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; Comprehensive Psychiatry 45 (5); 325-332

Commented by Professor Charles Pull, 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.
Last updated: 22.09.2004