Obsessive-compulsive disorder and axis II

Abstract

The relationship between obsessive-compulsive disorder (OCD) and personality traits and characteristics has been of great interest to psychiatrists and researchers. Psychoanalysts have long believed that obsessive-compulsive personality traits (e.g. rigidity, over-conscientiousness, resistance to change) stemmed from a fixation at the anal stage of character development and were the precursor to OCD. Research tended to support this view, as early studies showed these traits to be common in patients with OCD and in their first-degree relatives. However, more recent work using standardized assessments has shown that while 33% to 88% of patients with OCD meet criteria for a personality disorder (most commonly from cluster C), and many patients have obsessive-compulsive personality traits, only a few actually meet criteria for obsessive-compulsive personality disorder. Recent work has also shown that OCD patients with a personality disorder are more symptomatic than patients without a personality disorder, and are also more likely to respond poorly to medication, especially those with cluster A disorders (e.g. schizotypal, paranoid personality). Schizotypal personality specifically may predict response to augmentation of an anti-obsessional agent with an antipsychotic. Interestingly, many abnormal personality traits tend to improve once the patient with OCD has been successfully treated. The relationship between OCD and personality disorder continues to be debated. Some of the remaining issues include determining the true prevalence of personality disorder in unselected samples of OCD patients; determining whether personality disorder is independent and largely unrelated to OCD or develops as a consequence of having OCD; learning how personality disorders interfere with treatment response; and, finally, what happens to personality disorders in OCD patients over time. Long-term follow-up studies will be needed to help clarify these issues.