DSM-IV obsessive-compulsive personality disorder: prevalence in patients with anxiety disorders and in healthy comparison subjects

The relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) has not yet been fully clarified. The aim of the present study was to analyze DSM-IV OCPD prevalence rates in OCD and panic disorder (PD) patients to test for the specificity of the OCPD-OCD link, and to compare them to OCPD prevalence in a control group of subjects without any psychiatric disorder. A total of 109 patients with a principal diagnosis of DSM-IV (SCID-I) OCD and 82 with PD were interviewed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) in order to assess the prevalence of OCPD. All patients with a coexisting axis I diagnosis were excluded from the study to eliminate confounding factors when evaluating the association between prevalence rates of OCPD and anxiety disorder diagnoses. An exclusion criteria was also a Hamilton Depression Rating Scale (HAM-D) score >/=16. A sample of comparison subjects (age 18 to 65 years) without any psychiatric disorder was recruited from people registered with two general practitioners (GPs), whether or not they consulted the doctor, in order to evaluate OCPD prevalence rate in the community. A significant difference was found between the prevalence of OCPD in OCD (22.9%) and in PD (17.1%) on one hand, and that in the comparison sample (3.0%) on the other. No differences were found between the two psychiatric groups, even when splitting the samples according to gender. Our study failed to support the hypothesis of a specific relationship between OCPD and OCD; we confirmed the higher prevalence rate of this personality disorder in OCD subjects with regard to the general population, but we also confirmed the higher rate of OCPD in another anxiety disorder which is phenomenologically well characterized and different from OCD, such as PD.     

Factor structure of DSM-IV criteria for obsessive compulsive personality disorder in patients with binge eating disorder

OBJECTIVE: To examine the factor structure of DSM-IV criteria for obsessive compulsive personality disorder (OCPD) in patients with binge eating disorder (BED). METHOD: Two hundred and eleven consecutive out-patients with axis I diagnoses of BED were reliably assessed with semi-structured diagnostic interviews. The eight criteria for the OCPD diagnosis were examined with reliability and correlational analyses. Exploratory factor analysis was performed to identify potential components. RESULTS: Cronbach's coefficient alpha for the OCPD criteria was 0.77. Principal components factor analysis with varimax rotation revealed a three-factor solution (rigidity, perfectionism, and miserliness), which accounted for 65% of variance. CONCLUSION: The DSM-IV criteria for OCPD showed good internal consistency. Exploratory factor analysis, however, revealed three components that may reflect distinct interpersonal, intrapersonal (cognitive), and behavioral features.     

Obsessive-compulsive personality traits: how are they related to OCD severity?

Previous research has demonstrated that comorbid obsessive–compulsive personality disorder (OCPD) in patients with obsessive–compulsive disorder (OCD) is associated with greater overall OCD severity, functional impairment, and poorer treatment outcomes ( [Coles et al., 2008] , [0145] and [0225] ). However, research has only examined the effects of OCPD categorically and has yet to thoroughly examine the impact of individual OCPD characteristics dimensionally. Thus, the present study sought to investigate the relationships between various OCPD-related dimensions (e.g., perfectionism, rigidity) and OCD symptomology and severity. The study recruited a sample of OCD patients (n = 51) in the OCD units of two residential treatment facilities. Findings yielded significant relationships between OCD severity and the following OCPD dimensions: flexibility, doubts about actions (a dimension of perfectionism), and hoarding. Interpretations of these results and the implications for diagnosis, prognosis, and treatment outcome are discussed. Furthermore, the current study provides insight into a unique perspective which leaves room for more symptom overlap and variability between OCD and OCPD.     

