By Gary Trosclair, DMA, Licensed Clinical Social Worker
Do you really have OCD? Or is it OCPD?
OCD has become a household term we casually use to refer to anyone who needs to have things a certain way. As a casual term, it works well. It gives us a general sense of what’s being described. But if it’s used as an actual diagnosis to determine therapeutic treatment, it can cause problems. People who we might casually say have OCD may actually have a different condition, and the differences between these conditions call for a different approach to treatment. Â
OCD, Obsessive-Compulsive Disorder, may look similar at first to a different condition, OCPD, Obsessive-Compulsive Personality Disorder, which is often overlooked and even misdiagnosed by clinicians. But OCD is an anxiety disorder, while OCPD is a personality disorder.
Diagnostic Difficulties
Far fewer people have OCD than have OCPD: 1.2% of the population has OCD,[1]Â while as much as 7.9% has OCPD.[2]Â Â
About 20% of the people who have OCD also have OCPD,[3] making it difficult to distinguish between the two. And both diagnoses can be either severe or less-debilitating. Many people have some traits of Obsessive-Compulsive Personality Disorder but do not meet the full diagnostic criteria. These individuals can be very productive and fairly well-adapted socially.
Proper diagnosis should be completed by a licensed mental health professional. But following are some fundamental differences that may help you to better understand yourself in either case.
Symptoms: Specific vs. Generalized
People with OCD have specific obsessions (thoughts that are intrusive, involuntary, repetitive, irrational, and anxiety-provoking) and specific ritualistic compulsions (repetitive behaviors they can’t stop, such as checking and washing). On the other hand, the entire personality of someone with OCPD is affected by an overwhelming need to prioritize control, perfectionism, and order.
While people with OCD may try to control very particular things in order to quiet their obsessions, people with OCPD tend to be controlling universally. It’s as if the space they need to control is much larger. It’s not just the cupboards, it’s their entire world, and they can become very rigid about it.
Emotional Differences
People with OCD are more likely to feel anxious when specific things aren’t the way they want them to be. People with OCPD are more likely to feel angry if things aren’t the way they believe they should be. Â
For instance, Angie, who suffers from OCD, is concerned about how the dishes get washed because she feels anxious if they aren’t absolutely clean.
But Arthur, who suffers from OCPD, insists that the correct thing is to have the entire house in order all the time. People with OCPD may justify their efforts to control by trying to prove that their way is the right way. They feel that they are trying to do the right thing to make life better for everyone, and their efforts can be helpful. But in many cases, they may become rigid in their actions, and, contrary to their motivations, they can make things more difficult for others.
People with OCD don’t necessarily restrict their emotions. However, they do try to control their thoughts (which can range from mildly uncomfortable to very disturbing) by doing compulsive things, such as repetitive and ritualistic cleaning and checking.Â
But people with OCPD often try to control their emotions as well as their environment. They’re known for delaying gratification. They often give priority to their work, neglecting relationships and their own wellbeing. The emotions they are most aware of are anger, frustration, and resentment. They are more reluctant to be vulnerable than those with OCD, and may not even be aware of any underlying anxiety.
Angie gets anxious if the top is off the toothpaste tube because she fears germs. Arthur gets angry because it’s wrong to leave it off.
Shame or Pride about Their Condition
People with OCD don’t like their obsessions and compulsions and willingly seek help.
People with full-blown OCPD, because they try so hard to live their lives according to moral principles, are very proud of the way they live and don’t understand that they have a disorder. They tend to seek help only when forced to do so by a partner or when they become so depressed from trying to live with such demanding standards that they can’t go on that way any longer.
Motivations
People who have OCD are motivated to stay safe and to prevent catastrophes. People with OCPD are more motivated by rules and perfectionism. While they may justify their control by pointing to possible catastrophes, their underlying motivation often has more to do with wanting to avoid chastisement, blame, or failing to fulfill their responsibilities.
