Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) sound alike and have several symptoms in common. “Both can involve perfectionism, rigidity, anxiety, and difficulty with criticism and relationships,” says Michael Roeske, PsyD, senior director for the Newport Healthcare Center for Research and Innovation.
But despite their similarities, they’re two separate conditions. It’s important to understand the difference between the two because they’re treated in different ways, Dr. Roeske says. Here’s what you need to know about the similarities, differences, and treatment options for OCD and OCPD.
OCPD Symptoms
“Symptoms of OCPD can include a persistent obsession with order, perfectionism and control, leading to inflexibility, an excessive focus on details, difficulty delegating, a strong need for rules and a tendency to prioritize work or productivity over relationships and leisure time and activities,” says Tarik Hadzic, MD, PhD, a child, adolescent, and adult psychiatrist and medical director of Newport Healthcare’s National OCD Services.
Other symptoms of OCPD may include:
Difficulty completing tasks due to an obsession with perfection
Extreme doubt and inability to make decisions
An unwillingness to compromise
Going to extreme lengths to avoid their perception of failure
Difficulty dealing with criticism
Tendency to focus too much on others’ flaws
Unwillingness to throw out objects that are broken or have no value
Black-and-white thinking, also known as all-or-nothing thinking (thinking in extremes or absolutes)
Intense control over budgeting and spending money
“Seemingly, people with OCPD usually appear confident, organized and successful, however, their inability to compromise or change their behaviors usually negatively affects their relationships,” says Roeske.
OCD Symptoms
OCD is a mental health condition in which a person has persistent obsessions and compulsions that interfere with daily life. “Obsessions are persistent, unwanted thoughts, urges, or images that cause significant anxiety or distress,” says Dr. Hadzic. “These may include fears, harm obsessions, intrusive disturbing thoughts, and persistent doubts.”
Some common themes associated with OCD include fear of contamination, difficulty with uncertainty, an intense need for balance and order, and unwanted intrusive thoughts about harming oneself or others or about sex or religion. Obsessive symptoms of OCD may include:
Fear of contamination from touching objects that have been touched by others
Worries or doubts that you turned off the stove or locked the door
Intense distress when objects aren’t ordered or faced in a certain way
Intrusive, unwanted thoughts about harming people, such as driving a car into a crowd
Thoughts of losing self-control in public in ways like shouting obscenities or acting out in some way if you’re not careful enough
Unwanted sexual thoughts
Excessive preoccupation with your gender identity or sexual orientation
Going out of one’s way to avoid situations that may trigger obsessions, such as shaking hands
Excessive need for reassurance
Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or in accordance with rigid rules, adds Hadzic. People with OCD perform compulsions in hopes of reducing anxiety around their obsessions or preventing a feared event. Compulsive symptoms of OCD may include:
Bathing, cleaning, or washing hands until the skin becomes raw
Repeatedly checking a door to make sure it’s locked or the stove to ensure it’s off
Rituals involving numbers, such as counting in a certain pattern
Silent repetition of a word, phrase, or prayer during unrelated tasks
Attempts to replace each bad thought with a good thought
Arranging certain objects, such as canned goods, in very specific ways
Collecting or hoarding items with no value
Constant reassurance-seeking
According to Roeske, both OCD and OCPD can involve symptoms like:
Perfectionism
Repetitive behaviors
Rigidity
Anxiety
Difficulty with criticism and relationships
Despite these similarities, the causes of these symptoms are different for OCD and OCPD. “Perfectionism, inflexibility, and repetitive behaviors in OCD are driven by anxiety and fear of harm, while in OCPD, it’s more about control and order,” says Hadzic.
Another difference: OCD symptoms tend to fluctuate in response to the presence of anxiety symptoms. When anxiety increases, OCD symptoms usually do, too. That’s because OCD is strongly associated with anxiety disorders and even used to be classified as one, says Hadzic. In contrast, OCPD is a personality disorder, and its symptoms are continuous and don’t fluctuate much, he says.
The age at which each condition typically starts also differs. “OCPD tends to develop in the teens or early adulthood, while OCD often begins in childhood,” Hadzic says.
Awareness also tends to differ between the two illnesses. “People with OCPD generally don’t recognize their behaviors as problematic, whereas people with OCD often understand that their thoughts and behaviors are excessive or unreasonable,” says Hadzic.
Treatment options for OCD may include:
Psychotherapy (talk therapy), such as cognitive behavioral therapy (CBT) or exposure response prevention (ERP). CBT involves identifying and changing distorted thoughts and behavioral patterns. ERP is a component of CBT and involves gradual, supervised exposure to a feared object or obsession in a safe environment.
Medication, such as antidepressants. Certain antidepressants — such as fluoxetine (Prozac), sertraline (Zoloft), or fluvoxamine (Luvox) — are approved by the U.S. Food and Drug Administration (FDA) to treat some people with OCD.
Intensive outpatient and residential treatment programs, which typically last a few weeks and help a person with OCD who struggles with daily functioning due to serious symptoms.
Transcranial magnetic stimulation (TMS), an FDA-approved treatment for people with OCD whose symptoms haven’t been sufficiently relieved by traditional treatments. TMS is a noninvasive treatment that involves placing an electromagnetic coil on the scalp and delivers electromagnetic pulses to certain parts of the brain to help improve symptoms.
Deep brain stimulation (DBS), an FDA-approved surgical treatment for OCD for those whose symptoms haven’t improved enough with traditional treatments. It involves implantation of electrodes in the brain, which produce electrical impulses that can help manage impulses associated with OCD.
Treatment options for OCPD may include:
Psychotherapy, such as CBT or psychodynamic therapy (a form of talk therapy that involves using self-reflection to hone in on the roots of one's emotional issues, such as problematic behavioral patterns or relationships).
Medication for separate mental health issues that are common among people with OCPD, like depression or anxiety (there are no drug treatments that are FDA-approved to treat OCPD itself)
Both OCD and OCPD require professional treatment to properly manage them. Ideally, you should seek treatment as soon as you start having symptoms. Early intervention can help you better manage the condition in the long run.
People with mental health conditions have an increased risk of suicidal thoughts and actions than those without a mental health condition. Signs and symptoms of suicidal thoughts or behaviors may include:
Talking about death or wanting to die
Physical or emotional pain that feels like it’s too much to bear
Feeling shame, guilt, or like a burden to others
Intense sadness, rage, anxiety, agitation, or mood swings
Feelings of hopelessness or emptiness
Changes in sleeping or eating patterns
Increased alcohol or drug use
Social withdrawal or saying goodbye to loved ones with no other logical reason for doing so
Risk-taking behaviors, such as driving too fast
Looking up ways to die or creating a plan
OCD and OCPD are both mental health conditions that include anxiety, rigidity, and a strict observance of certain tasks.
These symptoms can greatly impact relationships and quality of life for those with either disorder.
Despite their similarities, they are two distinct disorders with different treatments.
Early intervention and lifelong treatment are key for managing symptoms and improving quality of life among people with either condition.
