OCD vs. OCPD: What’s the Difference?
Controlling, orderly, neat-freak: this is what many people imagine when they think of someone living with OCD. This depiction of OCD is inaccurate and can be harmful, but there is really a condition that leads people to behave this way.
It’s called Obsessive-Compulsive Personality Disorder, or OCPD, and despite their similar names, OCD and OCPD really have very little to do with each other.
Here’s everything you need to know about OCD and OCPD, and how they’re different.
What is OCD?
We’re pretty certain you already have a good understanding of what OCD is by now, but let’s freshen up our knowledge with a quick review.
OCD, or Obsessive-Compulsive Disorder, is a mental illness that’s defined by the presence of two key symptoms: obsessive thinking and compulsive behavior.
Obsessions are intrusive and unwanted thoughts that cause an extreme amount of anxiety. Obsessions can be about anything, from the fear of accidentally poisoning your family to the fear of germs. Compulsions are OCD’s reaction to obsessions: repetitive behaviors that are meant to soothe the obsessive anxiety. Of course, compulsions don’t actually soothe anxiety, but the person can’t stop performing them anyway.
Often, people with OCD are portrayed in the media as being intense perfectionists and neat-freaks; people who can’t stand a single pencil being out of line or when things are presented to them in odd numbers. People whose houses are sparkling clean at all times, and who need to wash their hands 10 times a minute.
Sometimes, OCD does present this way. People with the contamination theme of OCD do worry about cleanliness and washing their hands, and people with “just-right” themes of obsessions might worry excessively when their things aren’t in the “perfect” order.
However, a lot of the time, this is a complete misconception and misrepresentation of what living with OCD is like. Having OCD means that you experience obsessions and compulsions. These obsessions can be about anything under the sun, from worrying about whether or not you’re really in love with your partner to obsessing over whether you’re a sociopath. Compulsions can be any type of repetitive behavior, too.
In other words, not all (or perhaps, not even most) people with OCD worry about cleanliness or orderliness. Many of us aren’t perfectionists, although perfectionism as a personality trait does increase one’s risk for OCD. And most importantly, OCD isn’t a personality trait. It’s a neurological condition that you can recover from with the right treatment.
What is OCPD?
OCPD, or Obsessive-Compulsive Personality Disorder, is often confused as a “subtype” of OCD. We want to nip this myth in the bud: OCPD is not a subtype of OCD, and in fact, the two disorders have less in common than you might think.
OCPD is a personality disorder, which means its symptoms are deeply ingrained within the person’s way-of-being and worldview. People with OCPD are preoccupied with order, cleanliness, and control. They have high levels of perfectionism, and are often inflexible and need things to be done in certain ways.
People with OCPD often have a hard time letting go of control of both themselves and the people and situations around them. In order to maintain a sense of control, they set rigid rules that they and everyone else must follow so that everything is done “right”. They focus on schedules, details, procedures, and lists to keep them perfectly organized.
These symptoms can make people with OCPD, perhaps ironically, very inefficient in their home and work environments. They get so focused on minute details that they lose track of the big picture. Trying to correct every little thing that isn’t perfect keeps them from completing tasks, and can often drive the people around them away.
As you can imagine, relationships suffer greatly when you have OCPD. It’s difficult for people with OCPD to work on a team with others, because they find it nearly impossible to let go of control and delegate tasks. They are usually so focused on work and productivity that they have no work-life balance, causing their personal relationships to suffer, as well.
Another OCPD symptom that interferes with interpersonal relationships is the inability to openly express emotions. Often, people with OCPD express themselves in a formal, almost stiff way; they have a hard time relating to people who are overly affectionate or open with their feelings. Part of this is that they don’t want to say anything or express their feelings in any way until they’re absolutely sure it’s the “right” thing to do or say. This emotional rigidity often gets in the way of relationships, especially romantic ones.
People with OCPD also often struggle with hoarding-type behaviors. Since they have such a hard time letting go of control, they also can have a hard time letting go of useless items, even if they’re not sentimentally meaningful to them. They also tend to be quite stingy with money, preferring to save it rather than spend it; in a way, they “hoard” money, too.
In a sentence, people with OCPD are preoccupied with control, orderliness, perfection, and rules — all at the expense of flexibility and openness.
OCD vs. OCPD: Completely Different Disorders
When you really understand what both OCD and OCPD are, it starts to feel like the only true similarity they have between them is that they both start with the same two words. We’ll go over the few similarities that these two disorders share in a later section; now, let’s talk about the many ways in which OCD and OCPD are different.
It’s especially important to understand the differences between these disorders, because people often say “OCD” when they mean “OCPD” or perhaps, simply, “perfectionist”. The typical example of this is when someone says they’re “so OCD” because they have perfectionist tendencies, when perhaps they mean that they have OCPD-like perfectionism (or are just perfectionists and don’t have any mental health disorder at all).
This confusion perpetuates stereotypes and mass misconceptions of OCD, so we think it’s important to set the record straight.
Here are the most critical differences between OCD and OCPD.