People with OCD are more clearly motivated to relieve their anxiety. While people with OCPD may also have underlying anxiety or a fear of being abandoned, their conscious concern is that they want to be respected rather than criticized. Â
Behavioral Differences
While people with OCD may often behave in an insecure way because of their obsessions and compulsions, people with OCPD may become domineering, trying to hide their insecurities from themselves and others. Â
People who have OCD spend much of their time in compulsive rituals such as cleaning and organizing. People with OCPD spend more time planning and working.
OCD efforts are usually maladaptive, except insofar as it helps them to maintain good hygiene. In contrast, some OCPD traits can be adaptive in a practical way, allowing them to succeed in the outer world, even if it makes them very unhappy. Because they are very conscientious, meticulous, energetic, and committed, they can make significant contributions in many fields, from art to public service to accounting. Most successful performers and athletes are compulsive to some degree.
Differences Among Compulsive Personalities
There are wide variations in the degree of unhealthiness among people with compulsive personalities, based on how controlling, perfectionistic, and rigid they are. Some, who don’t technically have OCPD but only have some compulsive traits, have very few maladaptive symptoms and can be very helpful in planning, organizing, and getting things done.
And there are wide variations in the style of compulsive personality: some are domineering, some are workaholics, some are compulsive people-pleasers, and others are so obsessive about getting things just right that they can’t get anything done.
Treatment
There is significant research to demonstrate that targeting the specific symptoms of OCD, as short-term Cognitive Behavioral Therapy (CBT) does,[4]Â can be effective for treating OCD.
There is far less research regarding the treatment of OCPD. In fact, according to psychologist and researcher Anthony Pinto, “there is no empirically validated gold standard treatment for OCPD.â€[5]
However, there is reason to believe that approaching OCPD treatment by targeting specific symptoms may not be as effective as it is for OCD because of the pervasive nature of personality disorders. OCPD may benefit from a longer course of treatment in psychodynamic or expressive therapy.[6]Â This approach can help the individual to understand the possible benefits of their inherent personality style and to understand how those same traits can turn destructive when taken to extremes. Psychodynamic therapy can help them develop a better relationship with their emotions and use their need for control and perfectionism in a healthier way.
Getting to the Root Causes of OCPD
The causes of OCPD include genetic, environmental, and dynamic factors. These dynamic factors include the strategy the individual unconsciously adopted to cope with their particular combination of inherited traits and family situation. We can refer to these dynamic factors as old tapes, triggers, complexes, schemas, or patterns that they play out unwittingly, as if they were still living in the past with their families.
Attempting to treat the systemic, unconscious, and underlying character organization of OCPD by targeting just its external manifestations may not shift the underlying causes.
For example, some compulsives cope with their anxiety by externalizing, by getting those around them to do what they think should be done so that they feel safer. Other compulsives cope by internalizing, by taking too much responsibility on themselves and becoming people-pleasers to avoid a feared abandonment.
In most cases, people with OCPD feel a great need to prove themselves, and they attempt to do so with perfection, order, and control. Â
Whatever the underlying dynamic, a therapeutic experience that gives the individual a chance to identify their specific coping strategy by seeing their old tapes play out in session with a therapist can be very effective. Does the client try to control the therapist? Does the client try to control his own emotions in session? Do they try to prove to the therapist that they are ethically good? This process often requires patiently developing awareness of emotions and the capacity to tolerate them in session, rather than reacting to them by trying to control themselves or the therapist.
The Potential Benefits of Compulsive Personality
If your basic character style is compulsive by nature, you won’t be able to change that. But you can begin to use your natural meticulousness, conscientiousness, and tendency to plan in a healthier, more conscious way that works well for you and the people around you. This can’t happen if efforts to change includes only trying to eradicate symptoms. Â
I have referred to anxiety and a need for respect as motivations for the individual with OCPD. But on an even deeper level, they are motivated by a desire to help, plan, and repair in ways that can benefit everyone. Finding that original motivation can equip the OCPD sufferer with insight and direction, which can help them to heal and to be more helpful to those around them.
Footnotes
[1] National Institute of Mental Health website. Obsessive-Compulsive Disorder. https://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd.shtml. Retrieved 12.23.20.
