Decoding BPD vs OCD: Recognizing the Contrasts and Overlaps

Understanding the key differences in BPD vs OCD can help clarify symptoms, guide treatment decisions, and support individuals on their path to recovery.

The ability to distinguish between mental health disorders is crucial for accurate diagnosis, effective treatment, and recovery.

Borderline Personality Disorder (BPD) and Obsessive-Compulsive Disorder (OCD) are two conditions that have distinct yet overlapping features. 

If you have ever wondered about the key differences and similarities between BPD and OCD,  read on. This article also discusses coping strategies and treatment options for both disorders based on the latest scientific evidence. 

By the end of this article, you will have a better understanding of the unique characteristics and commonalities of these complex mental health conditions.

Let’s jump right in!

What is Obsessive-Compulsive Disorder? 

OCD is a mental health disorder characterized by two core features:

1. OBSESSIONS are unwanted and intrusive thoughts, images, or urges that feel outside of a person’s control and cause significant distress.

2. COMPULSIONS are repetitive behaviors or thoughts that a person does to try to alleviate distress. These behaviors can take on a ritualistic quality, meaning that a person feels they must do them.

OCD is commonly referred to as the “doubting disease” because pervasive doubt is a key characteristic of the condition. Some examples include:

• Lack of confidence in one’s memory, perception, attention, and internal states.

• Uncertainty and getting stuck in a cycle of “what if” scenarios.

Common Obsessions and Compulsions

Types of obsessions and compulsions can vary widely. Some common themes include:

COMMON OBSESSIONS Contamination Obsessions: Fear of perceived contaminated substances, objects, people, and/or places. Harm Obsessions: Fear of losing control and harming yourself or others. Scrupulosity/Moral Obsessions: Excessive concern with right/wrong morality, responsibility, or fear of offending God. Relationship Obsessions: Excessive concern about whether your relationship is “right”, whether you love your partner, or whether your partner truly loves you.Contamination Obsessions: Fear of perceived contaminated substances, objects, people, and/or places. Harm Obsessions: Fear of losing control and harming yourself or others. Scrupulosity/Moral Obsessions: Excessive concern with right/wrong morality, responsibility, or fear of offending God. Relationship Obsessions: Excessive concern about whether your relationship is “right”, whether you love your partner, or whether your partner truly loves you.

COMMON COMPULSIONS Washing and cleaning: Excessive washing or cleaning routines that must be done in a “right” way. Checking: That nothing terrible happened or you did not make a mistake or forget something.   Mental Compulsions: Mentally reviewing events, repeating a prayer or word, replacing a “bad” thought with a “good” thought. Reassurance Seeking: Telling, confessing, or asking others to get reassurance.

Regardless of the theme, the cycle of obsessions and compulsions takes up a great deal of time, gets in the way of important activities, and significantly reduces the quality of a person’s life. 

What is Borderline Personality Disorder?

BPD is a complex and chronic mental health condition that significantly disrupts a person’s  ability to regulate their moods, thoughts, and behaviors. 

To meet criteria for a diagnosis of BPD, a person must exhibit at least five of the following long-standing  symptoms:

1. Fear of abandonment and efforts to avoid real or perceived separation or rejection. 

2. Unstable and intense relationships, including rapid shifts from idealizing others to devaluing them, and vice versa. This may include romantic partners or any other close relationship.

3. Unstable or unclear self-image, including having an unclear sense of one’s goals, likes and dislikes, opinions, and general sense of self.

4. Impulsive behaviors that may be dangerous or reckless, including spending sprees, substance use, reckless driving, unsafe sex, and binge eating.

5. Emotional instability and highly variable moods, with abrupt shifts in moods lasting from a few hours to a few days. 

6. Chronic feelings of emptiness, loneliness, and dissatisfaction, often due to an unstable sense of self and turbulent relationships with others.

7. Explosive anger, difficulty controlling anger, and short temper.

8. Suspicious feelings and thoughts including paranoia and dissociation.

9. Recurrent suicidal behavior, gestures or threats, or self-harm behaviors.

BPD and OCD Symptom Comparison

BPD and OCD have similar symptoms and behavioral patterns, including intrusive thoughts, negative emotions, impulse control difficulties, and relationship uncertainty. However, there are key psychological differences within these domains.

