Obsessive-Compulsive Disorder (OCD)
Symptoms, treatment, and self-help for OCD
Know someone who fixates on small details and sets unrealistic standards for themselves and others? Or maybe that person is you? Here’s how to recognize and manage OCPD.
It's not unusual for someone to be diligent, orderly, or stubborn. In some cases, those personality traits can even come in handy. However, when those traits are taken to an extreme, they can reduce the quality of a person's physical, emotional, and social well-being.
People with obsessive-compulsive personality disorder (OCPD) have a fixation with perfection, control, and orderliness. Their preoccupation is severe enough to lead to impairment. Picture a student who is so focused on small details that they fail to complete an assignment. Or imagine someone whose moral code is so inflexible that they have trouble seeing things from another person's perspective.
A person with OCPD may not be aware of their condition or see a need for change. In fact, they may believe that other people are the ones who should change.
People with OCPD have a tendency to impose their high standards on others. For example, a husband with OCPD might refuse to let his wife help plant a garden unless the wife agrees to follow a strict methodology. If his partner deviates at all from the rules, the husband can become overly critical.
Unsurprisingly, this rigid approach to life can lead to difficulty maintaining relationships or adapting to new circumstances. Loneliness and depression may develop as relationships deteriorate. The person with OCPD may avoid or quit activities they don't immediately excel in, limiting their potential. In addition, an intense focus on perfectionism can lead to anxiety, eating disorders, and other physical and mental problems.
Do you think you recognize these symptoms in yourself or someone you love? Learn more about the specific signs of OCPD as well as self-help tips that can help manage the disorder.
OCPD is one of the most common personality disorders. Research indicates that somewhere between 3 to 8 percent of the population has OCPD, and it's most common in older people. This personality disorder involves a persistent pattern of behavior that often starts when the person is a teenager or young adult.
Experts haven't identified one exact cause of OCPD. However, research suggests that a person's upbringing may play a role. For example, being raised in an environment that has strict rules and harsh punishments may lead a person to obsess over doing things “the right way.” OCPD may also have a genetic component, meaning that it might be inherited.
For an OCPD diagnosis, a person must show at least four of the eight signs listed above. The symptoms must be part of a long-term pattern that was formed by early adulthood.
The diagnosis process will likely involve screening questionnaires, which allow the person to self-report on their own behavior. The screening is followed by an interview. In addition to self-reported details, information gathered from friends, family, and peers can also help a mental health expert make an accurate diagnosis.
A mental health expert will need to rule out other possible explanations for the behavior. For example, obsessive-compulsive disorder (OCD) is a separate condition that can also involve a preoccupation with orderliness and hoarding.
It can also be tricky to distinguish OCPD behavior from “conventional” behavior. Some questions to consider:
If you suspect you have OCPD, you may feel hesitant to seek a diagnosis. Perhaps you feel as though your approach to life is more helpful than harmful. In many cases, people with OCPD who seek a diagnosis do so at the request of a loved one. So, if your approach to life seems to be damaging your relationships, a formal diagnosis may offer insight and a path forward.
People with OCPD often struggle with other physical and mental health conditions. When multiple disorders are present, it's important to address all of the issues simultaneously, as they may affect one another. Some of these co-occurring disorders include:
Eating disorders. Perfectionism can motivate people with OCPD to reach for unrealistic standards, even at the cost of their own health. That degree of perfectionism is also found in people with eating disorders, such as anorexia and bulimia nervosa, so these conditions may co-occur with OCPD.
[Read: Eating Disorder Treatment and Recovery]
Mood disorders. Research shows that OCPD is associated with mood disorders, including depression. Workplace burnout, difficulty with social interactions, and failure to live up to their own high expectations may contribute to depressive symptoms. OCPD traits have also been linked to suicidal ideation.
Physical problems. One study found that OCPD traits are linked to cardiovascular health conditions, such as hypertension. Other research seems to indicate an association between OCPD and stroke and arthritis.Avoidant Personality Disorder (AVPD)
Other personality disorders. A person can struggle with overlapping personality disorders. People with OCPD may also be diagnosed with dependent, histrionic, borderline, avoidant, or narcissistic personality disorders.
