Skip to main content
SpringerLink
Log in

Comorbid Personality Disorders in Obsessive–Compulsive Disorder and Its Symptom Dimensions

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

The current paper was aimed at: (1) investigating the comorbidity between obsessive–compulsive disorder (OCD) and personality disorders (PDs) using an OCD sample and clinician-administered structured interviews; (2) exploring the associations of different cluster comorbid PDs with the specific symptom dimensions of OCD; (3) analyzing the variables which could play a significant role in the probability of having at least one comorbid PD, controlling for confounding variables. The SCID-II and Y-BOCS, together with a series of self-report measures of OCD, depression and anxiety symptoms were administered to a clinical sample of 159 patients with a primary diagnosis of OCD. 20.8 % of the participants suffered from at least one comorbid PD; the most common was obsessive–compulsive PD (9.4 %), followed by narcissistic PD (6.3 %). In OCD patients with comorbid cluster C PDs, the percentage of responsibility for harm, injury, or bad luck symptoms was significantly greater than other OCD symptom dimensions (p < .005). Logistic regression found some evidence supporting the association between severity of OCD symptoms and comorbid PDs. PDs are prevalent among Italian people with OCD and should be routinely assessed, as comorbidity may affect help-seeking behaviour and response to treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The DSM-5 chapter on anxiety disorder no longer includes obsessive–compulsive disorder, which is included with the obsessive–compulsive and related disorders.

References

  1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM5), 5th edn. Washington, DC, American Psychiatric Press, 2013.

    Google Scholar 

  2. Melca IA, Yücel M, Mendlowicz MV, de Oliveira-Souza R, Fontenelle LF: The correlates of obsessive-compulsive, schizotypal, and borderline personality disorders in obsessive-compulsive disorder. Journal of Anxiety Disorders 33:15–24, 2015.

    Article  PubMed  Google Scholar 

  3. Baer L, Jenike MA, Black DW, Treece C, Rosenfeld R, Greist J: Effect of Axis II diagnoses on treatment outcome with Clomipramine in 55 patients with obsessive-compulsive disorder. Archives of General Psychiatry 49:862–866, 1992.

    Article  CAS  PubMed  Google Scholar 

  4. Black DW, Noyes R, Pfohl B, Goldstein RB, Blum N: Personality disorder in obsessive-compulsive volunteers, well comparison subjects, and their first-degree relatives. American Journal of Psychiatry 150:1226–1232, 1993.

    Article  CAS  PubMed  Google Scholar 

  5. Piggott TA, L’Heureux F, Dubbert B, Bernstein S, Murphy DL: Obsessive compulsive disorder: comorbid conditions. Journal of Clinical Psychiatry 55:15–27, 1994.

    Google Scholar 

  6. Dèttore D, Pozza A. Obsessive-compulsive disorder and comorbid personality disorders. In: Crowe EM, O’Dell AR (eds.) Obsessive-compulsive disorder. Symptoms, prevalence and psychological treatments. Nova Science Publishers, New York; 2014. pp. 1-46.

  7. Pena-Garijo J, Villamón SE, de Alba AM, Ruipérez MA: Personality disorders in obsessive-compulsive disorder: a comparative study versus other anxiety disorders. ScientificWorldJournal, 2013. doi:10.1155/2013/856846.

    PubMed  PubMed Central  Google Scholar 

  8. Summerfeldt LJ, Huta VM, Swinson RP: Personality and obsessive-compulsive disorder. In: Swinson R, Antony M, Rachman S, Richter M (Eds) Obsessive-Compulsive Disorder: Theory, Research and Treatment. New York, Guilford Press, 1998.

    Google Scholar 

  9. Torres AR, Moran P, Bebbington P, Brugha T, Bhugra D, Coid JW, Farrell M, Jenkins R, Lewis G, Meltzer H, Prince M: Obsessive-compulsive disorder and personality disorder: evidence from the British National Survey of Psychiatric Morbidity 2000. Social Psychiatry and Psychiatric Epidemiology 41:862–867, 2006.

    Article  PubMed  Google Scholar 

  10. Friborg O, Martinussen M, Kaiser S, Øvergård KT, Rosenvinge JH: Comorbidity of personality disorders in anxiety disorders: a meta-analysis of 30 years of research. Journal of Affective Disorders 145:143–155, 2013.

