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BPD vs. OCD: The Similarities and Differences

Sometimes, mental health conditions can be hard to identify, primarily because the symptoms may resemble. Truthfully, there is probably nothing more frustrating and disheartening than feeling that something is mentally amiss, but being unable to pinpoint what it is. Two conditions that resemble in a lot of ways and are often misunderstood and misdiagnosed are obsessive-compulsive disorder (OCD) and borderline personality disorder (BPD).

Although, BPD and OCD are two different mental health conditions, getting a proper diagnosis can be painstaking. While BPD and OCD have some obvious commonalities, they also have some noticeable differences, which makes identifying one or both of these conditions challenging. The good news is you do not have to live in a land of uncertainty, doubt, and confusion anymore. In this article, you will learn more about OCD and BPD, so you can seek the appropriate treatment. With the right treatment, you will encounter a new world – one free of non-stop obsessions and compulsions.

Content

OCD – What is It?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), obsessive-compulsive disorder (OCD) is an anxiety condition. OCD is also characterized as a neuropsychiatric condition that can affect between one and three percent of the general population.

OCD involves recurrent, involuntary, and unwanted intrusive thoughts, urges, fears, emotions, doubts, mental images, worries (obsessions), and/or ritualistic behaviors (compulsions) that interfere with a person’s quality of life. It is one of the most common mental health conditions in the US. However, the exact cause of OCD, for most people, remains elusive and misunderstood. Still, certain risk factors appear to predispose individuals to OCD.

These risk factors include:

  • The presence of other mental health conditions, such as anxiety, depression, bipolar disorder, tics, etc.
  • A family history of mental illness and/or OCD (i.e., a parent, child, and/ or sibling)
  • Brain structural abnormalities
  • A history of childhood trauma (i.e., physical, emotional, emotional, and/ or sexual abuse)

Note: Children, who have contracted a streptococcal infection have a heightened risk of developing the pediatric autoimmune neuropsychiatric disorder (PANDAS).

BPD – What is It?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), borderline personality disorder (BPD) is a complex, chronic mental health condition characterized by unstable moods, thoughts, moods, emotions, behaviors, self-image, and/or relationships that can disrupt everyday functioning. Keep in mind that people with BPD typically have a hard time developing and maintaining healthy and meaningful romantic relationships and friendships.

Similar to OCD, BPD can be challenging to understand and diagnose. Also, like OCD, it can be hard to determine the root cause of BPD. Genes, brain structure and function, and environmental, cultural, and social factors can contribute to or increase one’s risk of developing borderline personality disorder. BPD typically presents during early adulthood with more severe symptoms arising during the initial stage of the condition.

How Can I Tell If I Have BPD?

Borderline personality disorder (BPD) can influence how you feel about your behavior and your interactions with other people. But understand that people with BPD may experience intense emotions for long periods, which makes regulating their emotions challenging, especially

It is not uncommon for people with BPD to feel extremely intense emotions for extended periods. This makes returning to a stable emotional baseline far more challenging, especially if the precipitating event was emotionally triggering.

Listed below are common BPD signs and symptoms:

  • Unsteady and dysfunctional romantic relationships and/or friendships that flip back and forth between exaggeration and underestimation
  • Real or imagined fears of being “abandoned” by family, romantic partners, and/or friends
  • Impulsive behaviors, such as engaging in unsafe or promiscuous sex, reckless driving, drug abuse, etc., could result in dire consequences like injury, illness, or death
  • An unrealistic or distorted self-image that affects your moods, relationships, goals, values, beliefs, emotions, and/or opinions
  • Urges to engage in self-harm (i.e., suicidal attempts)
  • Constant feelings of emptiness, loneliness, and/or boredom
  • Episodes of depression, anxiety, and/or irritability that can last a few hours or a few days
  • Dissociation
  • Extreme, inappropriate or taboo, and/ or uncontrolled anger that usually leads to feelings of guilt and/or shame

More specifically, to receive a BPD diagnosis, a person must exhibit at least five of the following symptoms, in a variety of situations:

  • Emotional instability
  • Feelings of emptiness, loneliness, or depression
  • “Avoidance” behaviors
  • Impulsivity
  • An identity crisis
  • Irrational, and/ or intense bouts of anger or rage
  • Temporary periods of paranoia and dissociation
  • Unstable, unhealthy, and/or dysfunctional relationships
  • Self-harming behaviors, and/or suicidal ideation (suicidal thoughts and attempts)

BPD is a difficult condition to diagnose and treat, primarily because of fluctuating symptoms. BPD treatment typically involves long-term dialectical behavior therapy (DBT). In the 1980s, Marsha M. Linehan developed DBT to treat people, who had been diagnosed with BPD, and who had tried to commit suicide multiple times.

DBT is an evidence-based psychotherapy that combines cognitive-behavioral therapy (CBT), psychoeducational theories, and mindfulness meditation to help people learn healthy coping skills and strategies. And, since its creation, DBT has been the “gold standard” treatment for BPD.