INTRUSIVE THOUGHTS SIMILARITIES: BPD and OCD both involve intrusive thoughts that are unwanted, persistent, and cause significant distress. DIFFERENCES: The nature of intrusive thoughts in OCD can vary widely across multiple themes, whereas the nature of intrusive thoughts in BPD tends to be focused on a fear of abandonment, self-harm, relationship difficulties, and identity disturbance.   Intrusive thoughts in OCD are accompanied by strong urges to compulse (i.e., to do something to alleviate distress associated with the obsession). Intrusive thoughts in BPD are often associated with rage and panic, as well as urges to act impulsively, including self-harm and risky behaviors. Intrusive thoughts in OCD are more likely to be experienced as unwanted, unreasonable, or irrational by the individual than those experienced in BPD.

NEGATIVE EMOTIONS SIMILARITIES: BPD and OCD both involve frequent and intense negative emotions including fear, anger, doubt, and shame. DIFFERENCES: OCD involves intense anxiety, fear, and/or disgust related to intrusive thoughts, urges, or images. People with OCD may experience feelings of “dirtiness”, “discomfort”, or “incompleteness” which may be triggered by certain places, people, thoughts, or memories. The experience of negative emotions in OCD is often significant, distressing, and difficult to regulate.  People with BPD experience a number of negative emotions that are not experienced in OCD to the same degree or frequency. These include: feelings of emptiness and loneliness, fear of rejection and/or abandonment, intense anger, dissociation, shame, suicidal feelings, and idealization and devaluation of others.  People with BPD also experience severe and sudden shifts in mood within a few hours to a few days, which can leave them feeling disoriented and out of control.  People with BPD typically have less insight into their emotions compared to people with OCD. The types of negative emotions experienced in BPD in combination with decreased insight into their emotional states makes regulating emotions especially difficult in BPD.

IMPULSE CONTROL   SIMILARITIES: BPD and OCD both involve difficulty controlling behavioral responses and urges. DIFFERENCES: Compulsive behaviors in OCD are actions that are performed repeatedly with the aim of relieving anxiety related to intrusive thoughts, images, and urges. The strong urge to engage in these behaviors makes them very difficult to resist. They may include performing rituals, seeking reassurance, mentally reviewing, or checking.  Impulsive behaviors in BPD are rapid and unplanned actions that  can occur in the context of abrupt changes in mood or by a desire for immediate gratification, connection with others, and/or attention. These behaviors may include spending, risky sexual behavior, substance use, reckless driving, self-harm, relationship changes, and binge eating.  Individuals with BPD tend to have greater difficulty controlling impulsive behaviors and urges than those with OCD.  OCD also tends to involve a preoccupation with guidelines, rules, details, and structure, which may make acting impulsively less likely in OCD  than in BPD.

RELATIONSHIP UNCERTAINTY SIMILARITIES: BPD and OCD can both involve relationship difficulties and uncertainty. This may involve one’s romantic partner, friends, or other close relationships. DIFFERENCES: People with BPD have unstable relationships where they shift rapidly from idealizing their partner to devaluing them, resulting in turbulent ups-and-downs. They typically fear abandonment within relationships and have difficulty regulating emotions with others.  BPD may also involve compulsive efforts to seek attention from others or to control their partners or relationships.  OCD can impact relationships in various ways, including 1) time-consuming rituals that make spending quality time with partners difficult; 2) reassurance seeking compulsions that may frustrate or exhaust partners and friends; 3) avoidance of certain activities that may interfere with emotional or physical activity with others; and 4) high emotional stress that may create tension in relationships.  A subset of people with OCD have Relationship OCD, characterized by intrusive fears and feelings of uncertainty about the rightness of their relationships or partners. In response to these intrusive concerns, they may engage in compulsions of reassurance-seeking, analyzing, checking, and comparing to alleviate anxiety. While relationships can be significantly strained in both conditions, people with BPD typically experience greater impairment in their relationships than those with OCD.

Can A Person Have Both BPD and OCD?

Yes, it’s possible to be diagnosed with both BPD and OCD. 

In fact, studies have found that:

• Roughly 5% of people living with OCD also meet criteria for BPD. 

• 15-35% of people living with BPD also meet criteria for OCD.

Can BPD Make OCD Worse?

Yes, BPD can exacerbate OCD in several ways.  Here’s how:

Emotional Dysregulation: People with BPD experience intense negative emotions and rapid shifts in mood. This heightened distress can exacerbate the anxiety that fuels OCD symptoms, making managing intrusive thoughts and resisting compulsions even more difficult. 

Impulsivity: BPD is marked by difficulty controlling behavioral responses and urges, which may intensify OCD rituals. Individuals may perform compulsions more frequently or in more extreme ways due to difficulty regulating impulsive behaviors – which is typical of BPD– and a strong desire to regain a sense of control – which is typical of OCD.