    Article  PubMed  Google Scholar 

  11. Garyfallos G, Katsigiannopoulos K, Adamopoulou A, Papazisis G, Karastergiou A, Bozikas VP: Comorbidity of obsessive–compulsive disorder with obsessive–compulsive personality disorder: does it imply a specific subtype of obsessive–compulsive disorder? Psychiatry Research 177:156–160, 2013.

    Article  PubMed  Google Scholar 

  12. Denys D, Tenney N, van Megen HJ, de Geus F, Westenberg HG: Axis I and II comorbidity in a large sample of patients with obsessive-compulsive disorder. Journal of Affective Disorders 80:155–162, 2004.

    Article  PubMed  Google Scholar 

  13. Maina G, Albert U, Salvi V, Pessina E, Bogetto F: Early-onset obsessive-compulsive disorder and personality disorders in adulthood. Psychiatry Research 158(2):217–225, 2008.

    Article  PubMed  Google Scholar 

  14. Mataix-Cols D, Baer L, Rauch SL, Jenike MA: Relation of factor-analyzed symptom dimensions of obsessive-compulsive disorder to personality disorders. Acta Psychiatrica Scandinavica 102(3):199–202, 2000.

    Article  CAS  PubMed  Google Scholar 

  15. Baer L, Jenike MA, Ricciardi JN 2nd, Holland AD, Seymour RJ, Minichiello WE, Buttolph ML: Standardized assessment of personality disorders in obsessive-compulsive disorder. Archives of General Psychiatry 47(9):826–830, 1990.

    Article  CAS  PubMed  Google Scholar 

  16. Samuels J, Nestadt G, Bienvenu OJ, Costa PT Jr, Riddle MA, Liang KY, Hoehn-Saric R, Grados MA, Cullen BA: Personality disorders and normal personality dimensions in obsessive-compulsive disorder. British Journal of Psychiatry 177:457–62, 2000.

    Article  CAS  PubMed  Google Scholar 

  17. Pinto A, Mancebo MC, Eisen JL, Pagano ME, Rasmussen SA: The Brown Longitudinal Obsessive Compulsive Study: clinical features and symptoms of the sample at intake. Journal of Clinical Psychiatry 67(5):703–711, 2006.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Albert U, Maina G, Forner F, Bogetto F: DSM-IV obsessive-compulsive personality disorder: prevalence in patients with anxiety disorders and in healthy comparison subjects. Comprehensive Psychiatry 45:325–332, 2004.

    Article  PubMed  Google Scholar 

  19. Mancebo MC, Eisen JL, Grant JE, Rasmussen SA: Obsessive compulsive personality disorder and obsessive compulsive disorder: clinical characteristics, diagnostic difficulties, and treatment. Annals of Clinical Psychiatry 17:197–204, 2005.

    Article  PubMed  Google Scholar 

  20. Coles ME, Pinto A, Mancebo MC, Rasmussen SA, Eisen JL: OCD with comorbid OCPD: a subtype of OCD? Journal of Psychiatric Research 42(4):289–296, 2008.

    Article  PubMed  Google Scholar 

  21. Bartz JA, Kaplan A, Hollander E: Obsessive-compulsive personality disorder. In: O’Donohue W, Lilienfeld S (Eds.) Personality Disorders: Toward the DSM-V, Thousand Oaks, Sage, 2007.

  22. Eisen JL, Coles ME, Shea MT, Pagano ME, Stout RL, Yen S, Grilo CM, Rasmussen SA: Clarifying the convergence between obsessive compulsive personality disorder criteria and obsessive compulsive disorder. Journal of Personality Disorders 20(3):294–305, 2006.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Baer L: Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. Journal of Clinical Psychiatry 55:18–23, 1994.

    PubMed  Google Scholar 

  24. Horesh N, Dolberg OT, Kirschenbaum-Aviner N, Kotler M: Personality differences between obsessive-compulsive disorder subtypes: washers versus checkers. Psychiatry Research 71:197–200, 1997.

    Article  CAS  PubMed  Google Scholar 

  25. Frost RO, Sher KJ: Checking behavior in a threatening situation. Behaviour Research and Therapy 27(4):385–389, 1989.

    Article  CAS  PubMed  Google Scholar 

  26. Frost RO, Shows DL: The nature and measurement of compulsive indecisiveness. Behaviour Research and Therapy 31(7):683–692, 1993.

