May 11, 2022

Intro

This week, we will explore the differences between Obsessive-Compulsive Personality Disorder (OCPD) and Obsessive-Compulsive Disorder (OCD). In the context of treating Eating Disorders, especially anorexia, it\’s important to understand the difference between OCPD, which is common among anorexics and impacts treatment outcomes, and OCD, which is not as common in this population. In general, the differences between the two disorders are not well understood even among eating disorder practitioners, such that OCPD is often missed altogether or is misdiagnosed as OCD. 

So let us clarify; Obsessive-Compulsive Personality Disorder is (as the title suggests) a personality disorder whereas Obsessive-Compulsive Disorder is a type of anxiety disorder with both an emotional and behavioral component. OCD is easy to spot because of the behavioral component; hand-washing, counting, checking and rechecking on burners or lights, etc. Whereas the OCPD is not. When OCPD is part of the anorexics’ presentation it is important to identify and understand it in order to maximize treatment effectiveness. In this mini-series, we will explore those differences and their Implications for treating eating disorders in more detail. 

OCPD

OCPD is classified as a \”Cluster C\” personality disorder, or one in which anxiety and fear are the primary features. Individuals suffering from OCPD demonstrate an excessive focus on details, order and rules, and the need to achieve a perfect outcome, often in a way that interferes with daily life. 

OCPD individuals are often viewed as being stubborn and/or self-absorbed due to an intense need to have things done a certain way. Although this may be a fair interpretation from someone viewing the behavior or living with an individual suffering from OCPD, it often does such individuals an injustice as they cannot control the need for order that drives their compulsive inclinations. 

Individuals with OCPD often suffer significant setbacks socially and professionally as the desire for order, perfection, accuracy, and the need to be in control, gets in the way of relationships. The OCPD condition in its most severe form can impede the individual’s ability to finish tasks, collaborate with other people, or engage in social activities and hobbies. On the other hand, if managed it can make for an ideal employee, or one who is detail oriented and takes pride in good results. Finally, in addition to demanding that others follow certain rules or meet their high standards, people with OCPD are usually severely self-critical.

Symptoms

Individuals with OCPD, according to the DSM-5, are obsessed with orderliness, perfectionism, and control. These traits usually begin in early adulthood but can begin earlier, especially if such individuals have an eating disorder.

In general, the most common characteristics include:

  • A preoccupation with order and details that result in the person missing the point of an activity.

  • Perfectionism that hinders the completion of tasks.

  • Devotion to work and productivity to an extent that is excessive and not explained by economic needs.

  • Excessive conscientiousness and inflexibility related to values (not explained by one\’s culture or religion).

  • An inability to get rid of worn or worthless objects, even if they lack sentimental value. OCPD folks who see clutter as a bad thing are the exception.

  • Reluctance to delegate tasks to, or work with, others unless things are done the “right” way….translation, their way.

  • Reluctance to spend money on oneself or others because of a fear that money should be hoarded for emergencies.

The manner in which OCPD manifests at work is that they may delay starting or finishing a task because they cannot settle on the \”best\” or \”right\” way to complete it. Any perceived loss of control in particular situations may provoke frustration.

Those with OCPD often have difficulty expressing feelings of affection and may be uncomfortable when others do so as they fundamentally do not believe that they deserve compliments and because they fear that the other individual has an agenda that may interfere with their need for order. Finally, they usually do not understand how their insistence on thoroughness negatively impacts others. In other words, they do not understand how they come across and impact other people.

OCPD can also share some characteristics with other personality disorders, but there are important differences. While people with narcissistic personality disorder may look down on the abilities of others, for example, the narcissist is unlikely to be self-critical in the way that those with OCPD are. When it comes to eating disorders, many individuals suffering from Anorexia also develop OCD tendencies, which are focused exclusively on food. So the Anorexia came first and the OCD followed. But of course, there is also the individual who has OCPD and becomes Anorexic, as a way to focus the anxiety and perfectionism, in which case the Anorexia arose out of the OCPD.

Causes of OCPD

Research indicates that genetics may explain a considerable amount of the risk of developing OCPD. The disorder also appears to be diagnosed approximately twice as frequently in males as it is in females, according to the DSM-5.

While genetics are a factor, some theories posit that parenting style can steer a vulnerable individual towards the OCPD spectrum, especially if the parent is highly controlling or protective, or highly critical. In this scenario, the personality disorder develops as a coping mechanism to avoid punishment. Because OCPD-like behavior has been documented in very young children, it is hard to assess the ways in which parenting and genetics might interact to stoke the disorder. 

Treatment

Some forms of psychotherapy may be useful for treating obsessive-compulsive personality disorder. There is evidence that cognitive therapy and cognitive behavioral therapy—related forms of therapy that seeks to address unhelpful thoughts and behaviors—can reduce the severity of symptoms. I find that Dialectical Behavioral Therapy, an improvement on CBT, works the best.  I have also used Emotional Freedom Tapping (EFT) as well as a family systems-based approach to treatment and have found both of them to be effective.

As is the case with all personality disorders, those who have OCPD may not experience it as a problem, but more as a way of life. Many people with OCPD do not seek treatment because they are not disturbed by the behaviors that characterize the disorder, and in some cases find them beneficial, especially professionally. 

When people with OCPD do seek treatment, it may be because they were referred by a family member or because they experience anxiety about their inability to live according to their own rules and standards. This perfectionism can transfer to body image, drive body dysmorphia, as well as the relentless pursuit of a “thin” body.

Stay tuned to find out how Obsessive-Compulsive Disorder (OCD) differs from Obsessive-Compulsive Personality Disorder (OCPD).