OCD with comorbid OCPD: A subtype of OCD?

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Abstract

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.

Section snippets

Participants

Data for the current study were drawn from the intake interview of a longitudinal study of the course of OCD in individuals who identified OCD as their biggest problem overall across their lifetime (“primary OCD”). Participants were recruited from psychiatric treatment settings, including an outpatient OCD specialty clinic, psychiatric inpatient units, community mental health centers, general outpatient psychiatric clinics, and the private practices of several experts in cognitive-behavioral

Results

Subjects with (n = 65, 27%) and without comorbid OCPD (n = 173, 73%) were compared on demographic (see Table 1) and clinical characteristics (see Table 2). Contrary to our hypothesis, there was no evidence for a higher proportion of males in the OCD + OCPD group. There was a trend suggesting that subjects with and without comorbid OCPD differed on their current marital status. The OCD + OCPD subjects were significantly more likely to have pursued education beyond college.

In contrast to the OCD  OCPD

Discussion

In the current study, 27% (n = 65) of 238 individuals with primary and current DSM-IV OCD were also diagnosed with comorbid OCPD. Comparisons of the individuals with and without comorbid OCPD revealed that the added presence of OCPD was associated with a number of specific clinical features including an earlier age at onset of initial obsessions/compulsions, greater frequency of certain obsessions and compulsions (symmetry, ordering, repeating, cleaning, and hoarding), and more impaired

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