OCD vs. OCPD: What’s the difference?

Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) sound like they might be the same condition. But despite the similar-sounding names, they’re completely different. The critical distinction? As the name suggests OCPD is a personality disorder. OCD, on the other hand, is not. Rather, it’s a serious mental health disorder that responds well to specialized treatment.

That said, OCD and OCPD can share some common features that can lead to some confusion. Keep reading to learn about the similarities and differences, and why it’s critical to receive the correct diagnosis for your symptoms.

How are OCD and OCPD defined and diagnosed?

OCD is a highly treatable mental health condition that occurs when someone gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, feelings, sensations, and/or urges that lead to feelings of distress. Compulsions are behaviors (or sometimes mental acts, such as rumination) that people do in an attempt to find relief from the distress—or escape the obsession itself. OCD is thought of as a cycle because the compulsion only provides temporary relief, which means the obsession inevitably returns. 

An OCD diagnosis means spending at least an hour per day on your obsessions/compulsions, experiencing a level of distress that affects your ability to show up for parts of your life like school and work, and considerably interferes with your daily functioning.

OCPD, on the other hand, has nothing to do with obsessions or compulsions. Rather, it’s a personality disorder that’s characterized by extreme preoccupation with orderliness, perfectionism, and control. Rigidity and stubbornness are often exhibited, along with (in some cases) excessive devotion to work. OCPD usually begins in your late teens or early 20s.

To merit an OCPD diagnosis, you must exhibit at least four of the following symptoms described in the DSM-5, 

• Rigidity and stubbornness
• A fixation on details, rules, schedules, organization, and lists
• A need for perfectionism that interferes with completion of tasks
• Excessive devotion to work and productivity not caused by financial necessity
• Excessive conscientiousness, fastidiousness, and inflexibility regarding ethics, morals, and values
• Inability to toss worn-out or worthless items, even those with no sentimental value
• Unwillingness to delegate tasks or work with others unless things are done in their specific way
• Hoarding money because you view money as something to be saved for emergencies

It’s important to note that many people have OCPD traits without having a full-blown personality disorder. “Where people go wrong is that they take tiny pieces of a disorder and go ‘that kind of fits me.’ Well, tiny pieces of most disorders can fit a bunch of people,” says Tracie Zinman-Ibrahim, LMFT, CST, and Chief Compliance Officer at NOCD. “It doesn’t mean you have the disorder unless you meet the entire profile based on an  assessment from a professional.”

OCD vs. OCPD: Key differences

One key difference is how people with OCD and those with OCPD move about their everyday lives. If you have OCD, you will likely experience your thoughts and actions as something you wish you could stop, but you can’t because they’re out of your control. By contrast, if you’re living with OCPD, you tend to operate with the personal conviction that your way of being is the “right” way.

“Maybe you excessively make lists or excessively have things done in a very specific way—but that’s not distressing to you if you have OCPD. This actually helps you feel better; this is what you like to do,” says Ibrahim.

In fact, since people with OCPD may not realize their thoughts and behaviors are an issue, it can be challenging for them to even seek out an evaluation or diagnosis. 

Another distinction: The rigid, controlling aspects of OCPD can apply to most parts of their lives. They have thoughts such as, “If everybody else just did things my way, everything would be fine.”

On the other hand, people with OCD usually have obsessions that center around a specific theme (or multiple themes)—meaning they don’t need nearly everything to be a certain way, just the things they have obsessions about. For instance, they may have Contamination OCD, where the fear of pollutants or germs leads them to spend a lot of time cleaning the house. Then there’s Relationship OCD, where intrusive thoughts and fears surrounding their relationship lead to compulsive behaviors such as requiring a partner to text them a set number of times per day. Or they may have “Just right” OCD—which involves obsessive thoughts and compulsions that are fueled by the feeling that something is incomplete or not quite right, such as objects that are not organized in a particular way.

OCD vs. OCPD: A quick comparison cheat-sheet

OCD: You feel distress over thoughts and behaviors

OCPD: You don’t feel distress 

OCD: Your thoughts/behaviors don’t align with your true values

OCPD: You believe there’s a purpose to your thoughts and behaviors

OCD: Intrusive thoughts/obsessions are the driving force  

OCPD: Control, rather than obsessions, is the driver for your behaviors

OCD: More awareness about your thoughts/behaviors

OCPD: Less awareness about your thoughts/behaviors  

OCD Compulsions vs. OCPD Behaviors 

It’s true that OCPD involves behaviors that may look, at least on the surface, a lot like compulsions. For instance, with OCPD you may struggle to throw items away, be preoccupied with lists, and consistently work late in an effort to be the “perfect” employee. But if your behaviors are part of your daily routine and you feel productive, good, or at least neutral about doing them, they’re probably not compulsions.