Anxiety disorders. As people with OCPD are striving to maintain order and achieve perfection, they may also be plagued by anxiety. Anxiety disorders, such as generalized anxiety disorder and panic disorder, may co-occur with OCPD. OCD is another anxiety disorder that may co-occur with OCPD, and the two conditions are commonly mistaken for each other.
Despite similarities in their names, OCPD and obsessive-compulsive disorder (OCD) have key differences.
People with OCD struggle with unwanted, anxious thoughts (obsessions) and feel compelled to perform ritualized actions to reduce their anxiety. For example, a fear of germs may lead a person with OCD to continually wash their hands. The person is often aware that their fears and urges are irrational.
[Read: Obsessive-Compulsive Disorder (OCD)]
People with OCPD are less likely to recognize their disorder than people with OCD. They typically aren’t driven by obsessive thoughts or specific repetitive actions. Instead, they have a more general desire for order and perfection, which they see as part of their own fixed values. Research also shows that people with OCPD are less impulsive and more willing to delay rewards than people OCD.
|OCD traits vs. OCPD traits|
|OCD traits||OCPD traits|
|You keep wiping down the kitchen counter because you have anxious, intrusive thoughts about food contamination. You’re aware this is a time-consuming activity, and the irrationality of it causes you distress.||You frequently clean the kitchen counter because you want it to look spotless. The activity is inconvenient for everyone else in your family, but you believe the kitchen needs to remain neat and orderly.|
|You keep checking and rearranging luggage items, trying to ease the fear of something being damaged, lost, or left behind.||You create a detailed list of what you want to pack and in which suitcase. You become so fixated on writing the list you no longer have time to pack.|
|You keep asking if you’ve insulted someone. You're experiencing intrusive thoughts about accidentally offending other people.||You take a long time to speak so your words avoid misinterpretation. In your mind, everyone should be this careful when speaking.|
OCPD is more common than OCD, but about 15 to 28 percent of people with OCD may also have OCPD. Someone with both disorders may experience more severe symptoms, as well as higher distress. Due to the stubborn nature of people with OCPD, they may be less willing to accept treatment. However, when they do accept treatment, their preoccupation with perfectionism may be beneficial. For example, they may be more thorough in following their self-help practices.
If you or a loved one have OCPD, there are many steps you can take to limit some of the more negative aspects of the disorder. Many of these strategies involve easing the strong desire to control every circumstance and perfect every task.
People with OCPD often feel they have a lot of tasks on their schedule and believe those tasks need to be done well. On top of that, crippling fear of failure can lead to procrastination. This can make for stressful days and outbursts of frustration.
Relaxation techniques can help you manage stress and improve your mood. They might also help you reflect on and accept matters that are beyond your control. Here are a few practices that may help:
Experiment with mindful breathing. This simple form of meditation involves focusing on your inhales and exhales. Long, deep breaths can decrease your stress response and keep you grounded in the present moment.
[Listen: Mindful Breathing Meditation]
Exercise regularly. Physical activity releases endorphins, hormones that promote a feeling of well-being. Activities such as yoga and tai chi can be especially helpful, as they combine physical activity with mindful breathing.
Get enough rest. Even if you think of yourself as a workaholic, it's important to get enough sleep every night. Lack of sleep not only raises your stress levels, it can also hinder your work performance.
Eat healthy meals. Poor eating habits can leave your body more susceptible to stress. Think of healthy meals as a high priority as you plan your daily schedule.
If you're living with someone with OCPD and want to encourage them to try the practices listed above, remind them that everyone can benefit from stress management. Frame it as a team activity that can improve both your lives, rather than an activity that is only meant to “fix” them. Take the time to meditate with them or join them in exercising and eating healthy.
If you have OCPD, there's no doubt that you have high expectations for yourself. When those expectations aren't met, you might take your frustrations out on yourself as well as friends and family members. You might also have a tendency to overinflate the flaws you see in yourself and others.
Self-compassion starts with accepting that you (and those around you) have limits. Despite your best efforts, you'll make mistakes and overlook things. Don't think of those shortcomings as evidence that you're a failure. Look at them as opportunities to grow and remember to forgive yourself rather than allow self-hatred to build.