Obsessions and Compulsions in OCD, but not OCPD
The most important way in which OCD differs from OCPD is that OCD is literally defined, as a disorder, by the presence of obsessions and compulsions. These two symptoms are critical to the diagnosis of OCD, and a person can’t be diagnosed with OCD if they don’t experience both of these.
Yes, the compulsions may be mental and invisible to others. But if the person isn’t 1. experiencing obsessive thinking and 2. engaging in compulsive behavior to combat the anxiety that comes with the obsessions — whether the behavior is physical (washing, checking) or mental (seeking reassurance, mental review) — then it isn’t OCD.
OCPD, on the other hand, is not distinguished by the presence of either of these symptoms. People with OCPD don’t experience obsessions or compulsions. Like we explained earlier, symptoms of OCPD include perfectionism and a high need for control. It has nothing to do with obsessions or compulsions.
People with OCD usually have some sort of insight that their thoughts and behaviors are not “normal”. That’s part of what makes OCD such a terrifying disorder; it’s hard to understand why we engage in compulsions, and we know that our obsessions aren’t 100 percent true. Even while knowing that our behaviors don’t make any sense and wishing desperately to be able to stop, it feels impossible to. This is why OCD is so torturous.
The self-awareness and insight that we have a problem, however, is almost always there despite the continued compulsions. People with OCD are often so embarrassed about their thoughts and behaviors, in fact, that it’s common for them to try to hide their symptoms.
People with OCPD, in general, display much less self-awareness about their symptoms, especially if they haven’t gone through treatment. Most people with untreated OCPD feel righteous in their thoughts, and disappointed and even angry when others don’t comply with the high standard of perfectionism and orderliness that they expect. They usually feel that others are the ones that need to change, not them.
In a sentence, people OCD don’t think they’re “right” — in fact, quite the opposite. People with OCPD, however, do.
OCPD Is More Common than OCD
Between 1 and 2 percent of the population is estimated to suffer from OCD. Although there aren’t as many studies on OCPD, its prevalence is thought to be much higher: up to 8 percent. Even people who don’t meet the criteria for the full-blown personality disorder have been found to display many of the characteristics of this personality type.
In fact, OCPD is thought to be one of the most common personality disorders.
Personality Disorder vs. Neurological Condition
OCPD is a personality disorder. This means that it is a long-lasting condition that has to do with a dysfunctional personality; the symptoms of OCPD have become a part of who the person is and how they see the world.
Personality disorders differ from other types of mental illnesses because it’s more entrenched into the person’s entire way-of-being. They aren’t just a matter of a chemical imbalance in the brain, and they usually take much more than medication to treat. Other examples of personality disorders include borderline personality disorder, which causes people to intensely fear abandonment and have relationship problems, and narcissistic personality disorder.
This means that the symptoms and traits of OCPD are deeply, deeply entrenched into the sufferer’s personality and way-of-being. Their entire worldview is usually based on these beliefs about everything needing to be in order, perfect, and done the “right” way. It usually takes a relatively long period of psychotherapy to be able to change these long-held worldviews and beliefs.
OCD, on the other hand, is a mental illness. It is a neurological condition that causes the brain to stop working as it should. Scientists think that people with OCD experience a lessening of gray matter in the brain, which makes us less likely to be able to control our impulses to perform compulsions.
Because of this, high doses of SSRI medication as well as behavioral interventions to literally “rewire” the brain are the most effective treatments for OCD.
Ego-Dystonic vs. Ego-Syntonic
Ego-dystonic and ego-syntonic are fancy psychological terms that refer to whether a symptom is seen as outside of yourself or part of yourself.
People with OCD experience their symptoms as ego-dystonic, or coming from outside of themselves. If you can, think back to your last OCD spike and remember what that felt like. Almost always, OCD symptoms don’t feel in-line with who we really are. It might have even felt like you were possessed in some way, or that you were losing your grip on reality.
That’s because most of us with OCD don’t see OCD as who we are. It feels clear that this is a mental health disorder, and we want to get rid of it. OCD feels unacceptable to us.
People with OCPD, on the other hand, experience their symptoms as ego-syntonic. They usually experience symptoms, like perfectionism and orderliness, as coming from within themselves, or as part of who they are. The traits are seen as acceptable, and not something that’s coming from the outside to invade them.
People with OCPD might seek treatment because they notice their traits are causing problems with relationships, but for the most part, people with untreated OCPD feel strongly that other people are the problem, not them.
OCD and OCPD: Are There Any Similarities?
We’ll be honest: OCD and OCPD, in general, really have little in common at all. We understand that their similar names are confusing, but OCD and OCPD are not even in the same category of mental health disorders. The two conditions have very few, if any, similarities.
One characteristic that OCD and OCPD could be said to share is both diseases’ ability to cause emotional distress. Both OCD and OCPD cause people to feel intensely upset, and this is one of the few things that these disorders have in common.
However, even the type of distress caused is usually different; OCD is more likely to cause people intense fear, anxiety, and guilt, and OCPD causes frustration, disappointment, and even anger. On top of that, emotional distress is something that most mental illnesses have in common, not only these two.
