Passing your National Licensing Exam
Getting licensed can open up incredible opportunities, but the exam can seem daunting. Our podcasts make passing more achievable and even fun. Dr Hutchinson and Stacy’s energy and passion for this content will get you motivated and confident.
We break things down in understandable ways - no stuffiness or complexity and focus on the critical parts you need so your valuable study time counts. You’ll come away feeling like, “I can do this!” Whether it’s nailing down diagnoses, theoretical approaches, or applying ethics in challenging situations, we help you get into a licensed mindset. Knowledge domains we cover in these podcasts include:
Professional Practice and Ethics
Intake, Assessment, & Diagnosis
Areas of Clinical Focus
Treatment Planning
Counseling Skills and Interventions
Core Counseling Attributes
And, of course, the DSM-5-TR.
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Passing your National Licensing Exam
Distinguishing OCD from OCPD
Ever double-checked that your door was locked, even though you knew it was? That momentary doubt is normal—but what happens when these urges become overwhelming and constant? Drawing distinct lines between everyday quirks and clinical conditions, we untangle the often confused Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD).
The key distinction is profound: OCD manifests as intrusive, unwanted thoughts triggering repetitive behaviors to reduce anxiety. These thoughts feel foreign to the person experiencing them—what psychologists call "ego-dystonic." Despite recognizing their irrationality, people with OCD feel powerless to stop the cycle that consumes at least an hour daily. Most shocking is the 11-year average delay between symptom onset and treatment, largely due to shame and misdiagnosis.
By contrast, OCPD represents a pervasive personality pattern centered on orderliness, perfectionism, and control. Unlike OCD, people with OCPD typically view their traits as rational or even virtuous—they're "ego-syntonic." This fundamentally different self-perception drives treatment differences: while OCD responds well to Exposure and Response Prevention therapy and medication, OCPD requires longer-term approaches focused on building flexibility and self-awareness.
We examine how cultural context complicates recognition of OCPD, as traits like diligence and meticulousness often receive positive reinforcement. Someone might excel professionally while struggling significantly in relationships due to rigidity and control needs. Consider how our society's emphasis on productivity and perfection might blur the line between dedication and disorder—when do high standards become harmful?
Whether you're a mental health professional seeking clarity or someone trying to understand these conditions better, this episode provides the framework to distinguish between unwanted symptoms and ingrained personality traits, guiding the path toward appropriate support and treatment.
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This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Welcome to the Licensure Exams podcast. You lovely therapists, you know that little mental nudge when things aren't quite right, like books on a shelf, Mm-hmm. You know double-checking the stove even when you're pretty sure it's off.
Speaker 2:Yeah, we all have those little quirks, those moments.
Speaker 1:Right, but what if those feelings, those urges, become well constant, really overwhelming? That's kind of the area we're getting into today.
Speaker 2:Exactly. A lot of you listeners have asked about the difference between you know everyday tendencies like that and maybe more formal conditions. So today we're doing a deep dive into two specific ones obsessive compulsive disorder, that's, ocd, and obsessive compulsive personality disorder OCPD. Okay, and we've got the official diagnostic criteria straight from the DSM-5-TR. We'll look at treatments too and, crucially, what really separates them.
Speaker 1:Perfect. Yeah, our mission here is really to unpack all of that to give you a much clearer picture of what makes each one distinct. We'll cover, like the main features, how they're diagnosed, typical treatment, goals and methods and I think this is key how people with OCD versus OCPD actually see their own thoughts and behavior. Hopefully this clears up some of the confusion that's definitely out there between these two.
Speaker 2:Okay, so let's kick off with excessive compulsiveorder OCD. What's really striking about OCD is just how intrusive it feels.
Speaker 1:Intrusive okay.
Speaker 2:The DSM-5 TRA criteria really zeroes in on this. It says OCD involves having obsessions or compulsions or actually quite often both.
Speaker 1:Okay, so let's define obsessions a bit more clearly.
