What comes to mind when you hear the term obsessive-compulsive? Perhaps you think about a person who is driven or extremely preoccupied with order, or someone who engages in repetitive, senseless behaviors. It is true that these behaviors are often characterized as obsessive and compulsive, but did you know that the term “obsessive-compulsive” is used to describe two very different emotional conditions?
Obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) are often mistaken for the same condition, but they are really quite different. They differ not only in symptoms, but also in severity and psychiatric category.
OCD is an anxiety disorder (an unrealistic, irrational fear or anxiety of disabling intensity), whereas OCPD is a personality disorder (a chronic pattern of inflexible and distorted personality and behavioral patterns). Let’s take a closer look at these disorders.
People with obsessive-compulsive disorder (OCD) experience repetitive thoughts and behaviors that make no sense. Their obsessive thoughts may include:
- Persistent fears of harm coming to themselves or a loved one
- Unreasonable concern with being contaminated
- Intrusive and unacceptable religious, violent, or sexual thoughts
- Excessive need to do things correctly or perfectly
Their compulsive behaviors may include:
- Excessive checking of door locks, stoves, water faucets, light switches, etc.
- Repeatedly making lists, counting, arranging, or aligning things
- Collecting and hoarding useless objects
- Repeating routine actions a certain number of times until it feels just right
- Unnecessary rereading and rewriting
- Mentally repeating phrases
- Excessive washing, sometimes for hours every day
These obsessive thoughts and compulsive behaviors are extremely difficult for the person to overcome. If severe and untreated, OCD may seriously impact a person’s ability to function at work, at school, or at home. OCD may also increase the risk of having suicidal thoughts and attempting suicide.
Treatment
OCD is commonly treated with behavior therapy and antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). Risk of suicide should be assessed and monitored in all persons diagnosed with and treated for this disorder.
Someone with OCPD has very high expectations and a need to control their environment. The person strives for perfection and does not view themself as in need of treatment. But, this personality disorder can greatly impact the person's relationships with family members, friends, and coworkers. These interpersonal problems can occur because the person may:
- Be extremely fixated on rules
- Be overly committed to his job
- Refuse to reassign duties to others
- Have unrealistic expectations for others and is very critical
- Follow very strict moral and ethical standards
- Create extensive lists and rules
- Be very stingy with money, and may hoard money or other items
OCPD is associated with mental health conditions, such as depression, alcohol addiction, somatoform disorder, such as hypochondria, as well as OCD.
Treatment
OCPD is usually treated with individual psychotherapy or counseling that focuses on helping people accept themselves, change inflexible thinking, and get more in touch with their feelings. Unlike OCD, medication is not usually prescribed for people with OCPD, although certain antidepressants, such as SSRIs, may be helpful for some. Hospitalization is rarely needed for people with OCPD, unless extreme stress results in compulsive behaviors that cause harm or lead to immobility.
Although both OCD and OCPD involve obsessive and compulsive behaviors, OCD is often a more severe and disabling condition. Many people with either OCD and OCPD can improve their mental health through treatment and lead fulfilling lives.
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Canadian resources:
References:
Obsessive compulsive disorder (OCD). EBSCO DynaMed website. Available at: //www.ebscohost.com/dynamed. Updated June 27, 2013. Accessed May 9, 2014.
Obsessive-compulsive disorder (OCD). Mental Health America website. Available at: //www.nmha.org/go/ocd. Accessed May 9, 2014.
Obsessive-compulsive personality disorder. EBSCO DynaMed website. Available at: //www.ebscohost.com/dynamed. Updated April 8, 2012. Accessed May 9, 2014.
Obsessive compulsive personality disorder. International OCD Foundation website. Available at: //www.ocfoundation.org/uploadedFiles/MainContent/Find_Help/OCPD%20Fact%20Sheet.pdf. Accessed May 9, 2014.
Last reviewed May 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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