OCD vs OCPD

Their abbreviated names sound very similar: OCD and OCPD. But in fact, OCD (obsessive-compulsive disorder) and OCPD (obsessive-compulsive personality disorder) are two very different conditions, each with their own symptoms and treatment plans. The good news for individuals who have either one is that with appropriate treatment, they can be well managed to the point that the disruption to one’s life is minimized.

“Although some people may have a tough time distinguishing OCD and OCPD from each other by name, they’re quite distinct in the nature of what they are,” says Simon Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine in New York City.

When it comes to OCD, the lifetime prevalence is about 2.5%, Dr. Rego explains. It’s estimated that about 2 to 8% of people have OCPD, and it’s believed to be twice as common in men as in women.2 Additionally, many people exhibit some of the signature traits and behaviors of OCPD, such as self-limiting perfectionism and rigidity, but don’t have the fully diagnosed personality disorder. 2

Here’s the rundown on these two mental health conditions.

Obsessive-Compulsive Disorder

An individual with OCD has frequent, upsetting thoughts (obsessions) that she tries to control by repeating particular behaviors (compulsions). The obsessions spark a great deal of anxiety because they are not only intrusive and unwanted but also recurrent, Dr. Rego says. “People with OCD will do anything to combat or escape the obsessions and therefore they resort to extensive compulsions and avoidance,” he explains.

Those with OCD are aware that their obsessions are unreasonable, and they can feel tortured by both the obsessions and compulsive behavior. Typically, OCD starts to develop in later childhood or during adolescence.1 Symptoms can wax and wane, with symptoms getting better at times and worse at others. “It’s not typical for OCD to start later in life,” Dr. Rego says. “But without treatment, the condition becomes chronic and worsens.”

OCD tends to be distressing because the person may realize that her symptoms are impairing her life but still feels compelled to do her compulsions, says Scott Krakower, DO, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, New York.

“For example, someone with obsessive symptoms of germs and contamination may be doing unwanted rituals to stay clean,” he says.  “This may ultimately worsen to where it begins to impact relationships and other functioning.”

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Selective serotonin reuptake inhibitors (SSRIs) are commonly used in the treatment of OCD. The most effective form of psychotherapy for OCD is a type of cognitive behavioral therapy (CBT) called exposure and response prevention, says Anthony Pinto, PhD, director of the Northwell Health OCD Center, located at Zucker Hillside Hospital. “In this form of therapy, the patient works closely with the therapist to gradually approach a situation that the patient finds terrifying, and then the patient learns to cope with their anxiety without relying on their compulsions or avoidance,” Dr. Pinto says. “Touching surfaces in a public restroom and then not washing is an example.”

The goal of this treatment is not to limit having the intrusive thoughts, but instead to learn, over time, to be open to them and not react to them in fear. Both in session and through homework assignments, the person learns to notice and acknowledge the intrusive thoughts without responding with compulsions and, through this process, the person reclaims her life since her routine and functioning are no longer disrupted.

Obsessive-Compulsive Personality Disorder

Individuals with OCPD tend to think their way of doing things is the “right and best way,” and they are fixated with following set procedures or routines in their work or daily living, even when these routines are inefficient. These individuals tend to be overly controlling of their environments or relationships, wanting others to conform to the strict rules they set.

This personality disorder includes maladaptive traits and behaviors, including perfectionism that interferes with completing tasks, rigid following of moral or ethical codes, hoarding behaviors, and an excessive fixation with lists and rules.2 A person with OCPD has an overwhelming need for order, a strong sense of “how things should be done,” and a rigidity when it comes to following rules. “For someone with OCPD, it’s all about rules and orderliness,” Dr. Rego says. “The person believes there is a certain right way of doing things, and that is how things should be done even at the expense of relationships.”

A person with OCPD can be successful in work life, he says. “Their perfectionism keeps them at a high standard,” Dr. Rego explains. “That said, others may find the individual with OCPD is difficult to work or live with because of their style of operating.”

The individual with OCPD is preoccupied with perfectionism at the expensive of openness, flexibility, and efficiency, Dr. Krakower says.

Treating OCPD may involve a combination of psychotherapy, medication, and mindfulness techniques. The SSRIs may be helpful because they can make the person feel less distressed and bogged down by minor things.

CBT can be effective for treating OCPD because it targets the individual’s quest for perfectionism and rigidity in thinking and helps focus on the stress that is causing the need to be perfect and organized. “It helps the person identify the distress that is driving her to be so perfect and organized,” Dr. Rego says.

“CBT also helps the person to identify the unattainable standards and rigid rules they are living by and to understand how these things get in their way,” Dr. Pinto says. “I work with patients to test these standards and rules so that they can come up with more flexible and time-efficient ways of living. In the process, we also aim to reduce self-criticism and broaden how the person evaluates herself to be based on various life areas rather than being just based on achievement.”

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Last Updated: Nov 16, 2018