See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/271329556

Obsessive–Compulsive Personality Disorder: a Current Review

Article  in  Current Psychiatry Reports · February 2015

DOI: 10.1007/s11920-014-0547-8 · Source: PubMed

CITATIONS READS

31 5,629

2 authors:

Alice Diedrich Ulrich Voderholzer

Ludwig-Maximilians-University of Munich University Medical Center Freiburg
13 PUBLICATIONS   191 CITATIONS    495 PUBLICATIONS   9,135 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

FABIANA View project

fronto View project

All content following this page was uploaded by Alice Diedrich on 14 April 2015.

The user has requested enhancement of the downloaded file.

Curr Psychiatry Rep (2015) 17: 2
DOI 10.1007/s11920-014-0547-8

PERSONALITY DISORDERS (C SCHMAHL, SECTION EDITOR)

Obsessive–Compulsive Personality Disorder: a Current Review

Alice Diedrich & Ulrich Voderholzer

Published online: 24 January 2015

# Springer Science+Business Media New York 2015

Abstract This review provides a current overview on the Keywords Obsessive–compulsive personality disorder . Fifth
diagnostics, epidemiology, co-occurrences, aetiology and Edition of the Diagnostic and Statistical Manual of Mental
treatment of obsessive–compulsive personality disorder Disorders . Epidemiology . Course . Co-occurrences .
(OCPD). The diagnostic criteria for OCPD according to the Obsessive–compulsive disorder . Aetiology . Treatment
recently published Fifth Edition of the Diagnostic and Statis-
tical Manual of Mental Disorders (DSM-5) include an official
set of criteria for clinical practice and a new, alternative set of
criteria for research purposes. OCPD is a personality disorder Introduction
prevalent in the general population (3–8 %) that is more
common in older and less educated individuals. Findings on Obsessive–compulsive personality disorder (OCPD) was first
sex distribution and course of OCPD are inconsistent. OCPD described more than 100 years ago [1]. In 1952, with the
is comorbid with several other medical and psychological publication of the first Diagnostic and Statistical Manual for
conditions. As for causes of OCPD, most empirical evidence Mental Disorders (DSM) [2], it became a diagnosable mental
provides support for disturbed attachment as well as the disorder. Since then, and unlike other personality disorders, it
heritability of OCPD. So far, cognitive (behavioural) therapy has been included in all revisions of the DSM including the
is the best validated treatment of OCPD. Self-esteem variabil- Fifth Edition of the DSM (DSM-5) [3]. It is characterized by
ity, stronger early alliances as well as the distress level seem to eight personality traits: preoccupation with details, perfection-
predict cognitive (behavioural) therapy outcome. Future re- ism, excessive devotion to work and productivity, over-con-
search is needed to further advance knowledge in OCPD and scientiousness, inability to discard worthless objects, inability
to resolve inconsistencies. to delegate tasks, miserliness, and rigidity and stubbornness
[4]. As the most common personality disorder in the general
population [5•, 6••], it is associated with at least moderate
impairment in psychosocial functioning [7, 8•, 9], reduced
This article is part of the Topical Collection on Personality Disorders quality of life [7, 8•] and a considerable economic burden
A. Diedrich [10]. Despite its importance for public health and economy,
Department of Psychiatry and Psychotherapy, Behaviour Therapy, research on OCPD is still scant and often inconsistent. Thus,
University of Munich, Nußbaumstr. 7, 80336 Munich, Germany the purpose of the present review is to provide both practi-
e-mail: [email protected]
tioners and researchers with a summary of significant current
U. Voderholzer theoretical developments as well as empirical findings regard-
Department of Psychiatry and Psychotherapy, University of Freiburg, ing the diagnostics, epidemiology, course, co-occurrences,
Hauptstraße 5, 79104 Freiburg, Germany aetiology, and treatment of OCPD. Hopefully, this will help
U. Voderholzer (*)
in initiating future research on this important but often
Schön Klinik Roseneck, Am Roseneck 6, 83209 Prien, Germany neglected mental disorder and thus advancing clinical practice
e-mail: [email protected] in OCPD.
2 Page 2 of 10 Curr Psychiatry Rep (2015) 17: 2

