Distinguishing Between OCD and OCPD

In basic terms, when a patient comes to see me with Obsessive Compulsive Disorder (OCD), they are troubled by their own thoughts. Their thoughts are irrational and ego dystonic (or ego alien) and they are enormously troubled by their “crazy mind,” whereas someone who presents with Obsessive Compulsive Personality Disorder (OCPD), are not as troubled by their thoughts as much as they are by their actions; and even then, it is to a lesser degree than someone with OCD who performs unwanted compulsions. Some examples: An OCPD person might be a perfectionist, attending to documents or tasks with an overly fastidious nature. They might call themselves neat freaks. Others might call them that just the same. There seems to be a lack of awareness of how their behaviors might be affecting others or even themselves. The therapy process helps bring to light the interpersonal conflict that any personality disorder might cause someone. It’s a characterological disorder; and though I would be the first to say to a patient, “it’s only a problem if it’s a problem,” if the person looks long and hard at how they may be wasting time by being overly correct or precise or recognize that their rigidity, and lack of flexibility, causes difficulties with others, a shift can then ensue. Whereas with OCD, the person is often tortured and has much insight into his “contorted mind” (I’m using words that patients have identified and labeled themselves). The OCD sufferer checks a stove that he knows is off or rechecks a lock that he knows has been locked. Or checks to see if a past e-mail might have been offensive to someone, but even after checking, that person will somehow convince themselves that despite all evidence, there must be something wrong! Was the e-mail too impolite? Was it in bad taste? Am I sure the gas on the stove is off? Maybe I didn’t lock all the locks fully? Summations are endless – calculating and recalculating the parts to the whole. Can someone have OCD and OCPD? Yes, absolutely. In therapy the treatment is similar. It still begins with an assessment and behavioral and cognitive techniques; and then crosses over to a more dynamic approach – though I would say the OCPD person will often be at the ready, more quickly, to go dynamically deeper. This point all depends on the relationship between therapist and patient. If the relationship is honest and authentic, all parties can go full speed and traverse between the behavioral and the dynamic.

To put a further distinction on the differences, OCD sufferers have enormous anxiety when in the throes of an attack. As mentioned, they will either repeat a scenario in their minds and try to reason with it or will relent to some behavioral repetition to calm themselves, though the repetition only serves as a brief reprieve and more likely the repeated behavior will only strengthen the initial obsession, or anxiety. OCPD people may become anxious if their grand plan for life is not carried out in order and to full completion, the way their anxiety presents is often with less intensity, the feeling diluted somewhat by an overall frustration that things aren’t working out. They both share one solution that hasn’t been fully processed and that is an acceptance to what is. The OCD person, at some point, must accept that nothing can be one hundred percent known or proven and the OCPD person must accept that others may see things differently; and indeed, that they can see things differently than what they initially thought and have thought for a good part of their lives.