Shades of Obsession: OCD and Personality Disorders

When it comes to linking mental health conditions together, obsessive-compulsive disorder (OCD) and personality disorders may not immediately spring to mind. But research has shown that personality disorders can be found in comorbidity with OCD. Read on to find out what they are, and how such a comorbidity is likely to present itself.

OCD personality disorder

OCD: One Does Not Simply Stop Obsessing

As its name suggests, obsessive-compulsive disorder is composed primarily of obsessive thoughts, compulsive behavior, or both. Individuals experiencing this condition are assailed with intrusive and unwanted thought content, which may also include disturbing ideas and imagery. As a result, those facing this disorder often start performing their own repeated rituals to ward off their obsessive thoughts. 

For example, someone fixated on the possibility of their significant other being involved in a car accident might begin tapping their phone screen a certain number of times, to be able to move past this thought. This may work at first, but eventually the act itself becomes compulsory, so that the individual feels they must do it to prevent the very scene they wish to stop imagining. Eventually, both the obsessive thoughts and compulsive behavior become a part of the patient’s cycle of OCD, feeding each other and making it that much harder for the individual to break free.

The four most common OCD themes are:

  • Cleanliness and contamination.
  • Catastrophe OCD, where one’s concern is about a violent or disturbing event happening to themselves or a loved one.
  • “Just right” thinking, focused on counting, checking, order, and organization.
  • Taboo thinking, where the individual is preoccupied with breaking with a religious decree, or a social taboo, or a moral transgression. 

The American Psychiatric Association (APA) states that 2.3% of US adults are diagnosed with OCD, as well as 1-2.3% of US children and adolescents. The condition has been found to appear at similar rates across the globe, with 1.1-1.8% of the world population believed to face it. 

An ongoing debate is currently going on, as to the central emotion at the heart of OCD. Traditionalists (including the APA) continue to state that it stems from anxiety—a survival mechanism kicked into overdrive that keeps the individual at an unpleasant state of hyperarousal, even when no threat exists. Alternative theoreticians argue that it is distress—an unrelenting feeling of great unease and discomfort—that lies at the core of this condition, and that this is what explains less “survival-related” OCD obsessions. 

OCD can greatly hinder one’s well-being, with its incessant obsessions and compulsive actions detrimentally affecting the individual’s relationships and ability to function in different life spheres.. Due to its debilitating potential, the World Health Organization (WHO) cites OCD among the top 20 causes for global disability.

Personality Disorders: For Tonight’s Entertainment, I Will Be Playing All the Parts

Personality disorders are considered some of the most stubborn mental health disorders to treat, due to how ingrained they are with the individual’s personality, way of thinking, and emotional reactivity.

The APA describes personality disorders as a distinct deviation from the individual’s society that causes their behavior, perspective, and expectations of others to be decidedly different from their own culture. 

It should go without saying that not all uniqueness is bad. Rather, only cases where the individual’s distinctiveness from those around them causes significant distress, and prevents them from adjusting to expected norms in order to experience greater well-being, may a personality disorder diagnosis be considered. 

Unlike disorders that primarily deal with one’s connection to external reality, such as schizophrenia, those with a personality disorder are generally able to correctly perceive the concrete world around them. However, it is their interpretation of reality that is usually too rigid, and often causes them distress. This is because personality disorders tend to cause the individual to perceive their relationships, others’ reactions with them, and additional relational aspects of their life, in a destabilizing manner. This, in turn, provokes extreme emotions, and creates conflict in situations that could have been de-escalated. 

The APA states that 15% of the US population contends with at least one personality disorder. Its most recent Diagnostic and Statistical Manual (the DSM-V) lists ten personality disorders, separating them into three clusters:

  • Cluster A: The odd cluster, with personality disorders that lean toward more eccentric behavior. It includes:
    • Paranoid Personality Disorder, marked by suspiciousness or significant distrust of others.
    • Schizoid Personality Disorder, marked by social detachment and limited emotional expression.
    • Schizotypal Personality Disorder, marked by extreme eccentricity, great discomfort within relationships, and at times with some reality distortion.
  • Cluster B: The dramatic cluster, with personality disorders that invoke extreme emotionality and erratic behavior. It includes:
    • Antisocial Personality Disorder, marked by a disregard for others’ safety or rule-abiding
    • Borderline Personality Disorder, marked by unstable relationships, a shaky self-image, and impulsivity.
    • Histrionic Personality Disorder, marked by excessive emotional volubility and attention-seeking
    • Narcissistic Personality Disorder, marked by self-centeredness and a lack of empathy, together with a continuous need for admiration.
  • Cluster C: The anxious cluster, with personality disorders that tend to induce fear. It includes:
    • Avoidant Personality Disorder, marked by feelings of social inadequacy, and a hypersensitivity to criticism, be it real or perceived.
    • Dependent Personality Disorder, marked by submissive behavior and a lack of independence.
    • Obsessive-compulsive Personality Disorder, marked by perfectionism, orderliness, and control.

BPD and OCD comorbidity

OCD and Personality Disorder Comorbidity

Several personality disorders have been found in relatively high comorbidity with OCD.

Obsessive-Compulsive Personality Disorder

According to the APA, 23%-32% of patients with OCD also contend with obsessive-compulsive personality disorder (or OCPD), making for a relatively high rate of comorbidity. That said, the two disorders are distinct from one another, and should be considered separately, according to the patient’s presenting symptoms: OCD is mainly defined by unpleasant and unwanted thought content that refuses to dissipate. OCPD, on the other hand, is defined by striving toward perfection, with the individual often believing that they are in the right for demanding complete order and control of others, while those who do not follow their stringent demands are in the wrong. 

Avoidant Personality Disorder

Avoidant personality disorder (or AVPD) is another relatively common personality disorder found with OCD, with a prevalence of 5%-15%. The extreme fear of rejection expressed by those with AVPD may pose a hindrance to those who also face OCD, as they might reject the possibility of therapy or find they are unable to fully commit themselves to it, for fear of being criticized for failing.

Dependent Personality Disorder

Dependent personality disorder (or DPD) has a prevalence rate of 7.6%, when found with OCD. The two disorders’ need for checking and reassurance may work to exacerbate both. Gradually reducing such a patient’s reassurance, as part of cognitive behavioral therapy (CBT), may find their DPD to be an obstacle, as patients with this personality disorder are greatly destabilized when their source of reassurance is made less available.

Borderline Personality Disorder

The prevalence of borderline personality disorder (or BPD) among patients with OCD has been found to be roughly 5%. Moreover, such patients with BPD and OCD comorbidity had a higher comorbidity with anxiety, mood, and eating disorders. Such cases, with BPD and OCD found together, have been shown to be related to compulsions concerning interpersonal domains, mental compulsions, and motor impulsivity.