Another step toward self-compassion involves paying attention to your self-talk. When you engage in negative self-talk, you use disparaging inner monologue such as, “I'm not good enough” or “I'm such an idiot.” These kinds of thoughts can lead you to depression and warp your perception of reality.
Try to notice when you're using negative self-talk and challenge those negative statements with neutral or positive self-talk.
|Negative self-talk||Neutral or positive self-talk|
|“I'm stupid for forgetting to do my taxes.”||“I forgot to do my taxes because I was busy with other things. This mistake doesn't make me a bad person.”|
|“My friends secretly hate the way I act.”||“I'm grateful I have supportive friends, and I can take steps to strengthen those friendships.”|
|“My relationship is falling apart, but therapy would be a waste of my time.”||“There's still time to repair my relationship. Therapy might help me grow.”|
|“I skipped my workout, which means that I'm lazy and unhealthy.”||“I didn't have the time or motivation to exercise today. I can do it some other time and let my body rest today.”|
Use self-talk to encourage yourself rather than tear yourself down. Talk to yourself as if you're trying to comfort or empower a loved one.
If you live with someone with OCPD, offer them praise to counter their negative self judgments. For example, if they didn't break their own jogging record, remind them that their current record is extremely impressive. Let them know that there is always time for growth. This may help steer them away from “all or nothing” thinking and remind them to be self-compassionate.
You can also encourage them to join you in meditation practices that focus specifically on self-kindness. Try our audio guide Being Kind to Yourself: A Meditation.
A 2015 study that investigated emotional functioning in people with OCPD found that the disorder is associated with high levels of negative emotions, such as frustration, as well as difficulties identifying and accepting their own emotions.
So, if you have OCPD, it's not unusual to want to hide back certain emotions, especially negative ones like shame, anger, or fear. You might even feel uncomfortable when other people express those emotions. However, suppressing your emotions can also lead to issues over time, such as angry outbursts and depressive episodes. Here are a few ways to better manage your emotions:
Identify your emotions. Learn to identify your emotions instead of denying what you're feeling. You might begin by learning to notice physical signs of your emotions. Maybe when you're angry you feel your jaw tighten, or perhaps when you're sad you feel yourself droop.
Accept your emotions. This can be difficult, especially if you pride yourself on keeping a level head. Just know that everyone experiences a range of emotions, and it's normal to feel everything from sadness to anger to shame. Having these emotions doesn't make you a weak person.
Problem solve. Identify what's bothering you. Maybe you made a mistake at work and feel angry at yourself for overlooking details. Is there anything you can do to address the root cause of the issue? Or maybe an argument with your partner has left you feeling tired and depressed. What can be done to repair the rift between the two of you?
Reevaluate the situation. Not every problem has a solution. In some cases, you may simply need to accept and reevaluate the situation. Imagine that you've fallen behind schedule and now you have no time for your daily run. In the grand scheme of things, does it matter that you've missed this workout? Perhaps your body needed the rest anyway. Reappraising matters can help put them in perspective and steer you away from catastrophizing.
HelpGuide’s free Emotional Intelligence Toolkit can help you learn how to identify and manage difficult emotions in healthier ways. Over time, it can make a huge difference in your ability to manage stress, balance your moods and emotions, and take back control of your life.
You can encourage your loved one to use the steps above, but you can also go further and make them feel comfortable venting to you. Be an engaged listener by asking questions and empathizing with them. You shouldn't try to write off their concerns as “no big deal,” but you can gently move them along in reevaluating the situation.
If you have OCPD, be willing to accept two potentially uncomfortable truths: You can't do everything alone and you have blind spots. Get in contact with self-help groups or online forums where people share their OCPD experiences. This can help you learn more about how the disorder affects people in different ways. You'll also learn how others cope with the negative aspects of OCPD.
If you're close to someone with OCPD, be prepared for them to push back on the idea that they need to change or improve at all. However, gently encouraging them to join OCPD self-help groups may lead them to self-reflection. They may be more willing to hear from people who have similar preoccupations with perfectionism and orderliness.
Another strategy is to point to depression, work burnout, anxiety, or irritability as a reason to seek out help rather than place the emphasis on OCPD. Appeal to the person logically, citing concrete examples of how certain traits impact your relationship.