Evaluation of DSM-IV personality disorder criteria as assessed by the structured clinical interview for DSM-IV personality disorders

The primary objective of this research was to investigate the psychometric and diagnostic efficiency properties of DSM-IV personality disorder (PD) criteria as assessed by the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Logistic regression analyses were also employed to identify discriminating and nondiscriminating diagnostic criteria within specific PD categories. Results based on a community sample of 149 psychotropic medication-free persons, 58% of whom had at least one PD as determined from the SCID-II, suggest problems with the assessment and/or conceptualization of some PD categories, most notably obsessive-compulsive PD. For many PD concepts, diagnostic criteria were identified that either detracted from the overall internal consistency and diagnostic efficiency of their associated PD criteria set or failed to uniquely discriminate individuals with specific PDs from those without. Most of these findings cannot be clearly attributed to limitations associated with the method used to assess PD criteria.     

Hoarding in obsessive-compulsive disorder and related disorders: a preliminary report of 15 cases

Hoarding, the repetitive collection of excessive quantities of poorly useable items of little or no value with failure to discard these items over time, is characterized in DSM-IV as a symptom of obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) but has, until recently, received scant empirical investigation. We describe the demographics, phenomenology, associated psychopathology and family history in 15 subjects presenting with hoarding behavior. Fifteen subjects were recruited from an OCD clinic and newspaper advertisement and assessed with the comprehensive Structured Clinical Interview for DSM-IV (SCID I and II), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and a hoarding questionnaire (devised by the authors). The sample comprised 11 women and four men who hoarded a mean of seven item types, with a mean duration of 13.2 +/- 3.9 years (range 2-15 years). Their mean age was 41.8 +/- 14.3 years (range 20-65 years). The most common motive for hoarding was the fear of discarding items of practical value. Nine subjects met DSM-IV criteria for OCD, 9 met criteria for OCPD, for symptoms and behaviors other than hoarding, while six subjects met criteria for a putative OCD spectrum disorder (Tourette's, body dysmorphic disorder, trichotillomania). Six subjects reported little or no control over their hoarding, but only one subject saw her symptoms as an 'illness' warranting treatment. Pathological hoarding is usually a covert and chronic behavior causing distress and/or impairment, and may be related to OCD and OCPD. Hoarding may meet the criterion for a compulsion in DSM-IV, yet there is evidence to suggest that hoarding may manifest in a variety of other psychiatric conditions. While a range of pharmacologic and behavioral treatments have been tried, their effectiveness in managing hoarding behaviors requires additional research.     

Longitudinal diagnostic efficiency of DSM-IV criteria for obsessive-compulsive personality disorder: a 2-year prospective study

OBJECTIVE: To examine the longitudinal diagnostic efficiency of the DSM-IV criteria for obsessive-compulsive personality disorder (OCPD). METHOD: At baseline, criteria and diagnoses were determined using diagnostic interviews, and blinded assessments were performed 24 months later with 550 participants. Diagnostic efficiency indices (conditional probabilities, total predictive power, and kappa) were calculated for each criterion determined at baseline, using the independent OCPD diagnosis at follow-up as the standard. RESULTS: Longitudinal diagnostic efficiencies for the OCPD criteria varied; findings suggested the overall predictive utility of 'preoccupied with details', 'rigid and stubborn', and 'reluctant to delegate'. CONCLUSION: These findings suggest the predictive validity of three cognitive-interpersonal OCPD criteria.     

Relationship between perfectionism,personality disorders and agoraphobia in patients with panic disorder

OBJECTIVE: In earlier reports, we found that perfectionism might be involved in the development and/or maintenance of agoraphobia in panic disorder. The present report extends this work by examining the relationship between perfectionism and comorbidity with personality disorders in panic disorder patients with agoraphobia (PDA) and those without agoraphobia (PD). METHOD: We examined comorbidity of personality disorders by Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and assessed perfectionism using multidimensional perfectionism scale in 56 PDA and 42 PD patients. RESULTS: The PDA group met criteria for at least one personality disorder significantly more often than the PD group. With stepwise regression analyses, avoidant and obsessive-compulsive personality disorders emerged as significant indicators of perfectionism in patients with panic disorder. CONCLUSION: These findings suggest that perfectionism in panic disorder patients may be more common in those with comorbid personality disorders, and may be an important target for preventive and therapeutic efforts.     

OCD with comorbid OCPD: a subtype of OCD?