[2] Burkauskas, J. F., Naomi. (2020). History and Epidemiology of OCPD. In J. E. Grant, Anthony Pinto, Samuel Chamberlain (Ed.), Obsessive-Compulsive Personality Disorder (pp. 1-16). Washington, D.C.: American Psychiatric Association Publishing.
[3] Mancebo, M. C., Jane L Eisen, Jon E. Grant, Steven A. Rasmussen (2005). Obsessive Compulsive Personality Disorder and Obsessive Compulsive Disorder: Clinical Characteristics, Diagnostic Difficulties, and Treatment. Annals of Clinical Psychiatry, 17(4), 197-204. doi:10.3109/10401230500295305
[5] Pinto, A. (2020). Psychotherapy for OCPD. In A. P. Grant JE, Samuel R. Chamberlain (Ed.), Obsessive-Compulsive Personality Disorder (pp. 143-178). Washington, D.C.: American Psychiatric Publishing.
To find a therapist in your area who can help you work through the concerns in your life, click here.
Editor’s note: Gary Trosclair, DMA, LCSW is a private practice psychotherapist and Jungian analyst in New York City and Westchester County, New York. His continuing education presentation for GoodTherapy, titled “The Healthy Compulsive: Treating Obsessive-Compulsive Personality Disorder,†will take place on March 27, 2020 and is eligible for two CE credits. This event is available at no additional cost to Premium and Pro GoodTherapy Members (Basic Members and mental health professionals without membership can view this event live for $29.95). Learn more and register here.
If your partner is controlling, rigid, perfectionistic, and preoccupied with work and orderliness, they may have OCPD, or obsessive compulsive personality disorder. While even many therapists are unfamiliar with this diagnosis, it’s the most common personality disorder found in the United States, at a rate of about 7.9% of the population (Sansone & Sansone, 2011).
But it’s also the most unrecognized (Koutoufa & Furnham, 2014).
OCPD vs. OCD
Many people, even clinicians, confuse OCPD with OCD, obsessive compulsive disorder. While there is some overlap in symptoms, OCD is significantly different and is characterized by more specific problems such as repetitive hand-washing, locking and unlocking doors, the need to have everything clean and orderly, and intrusive thoughts.
People with OCPD, on the other hand, have issues that affect the entire personality. And this can have a more devastating impact on relationships.
One of the defining distinctions between OCD and OCPD is that people with OCPD tend to be good at delaying gratification—often too good.
One of the defining distinctions between OCD and OCPD is that people with OCPD tend to be good at delaying gratification—often too good. To understate the case, they’re not typically known for being fun-loving.
The Continuum of Compulsive Personality
Many people have just traits of OCPD, not full-blown OCPD. That is, they may struggle in some of the ways that people with OCPD do but don’t meet all of the criteria for the diagnosis. In fact, compulsive traits are found on a continuum—from healthy and adaptive to unhealthy and maladaptive, from conscientious and productive to rigid and destructive.
Partners with a compulsive personality style can be loyal, hard-working, reliable, productive, meticulous, conscientious, and dependable.
Still, even people who have just some traits of OCPD can be difficult to live with. They may insist on having things their way because they’re convinced their way is the right way. They can be very critical and domineering. They may emphasize work over relationships. And they can get so caught up in rules and schedules that they lose the point of whatever they’re doing.
For instance, they may often forget the point of a vacation. They tend to keep working the whole time and are prone to getting upset when things don’t go exactly as planned.
OCPD and Relationships
The same can be said for how people with OCPD handle their relationships. Doing things right can become more important than being happy together. As someone who frequently writes about OCPD, much of the correspondence I receive comes from partners of people with OCPD asking desperately for advice about how to live with them.
You can’t always work out relationships with people who have full-blown OCPD. If they refuse to go to individual therapy or couples therapy if they are unwilling to acknowledge that their life is out of balance, and if they don’t take responsibility for how they treat you, there may be little you can do but protect yourself.
Improving a Relationship with an OCPD Partner
Some relationships with OCPD partners can improve. Their compulsiveness can be enlisted in the service of the relationship.
But in this article, I want to focus on what partners of individuals with OCPD can do to improve the relationship.
