Obsessive-Compulsive Disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD are both conditions of overcontrol that seem to have some overlap in the display of rigid behaviors and perfectionistic tendencies. However, despite these outwardly seeming commonalities, these conditions fall within different diagnostic categories, are maintained by different factors, and are experienced quite differently by people with these conditions. OCD is the more recognizable condition, perhaps (in part) because it is experienced as more distressing and impairing to individuals who have these symptoms. OCPD is less well-known and may be mistakenly labeled or diagnosed as OCD. On the whole, OCPD is largely under-diagnosed, despite having significantly higher prevalence rates than OCD. OCPD may fly under the radar and remain undetected, particularly if individuals are high-achieving and learn how to use their traits in productive ways to obtain successful outcomes. The roads to treatment may differ between those who have OCD and those who have OCPD, with the latter population being less likely to seek treatment for self-motivated reasons. Whether unrecognized, disregarded, or misdiagnosed, if a mental health condition is not properly assessed and identified, it cannot be effectively treated. The following blog aims to outline the similarities and the differences between OCD and OCPD. The blog will also explain the differences in symptom profiles, contrast the experiences of individuals who have these diagnoses, and identify the reasons why people with either condition generally pursue treatment.

What is Obsessive-Compulsive Disorder (OCD)?

According to diagnostic criteria set forth in the DSM-5, OCD is a mental health condition characterized by the presence of obsessions and compulsions. Obsessions are defined as recurrent and persistent thoughts, impulses, and/or images that are experienced as intrusive and unwanted, and that cause significant anxiety or distress. Generally, individuals experiencing obsessions attempt to ignore or suppress the thoughts, urges, and images, and/or exert efforts to neutralize them with some other thought or action. Actions that people take to neutralize their obsessions are called compulsions. Compulsions are repetitive behaviors (e.g. handwashing, ordering, checking, redoing, seeking reassurance) and/or mental acts (e.g. praying, counting, repeating words silently, replaying situations in their minds) that people feel compelled to perform in response to an obsession, intrusive thought, and/or according to rigid rules. Compulsions are exhibited with the intention to reduce distress and to prevent a feared outcome from occurring. Symptoms of OCD not only provoke a great deal of distress, but they are also time-consuming (taking up more than one hour of time per day) and/or cause significant functional impairment in important life areas.

What is Obsessive Compulsive Personality Disorder (OCPD)?

OCPD is a mental health condition characterized by maladaptive and consistent patterns of excessive perfectionism, preoccupations with orderliness and details, and inflexibility about doing things the “right” way. These traits are displayed across settings and situations. According to diagnostic criteria set forth in the DSM-5, in order to be diagnosed with this condition, an individual must exhibit at least four of the following traits:

• Preoccupation with details, rules, and order to the degree that the major point of the activity is lost
• Self-limiting perfectionism that interferes with task completion
• Excessive devotion to work and productivity to the exclusion of leisure activities and friendships
• Inflexibility and overconscientious about morality, values, and ethics
• Inability to discard worn-out or worthless items
• Reluctance to delegate tasks to others unless they will do it his/her way
• Miserly spending style toward self and others
• Rigidity and stubbornness

Individuals who meet diagnostic criteria for OCPD may experience functional impairments in their interpersonal relationships with coworkers, friends, family, romantic relationships, etc. They may also struggle with emotional regulation, particularly with managing anger outbursts when they feel that their sense of control is being threatened or that the effectiveness of their efforts are otherwise being diluted. Performance abilities may be compromised by indecisiveness (due to concerns about making the wrong choice), struggling to adapt to changes, being excessively adherent to rules, and engaging in procrastination.

Leading clinicians have delineated subgroups within the diagnosis of OCPD as being either a Hostile-Dominant Type or an Anxious Type. Although there are overlaps between the subtypes, there are differences in the manifestations of the traits within behavioral, cognitive, affective, and interpersonal domains. Please see the table below (created by Dr. Anthony Pinto, 2020) for subtype comparison:

How Do these Conditions Differ?

Prevalence and Demographics

The National Institute of Mental Health estimates that OCD affects 2.5 million adults or approximately 1.2% of the population in the United States. Similar to anxiety disorders, OCD prevalence rates are notably higher in women than men, as identified by the Anxiety & Depression Association of America. It is important to note that prevalence rates data may be partially reflective of the higher number of women who are inclined to seek mental health treatment, as compared to men. Despite the higher lifetime prevalence rate of OCD in women, the age of onset for OCD tends to occur earlier in males. However, the development of OCD can start at any time and at any age.

According to the International OCD Foundation, the prevalence rates for OCPD are estimated to be about 1 in 100 people (2-7% of the population) in the United States. Men are twice as likely as women to be diagnosed with OCPD. Like all other types of personality disorders, OCPD should not be diagnosed prior to young adulthood as this condition requires that an enduring pattern of symptoms/traits must be established and maintained in order to fit diagnostic criteria. Although many people may display traits of OCPD, they might not meet enough of the diagnostic criteria required to be diagnosed with this condition (a minimum of four traits is required for diagnosis).

