Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD): similar names but completely different disorders. How do we differentiate between them?
Well, OCD is a mental disorder, which involves a clinically significant disturbance in a person’s usual thoughts, emotions, or behaviours. OCD involves intrusive thoughts (known as obsessions) and/or repetitive behaviours (known as compulsions). The obsessions and compulsions are typically irrational and very distressing.
OCPD, on the other hand, is a personality disorder. Personality disorders involve pervasive and maladaptive patterns of behaviours, thoughts, and emotions. People with OCPD experience an excessive need for order and control, where they are often perceived as stubborn, perfectionistic, and inflexible. They typically adhere rigidly to schedules, rules, order, and details.
Both disorders can involve inflexible thoughts and behaviours involving perfectionism, excessive list-making, orderliness, and hoarding. So, not only do they share similar names, but they also share similar obsessive-compulsive tendencies.
There are, however, distinct differences between the two disorders. People with OCD tend to have insight into the irrationality of their obsessions/compulsions and, therefore, the obsessions and compulsions are inconsistent with their beliefs and personality (i.e., ego dystonic). In contrast, people with OCPD tend to lack insight into the irrationality of their thoughts/behaviours, often believing that their way of doing things is the best way. Therefore, the obsessions and compulsions are consistent with their beliefs and personality (i.e., ego syntonic). Indeed, many people with OCPD may be unaware that they have the disorder and how it may be affecting those around them.
Now that I’ve highlighted the main characteristics and differences between the two disorders, let’s explore this further through an example using two fictional people: Jill and Jane. Both characters experience anxiety, but one of them has OCD while the other has OCPD. See if you can notice the differences and guess the answer…
Jill copes with her anxiety by focusing on rules and details, with a goal of perfection. This goal means that Jill has trouble delegating tasks or accepting that there may be more than one way to do things. She truly believes her way of doing things is the best way. Because of this, Jill tends to prioritise chores, work and productivity over relaxation and relationships with others. Her approach has been rewarded with several promotions at work. Some might describe her as rigid, stubborn, and a bit of a hoarder.
Jane also copes with her anxiety by doing things in a particular way. She repeatedly worries about things being in the right place, and often doubts her memory. Because of these worries, she needs to make sure the pillows on the bed are arranged just right before leaving the house. She also needs to lock the door three times. These behaviours don’t really make sense to Jane, she just knows she needs to do them, or she won’t be able to shake the feeling of discomfort or distress. She often feels embarrassed by these behaviours too, where she will always attempt to hide them from others.
So, you may have noticed that, while both Jill and Jane experience anxiety and manage this through obsessive-compulsive tendencies, Jill’s pattern of behaviour pervaded many aspects of her life and Jane’s behaviours were much more situationally specific. Jill was rigidly focused on general order and control while Jane focused on avoiding or relieving discomfort or distress. Jane also demonstrated insight into the impact of these behaviours, while Jill did not. Similarly, Jane’s behaviours were ego-syntonic, while Jill’s were ego-dystonic. Based on these differences, we can conclude that Jill likely has OCPD, and Jane likely has OCD.
From a prevalence standpoint, OCPD is more common than OCD. Where OCD affects 1.1% of the global population, OCPD affects 6.5% of the global population (Clemente et al., 2022; Fawcett, Power, and Fawcett, 2020). Comorbid diagnoses of OCD and OCPD are not uncommon either (~34%) but generally mean the individual has poorer insight, greater severity, and greater impairment in functioning (Lochner et al., 2011).
Despite this, both OCD and OCPD can be successfully managed with gold standard treatments, and that the OCD Clinic has helped countless people struggling with OCD and OCPD to reclaim control over their lives. Please feel free to contact the clinic if you want to explore this further.
Blog post written by Sally Youdale, Clinical Psychology Registrar at The OCD Clinic. If you have questions about psychological therapy please contact our intake team: firstname.lastname@example.org