Understanding OCD and OCPD
When people hear the term “OCD,” they often think of someone who is extremely neat or particular about routines. In reality, Obsessive Compulsive Disorder (OCD) is very different from Obsessive Compulsive Personality Disorder (OCPD), although the two are often confused. Knowing the difference is important, especially for late diagnosed individuals who may have spent years wondering why they think or act in certain ways. At The Atypical View, we aim to clear up some of this confusion and provide insight into how therapy and coaching can support people navigating these challenges.
- OCD is an anxiety disorder. People with OCD experience intrusive, unwanted thoughts (obsessions) that create distress. They often engage in repetitive behaviors or mental rituals (compulsions) to reduce that distress. Importantly, most people with OCD recognize that these thoughts and rituals do not make logical sense, yet they feel unable to stop.
- OCPD is a personality disorder characterized by perfectionism, orderliness, and a strong need for control. The traits of OCPD often feel “right” or justified to the person, even when these patterns cause strain in relationships or daily life. Rather than intrusive thoughts, OCPD shows up as rigid expectations for oneself and others.
While there is evidence both Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD) may have genetic predispositions to developing these disorders, substantial research indicates that environmental and developmental factors play significant roles in their manifestation. This means these are not typically disorders you’re “born” with, in the same way evidence shows we are born with Autism or ADHD.
Exploring the Abandonment Theory in OCD
A theoretical perspective suggests that at the core of OCD may lie in a fear of abandonment. This theory posits that compulsive behaviors may serve as a mechanism to prevent perceived threats of loss or rejection. While empirical evidence is limited, some clinicians find this framework helpful in understanding and addressing the emotional underpinnings of OCD symptoms.
In therapeutic settings, exploring themes of attachment and fear of abandonment can provide insight into the individual’s experiences and inform treatment approaches. However, it’s essential to approach this theory as one of many lenses through which to understand OCD, rather than a definitive explanation.
Overlapping Traits in Autism
In neurodiversity, we see a lot of overlapping symptom expression from diagnosis to diagnosis. With OCD, OCPD we see shared traits with ASD that include:
- Repetitive behaviors and routines: Common in ASD and OCD.
- Perfectionism and rigidity: Seen in ASD and OCPD.
- Intense analytical thinking patterns: Seen in ASD, OCD, and OCPD.
It’s important to note that while these traits overlap, the underlying motivations and experiences may differ. For instance, repetitive behaviors in autism may serve as a coping mechanism for sensory processing differences, whereas in OCD, they aim to reduce anxiety related to intrusive thoughts.
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Therapeutic Approaches
While most clients won’t meet full diagnostic criteria for OCD or OCPD, many people display individual traits that significantly impact their functioning and quality of life. Rather than dismissing these traits for not meeting clinical thresholds, I find that treating them with adapted OCD/OCPD approaches can still lead to meaningful improvements:
- Exposure and Response Prevention (ERP)
- Best for: Classic OCD presentations including in autistic individuals. Important note: Adaptation is key. The rigid, confrontational style ERP is often taught in may not suit all autistic clients and can be harmful without appropriate attunement.
- Why it’s helpful: ERP remains one of the most empirically supported treatments for OCD. When adapted with a neurodiversity-affirming lens (e.g., accounting for sensory needs, pacing, and language), ERP can effectively help reduce distress from intrusive thoughts and rituals without reinforcing masking or shame.
- Somatic Therapies
- Best for: Clients with a heightened mind-body disconnect or trauma history.
- Why it’s helpful: Many neurodivergent clients live “in their heads” — often hyperaware of thoughts but disconnected from bodily cues. Somatic approaches build safety and grounding from the inside out, which can reduce compulsive symptoms fueled by internal chaos or overwhelm.
- Internal Family Systems (IFS)
- Best for: Clients with high levels of internal conflict, self-criticism, or perfectionism.
- Why it’s helpful: For clients who experience obsessive or controlling thoughts, IFS provides a framework that values these parts as protective, not problematic. Many neurodivergent people find this empowering, especially those who’ve spent years masking or invalidating their inner experiences.
Adapting these therapies to accommodate sensory sensitivities, communication styles, and cognitive processing differences is crucial for effectiveness in neurodivergent individuals.
Understanding the nuances between OCD and OCPD is vital for accurate diagnosis and effective intervention. Recognizing overlapping traits and adapting therapeutic approaches to the individual’s neurodivergent profile can lead to more personalized and effective care.
References
The book mentioned in today’s blog can be purchased here: https://amzn.to/4mKvfwc
Hershfield, J., & Corboy, T. (2013). The mindfulness workbook for OCD: A guide to overcoming obsessions and compulsions using mindfulness and cognitive behavioral therapy. New Harbinger Publications.
Jassi, A., Fernández de la Cruz, L., Russell, A., Krebs, G., Mataix-Cols, D., & Heyman, I. (2021). An evaluation of a new autism-adapted cognitive behaviour therapy manual for adolescents with obsessive–compulsive disorder. Child Psychiatry & Human Development, 52(5), 916–927. https://doi.org/10.1007/s10578-020-01066-6
International OCPD Foundation. (n.d.). OCD vs. OCPD: What’s the difference? OCPD.org. https://www.ocpd.org/articles/ocd-vs-ocpd
