DSM-IV Obsessive-Compulsive Personality Disorder: Prevalence in Patients With Anxiety Disorders and in Healthy Comparison Subjects
Albert U, Maina G, Forner F and Bogetto F;
Commented by , 22 Sep 2004
Aims of the study
To assess the prevalence of Obsessive-Compulsive Personality Disorder (OCPD) in patients with Obsessive-Compulsive Disorder (OCD), in patients with Panic Disorder (PD), and in healthy controls without any Axis I disorder.
Method
109 patients with OCD and 82 patients with PD were compared with 101 patients without a diagnosis of an Axis I disorder. Axis I diagnoses were assessed using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Patients with diagnoses other than OCD or PD were excluded. Severity of OCD was assessed using the Yale-Brown Obsessive-Compulsive Scale (YBOCS).
Severity of PD was assessed using the Sheehan Clinician Rated Anxiety Scale (SCRAS). The presence of OCPD in patients and in controls was assessed using the Structural Diagnostic Interview for DSM-IV Axis II disorders (SCID-II).
Results
Prevalence of OCPD was 22.9% in the OCD group, 17.1% in the PD group, and 3.0% in the control group. The prevalence of OCPD was significantly higher in patients with OCD and in patients with PD, but there was no significant difference in prevalence rates of OCPD between patients with either OCD or PD
Discussion
The relationship between OCD and OCPD has been debated all through the past century and has remained controversial up to the present. Kraepelin, Freud and Janet have postulated a close relationship between the two disorders. Recent investigations have, however, not confirmed this relationship.
First, recent studies based upon DSM-III-R diagnostic criteria have found rather low prevalence rates of OCPD in OCD, ranging from about 5% to 36% (ref. 1). The study by Albert et al. is the first investigation using DSM-IV diagnostic criteria. The results confirm that OCPD, whether based on DSM-III-R criteria or DSM-IV criteria, occurs more frequently in OCD than in the general population, but that it is not an intrinsic feature of OCD.
In addition, OCPD is often present in disorders other than OCD and as such is not specific of OCD. Several recent studies (ref. 2) have found high rates of co-occurrence between OCPD and other Axis I disorders, including major depressive disorder, general anxiety disorder, alcohol and drug abuse or dependence, and eating disorders. The prevalence of 17.1% in PD reported by Albert et al. is in line with these findings.
One limitation of the study is that it does not give any information on the prevalence of other personality disorders in OCD. According to recent studies (ref. 3 and 4) there is considerable overlap between OCPD and other personality disorders, especially with avoidant PD, dependent PD, and borderline PD. A second limitation is that the study does not provide any information on the prevalence of OCPD (called anankastic personality disorder) according to ICD-10 criteria. Since two of the ICD-10 criteria for anankastic PD are not listed in DSM-IV-TR, and two of the DSM-IV-TR criteria for obsessive-compulsive disorder are not listed in ICD-10, the prevalence rates of OCPD may be different from those of anankastic PD
On the whole, this is an interesting contribution to the ongoing debate concerning the relationship between OCD and OCPD. The results confirm that OCD and PCPD, based upon DSM-IV criteria, are two distinct entities. Whether OCPD should be considered as a discrete entity at all, distinct or not from OCD, or rather as a dimension, is part of another debate that remains unsolved.
References
1. The article discussed here (by Albert et al.) includes 15 references on this topic.
2. McGlashan TH, Grilo CM, Skodol AE, Gunderson JG, Shea MT, Morey LC, Zanarini MC, Stout RL (2000). The collaborative longitudinal personality study: baseline axisI/II and II/II diagnostic co-occurrence. Acta Psychiatrica Scandinavica, 102:256-264.
3. Stuart S, Pfohl B, Battaglia M, Bellodi L, Grove W, Cadoret R (1998). The cooccurrence of DSM-III-R personality disorders. Journal of Personality Disorders, 12, 302-315.
4. Widiger T, Trull T (1998). Performance characteristics of the DSM-III-R personality disorder criteria sets. In Widiger T, Frances A, Pincus H, Ross R, First M, Davis W, Kline M (eds). DSM-IV sourcebook (pp. 357-373), Washington D.C., American Psychiatric Press.