It is important to note that researchers have found a relationship between OCD and OCPD. Data reveals that the comorbidity rates between these two diagnoses are roughly between 20 to 25% (Mancebo et al., 2005). However, while comorbidity is possible between these two conditions, the majority of people who fit either diagnosis do not also meet diagnostic criteria for the other diagnosis.

Symptom Profile

While both OCD and OCPD are disorders of overcontrol and the behavioral manifestations of these conditions may look similar to an outside observer, the motivations for these behaviors are quite different. An individual with OCD is exhibiting behavioral and mental compulsions in response to unwanted obsessive and intrusive thoughts. They are trying to mitigate the distress that these thoughts provoke and prevent something “bad” from happening. In other words, individuals with OCD are distressed by and sometimes even ashamed of their symptoms. Despite having these negative reactions to their thoughts, individuals with OCD feel compelled to attend to their obsessions and respond with compulsions in order to prevent the catastrophic outcomes that they fear would otherwise be impending. Consequently, people with OCD tend to experience their symptoms as not only distressing, but also as the cause of functional impairments in their day-to-day lives as well as in their important relationships and activities.

Individuals who have OCPD do not experience obsessions or compulsions and generally are not distressed by their behaviors (even though their behaviors may seem perfectionistic and rigid to others). In fact, individuals with OCPD may experience these more extreme aspects of their personalities as qualities to be proud of and view these traits as beneficial. They are motivated by doing things the “right” and/or “best” way. People with OCPD are goal-oriented and strive for perfection. They may find ways to use their traits to help them reach their goals, and they generally do not view their traits as inhibitory to their success. People with OCPD tend to display a more narrow range of emotions (as compared to people with OCD).

While OCD is experienced in similar ways to anxiety disorders (historically, it was diagnostically categorized under the umbrella of anxiety disorders), OCPD is a personality disorder. Personality disorders involve relatively stable sets of traits that do not widely vary across settings, situations, or time. On the other hand, the symptoms of OCD are not as pervasive. They tend to be focused on the person’s area(s) of concern, such as germs, morality, harm, etc. The symptoms of OCD are more likely to remit once the underlying concerns are effectively addressed in treatment.

Level of Insight, Reactions to Symptoms, and Willingness to Seek Treatment

People with OCD often recognize that their obsessions are irrational and/or excessive. Regardless of this insight, they will continue to overfocus on obsessions and engage in elaborate and time-consuming compulsions/rituals in futile attempts to banish uncertainty and assuage their fears that their actions/inactions will lead to catastrophes. People with OCD (and good insight) usually view their symptoms as ego-dystonic, which means that they believe their symptoms to be contrary to what they actually believe, value, and want to do. Despite this awareness, their symptoms continue to plague them and can provoke strong feelings of self-condemnation. Due to the level of distress caused by this condition, most people are open to seeking professional help. However, individuals with OCD who have limited insight may believe that their symptoms are protective and therefore, that their symptoms are helpful. Consequently, they may not be inclined and may even be resistant to seeking treatment. In such cases, family members may be the ones who initiate the treatment process and begin the necessary therapeutic work.

Individuals who have OCPD generally see merit to their beliefs and behaviors. They are not distressed by their self-imposed rules (even though others may see these rules as excessive and unreasonable). Often, they are able to achieve many things that they set their sights on due to their level of conscientiousness and their unwavering efforts. Thus, people with OCPD generally see their traits as ego-syntonic, or as being compatible with their beliefs and values. They tend to view their traits as catalysts that propel them in desirable directions. They are likely to connect and attribute their successes (for which they have so persistently planned and worked towards) to their traits. Consequently, they are generally resistant to seeking professional help. In instances where treatment is sought by individuals with OCPD, personal relationships may be compromised, or their jobs may be in jeopardy for interpersonal reasons. Other important people in their life may view them as behaving in uncompromising and domineering ways. The resulting interpersonal strife can damage the integrity of important relationships, leading to fractures in the person’s social network. These external consequences may be enough to prompt individuals with OCPD to seek and participate in treatment.

Need Help or Support?

If you or a loved one are struggling with an anxiety disorder, OCD, or any other mental health concerns, know that you are not alone. If you are a parent or a caregiver and are seeking additional information about these diagnoses and how you can best support your child, our office provides parent training with the SPACE program. Please see previous blog entry – SPACE- Supporting Parenting for Anxious Childhood Emotions — for more information on SPACE.

To seek help for these or any other mental health concerns, please contact The OCD & Anxiety Center at (630) 522-3124 or info@theocdandanxietycenter.com. We have offices located in Oak Brook and Orland Park, Illinois and in Marietta, Georgia that specialize in helping individuals overcome anxiety disorders, Obsessive-Compulsive Disorder, and other co-occurring mental health conditions. We provide telehealth services that are available in Illinois, Indiana, Iowa, and Georgia.

At The OCD and Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, etc.). We will work closely with you to create an individualized treatment plan and discuss the appropriate frequency of appointments (once a week or more, if needed). We look forward to working with you!

Dr. Ashley Butterfield is a licensed psychologist at The OCD & Anxiety Center in Oak Brook, IL.  She specializes in Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy for anxiety, OCD, and anxiety-related disorders. She is comfortable working with children and adults and is able to provide treatment both in the office and outside of the office, wherever anxiety happens.