Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are similar but distinct mental health conditions.
OCPD is seen when someone with an extremely rigid, intense need for control and structure forcefully imposes their beliefs, needs, and preferences on people around them. A major distinction between OCPD vs OCD is that people with OCPD generally aren’t self-aware of their compulsive behavior. People with OCD, however, typically recognize their obsessions and compulsions.
“OCPD can be recognizable when a person’s individual rigidity and need for structure and control are imposed on others. This happens within relationships versus the often observed routinized behaviors that are common in OCD.”Talkspace therapist Elizabeth Keohan, LCSW-C, MSW
Read on to learn more about the nuances between these two serious but treatable mental health conditions.
What is OCPD?
OCPD is a personality disorder that causes people to fixate on perfection and being in control. While almost everyone knows at least a few people in life who are demanding of order and tidiness, those living with OCPD take it to extremes.
OCPD causes people to become so preoccupied with maintaining strict order that their compulsive behavior will begin to impact their physical and emotional quality of life. It’s this preoccupation that filters into and impacts their relationships.
Those with OCPD are usually unaware of their condition, behavior, and demands, which can make it quite difficult for them to recognize any need for change and OCD treatment. It’s common for them to impose their standards on others around them, and not unusual that they believe it’s others who need to be more perfect. They don’t understand the problem is them, and they’re the ones who need to change.
What is OCD?
The National Institute of Mental Health (NIMH) defines OCD as a prolonged, chronic mental health condition that affects about 1.2% of adults in the United States. OCD causes people to have recurring intrusive thoughts (obsessions) and/or behaviors (compulsions) that feel uncontrollable.
OCD can be characterized by an obsession, compulsion, or both. The symptoms of this mental health condition can affect all areas of life, including personal and/or professional relationships and school.
How is OCD Different from OCPD?
The key differentiating elements of OCPD vs OCD are easiest to understand when you keep one thing in mind. The manners and intensity that obsessions and compulsions are expressed will differ between the two disorders.
While someone with OCPD may periodically exhibit some unyielding behavior, they might not express an overpowering need to repetitively perform compulsive acts as a reaction to their obsessive thoughts or urges.
As noted earlier, people with OCD are typically more aware of their intrusive thoughts and behaviors. They generally understand their obsessions and compulsions are extreme, unfounded, and most often, unhelpful. This differs from those living with OCPD, who believe their stern standards are normal (or even positive) and that others would be better off if they’d change to meet these high standards.
Finally, OCD tends to penetrate all facets of a person’s life, causing challenges at school, work, home, and even in social settings. The repetitive behavior common in OCD can be very challenging for others to accept, tolerate, and live with.
Imagine loving someone but knowing they’re going to wash their hands 100 times today like they did yesterday and the day before. Even though your loved one might understand that their excessive hand washing is neurotic and negative, the compulsion to “get clean” can be uncontrollable.
Comparatively, OCPD means demanding so much control in an intrapersonal relationship that the other person can end up feeling like a disappointment. They might feel overly controlled and manipulated. Of course, this can lead to a lot of frustration, confusion, anger, and hurt.
Truly understanding the difference between OCD and OCPD means knowing the symptoms of each. While both conditions can share symptoms involving repetitive thoughts, perfectionism, and excessive organization, symptom expression in OCPD can be more intense and disruptive.
Let’s look at the traits of obsessive-compulsive disorder vs obsessive-compulsive personality disorder separately.
The primary OCD symptoms are obsessive thoughts and urges followed by compulsive reactions that are time-consuming and cause significant distress and anxiety.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), obsessions and/or compulsions for someone with OCD will usually absorb at least 1 hour of their day.
Common OCD obsessive symptoms might include:
- Anxiety about germs or contamination
- Unwanted sexual, religious, or harmful thoughts
- Being aggressive toward others or yourself
- An intense need to make things perfect or symmetrical
People living with OCD engage in repetitive behavior (compulsions) in response to their obsessive thoughts.
Common OCD compulsion symptoms might include:
- Cleansing and handwashing excessively
- Putting things in a very particular order
- Arranging items in a specific way, a characteristic of symmetry OCD
- Checking repeatedly for things like doors are locked or the oven is turned off
- Constantly counting
It’s important to note that not all habits and rituals are compulsions. We all have an urge to double-check things from time to time. However, those with OCD usually:
- Have little to no control over thoughts or behaviors, even when they know they’re excessive
- Spend at least 1 hour a day thinking or acting on obsessive thoughts
- Get no pleasure from performing rituals or behaviors, but continue in a desperate attempt to feel temporary relief
- Have significant difficulty in their daily lives because of their behavior
People with obsessive-compulsive disorder usually strongly wish they could avoid their unwanted thoughts and behaviors, yet feel powerless and continue to engage in habitual reactions.
Someone with OCPD will focus on obtaining perfect results for themselves and others by insisting on specific rules and orderliness in their environments.
Common symptoms of OCPD might include:
- Performing at an elevated level to achieve lofty personal and work goals
- Not fully grasping others’ points of view
- Poorly receiving (or being totally unable to receive) constructive criticism
- Intensely requiring excessive order and structure
A person with OCPD might pursue perfect results to the point they’re unable to complete the task at hand, feeling the needed level of flawlessness can’t possibly be achieved.
