Sarah has been preparing for the presentation in her office for 4 hours. After finishing, she checks her mobile phone 10 times to confirm she is ready. She had prepared for it the whole night (4 hours) and went through it 6 times. Still, she feels like something is wrong, like ‘what if I have missed something?’, ‘What if others feel that I haven’t prepared well enough?’ and so on.

On the other side of the building, Sarah’s colleague Mark is busy arranging his desk for the day. He is focused only on ‘perfect work’ like finishing work perfectly on time, keeping his pens in the exact right places, and making sure his files are in a straight line, etc. Though his team members think he is doing it to be more productive, Mark gets irritated if anyone just touches his belongings.

Both Sarah and Mark share similar symptoms, yet they are different patients with conditions called obsessive compulsive disorder (OCD) and Obsessive Compulsive Personality Disorder (OCPD). Yes, it is true for both that:

  • They have ‘obsessive compulsive’ in their names
  • They sound like perfectionism
  • They make daily life challenging

However, the reasons behind their actions aren’t the same. So, what is the difference between the two? Let’s understand their characteristics here.

Difference between OCD & OCPD

OCD is usually caused by an extreme fear of accidentally hurting someone or an extreme need to keep things the same, which increases the patient’s anxiety, and therefore, they try to avoid it. However, the patient with OCPD refuses to admit his mistake and, on the contrary, feels like his way of doing things is the best and the logic behind it cannot be questioned.

Sarah’s Story: Living With OCD

Now, let us see what a typical day in Sarah’s life looks like. She wakes up in the morning, and anxious thoughts start firing in her brain immediately, “Did I lock the door last night? What if some intruder entered the house? I need to go check.” Though she knows she locked the door, the anxious thought feels so real and scary that she needs to go and check it. She goes and checks the lock once, twice, and thrice. Each time she tries to recall the feeling of locking it, her attempt fails due to doubt.

In the office, Sarah spends almost 2 hours checking and rechecking her mail before sending it. Though she values perfection, she fears that any mistake in her work will lead to the end of her career. Though the rational side of her brain knows that a typo won’t end her career, the fear feels almost suffocating to her.

Sarah’s dangerous OCD symptoms cover many domains:

  • Checking behaviors (doors, mail, work)
  • Trying to overcome the fear of contamination by performing harmful activities like washing hands, drying her skin, etc.
  • Perfectionism resulting from irrational fear of dire consequences
  • Intrusive thoughts that do not make any sense

What is it that Sarah is attempting to run away from? She is attempting to run away from all the fearful thoughts and feelings. She is attempting to run away from repeatedly checking the traffic lights. She feels her thoughts are stuck in her head.

Mark’s Story: Living With OCPD

Mark’s case is somewhat different. He arrives at work at least half an hour before the working hours. Not because he has OCD and has an urge to check everything in the building, but because he wants to be perceived as a responsible employee. When most of his colleagues arrive early or late, he becomes frustrated and thinks, “Does no one take their job seriously?! When working in a team with a couple of his colleagues on a project, Mark feels that he cannot rely on them and that he is the only person who can cope with every single part of the project. When others suggest a different approach, he feels uncomfortable. Instead of saying yes, he asks mockingly, “Don’t you think my way is better?”

Here, a patient with OCPD describes himself as follows:

  • He knows what is right and wrong.
  • He feels uncomfortable when someone else is in charge.
  • He cares about work and productivity.
  • He is highly moralistic.
  • He has difficulties relaxing and enjoying.

What is typical for Mark is that he does not perceive his behavior as something negative. He is not frustrated by his thoughts and behavior; he is frustrated mostly by others, who do not act as he expects them to act.

Influence On Relationships

As expected, both disorders have an influence on relationships, although somewhat differently.

Influence of Sarah’s OCD on relationships:

  • She stays at work longer and leaves late. (This is a way of avoiding etiological confusion.)
  • She often avoids social activities, which she perceives as stressful.
  • She often seeks reassurance from others (e.g., by asking questions like “Are you sure this didn’t make you angry at me?”).
  • She blames herself for the consequences of her OCD on the quality of life of others.
  • She wants to control her symptoms but cannot.

Influence of Mark’s OCPD on relationships:

  • He is not able to maintain a relationship when someone doesn’t follow her rules.
  • He does not like to compromise or change his plans.
  • He complains to his colleagues about work. For him, this is a sign of laziness and lack of responsibility.
  • He is not aware that his behavior, which distracts him and his friends, is actually the problem.
  • He is convinced that everyone acts according to his rules.

Can someone Have Both Conditions? 

Yes, someone can have both OCD and OCPD. Imagine Sarah, who had some symptoms of OCPD:

  • She might fear that she will repeat rituals (OCD), and at the same time, she is fully convinced that her method of organizing work projects provides perfect results (OCPD).
  • She may not attend parties because of activity restrictions (e.g., giving style lectures, dress, and unnecessary travel expenses), but she believes it is perfect and that others should follow it as well.

That’s why a proper diagnosis and treatment are important. Both disorders have different treatment approaches.

Treatment options

It is necessary to correctly diagnose OCD and OCPD because some treatments that work best for one may not be as effective for the other.

Treatment for OCD:

  • Medication is the first-line treatment for OCD to alleviate symptoms of obsessions and compulsions.
  • Exposure and response prevention (ERP): Reduction of anxiety by means of habituation, increased exposure to situations one fears (e.g., leaving an unopened door unchecked), and resisting performing compulsive rituals.
  • Acceptance and Commitment Therapy (ACT): Reduces the control of the obsessions by accepting that the thoughts are merely thoughts.
  • Dialectical Behavior Therapy (DBT): Development of skills such as emotional regulation, mindfulness, coping skills, etc., to manage impulsive emotions.

Treatment for OCPD

  • Medication is the first-line treatment for OCPD in combination with therapy.
  • Psychotherapy: Finding the motivations and fears that underlie your thoughts and behaviors and learning to relate better to others.
  • Maintaining a healthy lifestyle and managing stress can improve the effectiveness of treatment and help to achieve long-term results.

The Takeaway

OCD and OCPD, though both disorders generally appear to be the same, differ in their manifestations. The main difference between the two is that OCD emphasizes the importance of distressing intrusive thoughts and compulsive behaviors, while OCPD emphasizes the personality’s need for moral certainty.

A lot of people assume that OCD and OCPD are not medical conditions that need treatment. This is not true. Both OCD and OCPD are medical conditions that need treatment because, if left untreated, they can impair work, relationships, and daily functioning. The most important thing is to get a correct diagnosis first. OCD and OCPD are two different psychiatric issues with different solutions. What works for one may not be the solution for the other. 

Mental health professionals like board-certified psychiatrists or neuropsychiatrists have in-depth knowledge of diagnosing and treating mental health issues, including OCD and OCPD. For any neurological issues (e.g., attention difficulties, memory loss, and cognitive decline), it is best to consult a neurologist near me. Neurologists are medical doctors who specialize in neurology and focus on conditions that affect the brain, nerves, muscles, and spinal cord.

Thus, if thoughts or behaviors are disturbing (like Mike or Sarah), seek help. Help is available. Many people can manage their obsessive-compulsive situation with prompt intervention.