Skip to main content

ocd Archives - Suzanne Wallach

Is There A Connection Between BPD and OCD?

Is There A Connection Between BPD and OCD?

Obsessive-compulsive disorder, or OCD, is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as an anxiety disorder. It is a neuropsychiatric disorder affecting between 1 to 3 percent of the population. OCD is characterized as a mental illness involving recurrent unwanted thoughts and/ or actions. OCD is known as one of the most common mental illnesses in America. The precise cause as to why an individual develops obsessive-compulsive disorder remains unknown. Several risk factors that have been noted to increase one’s predisposition for developing OCD include:

  • Presence of other mental health disorder 
  • Family history of OCD (e.g., parent, child, and/ or sibling diagnosed with OCD)
  • Differences in the makeup of one’s brain
  • History of child abuse (e.g., physical, verbal, and/ or sexual)
  • Experience with trauma

It is also possible for OCD to develop in children because of a streptococcal infection. This is referred to as PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections). An individual with OCD will engage in repeated and compulsive rituals that greatly interfere with his or her daily life.

Borderline Personality Disorder

The DSM-5 lists ten personality disorders that are classified into clusters. Although each personality disorder has distinct characteristics, each of the different personality disorders is categorized into one of three clusters (cluster A, cluster B and cluster C). The personality disorders that make up each clusters share similar symptoms and have overlapping characteristics. Borderline personality disorder (BPD) is listed under cluster B in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and is recognized as a chronic, mental health disorder. As defined by the National Institute of Mental Health (NIH), “borderline personality disorder is an illness characterized by an ongoing pattern of varying moods, behavior, and self-image.” The cause for borderline personality disorder remains unknown. However, research “suggests that genetics, brain structure and function, and environmental, cultural, and social factors play a role, or may increase the risk for developing borderline personality disorder.” It is highly common for individuals with BPD to lack the ability to foster and maintain meaningful, lasting relationships. 

The Connection

Experts haveon noted that “personality disorders are a common comorbidity in obsessive-compulsive disorder.” The most evident connection between BPD and OCD relate to the symptoms present in both ailments. The Journal of Psychopathology asserts “Obsessive-compulsive symptoms are…considered intrinsically related to borderline psychopathology. These symptoms are severe and are characterized in BPD patients by poor insight and resistance and obsessive control evident in personal relationships.” The symptoms that manifest because of borderline personality disorder often mimic those of other mental health disorders, which can make the diagnosis process rather challenging. It is, however, possible to be diagnosed with BPD and OCD. In fact, studies show that between 75 and 90 percent of people with BPD also meet the diagnostic criteria for at least one type of anxiety disorder, such as OCD. Specifically, evidence of a higher-than-expected overlap between OCD and BPD first came from the Epidemiological Catchment Area study, where 23 percent of those with BPD also met criteria for OCD. Subsequent studies have consistently supported these findings with rates as high as 15 to 35 percent.  


The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

Drugs vs. Therapy When Treating OCD

Obsessive-compulsive disorder (OCD) is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an anxiety disorder. It is characterized by habitual, recurrent and disturbing thoughts (also known as obsessions) and/ or repetitive behaviors (also known as compulsions). Research has indicated that OCD is rooted in a biochemical imbalance within one’s brain. It is most common for an individual with OCD to experience both obsessions and compulsions. In order for an individual with OCD to manage his or her obsessions, he or she will actively attempt to avoid any triggers, by way of avoiding situations, and/ or neutralizing obsessions by engaging in a related compulsion. Even in situations where an individual with OCD recognizes his or her thoughts and/ or behaviors to be excessive and/ or senseless, he or she will be unable to refrain from carrying them out. OCD can be a debilitating condition as it drastically affects one’s thoughts, actions, and behaviors. There are several common obsessions associated with OCD. They can include, but are not limited to the following examples:

  • Contamination (i.e. fear of germs, dirt, and/ or illness)
  • Safety 
  • Intrusive sexual thoughts 
  • Religiously preoccupied 
  • Unwanted acts of aggression 
  • A need for exactness and/ or symmetry
  • Superstitions 
  • Fear of losing or not having items one needs

The National Institute of Mental Health (NIH) provide examples of commonly reported compulsions in association with OCD, which include the following:

  • Habitually double checking things (i.e. door closed, appliance turned off, water faucet shut…etc.)
  • Constantly engaging in senseless behaviors in attempts to reduce stress (i.e. tapping, counting, repeating words…etc.)
  • Spending excessive amounts of time washing or cleaning (i.e. ritualized hand washing)
  • Consistently and continuously checking in on the safety of loved ones
  • Ordering and/ or arranging things symmetrically and/ or no flexibility regarding the placement of items
  • Unable to discard superfluous items (i.e. hoarding) 

It is not uncommon for an individual with OCD to struggle with several different types of obsession and compulsions simultaneously. Alternatively, some individuals may experience only one component of OCD (either compulsions or obsessions). The symptoms associated with OCD can be incredibly time consuming, and will undoubtedly impede an individual’s relationships as well as interfere with many aspects of his or her daily life. 

Treatment Options

Prior to seeking any type of professional treatment for OCD, an individual must be clinically diagnosed with the disorder. Much like any mental health disorder, it is best to obtain a diagnosis from a qualified mental health professional (i.e. psychiatrist, psychologist, clinical social worker…etc.). This typically includes a comprehensive psychological evaluation as well as a physical exam. Every individual is different and has nuanced needs when it comes to establishing a treatment plan for OCD. Each individual will respond distinctly to the various types of treatment methods available to those with OCD. The typical treatment options for OCD usually consist of medication and/ or psychotherapy. There are a variety of contributing factors when attempting to distinguish which is more effective. It is also not uncommon for both options to be integrated into an individual’s treatment plan.

