OCD vs. Obsessive Compulsive Personality Disorder

Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) have been a source of considerable confusion for researchers, healthcare professionals, and patients alike.

Despite having similar names and symptoms, OCD and OCPD are distinct forms of mental illness that have unique and specific characteristics. The main difference is that which one is designated an anxiety disorder while the other is considered a personality disorder.

OCD is an anxiety disorder defined as the presence of an obsession (an irrational thought or idea that continually repeats in a person's mind) or a compulsion (an irrational behavior performed repeatedly). These behaviors can occur together or on their own and interfere with a person's quality of life and ability to function.

Obsessions are not simply worries about real, everyday problems. They are defined by specific clinical characteristics, namely:

• Irrational thoughts, images, or ideas that won’t go away, are unwanted and cause extreme distress
• Thoughts that you accept are your own but feel are impossible to control
• Thoughts that are distressing enough to cause you to act in ways to actively dispel those thoughts, such as engaging in compulsive behaviors as means of distraction

Compulsions, similarly, are neither routines nor addictions; rather, they are characterized by abnormal behaviors which may include:

• Irrational and often ritualistic behaviors you feel you must carry out over and over again such cleaning, hand-washing, counting, tapping, or double checking
• Engaging in repetitive behaviors for fear that something terrible may happen, such as getting an infection
• Hoarding things out of fear that something bad may happen if you don't have the items near you
• Performing ritualistic behaviors to dispel anxieties about an obsessive thought, such as the fear of someone dying
• Repetitive behaviors that you recognize are irrational but find impossible to stop

By contrast, OCPD is defined by a strict adherence to orderliness and the control over of one's environment at the expense of flexibility and the openness to new experiences.

This personality disorder is characterized by:

• An excessive need for perfection and a relentless control over not only one's environment but the nature of interpersonal relationships
• A preoccupation with details, rules, lists, and order to the extent that you may miss the major objective of an activity
• An excessive devotion to work at the expense of family or friends
• A rigidity and inflexibility with regards to morals, ethics, values, or the adherence to rules
• The inability to get rid of items that no longer have value (hoarding)
• The inability to be generous to others

While there is considerable overlap between the two disorders, there are four, basic ways to tell OCD and OCPD apart:

• OCD is defined by the presence of true obsessions and/or compulsions. With OCPD, the behaviors are not directed by thoughts you are unable to control or irrational behaviors you repeat over and over again, often with no apparent aim.
• Persons with OCD are typically distressed by the nature of their behaviors or thoughts however much they are unable to control them. People with OCPD, by contrast, fully believe that their actions have an aim and purpose.
• Persons with OCD will often seek professional help to overcome the irrational nature of their behavior and the persistent state of anxiety they live under. Persons with OCPD will usually not seek help because they don't see anything they are doing is particularly abnormal or irrational.
• In persons with OCD, the symptoms tend to fluctuate in association with the underlying anxiety. Because OCPD is defined by inflexibility, the behaviors tend to be persistent and unchanging over the long term.

While there are clear conceptual differences between OCD and OCPD, in practice these disorders can be difficult to tell apart. In some cases, a person may even be affected by both disorders.

To come to an informed diagnosis and find appropriate treatment, it is important to seek the care of a qualified mental health professional such as psychiatrist or psychologist. This is especially true if a loved one doesn't recognize the detrimental impact of his or her behavior and may be in harm's way.

Sources:

American Psychiatric Association (APA). (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Washington, D.C.: APA.

Oulis, P.; Konstantokopoulos, G.; Lykouras, L. et al. "Differential diagnosis of obsessive-compulsive symptoms from delusions in schizophrenia: A phenomenological approach." World J Psychiatry. 201; 3(3):50-56. DOI: 10.5498/wjp.v3.i3.50.