With OCD, compulsions are performed specifically to reduce anxiety or distress caused by your intrusive thoughts, or prevent a “bad” outcome from happening. And the very thing you do to feel better actually can make you feel even more distressed.

Here are some common OCD compulsions:

• Checking stoves, doors, locks, etc.
• Constant cleaning
• Repeating acts, like re-reading texts over and over, or walking back and forth through a doorway multiple times
• Engaging in mental compulsions, like saying words or phrases that have to be repeated in a specific way
• Symmetry or making sure things are “just right”
• Hoarding 
• Counting
• Needing mental reassurance, such as replaying an incident in your mind countless times to soothe yourself from the belief that you did something wrong
• Avoiding particular places or situations 

As for whether your behaviors can be reflective of OCD and OCPD being present at the same time, it can happen—but it’s unlikely. “I honestly very rarely see them both together,” Ibrahim says. “Typically, you fall on one side or the other.”

OCPD vs. OCD: A case study

Emmet, who has an OCD fear about spending money, gets recurring, intrusive thoughts about what would happen if he ran out of funds. His mind is filled with images of a hacker stealing his money. He tries to find relief from this distress through compulsions. He repeatedly counts the money in his wallet and constantly checks his bank statements, sometimes for hours on end.

Yara, who has OCPD, is also very concerned with her money. Yara isn’t constantly ruminating about her funds, and when she does think about them, it’s not completely overwhelming. She doesn’t get the urge to perform rituals around money in the way that Emmet does. Rather, she exerts control with money in an effort to protect herself from future financial emergencies. For instance, Yara refuses to let her husband have access to any of their shared bank accounts because she thinks he will mess them up. This causes a lot of tension within their relationship, because Yara will not compromise her need for control.

What causes OCPD and OCD?

OCPD risk factors

OCPD, the most common personality disorder, affects an estimated two to seven percent of the population, according to the Journal of Personality Assessment. Research shows that men are approximately twice as likely as women to be diagnosed with OCPD.

Scientists have not yet defined a singular cause for the personality disorder, but they have some theories. Some hypothesize that OCPD can arise when a child doesn’t form a healthy bond or attachment to their caregiver, or when they felt that they had to behave “perfectly” to meet the expectations of a parent.

Studies show that it is not uncommon for OCPD to occur alongside anorexia nervosa, depression, illness anxiety disorder, certain other personality disorders and Parkinson’s disease.

OCD risk factors

Although the exact causes of OCD are unknown, research has identified a number of possible contributing factors. For instance, genetics can play a role—as having a parent or sibling with OCD is associated with an increased chance of developing the disorder yourself.  Likewise, there may be a biological component as people with OCD show similarities in certain parts of the brain.

Of course, the role of one’s environment can’t be ruled out: Some studies have found an association between childhood trauma and OCD symptoms. 

Treatments for OCD and OCPD

To treat OCD and OCPD, the most successful treatment is a form of behavioral therapy called Exposure and Response Prevention (ERP). ERP works best with the guidance of an ERP specialist—someone specifically trained in this form of therapy who will create a plan that’s customized for you. 

The exposure part of ERP refers to actively putting yourself in situations that trigger your reactions. By doing this, your therapist can help you learn response prevention techniques—things that don’t involve your typical OCPD behaviors or OCD compulsions. The therapy moves gradually so that you’re always starting off with exposures that aren’t too overwhelming.

Ultimately, the goal of ERP for OCD patients is to gain freedom from the cycles of obsessions and compulsions—so they can live more comfortably and enjoy the things that matter to them. With OCPD, people can use ERP to learn to be much more tolerant of others and their beliefs. 

Keep in mind that if you have OCPD, your tool-kit may include other modalities as well. “It’s sort of a whole picture versus when you have OCD, you’re often strictly going to do ERP,” says Ibrahim. “You may also do other types of therapy like Cognitive Behavioral Therapy (CBT) to deal with some of the rigidity of OCPD.”

For example, someone with OCPD might think clothes need to be folded a certain way as a result of their black-and-white thinking. Part of their CBT therapy would be about accepting that there are a number of ways to fold clothing—and not one of them is “correct” or “right.”

They may always have thoughts in the back of their heads that things should be done their way, but they won’t feel compelled to listen to them. Progress looks like being able to roll with things, even when things don’t go exactly the way they’d like.

The bottom line? Coping with OCD or OCPD can be challenging—but once you receive an accurate diagnosis, and connect with the right treatment, relief is absolutely possible.