Difference between OCD and Obsessive-Compulsive Personality Disorder

A little studied and known difference.

Hello friends!

In our DSM-5 Video Course (Major Changes from DSM-4), we are now studying OCD, Obsessive-Compulsive Disorder. And a doubt arose regarding the difference between OCD and Obsessive-Compulsive Personality.

In the lesson, we see that OCD gained a specific chapter in this new version of the Diagnostic and Statistical Manual of Mental Disorders and, thus, left the previous inclusion as an Anxiety Disorder. In addition, we had the inclusion of other disorders such as hoarding disorder, excoriation, body dysmorphia and trichotillomania as disorders related to OCD.

But what about doubt? What is the difference between OCD and Obsessive-Compulsive Personality Disorder? Let’s see the criteria for one and the other, according to the DSM-5, in order to better understand:

Obsessive-Compulsive Disorder – 300.3 (F42)

A) Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1) Recurrent and persistent thoughts, impulses, or images that, at some point during the disturbance, are experienced as intrusive and unwanted and that, in most individuals, cause marked anxiety or distress.

2) The individual tries to ignore or suppress such thoughts, impulses or images or counteract them with some other thought or action.

Compulsions are defined by (1) and (2)

1) Repetitive behaviors (eg, washing hands, organizing, checking) or mental acts (eg, praying, counting, or silently repeating words) that the individual feels compelled to perform in response to an obsession or in accordance with with rules that must be strictly enforced.

2) Behaviors or mental acts aimed at preventing or reducing anxiety or suffering or avoiding some feared event or situation; however, these behaviors or mental acts do not have a realistic connection with what they are intended to counteract or avoid, or are clearly excessive.

Criterion B:

Obsessions or compulsions take time (eg, take more than one hour a day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Criterion C:

Obsessive-compulsive symptoms are not due to the effect of a substance (eg, drug of abuse, medication) or other medical condition

Criterion D:

The disturbance is not better explained by symptoms of another mental disorder.

Specify if:

With good or fair insight

with poor insight

With absent insight / delusional beliefs

Differential diagnosis regarding Obsessive-Compulsive Personality Disorder:

“Although obsessive-compulsive personality disorder and OCD have similar names, their clinical manifestations are quite different. Obsessive-compulsive personality disorder is not characterized by intrusive thoughts, images, or urges or by repetitive behaviors that are performed in response to these intrusions; rather, it involves a pervasive, enduring maladaptive pattern of excessive perfectionism and tight control. If an individual manifests symptoms of both OCD and obsessive-compulsive personality disorder, both diagnoses may be given” (DSM-5, p. 241-242).

Obsessive-Compulsive Personality Disorder – 301.4 (F60.5)

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency that emerges in early adulthood and is present in multiple contacts, as indicated by four (or more) of the following:

1) Is so preoccupied with details, rules, lists, order, organization, or timing that the main purpose of the activity is lost.

2) Demonstrates perfectionism that interferes with completing tasks (eg, cannot complete a project because his or her own overly rigid standards are not met).

3) Is overly dedicated to work and productivity to the detriment of leisure activities and friendships (not explained by obvious financial need).

4) Is overly conscientious, scrupulous, and inflexible about matters of morality, ethics, or values ​​(not explained by cultural or religious identification).

5) Is unable to discard used or worthless objects even when they have no sentimental value.

6) He is reluctant to delegate tasks or work with others unless they conform to his exact way of doing things.

7) Adopts a miserly spending style towards self and others; money is seen as something to be hoarded for future catastrophes.

8) Displays rigidity and stubbornness (DSM-5, p. 678-679).

Differential diagnosis regarding OCD:

Despite similar names, obsessive-compulsive disorder is often distinguished from obsessive-compulsive personality disorder by the presence of true obsessions and compulsions in the former. When criteria are met for both, both must be registered (DSM-5, p. 681).

Conclusion

The main definition for OCD is the presence of obsessions and compulsions:

Obsessions: Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted.

Compulsions: are repetitive behaviors or mental acts that an individual feels compelled to perform in response to an obsession or according to rules that must be rigidly applied.

Although they have virtually identical names, the essential difference between OCD and Obsessive-Compulsive Personality Disorder is the presence or absence of these obsessions and compulsions (and the person’s reaction to those obsessions and compulsions). So that in the obsessive personality the main thing is the presence of preoccupation with order, perfectionism and mental control.

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