OBJECTIVE: The current study examined the validity of using comorbid obsessive-compulsive personality disorder (OCPD) to identify a subtype of individuals with obsessive-compulsive disorder (OCD). METHOD: Data for the current study were drawn from an ongoing, longitudinal study of the course of OCD and include intake assessments for 238 subjects with primary and current DSM-IV OCD who were treatment seeking. RESULTS: More than one fourth of the subjects (N=65, 27%) met criteria for comorbid OCPD. As compared to OCD-OCPD subjects, the OCD+OCPD subjects had a significantly younger age at onset of first OC symptoms (p=0.013), and a higher rate of symmetry and hoarding obsessions, and cleaning, ordering, repeating, and hoarding compulsions (all p's<0.01). Individuals with OCD+OCPD had higher rates of comorbid anxiety disorders (p=0.007) and avoidant personality disorder (p=0.006). The OCD+OCPD subjects also had significantly lower ratings of global functioning (p=0.001) and more impaired social functioning (p=0.004), despite a lack of significant differences on overall severity of OCD symptoms. CONCLUSIONS: Our findings indicate that individuals with both OCD and OCPD have distinct clinical characteristics in terms of age at onset of initial OC symptoms, the types of obsessions and compulsions they experience, and psychiatric comorbidity. Our findings, coupled with data from family studies showing a higher than expected frequency of OCPD in first degree relatives of OCD probands, suggest that OCD associated with OCPD may represent a specific subtype of OCD. Additional research is warranted to further establish the validity of this subtype.     

Twelve month test-retest reliability of a Japanese version of the Structured Clinical Interview for DSM-IV Personality Disorders

The purpose of the present study was to examine the long-interval test-retest reliability of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) Axis II Personality Disorders (SCID-II) Japanese version. One hundred and twenty outpatients with anxiety disorders completed the self-report SCID-II personality questionnaire (SCID-II-PQ) and structured interviews, and then again 12 months later. In the SCID-II-PQ, 70.8% and 71.7% of the patients had a personality disorder (PD) at the first evaluation and second evaluation 12 months later, respectively, and Cohen's kappas ranged from 0.29 for paranoid PD to 0.83 for histrionic PD, and overall kappa was 0.56. In the SCID-II interviews, 47.5% and 41.7% of the patients fulfilled the criteria for PD at the first and the second evaluations, respectively. At least one PD was identified in 49 subjects (40.8%), of whom 65.3% had one PD, 30.6% had two PD, 2% had three PD, and 2% had four PD; the most frequently diagnosed PD were from cluster C (60.9%). The overall base rate of 12 PD was 7%, and overall kappa was 0.87. Cohen's kappas ranged from 0.86 for obsessive-compulsive PD to 0.93 for avoidant PD and schizoid PD, and were comparable with those in the previous interrater studies. The test-retest reliability of the SCID-II-PQ was moderately good, and after the SCID-II interview the test-retest reliability of the SCID-II appeared to be of almost perfect reliability. This first long-interval, large-sample, non-Western-language research on the test-retest reliability of the SCID-II for DSM-IV indicated its usefulness and excellent reliability.     

Association between a serotonin transporter promoter polymorphism (5HTTLPR) and personality disorder traits in a community sample

Background

The serotonin transporter (SERT) polymorphism (5HTTLPR) has been reported to be associated with several psychiatric conditions. Specific personality disorders could be intermediate factors in the known relationship between 5HTTLPR and psychiatric disorders. This is the first study to test the association between this polymorphism and dimensions of all DSM-IV personality disorders in a community sample.

Methods

374 white participants were assessed by clinical psychologists using the International Personality Disorder Examination (IPDE). Associations between dimensions of each DSM-IV personality disorder and the long (l) and short (s) alleles of the 5HTTLPR were evaluated using non-parametric tests and regression models.

Results

The s allele of the 5HTTLPR polymorphism was significantly associated with higher avoidant personality trait scores in the whole sample. Males with the s allele had a significantly lower likelihood of higher obsessive-compulsive personality disorder (OCPD) trait scores, whereas females with the s allele were likely to have higher OCPD personality trait scores.