Speaker 2:What does that actually mean in this context? Is it just worrying a lot? And they cause pretty marked anxiety or distress? The key difference from regular worries is that they aren't just excessive concerns about, you know, real life problems. They feel intrusive, they're unwanted and the person actively tries to push them away, ignore them or somehow neutralize them. Often that's where the compulsions come in.
Speaker 1:Ah, okay, so the compulsions are linked to the obsessions. What are they exactly?
Speaker 2:Compulsions are basically repetitive behaviors. Things you can see like excessive hand washing, checking things over and over.
Speaker 1:Like the stove example earlier.
Speaker 2:Exactly, or they can be mental acts, things happening inside the person's head, like counting, maybe repeating words silently. Okay, and the person's head, like counting, maybe repeating words silently Okay. And the person feels driven like they have to perform these actions often according to really strict, self-imposed rules.
Speaker 1:And why. What's the goal?
Speaker 2:Well, it's usually not about pleasure. It's aimed at reducing that anxiety, the obsession stirred up, or trying to prevent a dreaded event or situation from happening.
Speaker 1:Got it. So the obsession creates anxiety, the compulsion tries to relieve it.
Speaker 2:Precisely and for it to be diagnosed as OCD according to the DSM-5-TR. These obsessions or compulsions have to be really time-consuming how time-consuming Generally the guideline is more than an hour per day or they have to cause clinically significant distress or impairment in important areas of life like work or relationships, social life, school, just general functioning. It has to really interfere.
Speaker 1:That makes sense. It's not just a quick thought. It's actually impacting their life negatively. Now, you mentioned this thing about how long it takes people to get help.
Speaker 2:Yes, that was quite striking. While the DSM criteria don't set like a minimum time you have to have symptoms for a diagnosis, they just need to be persistent and not caused by, say, medication or another condition. The source has highlighted this average delay it's about 11 years between the onset of OCD symptoms and actually starting treatment 11 years Wow, that's a really long time to be struggling.
Speaker 1:Why such a delay?
Speaker 2:Well, the sources point to a couple of big factors. Shame and secrecy are huge. People often feel really embarrassed by these thoughts or behaviors, afraid of what others might think, so they hide it.
Speaker 1:I can see that.
Speaker 2:And then there's misdiagnosis OCD can sometimes look like other anxiety disorders or even just extreme worry, so it might not get picked up correctly right away.
Speaker 1:Okay, so it's a combination of internal feelings and maybe external diagnostic challenges.
Speaker 2:Exactly. It can be hard for someone to even recognize that what they're experiencing is a treatable disorder.
Speaker 1:So let's say someone does get diagnosed. What are the primary goals when treating OCD? What are they aiming for?
Speaker 2:The immediate goals are usually about reducing the frequency and intensity of both the obsessions and the compulsions and, alongside that, improving overall daily functioning. Reducing distress Plus addressing any co-occurring conditions is important because things like depression or other anxiety issues often go hand-in-hand with OCD. The focus is often on relapse prevention, building skills to manage symptoms if they flare up and, really importantly, increasing the person's tolerance for uncertainty and distress without resorting back to those compulsions.
Speaker 1:Okay, learning to live with some level of uncertainty, and how do therapists actually measure if the treatment is working? You mentioned something about quantifiable goals.
Speaker 2:That's right. Therapy often involves setting very specific, measurable targets, for instance, maybe aiming to reduce the time spent on rituals to less than one hour a day.
Speaker 1:Concrete numbers.
Speaker 2:Yeah, and tools like the Y-Box, that's, the Yale-Brown Obsessive-Compulsive Scale, are commonly used. It helps assess the severity of symptoms at the start and track progress throughout treatment.
Speaker 1:Okay, got it. So what are the main treatment approaches? What actually happens in therapy?
Speaker 2:The cornerstone really is cognitive behavioral therapy, or CBT. The basic idea of CBT is looking at the links between unhelpful thoughts, feelings and behaviors, and within CBT there's a very specific and highly effective technique for OCD called Exposure and Response Prevention ERP.
