If you saw the movie “As Good As it Gets” with Jack Nicholson, you probably have a pretty good idea of what Obsessive Compulsive Disorder (OCD) is. Much less well-known is another psychiatric disorder with almost the same name: Obsessive Compulsive Personality Disorder (OCPD). What’s the difference between the two? Axis I versus Axis II One important difference has to do with how psychiatrists categorize and diagnose mental illnesses in general. An Axis I disorder is a major mental illness that responds to medical interventions (such as psychotropic medications and psychotherapy) and can be acute, coming on in adulthood and resolving with treatment. An Axis II disorder is by definition more chronic. Axis II conditions are either characterological or intellectual (for example, intellectual disability as evidenced by a very low I.Q. is coded on Axis II), and in order to diagnose one, evidence of it must be seen prior to adulthood. These disorders are best understood as fundamental aspects of personality, rather than diseases. Most personality disorders are not responsive to medications, and can only really be resolved by long-term and intensive psychotherapy. OCD: The Basics The main symptoms present with OCD are – you guessed it – obsessions or compulsions. An obsession is a thought that you just can’t get out of your head; a compulsion is something you feel you must do. One seasoned therapist put it this way: “Obsessions drive you crazy. Compulsions drive everyone else crazy.” Obsessions are thoughts, while compulsions are behaviors. People struggling with OCD experience obsessions or compulsions (or both) to a debilitating degree. These are the people depicted in the media as being germ-phobic, or unable to complete tasks without counting, arranging or engaging in a ritual (such as hand-washing or walking in a particular way). Their lives are ruled by their terrible anxiety if they do not complete their rituals or compulsions. Engaging in the behavior relieves anxiety, but it rebuilds quickly. OCPD: The Basics OCPD may well be a misnomer: the first difference you’ll notice if you place diagnostic criteria for OCD and OCPD side by side is that OCPD does not involve obsessions or compulsions. Obsessions and/or compulsions do not need to be a part of the picture at all! The person with OCPD is someone who has, since childhood been
- Rigid and orderly,
- Detail-oriented,
- Organized to the point of fussy,
- Perfectionistic in the extreme, such that ineffectiveness due to an overfocus on details is a risk,
- Morally and ethically rigid,
- Rigid in attitudes about money and thus thrifty to the point of being miserly,
- Can be very stubborn
- Prioritizes work and being “productive” and may not seek or maintain friendships as readily
- May not be able to let go of “stuff” – like a hoarder, may find it difficult to throw away items that are no longer useful
Treatment There is help for OCD. Both prescription medications and several different psychotherapies have been shown to be extremely effective at reducing or eliminating obsessions and compulsions. SSRIs, such as Luvox, Prozac, or Zoloft have been used with success, and cognitive behavioral approaches as well as desensitization approaches have been documented as highly effective. OCPD treatment would not involve medication under most circumstances, as medications are generally not effective against personality disorders. Psychotherapy aimed at modifying behavior or using a cost-benefit analysis of the behaviors related the OCPD may be most helpful. Thus while there is some overlap between the two in terms of how it might feel to spend time with them, as both disorders involve a high degree of tension and anxiety, they are fundamentally different. Different enough, in fact, that a person could be diagnosed with both.