Conclusion

This paper provides preliminary data on the relationship between personality disorders and the 5HTTLPR polymorphism. The relationship of the s allele and avoidant PD is consistent with findings of a nonspecific relationship of this polymorphism to anxiety and depressive disorders. Concerning the unusual sexual dimorphic result with OCPD, several hypotheses are presented. These findings need further replication, including a more detailed study of additional variants in SERT.     

Utility of the Leyton Obsessional Inventory to distinguish OCD and OCPD

The Leyton Obsessional Inventory (LOI) is a self-report questionnaire that assesses obsessional symptoms. The ability of the LOI to distinguish between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) has not been adequately addressed. Our purpose is to identify dimensions of obsessional symptoms from the LOI and determine how well they distinguish between OCD and OCPD. The LOI was completed by 488 participants diagnosed by trained clinicians. Factor analysis was performed on responses to the interference items of the LOI. The relationship between the factors, OCD and OCPD was evaluated using logistic regression. Five factors underlying the LOI were identified: (I) obsessional ruminations and compulsions, (II) ordering and arranging, (III) organizing activities, (IV) contamination, and (V) parsimony. Factors I, III, and IV were strongly associated with OCD. Only Factor II was associated with OCPD. Factor IV was negatively associated with obsessive-compulsive personality traits. LOI factors are useful in discriminating between OCD and OCPD. Obsessional ruminations and compulsions, organizing activities, and contamination fears may indicate OCD, and ordering and arranging symptoms may indicate OCPD rather than OCD. Parsimony may indicate neither disorder, and contamination, the absence of OCPD traits compared with the other LOI factors. These findings may contribute to effective diagnosis and treatment by allowing the LOI to screen for OCD and OCPD in a population exhibiting obsessional symptoms and traits.     

Personality disorder traits associated with risk for unipolar depression during middle adulthood

Data from the Children in the Community Study, a prospective longitudinal investigation, were used to investigate the association of personality disorder (PD) traits, evident by early adulthood, with risk for the development of unipolar depressive disorders by middle adulthood. Antisocial, borderline, dependent, depressive, histrionic, and schizotypal PD traits, identified between ages 14 and 22, were significantly associated with risk for dysthymic disorder (DD) or major depressive disorder (MDD) by a mean age of 33 after a history of unipolar depression and other psychiatric disorder was controlled statistically. Individuals without a history of unipolar depression who met diagnostic criteria for > or =1 PD by a mean age of 22 were at elevated risk for DD or MDD by a mean age of 33 years. Individuals identified as having a DSM-IV Cluster A (paranoid, schizoid, or schizotypal) or Cluster C (avoidant, dependent, obsessive-compulsive) PD by a mean age of 22 years were at elevated risk for recurrent or chronic unipolar depression. The findings of this study suggest that some types of PD traits that become evident by early adulthood may contribute to an increased risk for the development or recurrence of unipolar depressive disorders by middle adulthood.     

Personality disorders and relationship to personality dimensions measured by the Temperament and Character Inventory in patients with obsessive-compulsive disorder

The occurrence of personality disorders was investigated in 36 patients with obsessive-compulsive disorder by means of the SCID Screen questionnaire. In addition, the personality dimensions were explored by means of the Temperament and Character Inventory (TCI). In total, 75% of the patients fulfilled the criteria for a personality disorder according to the SCID Screen questionnaire, mostly (55%) within cluster C. Several significant correlations were found between the separate personality disorders (PD) and subscales of the TCI, the most pronounced being between avoidant and obsessive-compulsive PD and novelty-seeking and self-directedness. Strong correlations were also found between self-directedness and paranoid and borderline PD. In multiple regressions where the presence of PD in clusters A, B and C, respectively, were used as dependent variables and where the separate subscales of the TCI were used as independent variables, the multiple R reached 0.68, 0.76 and 0.80 in clusters A, B and C, respectively. Thus 46–64% of the variance in the personality disorder clusters could be explained by the TCI subscales.     