Speaker 1:ERP okay.
Speaker 2:That's considered the gold standard psychological treatment. Neurobiological factors are also understood to play a part.
Speaker 1:You mean like brain chemistry?
Speaker 2:Yes, particularly involving the neurotransmitter serotonin, research points to dysregulation in serotonin pathways. This understanding supports the use of certain medications.
Speaker 1:Like antidepressants.
Speaker 2:Specifically SSRIs. Selective serotonin reuptake inhibitors are often the first line. They help regulate serotonin levels, which can dampen down the intensity of the obsessions and compulsions for many people.
Speaker 1:Okay, let's back up to ERP. You said exposure and response prevention. What does that actually look like in practice? It sounds intense.
Speaker 2:It can be, yes, but it's done gradually and collaboratively. Erp involves systematically, step-by-step, exposing the person to the very thoughts, images, objects or situations that trigger their obsessions and anxiety, facing the fear, but and this is the crucial part preventing them from engaging in their usual compulsive response. The response prevention bit an exposure might be touching a doorknob they see as dirty, and the response prevention part is resisting the urge to immediately wash their hands for, say, an agreed upon amount of time.
Speaker 1:Wow, so they have to sit with that anxiety.
Speaker 2:They do, and what happens over time with repeated practice is that the link between the trigger and the compulsive urge weakens. The anxiety naturally decreases on its own without the ritual. It's a process called habituation.
Speaker 1:Okay, that makes sense.
Speaker 2:Challenging, but I can see the logic. What about the cognitive part of CBT? Right cognitive restructuring that focuses more directly on the thinking patterns. It involves identifying, examining and challenging the specific irrational or unhelpful beliefs that often fuel the obsessions.
Speaker 1:Like what kind of beliefs?
Speaker 2:Things like having an inflated sense of responsibility, feeling like you're solely responsible for preventing harm, or overestimating the probability of a threat, thinking a feared outcome is much more likely than it actually is, or needing certainty.
Speaker 1:Right, challenging those core assumptions Exactly.
Speaker 2:And we mentioned medications. Often SSRIs are used, sometimes at higher doses than for depression. If SSRIs aren't effective enough on their own, sometimes other medications, like certain atypical antipsychotics, might be added in low doses to augment the effect.
Speaker 1:Gotcha Any other approaches?
Speaker 2:Mindfulness-based strategies are also increasingly integrated. They help people learn to observe their intrusive thoughts and feelings with a bit more distance and non-judgment, rather than immediately getting entangled with them or trying to fight them.
Speaker 1:Okay, so kind of acknowledging the thought without having to act on it.
Speaker 2:Precisely. It complements ERP and cognitive work well.
Speaker 1:All right, that gives us a really solid picture of OCD. Now let's shift gears to the other condition, obsessive-compulsive personality disorder, ocpd. The names are so similar it's bound to cause confusion.
Speaker 2:Absolutely, and it's one of the main reasons we wanted to cover this. While the names overlap, OCPD is fundamentally different. It's classified as a personality disorder.
Speaker 1:Okay, so what does that mean?
Speaker 2:It means it's characterized by a pervasive pattern, something deeply ingrained in the person's way of being, related to orderliness, perfectionism and a strong need for mental and interpersonal control. Pervasive pattern, so like across many areas of life.
Speaker 1:The DSM-5 TRA criteria state, this pattern usually begins by early adulthood and shows up in various contexts, and for a diagnosis, someone needs to display at least four out of eight specific characteristics. Okay, four out of eight specific characteristics.
Speaker 2:Okay, four out of eight. What are those characteristics? Can you run through them?
Speaker 1:Sure. So number one is being preoccupied with details, rules, lists, order, organization or schedules, often to the point where the actual purpose of the activity gets lost.
Speaker 2:Okay, losing the forest for the trees, kind of.
