Prevalence, correlates, and comorbidity of DSM-IV obsessive-compulsive personality disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
Introduction
As currently formulated in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), essential features of obsessive compulsive personality disorder (OCPD) include a preoccupation with details and rules; self-limiting perfectionism; excessive devotion to work and productivity; over-conscientiousness; retention of worn out or worthless items; reluctance to delegate tasks and work; miserliness toward self and others; and rigidity and stubbornness (American Psychiatric Association, 2000). Although OCPD has been recognized in various but similar guises for over 100 years (Janet, 1904, Freud, 1908/1963, Mancebo et al., 2005, Eisen et al., 2008), there is a relative dearth of empirical research. Most research has involved small samples of convenience that are not representative of the general population. Further, the assessment of other symptom and personality disorders has been sporadic, often not employing structured clinical interviews.
The Epidemiological Catchment Area (ECA) survey estimated that 1.7% of individuals met DSM-III criteria for OCPD (Nestadt et al., 1991), consistent with a community sample (n = 2053) which found a prevalence rate of 2.0% using DSM-III-R criteria (Torgersen et al., 2001). Using DSM-IV criteria in a large community sample (n = 43,093), Grant and colleagues reported a much higher rate of 7.8% (Grant et al., 2004a). Despite being an arguably common personality disorder, we know little about its comorbidity (except in the case of comorbid obsessive compulsive disorder (OCD) (Coles et al., 2008, Lochner et al., 2011) or clinical correlates.
The purpose of the current report was to add to the scant knowledge of OCPD through the analysis of a large epidemiologic survey representative of the of the U.S. general community; the Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Several aims were pursued, both for the total sample and between male and female respondents. First, we examined rates of item endorsement. Second, we characterized the frequency and likelihood of OCPD with respect to sociodemographic variables. Third, we examined the co-occurrence of 12-month and lifetime DSM-IV OCPD and lifetime Axis I and II psychiatric disorders. Finally, we evaluated associations between lifetime DSM-IV OCPD and 12-Month Axis I psychiatric disorders, controlling for sociodemographic characteristics and other psychiatric disorders.
Section snippets
Sample
The present work was conducted using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The NESARC was designed and supervised by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and conducted by the U.S. Census Bureau Field Representatives from 2001 to 2002 (Wave 1) (Grant et al., 2003a, Grant et al., 2004b). All potential NESARC respondents were informed in writing about the nature of the survey, the statistical uses of the survey data, the
Prevalence and sociodemographic characteristics
The prevalence of OCPD in the NESARC sample was 7.9% (Table 1). Rates of OCPD were similar in male (7.9%) and female (7.9%) respondents. In the overall sample, younger respondents were less likely to carry the OCPD diagnosis. In the male and female subsamples this was true only for the youngest respondents (ages 20–29). Using Whites as the reference group, Asians or Pacific Islanders and Hispanics were less likely to carry the OCPD diagnosis. These relationships were also obtained in the male
Discussion
Based on the NESARC, the prevalence of OCPD in this general U.S. adult population is nearly 8%, a rate that is much higher than that found in previous epidemiological surveys (Nestadt et al., 1991, Torgersen et al., 2001). This discrepancy may be partly due to variation in the diagnostic method used. For example, this study used the AUDADIS-IV and DSM-IV criteria to make the OCPD diagnosis. This can be contrasted with some past studies using DSM-III criteria (e.g., DSM-IV dropped two criteria
Conflict of interest
Dr. Grant has received research grants from NIDA, NCRG, Psyadon Pharmaceuticals and Transcept Pharmaceuticals. These grants are not relevant to the subject of this article. Dr. Mooney reports no financial or other relationship relevant to the subject of this article. Dr. Kushner reports no financial or other relationship relevant to the subject of this article.
Ethical approval
The current investigation utilized publicly accessible, de-identified data and was thus exempted from formal institutional review board review.
Role of funding
No funding source for this study.
Contributors
Dr. Grant managed the literature searches and wrote the first draft of the manuscript. Dr. Mooney performed statistical analyses. All authors contributed to and have approved the final manuscript.
Acknowledgments
None.
References (22)
- et al.
Predictive value of obsessive-compulsivepersonality disorder in antiobsessional pharmacological treatment
European Neuropsychopharmacology
(1997) - et al.
OCD with comorbid OCPD: a subtype of OCD?
Journal of Psychiatric Research
(2008) - et al.
The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample
Drug and Alcohol Dependence
(2003) - et al.
Comorbid obsessive-compulsive personality disorder in obsessive-compulsive disorder (OCD): a marker of severity
Progress in Neuro-psychopharmacology and Biological Psychiatry
(2011) - et al.
Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder
Behaviour Research and Therapy
(2011) Diagnostic and statistical manual of mental disorders
(2000)- et al.
Prevalence and stability of the DSM-III-R personality disorders in a community-based survey of adolescents
American Journal of Psychiatry
(1993) - Eisen JL, Rasmussen SA. OCD and compulsive traits: phenomenology and outcome. Paper presented at the American...
- et al.
Clarifying the convergence between obsessive compulsive personality disorder criteria and obsessive compulsive disorder
Journal of Personality Disorders
(2006) - et al.
Obsessive-compulsive personality disorder
Character and anal eroticism
Cited by (61)
Obsessive compulsive personality traits: Understanding the chain of pathogenesis from health to disease
2019, Journal of Psychiatric ResearchCitation Excerpt :Although perhaps not uniformly distributed across everyone with OCPD, there might be some elements of impulsivity as has been reported in subgroups of people with OCD (Prochazkova et al., 2018). In addition, the National Epidemiological Study of Addictions and Related Conditions (NESARC) found significant associations between OCPD and a range of addictive and impulsive disorders (e.g., substance use disorders, ADHD) (Grant et al., 2012). Interestingly, when compared to healthy controls, participants with OCPD have reported significantly higher levels of negative affectivity, trait anger, emotional intensity, and emotion regulation difficulties strategies), all which often underlie impulsivity (Steenkamp et al., 2015).
Trait Polarity of the Personality Psychopathology 5 (PSY-5-r): A Content Analysis in Relation to the Patient Description Form
2023, Journal of Psychopathology and Behavioral AssessmentValidation of the short version of the obsessive compulsive spectrum questionnaire
2023, Frontiers in Psychology