In the previous article, I explained what Obsessive-Compulsive Personality Disorder (OCPD) is, what its symptoms look like, what potentially causes it, and what forms of treatment can help. In this article, I will explain similar topics related to Obsessive-Compulsive Disorder. 

Obsessive-Compulsive Disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain rituals repeatedly to the extent that it induces distress or impairs general function. As indicated by the disorder\’s name, the primary symptoms of OCD are obsessions and compulsions. Obsessions are persistent unwanted thoughts, mental images, or urges that generate feelings of anxiety, disgust, or discomfort. 

Common obsessions include fear of contamination, an obsession with symmetry, and intrusive thoughts about religion, sex, or dangerous elements. Compulsions are repeated actions or routines that occur in response to obsessions. Common compulsions include excessive hand washing, cleaning, arranging things, counting, seeking reassurance, and checking things. Many adults with OCD are aware that their compulsions do not make sense, but they perform them anyway to relieve the distress caused by obsessions. Compulsions occur so often, typically taking up at least one hour per day, that they impair one\’s quality of life. Among those with anorexia and/or body dysmorphia, body checking, face checking, eyelash checking, etc. can take hours every day.

Causes of OCD

The cause of OCD is unknown although genetics is a variable. Risk factors include a history of child abuse or other stress-inducing events; some cases have even occurred after strep infections. Diagnosis is based on presented symptoms and requires ruling out other drug-related or medical causes. Rating scales such as the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) assess the severity. Other disorders with similar symptoms include generalized anxiety disorder, major depressive disorder, eating disorders, tic disorders, and obsessive-compulsive personality disorder. The condition is also associated with a general increase in suicidality.

Obsessive-Compulsive Disorder affects about 2.3% of people at some point in their lives, while rates during any given year are about 1.2%. It is unusual for symptoms to begin after age 35, and around 50% of patients experience detrimental effects to daily life before age 20. Males and females are affected equally, and OCD occurs worldwide. The phrase obsessive-compulsive is sometimes used in an informal manner unrelated to OCD to describe someone as excessively meticulous, perfectionistic, absorbed, or otherwise fixated, in which case it is likely being confused with OCPD.

How is Obsessive-Compulsive Disorder different from an Obsessive-Compulsive Personality Disorder?

While there is overlap between some symptoms of OCPD and those of obsessive-compulsive disorder (OCD), and they co-occur in some people, they are distinct and separate disorders. The two disorders share features such as a strong preoccupation with details and lots of rules, but they differ in important ways. 

Despite their similar names, Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD) are significantly different conditions. OCD is marked by specific obsessions (unwanted, intrusive, and persistent thoughts) and compulsions, such as checking the oven or washing hands repeatedly. OCPD, in contrast, affects the entire personality with the need for control and perfectionism.

People with OCPD do not have unwanted thoughts that compel them to create routines or rituals, as do those with OCD. In fact, people with OCPD experience their thoughts and behavior as rational and purposeful. Their symptoms are stable across time, whereas symptoms of OCD often change over time and in response to anxiety-provoking circumstances. OCPD folks feel very much in control, OCD folks do not.

While OCD has become a household term and is applied liberally, OCPD is little known, little recognized, and probably under-diagnosed—even though it occurs in the general population about three times as often as OCD. Unfortunately, the two are often confused, and individual sufferers may pursue or get treatment that is less effective than if they were properly diagnosed and treated.

Another cross-over diagnosis with OCPD is hoarding. Although OCPD can involve hoarding-like behavior, the DSM-5 recommends that a diagnosis of hoarding disorder be reserved for severely disruptive or hazardous cases of hoarding, such as a house that is so full that there is no room left for the occupant.  Likewise, authoritarian personality types display obsessive-compulsive tendencies but do not rise to the level of an OCPD diagnosis.  

Treatment for OCD

The mainstays of treatment for OCD include the use of serotonergic antidepressant medications, (which I do not recommend or recommend only as a last resort) and particular forms of behavior therapy, the best being exposure and response prevention therapy, combined with Dialectical Behavioral Therapy (DBT.)  I also use Emotional Freedom Tapping (EFT) with this population and have found education and family interventions to be quite effective. In extremely refractory cases, a type of neurosurgery is used that has been shown to have some success.