The closely linked names and initials of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) have less in common than these similarities might suggest. Both are debilitating disorders that affect basic functioning, yet their causes differ vastly, and they have wildly different symptoms and treatment strategies.

OCPD Defined

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) describes OCPD as "a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency." People with this disorder have an unhealthy concentration on always achieving perfection, an excessive devotion to work at the expense of leisure time and close personal relationships, an inflexibility on issues of ethics and morality, and an inability to part with items that have outlasted their usefulness.

With a full-fledged personality disorder, those who have OCPD rarely recognize that a problem even exists, often shifting blame to others when problems arise or when their high-strung personalities encounter resistance 1. A recent study points to two central features of OCPD, namely order/control, or the tendency toward rigidity, perfectionism, and over-conscientiousness; and hoarding/indecision, which evidence suggests has a genetic cause2. Indeed, according to a study of identical and fraternal twins, heredity seems to have a larger role in the development of OCPD than unique environmental factors do3.

OCD Defined

On the other hand, OCD is marked by the presence of true obsessions and compulsions, as opposed to the haughty rigidity that defines OCPD. The DSM-5 defines these tendencies as recurrent and unwanted thoughts and impulses that cause anxiety and distress; attempts to silence such unwanted thoughts by substituting them with new thoughts and/or actions; repetitive behaviors such as constant checking and handwashing; and adopting such behaviors to stave off anxiety and distress1.

Comparisons and Contrasts

The ability to delay reward further differentiates OCD from OCPD, its personality-based counterpart. Studies indicate that those with OCPD can delay immediate reward in dogged pursuit of some future reward indefinitely), but those with OCD are continually in search of immediate gratification 4. The disorders are largely defined by very different forms of behavior, but a few shared traits connect them: a fear of contamination, a preoccupation with symmetry, and a nagging sense of doubt5.

Curiously, someone with OCPD can often demonstrate a sharpened visual acuity in comparison to those with other personality disorders: A recent study indicates that the participants with OCPD performed better than others on visual tasks such as scanning; this may be due to the highly focused attentional characteristic of this disorder 6.

Another OCDP study points to the difficulty the participants had in adjusting their thought patterns when the tasks before them were suddenly changed (a general inability to adjust to new ways of thinking), as well as a tendency to be more easily distracted than those in the control group who did not have OCDP 7.

Treatment Can Be Tricky

Even though they're highly distinct in many ways, there appears to be a significant link between the two disorders. This makes treatment options trickier and more protracted for those who have both disorders. Studies show that this co-occurrence amplifies the effects of OCD, including doubting, ordering, and hoarding symptoms; it also leads to higher rates of severe depression and increased alcohol consumption 8.

Moreover, people who have OCD and OCPD seem to be less responsive to cognitive behavioral therapy (CBT), and exposure and ritual prevention (EX/RP) in particular. This may be due to the OCPD patients' general reticence to place themselves in a collaborative setting or framework, in addition to their issues with trust and commitment. In this case, it can take quite a bit longer to see the results of therapy and require more expansive therapeutic strategies than those centered around EX/RP 9.

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Sources

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., Washington, DC: American Psychiatric Press.

2. Riddle, M. A., Maher, B. S., Wang, Y., Grados, M., Bienvenu, O. J., Goes, F. S., & ... Samuels, J. (2016). Obsessive-Compulsive Personality Disorder: Evidence for two dimensions. Depression & Anxiety, 33(2), 128-135. doi:10.1002/da.22452

3. Gjerde, L. C., Czajkowski, N., Røysamb, E., Ystrom, E., Tambs, K., Aggen, S. H., . . . Knudsen, G. P. (2015). A longitudinal, population-based twin study of avoidant and obsessive-compulsive personality disorder traits from early to middle adulthood. Psychological Medicine, 45(16), 3539-3548. https://doi.org/10.1017/S0033291715001440

4. Pinto, A., Steinglass, J. E., Greene, A. L., Weber, E. U., & Simpson, H. B. (2014). Capacity to delay reward differentiates Obsessive Compulsive Disorder and Obsessive Compulsive Personality Disorder. Biological Psychiatry, 75(8), 653–659. http://doi.org/10.1016/j.biopsych.2013.09.007

5. Park, J., Storch, E., Pinto, A., Lewin, A., Park, J. M., Storch, E. A., & Lewin, A. B. (2016). Obsessive-Compulsive Personality Traits in Youth with Obsessive-Compulsive Disorder. Child Psychiatry & Human Development, 47(2), 281-290. doi:10.1007/s10578-015-0565-8

6. Ansari, Z., & Fadardi, J. S. (2016). Enhanced visual performance in obsessive compulsive personality disorder. Scandinavian Journal of Psychology, 57(6), 542-546. doi:10.1111/sjop.12312

7. García-Villamisar, D., & Dattilo, J. (2015). Executive Functioning in People With Obsessive-Compulsive Personality Traits: Evidence of Modest Impairment. Journal Of Personality Disorders, 29(3), 418-430. doi:10.1521/pedi_2013_27_101

8. Gordon, O., Salkovskis, P., Oldfield, V. B. and Carter, N. (2013). The association between

obsessive compulsive disorder and obsessive compulsive personality disorder: prevalence and clinical presentation. British Journal of Clinical Psychology, 52, 300–315. doi:10.1111/bjc.12016

9. Pinto, A., Liebowitz, M. R., Foa, E. B. and Simpson, H. B (2011). Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder. Behavior Research and Therapy, 49, 453–458.

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