Standardized assessment of personality disorders in obsessive-compulsive disorder.

Massachusetts General Hospital, Boston, MA 02114.
Archives of General Psychiatry (Impact Factor: 13.77). 10/1990; 47(9):826-30.
Source: PubMed

ABSTRACT We assessed 96 patients with obsessive-compulsive disorder for DSM-III personality disorder diagnoses with a standardized interview instrument (Structured Interview for the DSM-III Personality Disorders). Fifty patients (52%) met criteria for at least one personality disorder, with mixed, dependent, and histrionic personality disorders most frequently diagnosed. Compulsive personality disorder was diagnosed in only 6 patients (6%), 5 of whom had had onset of obsessive-compulsive symptoms before the age of 10 years, indicating that DSM-III compulsive personality disorder is not invariably a premorbid condition for the development of obsessive-compulsive disorder. Schizotypal personality disorder, at 5%, was found to be less common than in past samples, reflecting differences in either assessment methods or sampling.

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    ABSTRACT: OBJECTIVE: The aim of this study is to assess the quality of life (QoL), family burden and psychiatric disorders in first-degree relatives of patients with obsessive-compulsive disorder (OCD) and to compare them with healthy controls and their relatives. METHODS: Forty patients with OCD and 47 of their first-degree relatives as well as 40 healthy subjects and 45 of their first-degree relatives were recruited in this study. OCD and comorbid anxiety or mood disorders were determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. Comorbid Axis II disorders were diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition Personality Disorders. Type and severity of obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive-Compulsive Scale, and the disability of patients with OCD was evaluated with the WHO DAS II. Family burden and QoL in the relatives were evaluated with the Zarit Burden Interview (ZBI) protocol and the World Health Organization Quality of Life Assessment-Brief, respectively. RESULTS: The mean ZBI score of family members of OCD patients was higher than the control relatives. Linear regression analysis indicated that the independent factors associated with ZBI were duration of OCD, comorbid major depressive disorder and poorer insight. Compared with those of control relatives, the QoL of relatives of patients with OCD was significantly lower in all domains. While the diagnosis of major depressive disorder in relatives of OCD patients was significantly higher than the control relatives, the diagnosis of any anxiety disorder did not differ. CONCLUSIONS: Our study provides evidence that OCD not only affects the lives of patients but also their family members.
    General hospital psychiatry 02/2013; · 2.67 Impact Factor
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    ABSTRACT: The prevalence of personality disorders varies between 0.5% and 2.5% in the general population and it increases drastically in the clinical population [1, 2]. In a psychiatric population, about one half of all patients have pathological personality [3]. Following the multiaxial classification of the Diagnostic Manual of the American Psychiatric Association (DSM-IVTR; [1]), Axis II personality disorders are defined as being stable, inflexible, and pervasive patterns of psychological experiences and behaviors that differ prominently from cultural expectations, and that lead to clinically significant distress or impairment in important areas of functioning. In the DSM-IV-TR, there are 10 distinct personality disorders organized into three clusters. Cluster ″A″ includes three personality disorders considered as odd or eccentric: paranoid, schizoid and schizotypal. Antisocial, borderline, narcissistic and histrionic personality disorders are grouped under Cluster ″B″, which is considered as the dramatic, emotional or erratic cluster. Finally, Cluster ″C″ comprises three anxious or fearful personality disorders: the avoidant personality disorder, the dependent personality disorder and the obsessive-compulsive personality disorder. In the next version of the DSM (DSM-V), the task force is proposing some major changes for Axis II and as per the may 1st 2012 online revision[4], the DSM-V will retain six personality disorder types : schizotypal, antisocial, borderline, narcissistic, avoidant and obsessive-compulsive. The comorbidity between Axis I and Axis II disorders is much documented, and there are some voices in the scientific community that would even question whether or not the distinction between those two axis should be revisited [5-8]. Specifically, Axis II disorders have been found to be strongly associated with anxiety disorders [9, 10] and an increased prevalence of personality disorders has been found in patients with anxiety disorders [11, 12]. Personality disorders are associated to high social cost and mortality, such as crime, disability, underachievement, underemployment, increased need for medical care, institutionalization, suicide attempts, self-injurious behavior, family disruption, child abuse and neglect, poverty, and homelessness [12]. This underlies the importance of finding optimal treatment for this population, and understanding the mechanisms by which personality pathology interferes with other psychiatric disorders, such as anxiety disorders. This chapter presents a comprehensive review of the literature on the co-occurrence of personality and anxiety disorders, and the treatment of the latter when comorbidity occurs. First, the influence of personality pathology on anxiety disorders in general is discussed, with no regard to specific anxiety disorders. Afterwards, the clinical features of each of the major anxiety disorders that are comorbid with personality disorders are examined separately. The influence of personality disorders on anxiety disorder symptomatology and on the course of illness is also discussed in terms of treatment. Emphasis will be on the outcome of cognitive and/or behavioral therapy, since its efficacy has been repeatedly established in the treatment of anxiety disorders. The influence of Axis II diagnosis on the outcome of pharmacological treatment of anxiety disorders is also briefly discussed. Major characteristics of the studies that are reviewed in the present chapter are presented in a table. Finally, future research questions on comorbidity of anxiety disorders in the presence of personality disorders are proposed.
    New Insights into Anxiety Disorders, 01/2013: chapter 12: pages 287-324; , ISBN: ISBN 978-953-51-1053-8
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    ABSTRACT: Objective. The purpose of this paper is to provide evidence for the relationship between personality disorders (PDs), obsessive compulsive disorder (OCD), and other anxiety disorders different from OCD (non-OCD) symptomatology. Method. The sample consisted of a group of 122 individuals divided into three groups (41 OCD; 40 non-OCD, and 41 controls) matched by sex, age, and educational level. All the individuals answered the IPDE questionnaire and were evaluated by means of the SCID-I and SCID-II interviews. Results. Patients with OCD and non-OCD present a higher presence of PD. There was an increase in cluster C diagnoses in both groups, with no statistically significant differences between them. Conclusions. Presenting anxiety disorder seems to cause a specific vulnerability for PD. Most of the PDs that were presented belonged to cluster C. Obsessive Compulsive Personality Disorder (OCPD) is the most common among OCD. However, it does not occur more frequently among OCD patients than among other anxious patients, which does not confirm the continuum between obsessive personality and OCD. Implications for categorical and dimensional diagnoses are discussed.
    The Scientific World Journal 12/2013; 2013:856846. · 1.73 Impact Factor