Obsessive-compulsive or Anal Retentive?

What is the difference between obsessive compulsive disorder and obsessive compulsive personality disorder? There is a very distinct difference, although most people seem to use the two interchangeably.

If you’ve ever seen the TV show Monk on USA Network, you know that Adrian Monk suffers from obsessive-compulsive disorder, or OCD. He has to touch certain items, like car antennae, as he walks past them, he doesn’t like touching people, even for a handshake, and he doesn’t like others touching him. In fact, he even has an assistant with him who carries sanitary hand wipes to give to him after he shakes someone’s hand. Extreme, you think? Not for someone who has OCD.

Obsessive-compulsive personality disorder (OCPD), on the other hand, is a little different. Although the names sound similar and they are mistakenly used interchangeably, there are key differences.


The current Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) defines obsessions in OCD as continuous, unwanted thoughts that persist despite efforts to suppress them. The sufferer will try to suppress them by trying to think of other things, to no avail, which will eventually lead them to take some sort of action to stop the obsessive thoughts, such as washing their hands 25 times a day because of their fear of germs.  

Compulsions, as defined by the DSM-IV, are the repetitious physical or mental actions that a person feels they must do because of their obsessions, such washing their hands 25 times or silently counting. There is also a paranoia involved in the compulsivity, as some patients need to lock and unlock the door 10 times to be certain the door is locked or turn the light switch on and off 20 times to insure that the lights are really off. This type of paranoia, however, is still somewhat reality-based, as opposed to the paranoia that one experiences as a paranoid-schizophrenic. In this OCD-based paranoia, managing the stress of the original thought and then the action will eventually make the paranoia disappear.  

The patient with OCD also realizes that their obsessions and/or compulsions interfere with their daily life, yet they continue to do them anyway. They know that their actions are exhausting, take up most of their day, or are truly unnecessary, yet they can’t seem to stop doing them and they don’t know why. This is where psychotherapy and medication can help the patient.


The DSM-IV defines OCPD as a person who is extremely concerned with perfectionism, cleanliness, doing things correctly (their way), following rules, making lists, being organized, working all the time and being inflexible.

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