Perfectionism Versus

Obsessive-Compulsive Disorder
The differences between OCD and a perfectionistic personality
Posted Dec 20, 2016

by Kristen Fuller, M.D., Sovereign Health

Source: karenfoleyphotography/Shutterstock

In the fifth edition of the Diagnostic and Statistical Manual of Mental

Disorders (DSM-5), obsessive-compulsive disorder (OCD) was separated from
the anxiety disorders (which are suggested to be emotional processing
problems) and placed in the category of the obsessive-compulsive and
related disorders (OCRDs), which also include hoarding disorder, body
dysmorphic disorder, excoriation disorder, and trichotillomania. The OCRDs
share distressing emotions, including anxiety, compulsive behavior, repetitive
thoughts, and dysfunctional beliefs, which vary with each disorder, thus
defining their unique qualities and characteristics. OCRDs also share
neurochemistry and malfunctioning frontal striatal pathways, including
those connecting the caudate and putamen nuclei to the cerebral cortex,
which is an important pathway supporting executive functioning (EF).

A meta-analysis evaluating executive functioning in 110 previous

studies revealed that individuals with OCD are impaired on tasks
measuring most aspects of EF, which include inhibition, cognitive flexibility,
and the ability to shift between tasks. Many OCD features may result in
executive-functioning impairment, including intrusive and persistent
thoughts, which the individual usually experiences as irrational and
excessive, as well as repetitive behaviors like checking and counting,
washing and cleaning, and organizing and praying.
Mislabeling

The term “OCD” is routinely used in casual conversations to label someone

who may be extremely detailed with specific tasks or their daily routines.
We all may have strange idiosyncrasies such as avoiding bath sponges,
organizing our closet by color and pattern, or refusing to touch the restroom
door in public, but these habits should not to be confused with obsessive-
compulsive disorder. OCD is often misunderstood as a disorder that simply
means being overly detailed or perfectionistic. In fact, OCD can be
debilitating for individuals who, for example, have to repeatedly wash their
hands until they bleed, and continue to do so without understanding why.

OCD symptoms usually begin presenting in individuals before age 25, and
the disorder affects approximately 1 to 3 percent of the general population.
Characterized by obsessive thoughts which are often, but not always,
directly associated with compulsive actions except in timing, this condition
is more than just excessive cleaning. These obsessive thoughts are
intrusive, ego-dystonic, and distressing to individuals by drastically
interfering with their daily activities. Examples of obsessive thoughts are
centered on orderliness, cleanliness, symmetry, safety, doubting one’s own
thoughts and perceptions, and aggression or unwanted sexual ideas.
People with this disorder may not be able to stop these thoughts or move
on to the next thought until the obsessive thoughts are diminished or
stopped by their compulsions, which are actions that may be repeated over
and over, like a needle stuck in a vinyl record.

Individuals with OCD who prepared a meal may not be able to eat the food
because of thoughts that the stove might have been left on. These thoughts
are so intrusive that they must continue to check the stove (compulsion)
until they come to terms with the fact that the stove is actually off. In
contrast, people without this disorder may wonder whether they have
forgotten to turn the stove off but then quickly confirm and resolve this by
checking the stove. Depending on the individual and the seriousness of the
thought, a person with OCD could spend minutes to hours tormented by
these thoughts and subsequent or associated compulsions, thus taking
hours, for example, preparing to leave home and go to work.

OCD can be accompanied by other mental health conditions. I have had

many patients with three or more symptoms, including panic disorder, social
anxiety, generalized anxiety, bipolar disorder, drug use disorders, ADHD,
and more. I am prone to say, “God never said you would only have one
problem.”
OCD can clinically be confused with bipolar disorder, since the racing
thoughts often seen in bipolar disorder are actually the rapidly recurring
thoughts of OCD. The “mood swings” into depression of bipolar disorder are
OCD patients' desperate, depressive response to not having control over
their OCD thoughts, feeling that they are going crazy or “losing it.” Many
OCD individuals will not tell anyone, including their physicians, about their
plight, since they know what is happening is abnormal, and they fear they
will lose their job or relationship, or end up in a psychiatry unit. Tics, hair
pulling (trichotillomania), body dysmorphic disorder, depression, and other
mental health disorders sometimes accompany OCD.

Obsessive-Compulsive Personality Disorder (OCPD)

Obsessive-compulsive personality disorder (OCPD) is often confused with

OCD, but there are major differences that may be unknown to the general
public. OCPD is characterized by ego-syntonic thoughts and habits,
meaning the person is not bothered by these thoughts and actions. The
person doesn't think these thoughts are irrational or abnormal, but rather
likes them. An individual with OCPD may be described as a perfectionist, or
as someone who pays excessive attention to detail, resulting in a poor
work-life balance, rigidity, stubbornness, and a preoccupation with lists and
tasks that cause the individual to lose sight of the big picture and often
prevents the task at hand from ever being completed.

In general, individuals with OCPD may not think they have a problem, while
individuals with OCD are aware that their thoughts and actions are
abnormal or irrational.

Personality disorders are abnormal, ingrained patterns of behavior that

deviate from society’s norms. Difficulty with interpersonal skills, impulse
control, and cognition are the specific underlying traits in an individual with a
personality disorder. OCPD is no different.

Can OCD and OCPD Be Cured?

Treatment for OCD and OCPD is similar in that they both

require psychotherapy. OCD can also be treated with antidepressants,
specifically selective serotonin reuptake inhibitors (SSRIs). Other
medications may be required, since between 40 to 60 percent of patients
with OCD do not respond adequately to SSRI treatment or clomipramine
trials (meaning less than a 35 percent decrease in The Yale-Brown
Obsessive Compulsive Scale after 10 weeks of treatment), with or
without cognitive behavioral therapy, and are considered treatment resistant,
according to Ozcubukcuoglu and colleagues in their study published in the
May 1995 Bulletin of Clinical Psychopharmacology.

Adding dopaminergic atypical antipsychotic medication, such as

risperidone or aripiprazole, can improve the outcome. Studies with
aripiprazole suggest that OCD may be the result of an imbalance between
dopaminergic and serotonergic pathways, where aripiprazole not only
inhibits dopaminerelease, but modulates or regulates serotonin, according to
studies published in Psychopharmacology and The Journal of Clinical
Psychopharmacology.

All systems of the body are interrelated. Cognitive behavioral therapy, can
change activation in the caudate nucleus, among other things, in OCD
patients who improve.

Exposure and response prevention is the first-line behavioral therapy used

to treat OCD. This is carried out by exposing an unwanted idea or trigger of
gradually increasing intensity in an effort to reduce the response. This is
generally extremely distressing to the individual, but over time symptoms
are shown to improve. In contrast, treatment for OCPD is aimed at
providing individuals with tools to express their feelings to replace
intellectualizing their emotions.

The next time you overhear people say that they are “OCD" about planning
an event or keeping their house clean, make a mental note of how their
description differs with the clinical definition of OCD. Vocabulary counts.

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https://www.psychologytoday.com/us/blog/the-truisms-wellness/201612/perfectionism-versus-
obsessive-compulsive-disorder