Disentangling depressive personality disorder from avoidant, borderline, and obsessive-compulsive personality disorders

Several studies have found that 3 personality disorders (PDs) tend to share moderate rates of comorbidity with depressive PD: avoidant, borderline, and obsessive-compulsive. This study sought to evaluate the diagnostic criteria of each disorder in an effort to understand where areas of overlap may occur and to modify criteria sets where reasonable to reduce any degree of overlap. One thousand two hundred psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality Disorders. The highest degree of comorbidity was observed between avoidant PD and depressive PD. Logistic regression analyses indicated that 2 criteria-avoidant criterion 5 and depressive criterion 2-could be removed from the diagnostic criteria sets and reduce the rates of overlap by as much as 15%. A factor analysis of the criteria of all 4 PDs indicated that there is a common clustering of many of the symptoms of avoidant, borderline, depressive, and obsessive-compulsive PDs and that borderline symptoms tend to cluster together most consistently. Avoidant and obsessive-compulsive personality symptoms clustered in ways that may reflect a problem of how to engage with others, suggestive of an approach-avoidance conflict. Depressive PD symptoms clustered in a way suggestive of problems with anger that is directed toward oneself and others. The factor analysis results suggest that an organization of symptoms around themes of conflict may provide useful ways of understanding the personality patterns of these 4 disorders.     

Obsessive-compulsive personality disorder traits and personality dimensions in parents of children with obsessive-compulsive disorder

PurposeTo compare patterns of temperament and character and the prevalence of Obsessive-Compulsive Personality Disorder (OCPD) and OCPD traits in parents of children with OCD and parents of healthy controls.MethodsTCI and SCID-II were administered to 63 parents of 32 children with OCD and 63 parents of age- and sex-matched controls with no psychiatric diagnosis. Interviewers were not blind to proband status. Personality dimension scores and frequencies of OCPD criteria in both groups were compared after excluding parents with a diagnosis of OCD. Relationships between TCI dimensions and OCPD symptoms in parents and the clinical characteristics of OCD children were also studied.ResultsParents of OCD children presented significantly higher scores in harm avoidance and lower scores in self-directedness, cooperativeness and reward dependence than parents of healthy children. A higher incidence of OCPD was found in parents of probands (p < 0.02). Hoarding, perfectionism and preoccupation with details were significantly more frequent in parents of OCD children. Counting, ordering and cleaning compulsions in OCD children predicted elevated odds of perfectionism and rigidity in their parents.ConclusionsThe existence of the dimensional personality profile associated with OCD in parents of children with OCD and the higher number of OCPD criteria in these parents in comparison to parents of healthy children highlight the importance of the role of personality factors in familial OCD.     

Some suggestions for the DSM-5 schizotypal personality disorder construct

This study relates to the schizotypal personality disorder (SPD) proposal of the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by investigating the construct validity of SPD as defined by DSM-IV in a large sample of patients from the Norwegian Network of Personality-Focused Treatment Programs (N = 2619), assessed by structured diagnostic interviews and the Longitudinal, Expert All Data standard. We investigated factor structure and psychometric properties of the SPD criteria, as well as co-occurrence patterns between SPD and other PDs. Thirty-six patients were diagnosed with SPD and 513 patients (21%) endorsed at least 2 schizotypal criteria. We found that 2 factors were specific for SPD, a cognitive-perceptual factor (ideas of reference, magical thinking, and unusual perceptual experiences) and an oddness factor (odd thinking and speech, constricted affect, and odd appearance or behavior). The criteria belonging to these factors had appropriate psychometric properties. The criteria of the cognitive-perceptual factor were more strongly associated with borderline personality disorder (PD) than with the other PDs. We did not find support for a consistent factor that reflected interpersonal problems. The criteria that used to be part of this factor (suspiciousness, lack of friends or confidants, and excessive social anxiety) performed poorly as specific SPD criteria. SPD was more strongly associated with antisocial PD and paranoid PD than with the other PDs. We suggest that ideas of reference should be included explicitly under the schizotypal facet of cognitive dysregulation in DSM-5, with less emphasis on the social phobic aspects of this feature. Furthermore, there should be more emphasis on the cognitive aspects of suspiciousness in SPD, and it should be considered to split up the affectivity criterion into constricted affect and inappropriate affect, with the latter type of affect being the expression of problems with intersubjective regulation. Finally, it is suggested that interpersonal dysfunction is secondary to the 2 primary SPD factors. Therefore, the SPD narrative should start by describing eccentricity and cognitive-perceptual aberrations rather than interpersonal difficulties.     

Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders

OBJECTIVE: This study tracked the individual criteria of four DSM-IV personality disorders-borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders-and how they change over 2 years. METHOD: This clinical sample of patients with personality disorders was derived from the Collaborative Longitudinal Personality Disorders Study and included all participants with borderline, schizotypal, avoidant, or obsessive-compulsive personality disorder for whom complete 24-month blind follow-up assessments were obtained (N=474). The authors identified and rank-ordered criteria for each of the four personality disorders by their variation in prevalence and changeability (remission) over time. RESULTS: The most prevalent and least changeable criteria over 2 years were paranoid ideation and unusual experiences for schizotypal personality disorder, affective instability and anger for borderline personality disorder, feeling inadequate and feeling socially inept for avoidant personality disorder, and rigidity and problems delegating for obsessive-compulsive personality disorder. The least prevalent and most changeable criteria were odd behavior and constricted affect for schizotypal personality disorder, self-injury and behaviors defending against abandonment for borderline personality disorder, avoiding jobs that are interpersonal and avoiding potentially embarrassing situations for avoidant personality disorder, and miserly behaviors and strict moral behaviors for obsessive-compulsive personality disorder. CONCLUSIONS: These patterns highlight that within personality disorders the relatively fixed criteria are more trait-like and attitudinal, whereas the relatively intermittent criteria are more behavioral and reactive. These patterns suggest that personality disorders are hybrids of traits and symptomatic behaviors and that the interaction of these elements over time helps determine diagnostic stability. These patterns may also inform criterion selection for DSM-V.     

The prevalence and structure of obsessive-compulsive personality disorder in Hispanic psychiatric outpatients

This study sought to confirm a multi-factor model of Obsessive-compulsive personality disorder (OCPD) in a Hispanic outpatient sample and to explore associations of the OCPD factors with aggression, depression, and suicidal thoughts. One hundred and thirty monolingual, Spanish-speaking participants were recruited from a community mental health center and were assessed by bilingual doctoral-level clinicians. OCPD was highly prevalent (26%) in this sample. Multi-factor models of OCPD were tested and the two factors - perfectionism and interpersonal rigidity - provided the best model fit. Interpersonal rigidity was associated with aggression and anger while perfectionism was associated with depression and suicidal thoughts.     

Differences in DSM-III-R and DSM-IV diagnoses in eating disorder patients

Two hundred eighty-eight eating disorder patients were administered the DSM-III-R Structured Clinical Interview (SCID) and the DSM-IV SCID for axis I and II. Concordance between DSM-III-R and DSM-IV was excellent for the axis I affective and anxiety disorders, bulimia nervosa, and substance abuse/dependence. It was also excellent for axis II paranoid, schizoid, borderline, and antisocial personality disorders. Agreement between the two nosological systems was lower for alcohol abuse/dependence with a kappa of.63. Kappas were also poor for the following personality disorders: schizotypal (.44), histrionic (.29), dependent (.54), obsessive-compulsive (.62) and not otherwise specified (.63). There was a substantial difference in the diagnosis of anorexia nervosa between DSM-III-R and DSM-IV. Fourteen patients were diagnosed with anorexia nervosa, binge/purge type, using DSM-IV criteria, while only six received the diagnoses of anorexia nervosa and bulimia nervosa using DSM-III-R criteria. Kappa was.49 and the percent agreement was 79%. While there are considerable areas of overlap in DSM-IV and DSM-III-R, there are also areas of substantial differences. Clinicians and researchers must be very cautious when attempting to compare data from the different nosologies.