Some examples of OCPD behavior include:
- A college student fixated on minute details to the point they’re unable to complete an assignment on time
- A community religious leader so morally inflexible they can’t understand situations from anyone else’s viewpoint
- Someone who prohibits a spouse or partner from washing their car (or doing the dishes, or helping with laundry) unless it’s done according to a strict protocol and quality standards
Obsessive-compulsive disorder is based on dread, worry, and attempts to control uncertain outcomes. The obsessive thoughts and compulsive reactions of OCD can intensify and weaken according to someone’s ever-fluxing anxiety levels.
However, people with obsessive-compulsive personality disorder will typically display more consistent behaviors. Most often their behaviors won’t fluctuate, though they can become more ingrained and consistent over time.
Causes for OCD vs OCPD are not well understood. However, there are several possible causal factors. Let’s look at the likely causes and risk factors for OCD and OCPD separately.
OCD causes and risk factors
According to NIMH, what causes OCD might include:
- Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS)
- Abnormalities in neurotransmitter levels, including dopamine, serotonin, and glutamate
- Neurological/anatomical factors that affect inner brain communication
- Family history of OCD resulting in genetic predisposition
It’s also believed that obsessive-compulsive disorder can be caused or exacerbated by environmental stressors including traumatic life events, brain injury, infection, and autoimmune deficiency.
OCPD causes and risk factors
Less research has been done looking at OCPD. So far, there seems to be a genetic component, as well as an increased likelihood of developing it if there’s a presence of family history. Some researchers believe that OCPD may onset during early childhood because of improperly formed attachment bonds, but more research is still needed to be sure of a link.
Treatment for obsessive-compulsive disorder vs obsessive-compulsive personality disorder is similar. Both conditions are typically treated either with routine psychotherapy (talk therapy), prescription medication, or a combination of both.
There are also lifestyle changes — like practicing the tools learned in therapy and learning to recognize and respond to triggers — that can be made to address the symptoms of OCD and OCPD.
“Working with a therapist can be the key to understanding internal sources of anxiety and stress that may influence compulsive behaviors. Over time, learning to acknowledge distressing thoughts in place of reactive behaviors can promote more relief in the day-to-day and impart an improved self-esteem.”Talkspace therapist Elizabeth Keohan, LCSW-C, MSW
Treatment for OCD
Common OCD medications include selective serotonin reuptake inhibitors (SSRIs) typically used to reduce the frequency and/or intensity of OCD symptoms. Some SSRIs that can treat OCD are:
- Prozac* (Fluoxetine)
- Luvox* (Fluvoxamine)
- Paxil/Pexeva* (Paroxetine)
- Zoloft* (Sertraline)
*NOTE: These are the only medications approved by the Food and Drug Administration (FDA) for OCD treatment.
There are several other off-label medications that might be prescribed to treat OCD if SSRIs aren’t effective — including tricyclic antidepressants (TCAs) and benzodiazepines.
All medications can be associated with possible adverse effects, making psychotherapy a preferred treatment option for many people.
OCD therapy is an effective form of treatment. Cognitive-behavioral therapy (CBT) and a subdiscipline of CBT called exposure and response prevention (ERP) can both be very helpful OCD treatments. CBT and ERP help those with OCD understand how obsessive thoughts influence their behavior. Therapy for OCD also teaches them how to replace compulsive behaviors with more positive, healthier acts.
“With the help of cognitive-behavioral therapy (CBT) and the right professional support and expertise, an individual with OCD can elevate coping and management, as it can certainly feel distressing when behaviors begin to interfere with daily life and relationships.”Talkspace therapist Elizabeth Keohan, LCSW-C, MSW
Treatment for OCPD
Obsessive-compulsive personality disorder hasn’t been studied as well as OCD has been. There are no particular medications approved for treating OCPD, but some doctors will prescribe the same SSRIs used to treat OCD to address OCPD symptoms.
CBT and ERP may also be effective treatment options for OCPD by helping someone examine their thoughts in real-time so they can consider their actions more carefully. Therapy can also help them begin to address how they treat others.
Can OCD Become OCPD?
The difference between OCD and OCPD is not well enough understood for us to determine whether one can become the other. However, research does suggest that people with obsessive-compulsive disorder are at increased risk of already having or developing OCPD.
Finding Help for OCD and OCPD
OCPD vs OCD: These are separate mental health conditions with unique symptomatology. Both conditions are treatable, though, primarily by focusing on learning to pay closer attention to developing thoughts so you can choose your actions deliberately instead of reacting compulsively.
If you notice symptoms of OCD or OCPD in yourself or a loved one, it’s important to reach out to a mental health professional who specializes in treating these and similar disorders. Online therapy platforms, like Talkspace, have trained therapists available to help you learn about and manage all forms of OCD. Left untreated, either of these conditions can progressively get worse and negatively impact your quality of life. You don’t have to suffer, though. Help is available, and you deserve to get it.