OCD or OCPD: do you know the difference?

Key points:

• OCPD affects more people than OCD, with research estimating that 3.1 to 7 percent of Australians have OCPD, whereas only 2 to 3 percent of Australians will experience OCD

• People with OCD are aware of their intrusive impulses and try to prevent them, whereas people with OCPD can negatively impact the lives of others and are not self-aware

• Popular depictions in the media of neurotic obsessions with cleanliness which are referred to as OCD are closer to OCPD

Obsessive-compulsive Disorder, commonly referred to as OCD and Obsessive-compulsive Personality Disorder — OCPD — are actually two completely different conditions, despite the similarity in names.

OCPD is one of the 10 personality disorders listed in the Fifth Edition of the Diagnostic and Statistical Manual and belongs to cluster C of the disorder groups.

• Cluster A is grouped under ‘odd and eccentric’ disorders
• Cluster B is categorised as ‘dramatic or emotional’ disorders
• Cluster C is made up of ‘anxious or fearful’ disorders

This edition of Disability Support Guide will provide an overview of OCD and OCPD, their similarities and differences along with respective treatment options, rounding things out by fact-checking some myths.

OCD

OCD is an anxiety disorder characterised by the need to act on intrusive thoughts, known as compulsions, which may present in the form of repetitive behaviours, such as hand-washing, checking for symmetry, etc or mental compulsions, such as counting, praying or repeating thoughts).

Genetics may contribute to the development of OCD, with studies showing that the likelihood of people presenting with symptoms may be higher in cases with a family history. However, traumatic events or environmental factors, including learned behaviours, are also cited as potential causes.

One of the diagnostic indicators of OCD is that acting on the compulsions takes up more than an hour out of their day and is not attributable to other disorders, such as: tourettes syndrome, body dysmorphia or generalised anxiety disorder.

People with OCD are aware of these compulsions and despite feeling the need to act, do not wish to have these thoughts or act on them. OCD can also be a psychosocial disorder and may be eligible for National Disability Insurance Scheme support based on the time-consuming impairment.

Treatment for OCD includes cognitive behavioural therapy and potentially exposure therapy if the onset of the condition is related to a life event that induces anxiety.

Medication, if warranted, may be prescribed to treat symptoms associated with OCD. Although trials have been conducted with some forms of antipsychotic medication, such as risperidone, selective serotonin reuptake inhibitor medicine is typically prescribed to treat the condition.

SSRIs, such as sertraline and fluvoxamine, are also commonly used to treat depression and other anxiety disorders.

OCPD

The DSM-5 lists eight criteria for OCPD, with four or more needing to be met for a diagnosis:

• Preoccupation with details
• Perfectionism interfering with task completion
• Rigidity and stubbornness
• Reluctance to delegate
• Excessive concern with minor details and rules
• Workaholic behaviour
• Desire to save — rather than spend — money
• Inability to discard worn-out or worthless objects

Research shows that OCPD is likely passed down in families through genetics, although studies have been done to show that attitudes towards attachment during development may play a role.

OCPD is a personality disorder, meaning that it cannot be medicated, but CBT and talk therapy can help people to deal with the disorder.

People with OCPD are not self-aware as to how the disorder impacts their life or the lives of the people around them.

Similarities and differences

Although the conditions are two separate things, people with one diagnosis are likely to receive a comorbid diagnosis, meaning that they have both.

While some people may experience OCD at some point in their lives but overcome it after a period, personality disorders are lifelong and cannot be treated with medication.

People with OCD act on intrusive thoughts without necessarily wanting to, whereas people with OCPD feel affirmed and required by acting in a strict and pre-defined manner.

People with OCD may act in repetitive or ritualistic ways which may not be logical, whereas people with OCPD tend to operate in a strict or “by the book” manner, valuing rules and guidelines over rituals or repetition.

OCPD shares many similarities with autism spectrum disorders, but people with OCD tend to have an easier time expressing social and emotional awareness.

Myths about obsessive-compulsive and personality disorders

“People with OCPD are good at work because they are dedicated to it and are sticklers for the rules.”

For people living with OCPD, adhering to the rules closely and to a fault does not mean that they will be more productive than their colleagues. The behaviour of someone with OCPD is abnormal, as it can negatively impact those around them and prevent work from getting done due to the emphasis on following procedure.

“I’m so OCD, I need everything to be clean!”

Although some people may experience OCD during periods in their life, the prognosis is not lifelong, as it is with an OCPD diagnosis. Despite this, a desire to have things clean and orderly is not necessarily indicative of either condition.

For people living with OCD, compulsive cleanliness might be how they manage their anxiety, but other compulsions may not always make sense or be something that the person benefits from.

For people with OCPD, the desire to have everything ‘just right,’ even if it comes at the time and labour of themselves or a colleague for personal satisfaction, may be a symptom.

“I’m self-diagnosed.”

While people with OCPD tend to view their behaviour as normal and as a result, are unlikely to self-diagnose or seek a professional diagnosis, both OCD and OCPD can only be diagnosed by a specialist.

Self-diagnosis, particularly when viewing OCD as a personal trait rather than a disorder, can minimise the challenges that people living with OCD face in day-to-day life.

Do you live with OCD or OCPD? Let the team at Talking Disability know your story and we’d be glad to learn more.

Related content:

An overview of the 10 personality disorders

I think I might be neurodivergent but haven’t got a diagnosis

What is a communication disability?