Diagnostics of OCPD Thus, most of the issues of the DSM-IV criteria were
addressed in the alternative set of criteria of the DSM-5.
The most important recent development in the classifica- However, the development of two different sets for clinical
tion of OCPD is the inclusion of two sets of diagnostic practice and research has in fact increased the heterogeneity of
criteria for OCPD in the DSM-5, namely the official set OCPD and further complicates the integration of research
of criteria and the so called alternative set of criteria findings due to different diagnostic criteria. Thus, there is still
[11••]. Whilst the criteria from the official set have a need for clarification and unification of the construct of
remained unchanged from DSM-IV criteria and should OCPD for both research and clinical practice.
be used in clinical practice [12], the criteria from the
“alternative set” represent additional and/or revised criteria
and should be used for research purposes [11••]. Epidemiology and Course of OCPD
Changes in the alternative set of the DSM-5 for OCPD
evolved as a response to criticisms of the DSM-IV criteria for Due to changing diagnostic criteria, the variety of tools used
OCPD [13•]. Specifically, DSM-IV criteria had been criticized for the assessment of OCPD and the different populations
for not being sensitive enough to correctly identify the per- investigated, findings on the epidemiology and course of
centage of individuals that suffer from OCPD and for not OCPD are partially inconsistent. Nonetheless, a number of
being specific enough to correctly identify the percentage of studies provide evidence that OCPD is the most prevalent
individuals that do not [13•]. Problems of specificity included personality disorder in the general population (for an over-
the presence of polythetic criteria instead of the inclusion of a view, see deReus and Emmelkamp, 2012 [5•]; for an incon-
hallmark feature [13•]. These problems resulted in an indis- sistent finding, see for example Lenzenweger, Lane, Loranger,
tinct diagnostic category that contained a plurality of (partly and Kessler, 2007 [20]). Lifetime prevalence rates for OCPD
even incompatible) types of OCPD. These were summarized according to DSM-IV criteria range from 3 to 8 % [6••, 21,
as one diagnosis in which central traits for OCPD were partly 22]. In an outpatient population, OCPD was identified as the
neglected [14–18]. Problems of sensitivity included the exclu- third most common personality disorder (diagnosed according
sion of elements that had before been identified as important to DSM-IV criteria) with a point prevalence rate of 8.7 % [23]
for the diagnosis of OCPD (e.g. future-oriented planning at the and in a psychiatric inpatient population as the second most
cost of present moment pleasure, attentional bias on minute prevalent personality disorder with a rate of 23.3 % (not
details and problematic affect regulation) as well as the inclu- specified which kind of prevalence) when considering DSM-
sion of criteria that were formulated too concretely and liter- III-R-criteria [24]. As for sex distribution, some studies dem-
ally (e.g. miserliness, hoarding) to detect the underlying key onstrate the same rates for men and women [6••] whereas
disposition [13•, 15, 16]. others indicate higher prevalence rates amongst men than
Thus, the following criteria have been developed as part of women [25, 26]. Regarding further demographic characteris-
the alternative set of the DSM-5 [19]: (1) There is at least a tics, OCPD seems to be less common in younger adults as
moderate level of impairment in personality functioning, well as in Asians and Hispanics but more common in individ-
which is manifested by the specified difficulties in two or uals with a high school education or less [6••].
more of the following four areas: identity, self-direction, em- In terms of the course of OCPD, an increasing number of
pathy and intimacy. (2) Apart from rigid perfectionism, there studies show that personality disorders including OCPD are
must be at least two of three of the following ‘pathological less stable and persistent than originally assumed. Shea and
personality traits’: perseveration, intimacy avoidance and re- colleagues (2002) [27] found that a significant majority of
stricted affectivity. As such, the official and alternative criteria OCPD subjects (58 %) no longer meet DSM-IV diagnostic
differ in four important ways [11••]: First, a diagnosis accord- threshold at a 12-month follow-up. Grilo and colleagues
ing to the official set of criteria requires any combination of (2004) [28] reported a remission rate of 38 % within a 24-
four OCPD diagnostic criteria, whereas for a diagnosis ac- month follow-up period whilst remission was defined as hav-
cording to the alternative set, rigid perfectionism must be ing two or fewer OCPD criteria for 12 consecutive months. In
present. Second, the criteria miserliness and hoarding have contrast to these findings, other data suggest that OCPD
been removed in the alternative set whereas most of the remains stable or even worsens with age [29–31]. These
alternative criteria (perseveration, intimacy avoidance and diverging results may be explained by the finding that some
restricted affectivity) are not listed in the official set. Third, OCPD criteria (e.g. rigidity, problems delegating, hoarding)
the official set is categorical whereas the alternative set are more stable and trait-like than others (miserly behaviours,
combines categorical and dimensional diagnostic ap- strict moral behaviours) that can change in severity and/or
proaches. And fourth, the alternative criteria seem to expression over time [28, 32–34]. However, the inconsistency
be stricter and lead to less frequent diagnoses of OCPD of findings might also be a result of methodological differ-
based on these criteria. ences as described before.
Curr Psychiatry Rep (2015) 17: 2 Page 3 of 10 2

