Prevalence, correlates, and comorbidity of DSM-IV obsessive-compulsive personality disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

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Abstract

Although recognized for over 100 years, there is a relative dearth of empirical research on obsessive compulsive personality disorder (OCPD). The goal of the current study is to present nationally representative findings on prevalence, sociodemographic correlates, and comorbidity of OCPD among men and women. The current study uses nationally representative data to examine sociodemographic correlates and comorbidity of OCPD. Face-to-face interviews were conducted with 43,093 adults in the United States. The prevalence of lifetime OCPD was 7.8%, with rates the same for men and women. OCPD was significantly less common in younger adults and in Asians and Hispanics but was significantly more common in individuals with a high school education or less. When sociodemographic variables and other comorbidities were controlled for, current associations remained significant for all mood and anxiety disorders as well as lifetime personality disorders among both men and women. OCPD is a prevalent personality disorder in the US population and is equally represented in men and women. The results highlight the need for further research to identify common pathophysiological elements common to OCPD and associated disorders.

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.

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