In order to jump-start that process, you may need to consider that they don’t cause all the problems on their own. Conflict in relationships is most often an issue of fit and chemistry. And there are two sides to every story. As people with high levels of compulsiveness can become very adamant about being right, it can be hard not to get caught up in the same approach. This can lead to defending yourself rather than seeing what you might do differently to help the relationship get back on track.
Getting out of “right and wrong†thinking will probably take initiative on your part. And if you see that you have some role in the conflicts, you have more power to start the process of change.
Even if you don’t have a role in the problems, you may be the one who needs to instigate change. It’s not fair. But it just may be the reality of your situation.
Keys to Change in OCPD Relationships
Here are some things you can do if you want to stay in the relationship and try to make it work.
I will address these in three separate categories: how you see and treat your partner, how you communicate with your partner, and how you take care of yourself. Any one of these keys will probably not be enough in itself to initiate change. However, the three together can make a significant impact on the quality of your relationship.
Perspective
- Despite how they come across, your partner likely wants to do the right thing. When they become mean and rigid, it’s often because their anxiety is very high. This insecurity can lead them to be defensive. Work, perfection, control, and rules may be their way to try to protect themselves against shame.
- Do what you can to lower their anxiety, which could in turn help them lower their demands.
- Ask yourself if you play any role in their anxiety. If they feel they have to be responsible for getting everything done, they are likely to become angry and resentful because they may fear they won’t get it right, and they will be blamed.
- Reflect on whether you’ve allowed a situation to develop in which you allow them to do most of the work or take most of the responsibility because it’s easier for you. This would not be obvious, conscious, or intentional on your part. But it may still be part of the equation.
- Appreciate what they do well and tell them about it. Notice what their temperament contributes to the relationship, such as being loyal, reliable, conscientious, and hardworking.
While it may have become skewed, the original intention of their rules was likely to make things safe for people.
Communication
- Reassure them that they don’t have to be perfect, and point out how their perfectionism is hurting them.
- Let them know the effect they have on you with “I†statements (not “you” statements). People with OCPD tend to be so consumed with getting projects done and with doing them in a particular way that they may lose track of the effect they have on others.
- Ask them to attend couples therapy with you. Remind them that therapists are cheaper than divorce attorneys.
- Encourage them to go to individual therapy for their own benefit. They’re probably hurting themselves living the way they do. Find a way to describe this that will not raise their defenses. (Hint: Telling them they have obsessive compulsive personality disorder or that they are a “control freak” probably won’t help. Telling them they are “driven,†a “workaholic,” or “type A personality” might work.)
- Set appropriate boundaries. Just because they feel that the house should be vacuumed every day doesn’t mean you have to do it.
Self-Care
- Partners of people with OCPD often have a sense of being “under†the person with OCPD, of being dominated by them. While this is often an accurate assessment, if you can recognize that it is their anxiety that leads to their need to control and that they actually need what you have to offer them, you may be able to get out from “under†them and forge a more equal relationship.
- Reflect on whether your own personality style (e.g. easygoing, people-pleaser, or submissive) makes it difficult to be on more equal terms. If you don’t own your power, your partner will.
- Remember that despite the way they act, they still have a need for love, and probably a need for a connection with you. There is likely something you have that they lack and need from you—humor, kindness, sensitivity, generosity, or the ability to loosen up and play.
- Protect yourself and find support with family, friends, groups, and a therapist. If your own personality style makes you vulnerable to their domination, it will be especially important to get support in shifting the balance in the relationship.
While some relationships with partners who have OCPD may not be viable, others can improve with psychotherapy and a different approach from you, their partner. This will take heroic initiative on your part, but it may be worth it.
References:
- Koutoufa, I., & Furnham, A. (2014, January 30). Mental health literacy and obsessive–Compulsive personality disorder. Psychiatry Research, 215(1), 223-228. doi: 10.1016/j.psychres.2013.10.027
- Sansone, R. A., & Sansone, L. A. (2011). Personality disorders: A nation-based perspective on prevalence. Innovations in Clinical Neuroscience, 8(4), 13–18. Retrieved from www.ncbi.nlm.nih.gov/pubmed/21637629