Co-occurrences of OCPD with the classification of OCPD and OCD as distinct mental
disorders in the DSM [4], some researchers assume that both
OCPD has been found to co-occur with a variety of mental as disorders constitute different mental conditions that are not
well as medical conditions. Due to the large amount of studies specifically related to each other [21, 45, 46]. Accordingly, it
reporting co-occurrence rates of OCPD and other mental is a common use in clinical practice to distinguish OCPD from
disorders, we focused on studies in which structured inter- OCD due to its ego-syntonic character and the absence of
views and DSM-IV criteria were used for assessment pur- obsessions and compulsions [4, 47]. However, the utilization
poses. Studies from non-clinical populations indicate that a of these criteria to separate both disorders from each other can
lifetime diagnosis of OCPD is moderately common in indi- be questioned as clinical manifestations of OCPD are not
viduals with 12-month diagnoses of anxiety disorders (23– always ego-syntonic (e.g. perfectionism) and manifestations
24 % [6••, 35]), affective disorders (24 % [6••, 35]) and/or of OCD are not always ego-dystonic (e.g. contamination pre-
substance-related disorders (12–25 % [6••, 36]). Amongst occupation) [11••]. Moreover, many researchers hypothesize
patients with anxiety disorders, a lifetime diagnosis of OCPD that both conditions are strongly related to each other or even
is most common in individuals with 12-month diagnoses of overlap conceptually and share many common features, for
panic disorder (23–38 % [6••, 35]), generalized anxiety disor- example compulsions (see for a detailed overview, Pinto and
der (34 % [35]), social phobia (33 % [6••, 35]) and specific Eisen, 2011 [47] and Starcevic and Brakoulias, 2014 [11••];
phobia (22 % [35]). Amongst patients with affective disorders, Baer, 1994 [48]). Some researchers even suggest that there
lifetime prevalence rates of OCPD are comparably high in might be a distinct subtype of individuals with OCD who also
individuals with 12-month diagnoses of unipolar (23–28 % suffer from OCPD [47, 49, 50] or that the comorbidity of
[6••, 35]) and bipolar disorders (26–39 % [6••, 35]). However, OCPD and OCD indicates a marker of severity of OCD [51].
amongst patients with substance use disorders, prevalence Empirical evidence regarding this theoretical debate is not
rates of lifetime OCPD are higher in individuals with 12- in all parts consistent, but there appears to be a specific but
month diagnoses of alcohol or drug dependence (15–29 % rather small to moderate overlap between both disorders.
[6••, 36]) than in individuals with alcohol or drug abuse (9– Indication for this hypothesis comes from studies that utilized
13 % [6••, 36]). Studies from clinical samples demonstrate structured interviews and DSM-IV criteria demonstrating co-
moderate prevalence rates of lifetime OCPD in individuals occurrence rates that range between 23 and 45 % [21, 49,