  • Medication: while medications have not been identified as a sole treatment method for OCD, depending on the situation, there are several psychiatric medications that may be helpful to one’s treatment. For example, antidepressant medications such as SSRIs (selective serotonin reuptake inhibitors) are FDA-approved as an effective treatment option for adults with OCD.
  • Therapy: there are a variety of psychotherapeutic methods relied upon by mental health clinicians to help treat an individual with OCD. Many individuals with OCD will require tailored treatment plans, which often involve utilizing a combination of different therapy strategies. Specific types of therapy frequently used to treat OCD include various types of cognitive behavioral therapy (CBT) and behavior techniques, more specifically the behavioral treatment known as ERP therapy (exposure and response prevention). 

In addition to formalized psychotherapy, there are a myriad of relaxation techniques that can be helpful in managing one’s OCD symptoms. Furthermore, maintaining a healthy lifestyle (i.e. regular exercise, adequate sleep, and healthy eating habits) can contribute to reducing one’s anxieties and keeping OCD symptoms at bay. In situations where medication is deemed beneficial in assisting to regulate the manifestation of one’s OCD symptoms, it is usually done so as a supplementary component of one’s treatment plan that consists of one or more therapeutic modalities. According to the Mayo Clinic, a combination of psychotherapy and medication provide an individual with optimum chances for a successful outcome. Although each individual is different, with the proper treatment, an individual with OCD can generally begin to experience some relief from his or her symptoms within six months. 

OCD Signs in Children and Therapy Options

Obsessive-compulsive disorder (OCD) is a neurobiological illness, and is listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) as an anxiety disorder. It is characterized by excessive, intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions). While the exact cause of OCD remains unknown, certain research findings have indicated that a child diagnosed with OCD does not produce sufficient amounts of serotonin, alluding that the development of OCD may originate within one’s brain. The Obsessive Compulsive Foundation of Metropolitan Chicago asserts that OCD appears to be “at least partially genetic and, in some cases, may be activated by a strep infection.” For children that are genetically predisposed, the onset of OCD can occur as young as three years old. It is more common, however, for OCD symptoms to begin in children around age ten. While there are several overlaps, the signs and symptoms of OCD manifest and are exhibited differently in children than in adults. OCD affects the way a child is able to adequately filter and process information. This, in turn, leads the child to perseverate on thoughts that would be otherwise ignored or dismissed by a child without OCD. 

Signs and Symptoms

Adolescence is a challenging time in one’s life. It is a time of significant physical, emotional, educational and developmental growth. It is not uncommon for a child to exhibit a plethora of varying behaviors prior to and throughout his or her adolescence. The signs and symptoms that a child with OCD may present might appear similar to the neurotypical child, but for a child with OCD they will be debilitating. The International OCD Foundation provide the following examples of commonly reported obsessions and compulsions displayed by children with OCD:

  • Obsessions:
    • Religious fixations
    • Aggressive thoughts
    • Fear of contamination
    • A need for order, symmetry and/ or precision 
    • Sexual thoughts
    • Fear of germs and/ or dirt
    • Preoccupation with bodily waste
    • Intrusive sounds and/ or words
    • Preoccupation with household items
    • Fear of illness and/ or harm coming to oneself and/ or others
  • Compulsions:
    • Repeating rituals (i.e. entering and exiting doorways multiple times) 
    • Ordering and/ or arranging objects
    • Grooming rituals (i.e. showering, brushing teeth, hand washing, hair combing…etc.)
    • Counting rituals
    • Checking rituals (i.e. pushing repeatedly on doors to assure they are closed)
    • Touching rituals
    • Cleaning rituals (i.e. household items)
    • Hoarding 
    • Rituals to prevent self-harm and/ or harming others 

It is important to note that stress does not cause OCD, however it can exacerbate one’s symptoms. It is common for a child to attempt to hide his or her symptoms due to confusion and/ or embarrassment, depending on his or her age. 


Children are highly susceptible to contracting typical illnesses (i.e. strep, the flu, the common cold, conjunctivitis…etc.). Some studies have found that a strep infection may trigger the onset of OCD symptoms in children. When this occurs, it is known as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). The studies indicate that strep antibodies attack certain parts of a child’s brain, which can manifest as OCD symptoms. Although this is possible, it is imperative to bear in mind that the majority of strep infections in children do not lead to the development of any obsessions nor compulsions. Furthermore, most reported childhood OCD is unrelated to infection.

Treatment Options

The most effective method of treatment for children with OCD is formalized psychotherapy. There are a variety of different types of therapy that can be combined to create the ideal treatment plan for a child. Cognitive behavioral therapy (CBT) is most commonly used when treating children with OCD, according to the Child Mind Institute. CBT is multifaceted and a form of psychological treatment that is used by many mental health professionals. One of the specific types of CBT that is used in a child’s treatment plan is known as Exposure and Response Prevention (ERP) therapy. Through ERP therapy a child learns techniques to not only confront his or her obsessions but also actively commit to not engage in the compulsive behavior. 

Depending on several contributing factors, supplementary treatment methods, such as medication, may be incorporated into a child’s treatment plan. Additionally, maintaining a healthy lifestyle by engaging in regular exercise, establishing healthy eating habits, and obtaining ample sleep can help reduce the severity and/ or frequency of a child’s OCD symptoms. With the proper treatment and support a child can learn to control his or her symptoms and implement healthy coping strategies for navigating and managing any subsequent recurrences. 


Back to top