Speaker 1:Sort of yeah. Two is perfectionism that actually interferes with completing tasks. They might get so bogged down in getting it just right, they never finish. Three is excessive devotion to work and productivity, often excluding leisure activities and friendships. Work becomes everything. Four is being over-conscientious, scrupulous and inflexible about matters of morality, ethics or values beyond what's typical for their culture or religion.
Speaker 2:Very black and white thinking there. Five is an inability to discard worn out or worthless objects, even when they have no real sentimental value. Hoarding tendencies can sometimes be part of it. Six is reluctance to delegate tasks or work with others unless they submit to exactly their way of doing things. The control aspect, again Seven, is a miserly spending style, hoarding money for future catastrophes, being very reluctant to spend on themselves or others. And eight general rigidity and stubbornness, difficulty compromising or seeing other points of view.
Speaker 1:Wow, okay, that definitely paints a very different picture from the OCD symptoms. We talk about the specific intrusive thoughts and rituals.
Speaker 2:Very different.
Speaker 1:And the sources mention something absolutely critical here the idea of egocentronic versus egodistonic. Can you explain that?
Speaker 2:This is probably the single most important distinction. Egocentronic means the person experiences these traits, their perfectionism, their need for order, their rigidity, as being consistent with their self-image.
Speaker 1:So they think it's normal or even good.
Speaker 2:Often, yes, they might see these traits as rational, logical, desirable or simply part of who they are. They might even see them as virtues like being diligent or prudent. They don't typically view these traits themselves as the problem.
Speaker 1:Whereas with OCD you said it's ego-dystonic.
Speaker 2:Right. People with OCD generally experience their obsessions and compulsions as intrusive, unwanted, irrational and distressing. They conflict with their self-image. They know something is wrong or excessive, even if they can't stop it. That's ego-dystonic, inconsistent with the self.
Speaker 1:Okay. So OCPD folks might think this is just how I am and it's the right way to be, while OCD folks often think this isn't me. I wish these thought surges would stop.
Speaker 2:That's a great way to put it, and you can immediately see how this difference impacts treatment seeking.
Speaker 1:Yeah, if you don't think there's a problem with your traits, why would you seek help to change them?
Speaker 2:Exactly. People with OCPD might come to therapy, but often it's because of problems caused by their traits, like relationship conflicts or trouble at work due to inflexibility or maybe co-occurring depression, rather than wanting to change the core traits themselves, at least initially.
Speaker 1:That makes sense and the DSM also mentioned that these OCPD patterns are enduring and inflexible, starting early on.
Speaker 2:Yes, typically emerging in adolescence or early adulthood and persisting. It's a chronic pattern unless there's intervention. And the sources also noted the role of culture. How so Well. In some cultures or work environments, traits like extreme meticulousness, strong work ethic or frugality might be highly valued.
Speaker 1:Right seen as positive attributes.
Speaker 2:Yeah. So sometimes the problematic aspects of OCPD can be masked or even reinforced by the environment, potentially delaying recognition that it's actually a personality disorder causing significant impairment, especially in relationships or overall well-being.
Speaker 1:Interesting. So if someone with OCPD does end up in treatment, what are the goals? Usually it sounds different from just reducing OCD symptoms.
Speaker 2:Very different. The focus isn't typically on eliminating specific obsessions or compulsions, because those aren't the core issue. Instead, therapy aims to help the person become aware of their rigid patterns and the impact they have.
Speaker 1:Okay, building self-awareness.
Speaker 2:Yes, and then working towards reducing that overall rigidity, improving interpersonal relationships, learning to collaborate, compromise, be more empathetic. Enhancing emotional expression is often a goal too, as people with OCPD can sometimes seem quite constricted emotionally.
Speaker 1:So more flexibility, better connections.
Speaker 2:Exactly Fostering flexibility and thinking and behavior, maybe reducing some of the workaholic tendencies, if that's an issue, and addressing any comorbid conditions like depression or anxiety, which are common. It's less about symptom reduction, like in OCD, and more about modifying these ingrained personality patterns to improve overall quality of life and relationships.
Speaker 1:Okay, and what therapies are used for OCPD? Is it still CBT?