What Causes BPD?

The exact cause of BPD varies or is unknown, however, certain factors appear to play a role in its development and progression.

Listed below are *possible* causes of BPD:

Genetics

People with a family history (i.e., parent, sibling, etc.) of BPD may have a heightened risk of developing BPD. People, who have at least one biological relative with BPD, are 5x five more likely to also develop BPD.

Environmental Factors

Adults who grew up in an unhealthy, dysfunctional, abusive, and/or neglectful home have an increased risk of developing BPD.

Brain Chemistry & Structure

Some studies suggest that people with BPD have unbalanced brain chemistries and/or abnormal brain structures that predispose them to the condition. This is especially true when these abnormalities occur in the regions of the brain responsible for emotional regulation and impulse control. Low serotonin levels (serotonin deficiency) may also trigger BPD in some people. Serotonin is a hormone/neurotransmitter that is responsible for regulating your moods and causing feelings of joy, happiness, and overall well-being.

Note: Although, these factors may contribute to the development of BPD, just because a person has encountered one or more of them does not automatically mean he or she will develop BPD. Because, BPD is often misunderstood and the exact cause largely unknown, it is almost impossible to designate a universal cause of BPD.

What Are BPD Risks and Triggers?

Although BPD triggers vary from person to person, some triggers have been known to accompany BPD, such as:

  • An illogical or realistic fear of abandonment
  • Any type of “rejection”
  • Job termination and unemployment
  • Locations that are linked to upsetting or traumatic events
  • Reminders of traumatic events (i.e., a certain song, location, smell, etc.)
  • Romantic breakups or divorces

Note: Emotional distress appears to most common BPD trigger, however, triggers are attached to the individual. Most researchers agree that a variety of factors contribute to the development and progression of BPD.

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How Are BPD and OCD Connected?

Researchers suggest that personality disorders and OCD is a common comorbid condition.

Thus, BPD and OCD are connected by similar symptoms. According to a 2015 study, OCD is essentially linked to borderline psychopathology. BPD symptoms typically consist of poor insight, resistance, denial, and an “obsessive” control in romantic relationships, family dynamics, and friendships. Because BPD symptoms often mimic the symptoms of other mental health conditions, it can be hard to diagnose.

However, it is still possible to be diagnosed with BPD and OCD. Studies suggest that approximately 83% of people with BPD also meet the diagnostic criteria for an anxiety condition, like OCD. Moreover, researchers have a significant overlap between BPD and OCD, in which 23% of people with BPD also meet the diagnostic criteria for OCD. Later studies have consistently supported these findings, suggesting that this comorbidity could be as high as 35%.

A person with a co-occurring diagnosis of BPD and OCD may “obsessively” seek the attention of others, such as friends, romantic prospects or potential romantic partners, family members, and/or peers. It is a known fact that people with BPD struggle with interpersonal relationships. When both conditions are present at the same time, a person with this comorbidity may exhibit aggression and/or may manipulate others to control them and the situation, so they enable their behaviors.

How is BPD Similar to OCD?

If you have borderline personality disorder (BPD), you have probably been called, “obsessive” at one time or another. However, what most people do not understand (especially friends, romantic partners, and loved ones) is that for someone with BPD, the main issue is often not so much about the target of the obsession, rather, it is the underlying symptoms of BPD that is the real issue. The good news is if you struggle with BPD or “being obsessive,” you are not alone. It is not uncommon for people to exhibit both BPD and OCD symptoms.

Listed below are ways that BPD resembles OCD:

