- Understand the diagnostic criteria for OCD.
- Become familiar with OCPD.
- Recognize the importance of the language we use about behaviors.
Have you ever heard or said something like, “I am so OCD about my room,” or, “I am so OCD about sorting,” to describe your behavior? Comments about someone’s desires for organization or cleanliness may seem lighthearted but it does not necessarily describe the 2.2 million adults who truly struggle with OCD every day. Oftentimes, people use the term "OCD" for being particular or liking things a certain way; that actually describes what we would call OCPD (obsessive-compulsive personality disorder).
What is OCD?
Obsessive-compulsive disorder, or its commonly used acronym, OCD, is a mental disorder that consists of persistent and intrusive thoughts, ideas, or urges (obsessions) which may include repetitive behaviors or mental acts aimed at preventing or reducing anxiety or distress (compulsions).
OCD is often complex and disabling. In the past, OCD was considered an anxiety disorder, but after much research, the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) now has it in its own category. OCD is primarily characterized by obsessions or compulsions, or both.
Obsessions are persistent and intrusive thoughts, ideas, images, or urges to perform a task. Such experiences are referred to as “ego-alien” since the thoughts and images are alien to the person's sense of themselves or their world. Common themes include contamination, aggression, harm avoidance, sexual thoughts, religious concerns, perfection, and many more.
Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rigid rules. They are often aimed at preventing or reducing anxiety, distress, or a dreaded situation; however, these compulsions are not realistically connected to the event or are excessive. Common compulsions include washing, checking, a need to ask or confess, arranging, repeating, and many others.
But you might ask, don't we all experience those? Yes and no. Obsessions and compulsions are “technically” both a part of our daily cognitive repertoire and can include intrusive thoughts that spontaneously pop into people’s minds or the repetitive behaviors that are driven by cultural superstitions, religious beliefs, or useful habits like brushing teeth or nightly routines.
Yet, our daily obsessions and compulsions don’t necessarily mean we meet the criteria for OCD. Obsessive-compulsive disorder is a categorically different experience from developmentally normative preoccupations and rituals by being excessive or persisting beyond appropriate periods.
What separates everyday intrusions from clinical obsessions is a process called “thought-action-fusion." individuals diagnosed with OCD are aware that these obsessions are products of their own minds and try to suppress them, although their actions are usually futile, leading to increased distress and anxiety.
What is Obsessive-Compulsive Personality Disorder?
OCPD marks the extreme of a conscientious personality style, which consists of the following traits: hard work, always doing the right thing, completing things the right way, perfectionism, perseverance, orderliness, prudence, and accumulation of things for future use. All these traits may sound admirable to you and they are advantageous for success at moderate levels. However, individuals with OCPD struggle to adapt to the demands of reality or meet their personal and professional goals due to the rigidity in their ways.
OCD vs. OCPD and Gold-Standard Treatments
While OCPD and OCD have similar names, the manifestation of these disorders differs and cannot be used as interchangeable acronyms. It is possible for individuals to be diagnosed with both OCD and OCPD (with estimates of co-existence around 25 percent). In fact, OCD has a 12-month prevalence of about 1.2 percent in the United States and 1.1-1.8 percent internationally. OCPD is one of the most prevalent personality disorders in the general population, ranging from 2.1 percent to 7.9 percent. Research on OCPD lags behind OCD.
The gold standard treatment for OCD is cognitive-behavioral therapy with exposure and response prevention. On the other hand, treatment for OCPD includes psychoeducation, psychotherapy (e.g., cognitive-behavioral therapy), and pharmacotherapy. Unfortunately, individuals with OCPD are less likely to seek treatment than individuals with OCD. This is because individuals with OCPD are set on the belief that their way of doing things is the “right way” and rarely perceive their behaviors as a problem. Conversely, individuals with OCD struggle with unwanted, obsessive thoughts and behaviors that invoke immense anxiety and distress. Seeking treatment can greatly improve the lives of those struggling with OCD and OCPD.
It is crucial to educate ourselves and those around us about what OCD looks like and how debilitating it can be to a person’s life. Education increases thoughtfulness and awareness about how we use this psychiatric term. We defined OCD and OCPD to educate and clarify the misconceptions about these two terms.
Danna Ramirez and Julia Myerson are research assistants at The Menninger Clinic. Ramirez’s research interests include the interactions of personality and psychopathology, and how these relate to maladaptive behaviors. Myerson’s research interests include adolescents, emerging adults, and depression. John Hart, Ph.D., has over 30 years of experience in treating obsessive-compulsive-related disorders. He currently owns Behavioral Therapy of Houston and provides diagnostic consultations for The Menninger Clinic. He has published several research articles and has presented nationally and internationally on OCD and anxiety-related disorders.
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