Obsessive-Compulsive Personality Disorder and Eating Disorders

Obsessions, compulsions, and personality traits such as perfectionism and inflexibility are commonly described in eating disorder patients. A lack of precise clarification has existed in defining the presence of obsessive-compulsive disorder and obsessive-compulsive personality disorder in the various eating disorder subtypes. Research clarifying these definitions and the components of perfectionism as it pertains to eating disorders is reviewed in this article.     

Obsessive-Compulsive Personality Disorder and Eating Disorders

Obsessions, compulsions, and personality traits such as perfectionism and inflexibility are commonly described in eating disorder patients. A lack of precise clarification has existed in defining the presence of obsessive-compulsive disorder and obsessive-compulsive personality disorder in the various eating disorder subtypes. Research clarifying these definitions and the components of perfectionism as it pertains to eating disorders is reviewed in this article.     

Boldness Explains a Key Difference Between Psychopathy and Antisocial Personality Disorder

Although antisocial personality disorder (ASPD) has represented the current operationalization of psychopathy since DSM?III, it has long been recognized as failing to capture the full range of the construct. The current study examined the degree to which Boldness, a trait domain within the triarchic conceptualization of psychopathy that captures fearlessness, dominance and low stress reactivity, represents a distinct difference between psychopathy and ASPD. Utilizing a sample of 152 male prison inmates, the current study examined the extent to which Boldness, relative to Meanness and Disinhibition (indexed by the Triarchic Psychopathy Measure [TriPM]), accounted for incremental variance beyond ASPD symptom counts (indexed by the Structured Clinical Interview for DSM?IV Axis II Disorders ASPD module) in predicting psychopathy (as indexed by Psychopathy Checklist-Revised [PCL?R] total, factor and facets scores). TriPM Boldness added to the incremental prediction of PCL?R Factor 1 (Interpersonal/Affective) and Facet 1 (Interpersonal) scores above and beyond ASPD scores.     

Comparison of Attachment Styles in Borderline Personality Disorder and Obsessive-Compulsive Personality Disorder

The intense, unstable interpersonal relationships characteristic of patients with borderline personality disorder (BPD) are thought to represent insecure attachment. The Reciprocal Attachment Questionnaire was used to compare the attachment styles of patients with BPD to the styles of patients with a contrasting personality disorder, obsessive-compulsive personality disorder (OCPD). The results showed that patients with BPD were more likely to exhibit angry withdrawal and compulsive care-seeking attachment patterns. Patients with BPD also scored higher on the dimensions of lack of availability of the attachment figure, feared loss of the attachment figure, lack of use of the attachment figure, and separation protest. The findings may be relevant for understanding the core interpersonal psychopathology of BPD and for managing therapeutic relationships with these patients.     

Anxiety Disorders and Obsessive-Compulsive Disorder in Individuals with Autism Spectrum Disorder

Purpose of Review

This review aims to synthesize the most recent research on anxiety disorders and obsessive-compulsive disorder (OCD) in individuals with autism spectrum disorder (ASD) and discuss the relationship between these conditions and challenges for assessment. Furthermore, implications for treatment and future directions are discussed.

Recent Findings

Research suggests that anxiety disorders and OCD are highly prevalent in individuals with ASD. However, the significant overlap of ASD features with anxiety and OCD symptomology makes differential diagnosis of these disorders particularly challenging. Though several treatments for anxiety have been adapted for youth with ASD (e.g., cognitive behavior therapy), pharmacological treatments and treatments for adults are still marked undeveloped.

Summary

Despite the high prevalence of anxiety disorders and OCD in ASD and some recent advances in assessment and treatment, research is needed to clarify the multifaceted relationship of these conditions and develop tailored assessment and treatment approaches appropriate for a full range of individuals with ASD.