Some subtypes of OCD might, on the surface, seem to have more in common with OCPD than others. Like we mentioned briefly before, people who suffer from contamination themes of OCD have obsessions about cleanliness and, conversely, dirtiness. They worry that touching surfaces or even people who they see as “unclean” will contaminate them in some way, whether it’s mentally or physically.
This may lead them to engage in compulsions that may be seen by others as “controlling”, like making sure their surroundings are sparkling clean at all times. However, it’s important to differentiate that people with contamination OCD clean not because of a need for orderliness but because they can’t stop themselves, even when they want to. They may have an intense obsessional fear that something terrible will happen if they don’t clean.
There’s another theme of OCD that is often referred to as the “just right” subtype; people who suffer from obsessions that fall into this category feel intense anxiety when everything around them isn’t “just right”. This is different from the perfectionism that comes along with OCPD, like we talked about earlier. But to someone who doesn’t know better, it may look like the person is ordering things around just because they need things to be a certain way.
Hoarding is a symptom that both people with OCD and OCPD can suffer from. Although hoarding isn’t listed as a symptom of OCD (it is listed under OCPD), research shows that many people with OCD hoard items. The difference is the motivation behind the hoarding. People with OCPD often hoard items because they have difficulty letting go of control. People with OCD hoard as a compulsive behavior in response to an obsession; for example, maybe they feel that if they throw something away, God will punish them.
In general, and perhaps surprisingly to most people, OCD and OCPD don’t have very much in common besides their names. It’s critical to distinguish between these two conditions; understanding that they’re completely different disorders has implications for treatment.
Can You Have OCD and OCPD?
As if OCD and OCPD weren’t painful enough on their own, it’s possible for people to be diagnosed with both. Research shows that it’s not as common as you might assume for people to have co-occurring OCD and OCPD — around a fourth of people with OCD, in one study, met the diagnostic criteria for OCPD — but it does happen.
Unsurprisingly, people with both OCD and OCPD are shown to have higher rates of depression.
In general, however, most people with OCD do not have OCPD.
Treatment for OCD vs. OCPD
Since OCD and OCPD are such drastically different disorders, you’d be correct if you assumed that the treatment for them is wildly different, too. To put it briefly, treatment for OCD focuses on helping the person stop engaging in compulsions, and treatment for OCPD focuses on healing long-standing personality traits.
Treatment for OCPD
The primary treatment for OCPD is typically some form of psychotherapy (talk therapy). Especially talk therapy methods like Cognitive-Behavioral Therapy (CBT) can help people with OCPD challenge the way they think and examine the way their personality disorder is harming them and their relationships.
CBT helps people with irrational thinking to challenge their thoughts. It’s based on the premise that our feelings, behaviors, and thoughts are all interlinked, so if we can correct dysfunctional and unhealthy thinking, then we can start to feel better. CBT is commonly used in the treatment of anxiety and depressive disorders. A very specific type of it is used for the treatment of OCD as well, which we’ll talk about later.
CBT, when used for OCPD, challenges sufferers to examine their core beliefs and values about perfectionism and orderliness, and really think about whether these thoughts are true. They invite the person to reflect on whether this pattern of thinking has been helpful to them, and how they can replace these types of thoughts to improve their relationship and their lives.
Medication might also be used for the treatment of OCPD, especially if they’re struggling with mood issues.
Some people say that the treatment prognosis for OCPD is better than for other notoriously difficult-to-treat personality disorders, like narcissistic personality disorder, because the person with OCPD may rigidly commit to keeping their appointments with their therapists.
Treatment for OCD
Treatment for OCD also involves the use of CBT. Unlike for OCPD, however, the pure talk-therapy form of CBT is unlikely to help OCD symptoms, and may even make them worse. This is why it’s so critical to differentiate between OCD and OCPD; the treatments for them are drastically different.
OCD can’t be beat with logic. That’s because part of OCD is the absolute inability to tolerate any level of uncertainty. It doesn’t matter if our obsessive thoughts are “illogical” or “unlikely” — even “almost impossible”. Almost impossible isn’t absolutely, 100 percent impossible, so challenging OCD thoughts in this way isn’t effective.
Rather, the CBT intervention that has emerged as the gold-standard treatment for OCD is a technique called ERP, or Exposure and Response Prevention. In this highly behavioral form of CBT, people with OCD are asked to intentionally expose themselves to the things (thoughts, situations, or people) that induce an OCD spike.
Then, they are guided to let the obsession be present without reacting to it with a compulsion. By allowing the obsession to just be there, without needing to do anything about it, eventually lends the thought less power. The person learns to allow obsessions to sit in the back of their brain but still go about their day, without losing so much time to the obsession-compulsion cycle.
The same type of medication that’s sometimes used to treat OCPD, SSRI antidepressants, is also often used for the treatment of OCD.
Good News: OCD and OCPD Are Treatable
The good news is that whether or not you suffer from OCD or OCPD, you can recover with treatment. It’s important to get the correct diagnosis from a mental health provider who specializes in these types of disorders, because receiving the appropriate treatment will, obviously, make a big difference.
If you’re ready to get started on your OCD recovery journey, learn more about our self-guided audio program. This program uses evidence-based tools, including ERP techniques, to help you recover from your specific type of OCD.