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Have you ever met someone who takes the fun out of vacation by adherence to an hourly schedule? Someone who finds it more important to do projects perfectly than to get them done on time, and for whom "good enough" would never pass their lips? A person who must analyze minutia between similar products before choosing one? An individual who always needs to take over because you’re not doing something right or well enough? Somebody whose life revolves around to-do lists and organizational charts?
I’ll bet most readers are thinking, “That is so OCD.”
Clinical semantics
It's easy for new and seasoned practitioners to fall prey to popular culture misconception/indoctrination and the sometimes confusing overlap of clinical terms and conditions. We encounter yet another incident of semantic befuddlement within the term "obsessive-compulsive." Without attention to detail, anyone deemed "obsessed" may become part of a homogenized Obsessive-Compulsive Disorder (OCD) blur, receiving improper diagnosis and care.
As discussed in my earlier post ("Avoidant Personality or Social Phobia?") it's not enough to simply recognize a chief symptom. Obsessive-compulsive is not obsessive-compulsive. Accurate differential diagnosis is essential because symptoms, though similar in name, are not usually mutually-exclusive.
Organization, perfection, and control
When people comment "I'm so OCD" in relation to organizational, perfectionistic, and controlling tendencies, it's got nothing to do with Obsessive-Compulsive Disorder. Another victim of pop culture misunderstanding, OCD, as noted here, consists of anxiety-inducing intrusive thoughts/images/impulses (obsessions) followed by ritualistic (e.g., tapping, counting, repeating) behaviors (compulsions) to control the anxiety.
True, OCD sufferers must perform rituals "just right," but the perfection is limited to the ritualizing. They are not driven by pathological core beliefs about the need for perfection, over-attention to details, and control in all realms of their life. This indicates a condition of personality given the inflexible, maladaptive need for global perfection and control.
What’s in a name?
There is a name for such a personality, and it is easy to understand how earlier classification may have contributed to confusion with OCD. This is because it's historically known as Obsessive-Compulsive Personality Disorder (O-CPD). The term's background, as it relates to personality, is rooted in an international, Victorian-era, clinical-philosophical debate of semantics. The words "obsession" and "compulsion," though contemporarily divorced as perceived by most of us, were once used interchangeably (and are still synonymous in thesauri). Which term prevailed was a matter of era-specific cultural preference ("e.g., obsession in London, compulsion in New York" [Millon, 1996]).
To accommodate our modern conceptualization of obsessive and compulsive as independent terms, students seem to find it helpful to differentiate O-CPD from OCD by understanding it thus: Obsessive-Compulsive Personality Disorder is a condition wherein people are compelled ("compulsive") to live by their preoccupation ("obsession") with rules, details, schedules, control and perfection.
Readers may be wondering why O-CPD cannot just be renamed for less confusion. For years, the prominent personality disorder researcher Theodore Millon, Ph.D., referred to it as the Conforming Pattern given the characteristic rigid conformation to rules, attention to details, and precision. Millon’s terminology was more understandable from an operational standpoint, but still a bit blurry.
History has a way of embedding itself, and the term Obsessive-Compulsive Personality Disorder was retained in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Despite this, it has been my experience that it is increasingly common for clinicians to use the alternative term of "Perfectionistic Personality" to reflect the consumption with precision and unwavering methodical approaches to life.
Differentiating in the clinical setting
It is important to not only recognize the difference between OCD and O-CPD, but also that not all perfectionism is pathological. Most of us are guilty of some level of perfection, such as in a hobby interest, our hygiene, or vehicle upkeep, but it’s limited to that. Additionally, those with Autism-Spectrum Disorders (ASD) may be “obsessed” with pieces and parts of things or have a need to perfectly adhere to schedules and other structures; such behaviors are reflective of ASD and neither OCD nor O-CPD.
Readers are invited to familiarize themselves with the DSM-5’s section on Perfectionistic/O-C Personality Disorder. Others who would like an in-depth case study that reads like a novel, including play-by-play treatment, are referred to famed personality disorder expert Stuart Yudofsky’s book Fatal Flaws (2005).
For all practical purposes, if you are wondering how to quickly remember the difference between OCD and Perfectionistic/O-CPD, keep in mind: “Is this someone who engages in counting/tapping/repeating in response to an intrusion, or someone so overwhelmingly detailed and bent on precision and control it’s hard to be around them?”
Remember, don’t contribute to the misunderstanding by casually using “OCD” for perfectionism and organizational quirks. Also, politely educate people who are misusing the terms. Misunderstanding of mental illness or assigning mental illness diagnoses to mere quirky behavior trivializes conditions and leads to stigma.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Millon, T. (1996). Disorders of personality: DSM-IV and beyond (2nd Ed). Wiley.
Yudofsky, S. (2005). Fatal flaws: Navigating destructive relationships with people with disorders of personality and character. American Psychiatric Publishing.