     

Examining the Evidence for Anxiety-Related Cognitive Biases in Obsessive-Compulsive Disorder

In light of current concerns about the diagnostic classification of obsessive-compulsive disorder (OCD), this article critically examines recent experimental research on anxiety-related cognitive biases in OCD in order to determine whether it provides grounds for OCD’s differentiation from other anxiety disorders. This small body of work is found to be fraught with defects, anomalies, and inconsistencies. These findings contrast dramatically with the robust results obtained with other clinical anxiety disorders. When biases are in evidence it tends to be with a select group of subjects, that is, those with contamination concerns. It is suggested that only this subtype of OCD, or some core characteristic underlying it, may be associated with cognitive tendencies comparable to those found in other anxiety disorders (i.e., biases at the attentional level associated with the emotional tone, or content, of information). Cognitive tendencies in other subtypes likely require different explanatory frameworks. This review provides evidence for the partial uniqueness of OCD from other anxiety disorders.     

The 5-Year Course of Obsessive-Compulsive Symptoms and Obsessive-Compulsive Disorder in First-Episode Schizophrenia and Related Disorders

Objective: To determine the course of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) in first-episode schizophrenia and related disorders and their relationship with clinical characteristics. Methods: Consecutively, admitted patients with a first-episode of schizophrenia, schizophreniform disorder, or schizoaffective disorder were screened for OCS, and these were measured with the Yale-Brown Obsessive-Compulsive Scale. Positive and Negative Syndrome Scale and Montgomery Åsberg Depression Rating Scale were used to assess severity of other symptoms. The course of 3- and 5-year symptoms, psychotic relapse, substance use, remission, full recovery, suicide, and social functioning were assessed. Results: One hundred and eighty-six consecutively admitted and consenting patients were included. Five years after admission, OCS could be assessed in 172 patients. Ninety-one patients (48.9%) reported no OCS symptoms on any of the assessments. OCS restricted to the first assessments occured in 15.1%, 13.4% had persistent OCS, 7.0% had no OCS at first assessment but developed OCS subsequently, and 15.6% had intermittent OCS. The proportion of patients with comorbid OCD varied between 7.3% and 11.8% during follow-up. OCD was associated with more severe depressive symptoms and poorer premorbid functioning and social functioning at follow-up. Conclusions: The 5-year course of OCS/OCD in patients with first-episode schizophrenia or related disorders is variable. OCS/OCD comorbidity was not associated with a more severe course of psychotic symptoms and relapse. Comorbid OCD was associated with more severe depressive symptoms, social dysfunction and worse premorbid functioning. Specific treatment options for schizophrenia patients with comorbid OCD are needed.     

Obsessive-Compulsive Disorder,Psychosis, and Bipolarity: A Longitudinal Cohort and Multigenerational Family Study

Obsessive-compulsive disorder (OCD) often co-occurs with psychotic and bipolar disorders; this comorbidity complicates the clinical management of these conditions. In this population-based longitudinal and multigenerational family study, we examined the patterns of comorbidity, longitudinal risks, and shared familial risks between these disorders. Participants were individuals with a diagnosis of OCD (n = 19814), schizophrenia (n = 58336), bipolar disorder (n = 48180), and schizoaffective disorder (n = 14904) included in the Swedish Patient Register between January 1969 and December 2009; their first-, second-, and third-degree relatives; and population-matched (1:10 ratio) unaffected comparison individuals and their relatives. The Swedish Prescribed Drug Register was used to control for the potential effect of medication in the longitudinal analyses. Individuals with OCD had a 12-fold increased risk of having a comorbid diagnosis of schizophrenia and a 13-fold increased risk of bipolar disorder and schizoaffective disorder. Longitudinal analyses showed that individuals first diagnosed with OCD had an increased risk for later diagnosis of all other disorders, and vice versa. The risk of bipolar disorder was reduced, but not eliminated, when the use of selective serotonin reuptake inhibitors was adjusted for. OCD-unaffected first-, second-, and third-degree relatives of probands with OCD had a significantly increased risk for all 3 disorders; the magnitude of this risk decreased as the genetic distance increased. We conclude that OCD is etiologically related to both schizophrenia spectrum and bipolar disorders. The results have implications for current gene-searching efforts and for clinical practice.Key words: OCD, schizophrenia, schizoaffective disorder, bipolar disorder, genetic epidemiology     

Risk Factors in Childhood That Lead to the Development of Conduct Disorder and Antisocial Personality Disorder

With juvenile crime on the rise, understanding and preventing juvenile delinquency is one of the greatest challenges facing mental health professionals today. Recognizing early signs of conduct disorder (CD) can be difficult, but identifying risk factors is an important step in preventing a child's progression to CD or Antisocial Personality Disorder (APD). This paper focuses on various risk factors for CD and APD, such as intrinsic individual differences, psychosocial/environmental factors, genetic and neurochemical factors. Early recognition and intervention may prevent the progression from aggressive and maladaptive behaviors to CD and later APD.     