Heightened Sensitivity to Stress: People with BPD exhibit heightened sensitivity to stress, including intense emotional reactions to stressors and difficulty regulating emotions effectively. Because stress is a known trigger for both disorders, a heightened sensitivity to stress can intensify OCD symptoms and make them harder to manage.

Difficulty in Treatment Compliance: Adherence to Exposure and Response Prevention (ERP), the gold standard treatment for OCD, is necessary for recovery. However, the emotional instability, rapid shifts in mood, and interpersonal difficulties experienced in BPD make it harder for individuals to consistently follow through with treatment. This inconsistency may lead to poorer outcomes and worsening OCD symptoms over time.

One subtype of OCD, called Relationship OCD (ROCD), can be exacerbated when a person has both BPD and OCD.

ROCD is characterized by intrusive, distressing thoughts and urges to engage in compulsive behaviors related to romantic relationships. Examples include obsessively questioning their feelings for their partner, worry about their partner’s feelings for them, or fear that they are not in the “right” relationship. Common compulsions include seeking reassurance, analyzing the relationship, or avoiding situations that trigger anxiety.

A person with both BPD and ROCD may: 

• Experience more obsessions and intrusive thoughts about romantic relationships.

• Be more preoccupied with having control over people and situations.

• Exhibit more impulsive behaviors to seek attention from others. 

They may frequently switch from idealizing their partner (seeing them as “the best”) to devaluing their partner (seeing them as “the worst”), sometimes within the same day or week. These ups-and-downs can lead to even more intrusive thoughts and uncertainty about their relationship as well as more compulsive analyzing, comparing, and reassurance-seeking. 

Having both BPD and ROCD may leave a person feeling particularly uncertain, distressed, and emotionally dysregulated within romantic and other close relationships. 

Can BPD and OCD be Treated?

Yes! The good news is that both BPD and OCD can be treated using evidence-based methods. 

TREATMENT FOR OCD Exposure and Response Prevention (ERP) is a type of Cognitive Behavioral Therapy (CBT) considered most effective for treating OCD based on clinical research for over 40 years.  It entails gradually exposing to stimuli that trigger intrusive thoughts without relying on compulsions to immediately alleviate anxiety. Over time, this increases tolerance for uncertainty and distress, corrects mistaken beliefs about danger, and significantly decreases anxiety experienced in the face of an obsession.  Clinicians at The Reeds Center are expertly trained in ERP to support clients in learning the skills necessary to return to a healthier and fuller life. To learn more about the evidence-based treatment for OCD at The Reeds Center, click here.

TREATMENT FOR BPD Dialectical Behavioral Therapy (DBT) is a structured, evidence-based treatment that was developed to treat BPD.  It focuses on teaching and implementing 4 core skills:  Mindfulness to increase awareness of triggers and one’s responses. Emotion regulation to reduce the frequency of negative emotions. Distress tolerance to reduce engaging in unhelpful and harmful behaviors. Interpersonal effectiveness to maintain healthier relationships. DBT is provided utilizing individual therapy, group therapy, and phone coaching. To learn more about how DBT works and its effectiveness, click here.

COPING STRATEGIES FOR OCD AND BPD In addition to evidence-based treatments, coping strategies for both OCD and BPD may include: Developing a mindfulness practice to: Increase awareness of the present moment. This can help one feel more grounded in the here and now than caught up in thoughts or emotions. Increase acceptance of difficult emotions when they arise. This can help one resist getting “hooked” by intrusive thoughts and urges to engage in unhelpful behaviors. Learn grounding skills to use when acutely distressed. See this website for some ideas. Minimize stress in your daily life to reduce vulnerability to triggers. Healthy lifestyle changes, including: Treating physical illness. Maintaining a nutritious and healthy diet. Getting plenty of rest and sleeping well. Exercising regularly.  Spending time in nature and/or community. Developing new hobbies and interests. Join support groups and online forums to connect with others experiencing similar symptoms and behavioral patterns.  Read self-help books to learn more coping skills.

Treatment Considerations for People with Both BPD and OCD

Individuals diagnosed with both BPD and OCD may benefit from a combined treatment approach from a mental health professional experienced in both ERP and DBT. 

Adjunct treatment including group therapy and psychiatric medication may also be helpful for comorbid presentations or more severe symptoms. 

In Summary…

Differentiating between BPD and OCD is crucial for accurate diagnosis and effective treatment. 

We hope this article was helpful in clarifying the main similarities and differences of these conditions, as well as explaining treatment options and coping strategies backed by science.

If you find you need further help or want to learn more, please feel free to reach out to us for a consultation or to request an appointment. 

Thanks for reading!

Mai Buschmann, Psy.D.