Speaker 2:CBT can be helpful. Yes, particularly the cognitive parts challenging rigid thinking patterns like perfectionism and the need for absolute control. But because we're dealing with deeper, long-standing personality patterns, other approaches are often integrated or used instead. Psychodynamic therapy, for example, can be very valuable.
Speaker 1:How does that work?
Speaker 2:It explores potential underlying conflicts, maybe stemming from childhood experiences related to things like autonomy, criticism or self-worth, which might contribute to the development of these rigid defenses.
Speaker 1:Okay, digging a bit deeper into the roots.
Speaker 2:Exactly. Schema therapy is another approach that can be effective. It focuses on identifying and changing these deeply ingrained negative patterns of thinking and feeling, called early maladaptive schemas, that drive the OCPD traits Schemas like core beliefs, improving communication and relationship skills, addressing the interpersonal friction that OCPD traits often cause.
Speaker 1:Can you give some examples of specific techniques used within these therapies for OCPD?
Speaker 2:Sure. So in CBT, a therapist might work with the person to challenge all or nothing, thinking about success and failure. Behavioral experiments could involve encouraging them to deliberately delegate a task and not micromanage it, to see that the world doesn't end if it's not done perfectly.
Speaker 1:Right testing those beliefs in the real world.
Speaker 2:Exactly. Group therapy can be really helpful too, providing a safe space to get direct feedback on how their rigidity or control needs impact others and to practice more flexible social skills.
Speaker 1:I can see how that would be valuable.
Speaker 2:Psychodynamic techniques might involve exploring early relationships with caregivers, looking for patterns related to criticism or control. Related to criticism or control, and schema therapy might use techniques like role-playing to help the person challenge their inner critic, that harsh, demanding voice driving the perfectionism.
Speaker 1:Okay, a range of tools, depending on the person and the approach.
Speaker 2:Definitely. It's often a longer-term process than OCD treatment.
Speaker 1:Right, okay, so we've looked at OCD, we've looked at OCPD individually. Now let's really crystallize those key differences.
Speaker 2:So let's recap the main distinctions. First, just a core symptomatology OCD is about those intrusive thoughts, images, urges, the obsessions and the repetitive behaviors or mental acts, the compulsions.
Speaker 1:All right specific symptoms.
Speaker 2:Whereas OCPD is about those pervasive personality traits, the intense preoccupation with order, perfection and control. It's the overall pattern.
Speaker 1:Got it. And the second big one we talked about was insight right.
Speaker 2:Yes, insight. Generally, OCD is egodistonic. The person recognizes the thoughts, behaviors as excessive or irrational, causing distress. Ocpd is typically egocentronic the person sees their traits as part of them, often as logical normal or even virtuous.
Speaker 1:They don't inherently see the trait as the problem and that difference hugely impacts treatment motivation.
Speaker 2:Absolutely. It's a fundamental difference in how the condition is experienced.
Speaker 1:Okay, what else?
Speaker 2:Their DSM-5-TR classification is different. Ocd is under obsessive-compulsive and related disorders. Ocpd is under personality disorders in cluster C, the anxious-fearful cluster, which reflects the different diagnostic focus. For OCD, it's confirming obsessions and meritorious compulsions. For OCPD, it's identifying that pattern of at least four characteristic personality traits.
Speaker 1:Okay, and do they tend to show up alongside other mental health issues differently? Comorbidity.
Speaker 2:Yes, there are tendencies. Ocpd seems more frequently linked with depressive disorders. Ocd has stronger links with other anxiety disorders like panic disorder or social anxiety.
Speaker 1:Interesting and the treatment pathways diverge quite a bit, as we discussed.
Speaker 2:Significantly. Ocd treatment often focuses on ERP and SSRIs, directly targeting symptom reduction, and can sometimes show results relatively quickly. Ocpd treatment is typically longer-term psychotherapy CBT, psychodynamic schema therapy aimed at modifying those deeply ingrained personality patterns, improving insight and flexibility. Medication isn't usually the primary treatment for the core OCPD traits, though it might be used for co-occurring conditions like depression.