Personality and Alexithymic Disparity in Obsessive-Compulsive Disorder Based on Washing and Checking

The aim of this study was to investigate pathway relationship of personality characteristics and alexithymic traits in OCD symptoms of obsession, and compulsive behavior of washing and checking. Two-hundred and seventy patients diagnosed with OCD were consecutively recruited from the psychiatric outpatient department of a teaching hospital. Structural equation modeling showed those more neurotic, less extraverted and with higher levels of alexithymia difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT) were more likely to develop obsessive thoughts. Those less extraverted was more prone to develop washing compulsions, and those more neurotic were more likely to develop checking compulsions. EOT was the only alexithymic trait to have no gender difference within this group of patients with OCDs. The different personality and alexithymic trait pathways found between OCD obsession, washing and checking symptoms provide support that they may be different subtypes within the OCD diagnosis. Obsession was associated with washing, but not checking. Furthermore, no gender difference was found between the obsession and compulsive symptoms. Extraversion and neuroticism can be used to differentiate washing and checking, and alexithymia to differentiate washing and obsessions. This should be taken into consideration for intervention targeting patients with different OCD symptoms.     

Diagnosing Evil in Australian Courts: Psychopathy and Antisocial Personality Disorder as Legal Synonyms of Evil

Mental health review tribunals (MHRTs) were established under the Mental Health Act (MHA) 1959 (UK) as one of the “main safeguards against improper admission under compulsory powers” and “unduly protracted detention”. In the United Kingdom a draft Mental Health Bill was published in June 2002. It proposed a new legal framework for the compulsory treatment and detention of people defined as mentally disordered. The mental health review tribunal is to be replaced by a new mental health tribunal. Although the aim of the new tribunal — the mental health tribunal — remains the same, there are some fundamental differences in the way in which the tribunal will operate. In this article the author uses the findings from previous research on decision-making in mental health review tribunals to assess the nature of the proposed tribunal reforms.     

Smoking Prevalence,Nicotine Dependence,and Impulsivity in Obsessive-Compulsive Disorder

This study compared obsessive-compulsive disorder (OCD) and control participants in terms of smoking prevalence, nicotine dependence, and impulsivity. Data derived from 314 OCD patients and 319 control participants revealed that smoking prevalence did not differ between the two groups yet the severity of nicotine dependence was higher among OCD patients. OCD group also exhibited greater total, cognitive, and non-planning impulsivity than controls, and this pattern of differences was also evidenced in OCD and control current and never smokers. In both OCD and control group, modest positive associations were found between impulsivity and nicotine dependence, yet the relationships were relatively stronger for the OCD group. Results are discussed in terms of how smoking, dependence, and impulsivity might articulate to play a role in obsessive-compulsive disorder.

     

The Place of Antipsychotics in the Therapy of Anxiety Disorders and Obsessive-Compulsive Disorders

Purpose of Review

The purpose of this review was to assess and present the findings up to this date on the efficacy of antipsychotics in the treatment of generalized anxiety disorders (GAD), social anxiety disorders (SAD), panic disorders (PD), and obsessive-compulsive disorders (OCD), mostly based on published randomized controlled trials (RCTs) or on open-label studies when RCT were lacking.

Recent Findings

Quetiapine could be recommended in patients with GAD. The efficacy of aripiprazole in two open-label studies on patients with antidepressant-refractory GAD should be assessed in RCTs. Despite preliminary positive results in open studies, there are currently no strong evidence for the effectiveness of antipsychotics in refractory SAD and in refractory PD. Conversely, risperidone and aripiprazole can be used for the treatment of refractory OCD as augmentation agents to antidepressants.

Summary

Contrary to SAD and PD, this review found evidence for the use of second-generation antipsychotics in GAD and OCD. Otherwise, first-generation antipsychotics cannot be recommended in anxiety disorders and OCD.