    Article  CAS  PubMed  Google Scholar 

  27. Ecker W, Kupfer J, Gönner S: Incompleteness as a link between obsessive-compulsive personality traits and specific symptom dimensions of obsessive-compulsive disorder. Clinical Psychology & Psychotherapy 21(5):394–402, 2014.

    Article  Google Scholar 

  28. Brown TA, Di Nardo PA, Barlow DH: Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV). San Antonio, Psychological Corporation/Graywind Publications Incorporated, 1994.

    Google Scholar 

  29. First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS: Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Interview and questionnaire, Washington, DC, American Psychiatric Press, 1997.

    Google Scholar 

  30. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR), 4th edn, text revision, Washington, DC, American Psychiatric Press, Washington, DC, 2000.

  31. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann R, Hill CL et al.: The Yale-Brown Obsessive-Compulsive Scale I: development, use, and reliability. Archives of General Psychiatry 46:1006–1011, 1989a.

    Article  CAS  PubMed  Google Scholar 

  32. Goodman WK, Price LH, Rasmussen SA, Mazure C, Delgado P, Heninger GR et al.: The Yale-Brown Obsessive Compulsive Scale: II validity. Archives of General Psychiatry 46:1012–1016, 1989b.

    Article  CAS  PubMed  Google Scholar 

  33. Mazzi F, Morosini P, De Girolamo G, Lusetti M, Guaraldi P: Structured Clinical Interview for DSM-IV Axis II Disorders (Italian Version). Firenze, Organizzazioni Speciali, 2003.

    Google Scholar 

  34. Abramowitz JS, Deacon BJ, Olatunji BO, Wheaton MG, Berman NC, Losardo D, et al.: Assessment of obsessive-compulsive symptom dimensions: development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment 22:180–198, 2010.

    Article  PubMed  Google Scholar 

  35. Melli G, Chiorri C, Bulli F, Carraresi C, Stopani E, Abramowitz J: Factor congruence and psychometric properties of the Italian version of the Dimesional Obsessive-Compulsive Scale (DOCS) across non-clinical and clinical samples. Journal of Psychopathological and Behavioral Assessment, 2014. doi:10.1007/s10862-014-9450-1.

    Google Scholar 

  36. Hénin M: Yale-Brown Obsessive-Compulsive Scale. In: Sica C (Ed.) Disturbo Ossessivo-Compulsivo. Questionari e interviste per la valutazione clinica. Trento, Erickson, 2012.

  37. StataCorp. Stata Statistical Software: Release 12. College Station, StataCorp. LP, 2011.

  38. Brandes M, Bienvenu OJ: Anxiety disorders and personality disorders comorbidity. In Stein MB, Antony MM (Eds.) Oxford Handbook of Anxiety and Related Disorders. Oxford, Oxford University Press, 2009.

    Google Scholar 

  39. Huh MJ, Shim G, Byun MS, Kim SN, Kim E, Jang JH, Shin MS, Kwon JS: The impact of personality traits on ratings of obsessive-compulsive symptoms. Psychiatry Investigation 10:259–265, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Svrakic DM, McCallum K, Milan P: Developmental, structural, and clinical approach to narcissistic and antisocial personalities. American Journal of Psychoanalysis 51:413–432, 1991.

    Article  CAS  PubMed  Google Scholar 

  41. Salkovskis P, Shafran R, Freeston MH: Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research. Behaviour Research and Therapy 40:25–36, 2000.

  42. Lochner C, Serebro P, van der Merwe L, Hemmings S, Kinnear C, Seedat, Stein DJ: Comorbid obsessive-compulsive personality disorder in obsessive-compulsive disorder (OCD): a marker of severity. Progress in Neuropsychopharmacology and Biological Psychiatry 35:1087–1092, 2011.

  43. Starcevic V, Berle D, Brakoulias V, Sammut P, Moses K, Milicevic D, Hannan A: Obsessive-compulsive personality disorder co-occurring with obsessive-compulsive disorder: conceptual and clinical implications. Australian and New Zealand Journal of Psychiatry 47(1):65–73, 2013.

    Article  PubMed  Google Scholar 

  44. Gordon OM, Salkovskis PM, Oldfield VB, Carter N: The association between obsessive compulsive disorder and obsessive compulsive personality disorder: prevalence and clinical presentation. British Journal of Clinical Psychology 52:300–315, 2013.