Speaker 1:So that affects the prognosis or the expected outcome too.
Speaker 2:Generally, yes. Ocd often responds more readily to targeted treatments like ERP. Ocpd, being a personality pattern, usually requires more sustained therapeutic effort to achieve significant change. It's changeable, but it takes time.
Speaker 1:Okay, what about neurobiology? Any differences known there?
Speaker 2:There's more distinct research on OCD, pointing to things like serotonin system irregularities and hyperactivity in brain circuits like the orbital frontal cortex Right. For OCPD, the neurobiological markers aren't as clearly defined. Some research links it to cognitive inflexibility, but there isn't a specific brain signature identified.
Speaker 1:In the same way as for OCD, Fascinating, and you touched on cultural interpretation earlier, especially for OCPD. Yes, that's an important practical difference.
Speaker 2:Because some OCPD traits yes, that's an important practical difference Because some OCPD traits, like diligence, meticulousness, thriftiness can be viewed positively in certain cultures or contexts.
Speaker 1:Like a strong work ethic.
Speaker 2:Exactly. It can sometimes be harder to recognize when these traits cross the line into a personality disorder causing impairment, especially interpersonal problems. Ocd symptoms being more overtly strange or time-consuming are perhaps less likely to be misinterpreted as positive.
Speaker 1:Right. And finally, how does the functional impairment, the way it messes up someone's life, tend to differ?
Speaker 2:That's another key distinction With OCD. The impairment often stems directly from the time consumed by rituals, the avoidance of triggering situations and the sheer distress caused by obsessions.
Speaker 1:It takes up space and energy.
Speaker 2:A lot of it With OCPD. While someone might be highly functional, even successful, in structured work environments, the impairment frequently manifests in interpersonal relationships. Impairment frequently manifests in interpersonal relationships. Their rigidity, difficulty delegating, need for control, emotional constriction and perceived criticism of others can lead to significant conflict with partners, family, friends and colleagues. They might struggle with teamwork or intimacy.
Speaker 1:Okay, so OCD impacts more via the symptoms themselves, OCPD more via the impact of the traits on relationships and flexibility.
Speaker 2:That's a good summary of the general tendency.
Speaker 1:yes, All right, let's try and boil down the absolute key takeaway for everyone listening.
Speaker 2:Okay. The absolute core difference is this Think of OCD as being driven by anxiety about specific intrusive thoughts, obsessions leading to behaviors, compulsions aimed at reducing that anxiety, which the person usually knows are excessive or irrational, even if they can't stop.
Speaker 1:Ego-dystonic.
Speaker 2:Right. Think of OCPD as a pervasive, lifelong style characterized by a need for order, perfection and control, where the person often sees these traits as reasonable, logical or even virtuous aspects of themselves.
Speaker 1:Ego-syntonic.
Speaker 2:Exactly. Ocd is more about unwanted symptoms. Ocpd is more about ingrained personality traits perceived differently by the individual.
Speaker 1:So for you, listening, really grasping that difference, the intrusive symptoms versus the pervasive traits, and especially that egocentronic distal piece, gives you a much sharper lens to understand these distinct experiences.
Speaker 2:Absolutely, and it highlights why a correct diagnosis is so vital for guiding the right kind of help. The approaches are really quite different.
Speaker 1:Definitely Okay. Finally, maybe a little something for you to mull over after this Consider how much our society values things like high productivity, efficiency, organization and well perfection.
Speaker 2:Right. Those things are often praised.
Speaker 1:So think about how those societal values might sometimes blur the lines or maybe even inadvertently reinforce some OCPD traits, even if those traits are causing someone private distress or creating real friction in their relationships, externally they might just look like someone who's incredibly conscientious or successful.
Speaker 2:That's a really interesting point how external validation or judgment interacts with the internal experience.
Speaker 1:Thanks for being with us today and remember it's in there.