with lifetime diagnoses of alcohol dependence (31 % [37]), 52–54]. Lower co-occurrence rates were found in (earlier)
panic disorder (17 % [21]), hypochondriasis (15–22 % [38, studies in which DSM-III, DSM-III-R or ICD-10-criteria were
39]), eating disorders (13 % [40]) and unipolar depression utilized as well as clinical judgments, questionnaires, and semi-
(14 % [41]). Moreover, there is growing evidence for a con- structured interviews for diagnostic assessment purposes [e.g.
siderable co-occurrence of OCPD with Cluster A personality 55–57]. Further evidence for an overlap between OCD and
disorders, in particular with paranoid and schizotypal person- OCPD originates from studies showing significantly higher co-
ality disorders [16, 24, 42], which have led to the question occurrence rates between OCPD and OCD than between
whether OCPD should continue to be classified as a Cluster C OCPD and the general population [21, 22] or other mental
personality disorder. Finally, it has recently been found that disorders [52, 58] (for contradictory findings, see Albert
OCPD is very common amongst individuals suffering from et al., 2004 [21]) (for more details, see Table 1). Even more
medical conditions such as joint hypermobility syndrome/ evidence comes from studies demonstrating (significantly)
Ehlers–Danlos syndrome hypermobility type [43] and higher comorbidity rates between OCPD and OCD than be-
Parkinson’s disease [44]. High rates in joint hypermobility syn- tween other personality disorders and OCD [22, 53, 54, 56, 59,
drome/Ehlers–Danlos syndrome hypermobility type were ex- 60]. Moreover, studies investigating similarities and differences
plained with an elevated need of a “hyper-control” in congeni- between both disorders specified that (pure) obsessions as well
tally hypermobile subjects due to musculoskeletal consequences as contamination and cleaning-related symptoms seem to be
or associated features, such as joint instability and lack of specific for individuals with OCD, whilst rigidity and excessive
proprioception, which occur early in their life [43]. The associ- self-control were found to be specific for individuals with
ation of OCPD with Parkinson’s disease was explained by OCPD [8•, 48]. In contrast, symmetry and hoarding-related
similar dysfunctions in the fronto-basal ganglia circuitry [44]. symptoms as well as compulsions were identified as common
in both individuals with OCPD and OCD and seem to connect
both conditions [8•, 48]. Findings showing that OCPD and
OCPD and Obsessive–Compulsive Disorder OCD seem to have both similarities and differences might—
apart from methodological issues such as variety in study
The relationship between OCPD and obsessive–compulsive populations and the heterogeneity of the construct of
disorder (OCD) has long been a source of much controversial OCPD—at least in part explain the variety of results on the
debate (e.g. deReus and Emmelkamp, 2012 [5•]). Consistent relationship between OCPD and OCD.
2 Page 4 of 10 Curr Psychiatry Rep (2015) 17: 2