  • “If I have a flight with someone or I feel like someone is avoiding me, I obsess over these intrusive thoughts. In other words, I spend hours replaying conversations and actions – basically anything I have ever said or done to someone (or vice versa). I have a habit of trying to figure out why and where I “messed up” or where the train went off the rails, usually in hopes of ‘fixing’ things.” ~Mandy
  • “I tend to become “obsessed” with television shows and characters. I tend to binge watch episodes, read tons of “fan fiction” and look at tons of “fan art.” I like to read and analyze theories because it makes me feel connected to the show and the characters. Sometimes when I am really “out of sorts,” I will morph into the characters on my shows. But unfortunately, the void never goes away and my needs never seem to get met. That is when my world comes crashing down.” ~ Sandy
  • “I have a habit of apologizing even when it is not my fault. People often ask me why I am always apologizing for things that do not concern me. My friends, loved ones, and co-workers have gotten to my non-stop apologies. I think I do this because I was abused as a child. As a result, I learned to apologize a lot as a child. I do it to avoid confrontations. I do not like to argue with people. I typically avoid eye contact when I apologize and hate that I do it but cannot seem to quit doing it.” ~James
  • “If I think someone is mad or upset, especially my hubby, I will continuously ask what is wrong. More specifically, if I sense that something is “off,” I will repeatedly ask what is wrong, and how I can make things better. My hubby tends to get angry and frustrated with me because I am always asking him what is wrong. I know it is annoying but I just cannot stop because at the end of the day it makes me feel better.” ~ Melissa
  • “I am ‘obsessive’ about my partner. He is my whole world. I know it is unhealthy, but I am unable to control it! It is like no one else matters. The truth is I have a hard time getting along with other people. I know that I come off as “needy” but it is the result of my conditions (BPD and OCD). I realize how unhealthy it is for me to be jealous of people, who get his attention. I want it all to myself. I cannot help it.” ~Anna
  • “If I want to purchase an expensive item, I will literally spend days, weeks, or sometimes months researching everything about it. I will read every review (that I can find) on it, and visit every website that sells it. I will even create spreadsheets to compare prices. I cannot stop thinking about the item until I have thoroughly researched it.” ~Monica
  • “Once I develop even an inkling of an attraction for a woman, I immediately start ‘obsessing’ over her. My insecurities also tend to pop up during this time. I start to analyze everything. I am unable to sleep or eat. I become ‘lovesick,’ and feel like I cannot function without her – until I get fed up with her and start to emotionally disassociate from her. Then, my ‘love’ unceremoniously turns to ‘hate.’ My feelings fluctuate for a while until one day I wake up and am no longer “infatuated” with her. But it takes a while to get to this point.” ~Chris
  • “I have both BPD and OCD. My ‘obsessions’ almost always pop up the same way. For instance, I remember something I said or did and keep replaying it in my mind to try to figure out where I “messed up” or where things went wrong. I once spent four years ruminating over why my relationship ended. It destroyed me.” ~ Stephen
  • “If I am honest, I am ‘obsessed’ with time. I feel like I must leave my house within a 10-minute timespan each morning. Every morning (excluding the weekends) I get to work about an hour before it is time for me to clock in to ensure that I am on time. If I am not at least 15 minutes early to anything, I experience panic attacks. Truth be told, I am a perfectionist, which can make completing tasks, especially work tasks, challenging. I feel compelled to keep redoing things until I feel they are right. I also feel compelled to touch door knobs, chairs, walls, etc., as I walk past them.” ~ Alice
  • “I tend ‘obsess’ over who is the ‘real me.’ I have two totally different sides of myself, which can fluctuate several times a day. Honestly, trying to figure out who I am can be utterly exhausting. I am currently in a ‘gray area’ when it comes to people because I am always someone different. I would like to combine my easy-going self with my quick-to-anger self. I need to find a ‘medium’ when it comes to myself and other people, but have been unable to do so…yet.” ~Alan
  • “No matter what I am doing – doing a craft, reading a book, cleaning my house, I can only focus on one thing at a time. For instance, I work from home and when I am working, I have a habit of forgetting to eat or going to the restroom. All I can do is focus on my work tasks to the detriment of anything else. I cannot think about anything else when I get in this mode.” ~Penelope

How is BPD Different from OCD?

Although BPD and OCD share some common symptoms, there are also some differences between the two conditions.

These differences may include:

OCD typically involves perfectionism, orderliness, and control. People with OCD also tend to have a preoccupation with guidelines, rules, regulations, details, and structure. According to prior studies, it is common for people with OCD to desperately try to control situations, people, and even themselves, regardless of any emotional factors.

People with BPD, on the other hand, tend to grapple with emotional dysregulation and sudden mood swings. According to a 2015 study, people with OCD may experience negative emotions, personality “trait” anger, and “state” anger due to upsetting situations. However, people with BPD tend to experience these negative emotions at higher levels than those with OCD.

Generally, the main differences between OCD and BPD involve emotional reactivity and the ability to control impulses. In other words, people with BPD exhibit higher levels of negative emotions, while people with OCD exhibit lower levels of impulse control.

Can a Person Have Both BPD and OCD?

Yes, a person can have both BPD and OCD simultaneously!

Although it is possible to have both conditions (BPD and OCD) at the same time, it is fairly uncommon, accounting for less than 10% of comorbidities (co-occurring conditions. People with this comorbidly tend to become preoccupied with being in control of people and situations, and/or “being perfect” at all times. Thus, these individuals favor orderliness and perfectionism over healthy relationships.

What Are Some Natural Ways BPD and OCD Can Be Treated?

OCD and BPD can be treated in a variety of ways, such as with CBT, ACT, and/or ERP therapy, along with lifestyle changes (i.e., a healthy diet, plenty of rest, and regular exercise), natural remedies (i.e., mindfulness meditation, CBD, vitamin and mineral supplements, OCD books, etc.), and self-help tools, like hypnosis, OCD support groups and forums, and Impulse Therapy, an online OCD program that can help you get control of your BPD and OCD symptoms.

References

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Author

DR. R. Y. Langham

Dr. R. Y. Langham has a B.A. in English, an M.M.F.T in Marriage and Family Therapy (Psychology), and a Ph.D. in Family Psychology. She is currently a medical, health & wellness contributor, copywriter, and psychological consultant

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