If you're in a relationship with someone with OCPD, you might struggle with your friend or partner's persistent need for control. Maybe they always insist on planning out every detail of your vacation. Or perhaps they demand that every room in the house be cleaned in a specific way and according to a specific schedule. You may have grown accustomed to walking away from arguments or feeling like their work life takes priority over you.
And if you're the one with OCPD, you might feel frustrated that the people around you have different standards. Maybe your spouse or roommate doesn't keep things as tidy as you'd like. Or perhaps they aren't as punctual or frugal as you.
Despite all of these potential frustrations, it's possible for people with OCPD to have long and healthy relationships with others. Whether you or your loved one has OCPD, use the following strategies to keep the peace:
This can be particularly challenging for a person with OCPD, who may feel a strong desire to be right. However, even those without OCPD may struggle with this. Do your best to put your ego aside during arguments, and look to resolve conflicts rather than “win” them.
Be respectful and thoughtful in communicating, even if you both need to take an occasional pause to clear your heads. Use “I” statements to express your perspective. Avoid using “you” statements to assign blame. Don't hesitate to apologize when necessary.
Sometimes it's easy for a person with OCPD to fall into a routine of being overly critical. And the person without OCPD may fall into a similar pattern, focusing only on their friend or partner's rigidity and negative aspects.
Remember to be vocal about what traits you appreciate in each other, such as work ethic and reliability. Tell the person how they've improved your life, whether that includes their emotional support or their contributions to the household. This helps create a sense of security.
Despite a tendency to be controlling, people with OCPD often have good intentions. And when they show annoyance or frustration, they're likely grappling with feelings of anxiety or helplessness. Recognize those feelings, and ask what you can do to help.
If you have OCPD, it's also important to recognize the other person's good intentions. Their drive toward perfection may not be as strong as yours, but, in the end, neither of you can ever be flawless.
Having a relationship with someone with OCPD may require you to be more assertive. Be clear about what expectations are too high. For example, if you believe their cleanliness demands are unreasonable, let your loved one know.
Try to compromise on a solution, and don't feel the need to overextend yourself. Recognize that your way of doing things doesn't have to match their way of doing things.
If a romantic relationship isn't working, couple's therapy can be helpful. However, if your partner is abusive or unwilling to change, you may need to accept that the relationship won't work at this time.
[Read: Dealing with a Breakup or Divorce]
When self-help treatments offer little relief from negative OCPD symptoms, professional treatments are the next step. Again, many people with OCPD may not see the need to treat symptoms, much less visit a professional. You may need to be patient and present evidence that intervention is needed.
Two common approaches to therapy for OCPD include cognitive behavioral therapy (CBT) and psychodynamic therapy.
During CBT, a therapist may draw the person's attention to how their core beliefs can be detrimental to their mental health, physical health, and relationships. For example, a therapist might challenge a person's core belief of, “I need to create lists and plan things out to feel comfortable.” CBT can also help a person find constructive ways to express emotions such as frustration.
Psychodynamic therapy helps a person with OCPD connect present-day traits with past experiences. A person with OCPD might find that their need for control and order is rooted in childhood experiences with overly critical parents.
[Read: Online Therapy: Is it Right for You?]
Other potential therapy interventions may include:
You won't find a single type of medication for treating the entire spectrum of OCPD symptoms. However, certain medication can be prescribed to treat specific aspects of OCPD and its co-occurring disorders. A few examples include:
Finding the right mix of medication and therapy may require some trial and error. In the meantime, a focus on accepting imperfections and managing negative emotions may lead to noticeable changes.
Call the NAMI HelpLine at 1-800-950-6264.
Call the SANEline at 07984 967 708.
Call the Sane Helpline at 1800 187 263.
Visit Mood Disorders Society of Canada for links to provincial helplines.
Call the Vandrevala Foundation Helpline at 1860 2662 345.
Find links to forums and support groups at The OCPD Foundation.
Millions of readers rely on HelpGuide.org for free, evidence-based resources to understand and navigate mental health challenges. Please donate today to help us save, support, and change lives.Donate to HelpGuide.org today