Your colleague Mitch works very late hours, insists on perfection in team documents, and can get pretty bent out of shape at meetings, letting people know exactly how they should be doing things. He needs to have things a certain way and his anxiety is palpable if he doesn’t.
You might think to yourself, “He’s kind of crazy!” but you’re not sure exactly what kind of crazy he is. You might think, “Maybe he has OCD.” But you’d be wrong if you did.
OCPD is different from the more well-known (OCD) Obsessive-compulsive disorder). Most people, including many clinicians, don’t know the difference between OCD and OCPD, so too often it’s not recognized as a mental illness. And that’s really unfortunate because those with OCPD can make themselves–and everyone around them–really miserable.
And it doesn’t have to be that way.
OCPD is treatable, but it needs to be identified as different from OCD–and acknowledged–before work can begin.
About 2.3% of the population meet the full criteria for OCD, while estimates for those meeting criteria for OCPD is between 3 and 8%. So, if we split the difference, at least twice as many people actually have OCPD as have OCD. Even some clinicians are not aware of OCPD, and are therefore not able to make a differential diagnosis. This means there are a lot of people running around out there with OCPD who think they have OCD.
So what is the difference between OCD and OCPD?
What is OCD?
OCD is a type of anxiety disorder which has specific, limited, effects on a person’s behavior and thinking. It leads to specific obsessions and compulsions: rituals, checking, and cleaning. In some cases it puts serious constraints on the individual. Sufferers can get lost in cleaning or rituals (compulsions) at the expense of all other areas of their lives. Intrusive thoughts (obsessions) can be violent and extremely disturbing.
What is OCPD?
In contrast, compulsive personality affects a person’s entire character. For better or worse.
People can have an obsessive-compulsive personality style but not have the disorder. At their best, people with a compulsive style are creative, productive and reliable. In fact you can be compulsive and live quite well on the healthy end of the spectrum. That’s the whole point of this blog.
But at its worst the compulsive personality drifts into the personality disorder, (OCPD). People with this condition are rigid, over-controlling, and perfectionistic. They have difficulty tolerating situations that they find to be unorganized or unethical. They lack flexibility. They have difficulty delegating, sometimes hoard, and are often needlessly frugal. They are all work and no play. They neglect or boss their partners.
But to keep it simple, today I’m just going to compare OCD with OCPD, the unhealthy version of compulsive personality.
What is the Difference Between OCD and OCPD
Here is a chart outlining the differences. Some individuals have both OCD and OCPD, and there is some overlap, but these are still distinct conditions. Variations occur of course, but these are the traits that typically describe the two conditions:
|Anxiety Disorder||Personality Disorder|
|Do not like their symptoms||Take pride in their personality|
|Have specific obsessions and compulsions||Entire personality is affected|
|Motivated by need to prevent catastrophes||Motivated by perfectionism and conscientiousness|
|Willingly seek professional help||Resist seeking professional help|
|Seek help for relief from symptoms||Seek help mostly to salvage relationships or to get relief from depression|
|Spend time on compulsive rituals (e.g. cleaning & checking)||Spend time on work projects and planning|
|Symptoms are generally maladaptive (except regarding hygiene)||Traits may be adaptive if used consciously|
|Emotions are not necessarily suppressed||Emotions are controlled and gratification is delayed|
|Often feel insecure in regard to others||May become domineering|
While both conditions have a genetic component, the biological origins for OCD appear to be more significant than those for OCPD, which might explain why OCD responds more to medication than OCPD does. Medication can be helpful for OCD, but I’ve also worked with many people in talk therapy whose OCD symptoms diminished significantly without medication.
Examples: Deidre (OCD) and Peter (OCPD)
To illustrate the difference let me introduce you to a couple. Diedre, a bank manager, suffers from typical OCD symptoms. Her husband Peter owns his own consulting firm and struggles with typical OCPD symptoms: he’s on the unhealthy end of the compulsive personality spectrum. They’re very different people.
Deidre (OCD) tends to engage in rituals and checking in efforts to calm her anxiety. She needs to have things at right angles. Her desk is always clear. She fears germs and constantly washes her hands. In order to avoid disturbing intrusive thoughts she has to go where no one will see her and take her shoes off and put them back on. Three times. No more no less. She checks to make sure the door is locked four times before she leaves her house. She doesn’t like all this foolishness, but it feels absolutely necessary to her. She takes medication for it and it helps some, but there are those side effects.
Peter (OCPD) tries to deal with his anxiety by perfecting, planning and completing tasks. He might have a messy desk, but he’s very organized and gets lots of work done. Too much work most people would say. He would never check the door four times because that’s inefficient, a waste of his time. And he never wastes time. Friends have suggested he get some help (as in psychotherapy), but he doesn’t want to spend the time or money. Besides, as far as he’s concerned he’s just fine. He has strong ideas about what’s right and wrong, and he makes damn sure he’s on the right side of wrong.
Diedre’s OCD problems started when she was a kid. She had the germ thing going and she worried constantly about doing something wrong and her parents dying as a result. Peter’s obsession with work started late in high school, and got more intense after graduating from college.
A Day in the Life with OCD and OCPD
Today at work Diedre had no problem calling the central office for help. Peter slogged through his day doing everything himself. He won’t hire anyone to help because no one else will do it as well as he does. He can’t delegate.
Diedre suggests they go out to dinner to do something different for fun. Peter complies because he really does want to do the right thing. But because he’s obsessed with work, they both end up feeling that he’s just checking off a box.
When they get to the restaurant, Diedre is on the lookout for germs. Peter is on the lookout to see that the waiter gets the order right.
Diedre gets anxious about whether the iron is still on at home. Peter is still thinking about a project he hasn’t completed.
While they wait for the check Diedre arranges everything on the table neatly. When the check does come, Peter scrutinizes it for errors. He won’t pay a penny more than he owes. He’s frugal and holds tightly to his money.
When they go home, Diedre arranges her closets to relax. Peter goes back to his office and works more.
The Potential for Happiness
Despite all of her quirks, Diedre is a fairly happy woman. She’s not perfectionistic and she knows how to have a good time, which usually happens when Peter is away since he’s such a killjoy.
Peter, on the other hand, is rarely satisfied, content or joyful. The stars have to line up perfectly for him to be happy, which happens only when all of his projects are completed. Perfectly. He goads himself into accomplishment with discontent and self-criticism. Not to mention how critical he is of others. He’s not sure what the point of all the work is anymore. He just knows that he has to keep working. Peter’s capacity for hard work and conscientiousness are hijacked by his insecurities. Healthier compulsives are able to enlist these traits in the service of their passions.
Deidre’s diagnosis is more well-known and therefore more easily acknowledged and dealt with. Peter’s, unfortunately, often goes unrecognized, and, sadly for everyone, untreated.
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