Where is the line between perfectionism and OCD?

DEAR DOCTOR K:

I think of myself as a perfectionist. But more than one person has jokingly referred to me as “OCD.” Where is the line between the two?

DEAR READER:

Where is the line between a common way of behaving and a mental health disorder? It’s a common question, and I’m not sure it can ever have a definite answer on which everyone would agree.

First of all, when is perfectionism a good thing, and when is it a human tendency that goes overboard? My answer: Perfectionism is a good thing if the goal at hand absolutely requires it.

Do I want the pilot of my plane to go through his pre-takeoff checklist with perfect accuracy? You bet.

Do I want that pilot to be absolutely sure there is not a single flake of dandruff on his jacket as we take off? I really don’t care. But if he wants to impress a co-worker, he might care a lot. I wouldn’t begrudge him his perfectionism.

At the same time, perfectionism can go overboard. Should the pilot on my plane go through the takeoff checklist four or five times, to be absolutely sure everything is in order? Well, I want the flight to be safe, but I also want to take off on time.

Can there be a fine line between perfectionism and obsessive-compulsive disorder (OCD)? Yes, but not usually. A person with OCD has uncontrollable obsessions and compulsions. Obsessions are involuntary and repetitive thoughts, worries or urges. Compulsions are ritual behaviors.

A person uses obsessions and compulsions in an attempt to feel safe and decrease anxiety — but there is no rational reason for them to feel unsafe and anxious. Adults with OCD may realize that their thoughts and behaviors are unreasonable. But they can’t control them. That’s because doing so causes unbearable anxiety.

I spoke to my colleague, Dr. Jeff Szymanski, a clinical psychologist and executive director of the International OCD Foundation. He drew the following comparison to show the distinction between perfectionism and OCD:

Say a person with OCD and a perfectionist are writing an essay on ruled-line blank paper. Both might aim to write so that every letter touches the ruled line and is exactly the same height. In a person with OCD, however, a mistake would require erasing everything and starting over again.

The core of perfectionism is the intention to do something well. If you can keep your eye on that goal, you’re fine. But does the effort to do things perfectly become so time-consuming that you lose sight of the big picture? Are you spending so much time on unimportant details that you no longer have time to pursue your hobbies? If so, you may have a problem.

If you’re concerned, see a mental health specialist. There are effective treatments for OCD — usually selective serotonin reuptake inhibitor (SSRI) antidepressants combined with talk therapy, such as cognitive behavior therapy (CBT) or exposure therapy.