwanted, people with OCPD see them as necessary. In other words, people with OCPD regard their obsessive thoughts as correct. Additionally, people with OCPD may possess less self awareness than those with OCD. Therefore, people with OCPD may be at risk of acting impulsively and potentially causing harm to themselves or others.

Finally, there are differences in how people with OCD and OCPD express their emotions. For example, people with OCD may react to people not adhering to their routines by focusing their frustrations inward or becoming anxious. In contrast, someone with OCPD might struggle with intense outbursts, such as anger.

Diagnosis of OCD and OCPD

OCD and OCPD are typically diagnosed by a psychologist or psychiatrist. If you are concerned that you may have one or both of these disorders, it’s important to consult your general health provider about getting a referral.

During a psychological assessment, a professional will ask questions about the intensity, duration, and nature of obsessive thoughts and compulsions, as well as how much they impact quality of life.

Based on the outcome of this evaluation, a psychologist or psychiatrist may recommend some of the following treatment options.

Treatment for OCD and OCPD

Treatment for both OCD and OCPD may be multimodal, meaning that it might involve both psychopharmacological intervention and therapy.

A psychopharmacological approach may involve medications that target the anxieties and mood disorders that can result from OCD and OCPD. A GP or psychiatrist will discuss such options and prescribe.

In general, talk therapies are found to be highly effective for OCD. This includes techniques such as cognitive behavioral therapy (CBT). However, studies have found that individuals with OCPD may not respond as well to talk therapies. This may be due to a lack of self awareness and strong beliefs that obsessive thoughts are correct and protective. Furthermore, people with comorbid OCD and OCPD may not respond as well to intervention due to the high levels of depression associated with the combination and intensity of symptoms [5,6].

Therefore, people with OCPD – or comorbid OCD and OCPD – may respond best to both psychopharmacological and therapeutic intervention. It’s also important to be aware that it may take time, effort, and patience before positive change is achieved.

OCD and OCPD Prognosis

The prognosis for OCD may be better than that for OCPD due to how OCD is more responsive to treatment methods. However, the outlook for OCPD may be more positive than other anxiety or personality disorders due to how rigid people with OCPD are around control and reducing risk of harm. Therefore, people with OCPD may be less likely to abuse substances in attempts to reduce their fears and anxieties.

Yet, due to how OCPD can cause emotional dysregulation issues and social isolation, it can lead to mood disorders such as depression if it is not managed adequately. As discussed previously, a combination approach of talk therapy and psychopharmacological intervention can be successful with time, dedication, and patience.