    Article  PubMed  Google Scholar 

  45. Pinto A, Liebowitz MR, Foa EB, Simpson HB: Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder. Behaviour Research and Therapy 49:453–458, 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Hudak R: Introduction to obsessive-compulsive disorder. In: Hudah R, Dougherty DD (Eds.) Clinical Obsessive-Compulsive Disorders in Adults and Children. Cambridge University Press, Cambridge, 2011.

  47. Fricke S, Moritz S, Andresen B, Jacobsen D, Kloss M, Rufer M, Hand I: Do personality disorders predict negative treatment outcome in obsessive-compulsive disorders? A prospective 6-month follow-up study. European Psychiatry 21:319–324, 2006.

    Article  PubMed  Google Scholar 

  48. Dèttore D, Pozza A, Coradeschi D: Does time-intensive ERP attenuate the negative impact of comorbid personality disorders on the outcome of treatment-resistant OCD? Journal of Behavior Therapy and Experimental Psychiatry 44:411–417, 2013.

    Article  PubMed  Google Scholar 

  49. Thiel N, Hertenstein E, Nissen C, Herbst N, Külz AK, Voderholzer U: The effect of personality disorders on treatment outcomes in patients with obsessive-compulsive disorders. Journal of Personality Disorders 27:697–715, 2013.

    Article  PubMed  Google Scholar 

  50. Cavedini P, Erzegovesi S, Ronchi P, Bellodi L: Predictive value of obsessive-compulsive personality disorder in antiobsessional pharmacological treatment. European Neuropsychopharmacology 7:45–49, 1997.

    Article  CAS  PubMed  Google Scholar 

  51. McKay D, Neziroglu F, Todaro J, Yaryura-Tobias JA: Changes in personality disorders following behavior therapy for obsessive-compulsive disorder. Journal of Anxiety Disorders 10:47–57, 1996.

    Article  Google Scholar 

  52. Sanderson WC, Beck AT, McGinn LK: Cognitive therapy for generalized anxiety disorder: significance of comorbid personality disorders. In: Leahy RL, Dowd ET (Eds.) Clinical Advances in Cognitive Psychotherapy: Theory and Application. New York, Springer, 2002.

    Google Scholar 

  53. Martino F, Menchetti M, Pozzi E, Berardi D: Predictors of dropout among personality disorders in a specialist outpatients psychosocial treatment: a preliminary study. Psychiatry and Clinical Neurosciences 66:180–186,2012.

    Article  PubMed  Google Scholar 

  54. Bienenfeld D: Cognitive Therapy of Patients with Personality Disorders. Psychiatr Annals 37:133–139, 2007.

    Google Scholar 

  55. Foa EB, Liebowitz MR, Kozak MJ, Davies S, Campeas R, Franklin ME, Huppert JD, Kjernisted K, Rowan V, Schmidt AB, Simpson HB, Tu X: Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry 162:151–161, 2005.

    Article  PubMed  Google Scholar 

  56. Abramowitz JS: The psychological treatment of obsessive-compulsive disorder. Canadian Journal of Psychiatry 51:407–416, 2006.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Dr. Eva Zysk for her comments on an earlier version of this manuscript.

Funding

None funding or other support.

Author information

Authors and Affiliations

  1. Institute of Behavioral and Cognitive Psychology and Psychotherapy, Via Mannelli 139, 50132, Florence, Italy

    Francesco Bulli, Gabriele Melli, Veronica Cavalletti, Eleonora Stopani & Claudia Carraresi

  2. University of Pisa, Pisa, Italy

    Gabriele Melli

Authors
  1. Francesco Bulli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriele Melli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veronica Cavalletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eleonora Stopani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claudia Carraresi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Bulli.

Ethics declarations

Conflict of interest

The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. None of the authors nor their institutions at any time received payment or services from a third party for any aspect of this work. There were no financial relationships with entities that could be perceived to influence, or that give the appearance of potentially influencing, what it has been written in this work. No patents and copyrights, either pending, issued, licensed or receiving royalties relevant to this work, need to be declared. There were no other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what it has been written in this work.

Ethical approval

Institutional review board (IRB) approval was obtained for procedures and all patients volunteered to take part to the study after being presented with a detailed description of the procedure, signed a written informed consent and were treated in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. No external incentives were offered for participating in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bulli, F., Melli, G., Cavalletti, V. et al. Comorbid Personality Disorders in Obsessive–Compulsive Disorder and Its Symptom Dimensions. Psychiatr Q 87, 365–376 (2016). https://doi.org/10.1007/s11126-015-9393-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-015-9393-z

Keywords

Search

Navigation