Table 1 Overview and characteristics of studies comparing frequencies of OCPD in OCD with frequencies of OCPD in the general population or other
mental disorders

Study Prevalence Instrument of evaluation Diagnostic criteria N Samples Frequencies p value

Albert et al., 2004 [21] Lifetime SCID-I DSM-IV 109 OCD 23 % (25) <.001
SCID-II 101 General population 3 % (3)
Samuels et al., 2000 [22] Lifetime SIDP-R DSM-IV 72 OCD 32 % (23) <.001
72 General population 6 % (4)
Albert et al., 2004 [21] Lifetime SCID-I DSM-IV 109 OCD 23 % (25) =.32
SCID-II 82 Panic disorder 17 % (14)
Gordon et al., 2013 [52] Not specified SCID-I DSM-IV 189 OCD 45 % (85) <.001
SCID-II 170 Panic disorder 15 % (25)
Diaferia et al., 1997 [58] Lifetime DIS-R DSM-III-R 88 OCD 31 % (27) <.001
SIDP-R 131 Panic disorder 11 % (15)
Diaferia et al., 1997 [58] Lifetime DIS-R DSM-III-R 88 OCD 31 % (27) <.001
SIDP-R 58 Major depressive disorder 14 % (8)

OCPD = obsessive–compulsive personality disorder, OCD = obsessive–compulsive disorder, SCID = Structured Clinical Interview for DSM Disorders,
SIDP-R = Revised Structured Instrument for the Diagnosis of Personality Disorders, DIS-R = Diagnostic Interview Schedule, Revised Version, DSM =
Diagnostic and Statistical Manual for Mental Disorders

Hence, research so far indicates that there might be a dominance, over-control and intrusiveness (e.g. rigid toilet
particularly strong relation between OCPD and OCD for a training practices). However, the small number of studies that
subgroup of individuals who suffer from specific symptoms has been conducted so far does not provide any evidence for
of both disorders. Studies specifically focusing on charac- these etiological models [64]. According to attachment theory,
teristics of individuals suffering from both disorders show attachment issues are considered an important etiological factor
that these individuals suffer from higher rates of doubting, [63•]. So far, at least two studies provide support for this
symmetry and hoarding obsessions [51, 52]; cleaning, or- hypothesis showing that individuals suffering from OCPD
dering, repeating and hoarding compulsions [49, 51, 61]; have never formed secure attachments, received less care and
and alcohol consumption [52] as well as lower levels of more overprotection during their childhood and failed to de-
insight and global functioning [49–51, 53] than individuals velop emotionally and empathetically [65, 66] (for an incon-
suffering from OCD alone. However, findings also consis- sistent finding, also see Perry, Bond, and Roy, 2007 [66]).
tently demonstrate that individuals who only suffer from In terms of biological causes of OCPD, empirical evidence
OCD and subjects with a comorbid OCPD do not differ clearly provides support for the heritability of OCPD [67, 68].
significantly with respect to sex, clinician-rated severity of However, findings on the extent of the impact of genes on the
OCD, duration of OCD, morbidity risk for OCD, levels of development of OCPD are inconsistent. Whilst Togersen and
disability, positive family history for tic disorder/Tourette colleagues (2000) [68] identified a heritability rate of 0.78 for
syndrome and distribution of gene variants [51, 58, 61]. OCPD, Reichborn-Kjennerud and colleagues (2007) [67]
Finally, findings are inconsistent regarding possible differ- found that genetic effects account for only 27 % of the
ences in both groups in the age at onset of first OC variance of OCPD. Unfortunately, only few studies have dealt
symptoms [50–52, 58, 61], the severity of self-reported with specific genetic and neurobiologic abnormalities in
OCD symptoms [49–53] and treatment response [51, 62]. OCPD so far, especially when compared to the vast amount
Thus, in sum, there is at least some indication for the of research that has been conducted on genetics and neurobi-
existence of an OCPD-OCD subtype. ology in OCD (for an overview, see for example Karch and
Pogarell, 2011 [69] or Pauls, Abramovitch, Rauch, and Geller,
2014 [70]). Some of the few studies that have been conducted
Aetiology of OCPD in individuals with OCPD indicate associations between
OCPD and the dopamine D3 receptor Gly/Gly genotype
The literature on psychological and biological theories regard- [71], the serotonin transporter 5HTTLPR polymorphism
ing OCPD is scant and often contradictory. Psychological [72] and a blunted prolactin response to fenfluramine indicat-
etiological models on OCPD include psychoanalytic theories ing a potential serotonergic dysfunction [73]. However, it
as well as the attachment theory [63•]. Psychoanalytic etio- must also be noted that some of these findings could not be
logical models (for an overview, see Hertler, 2014 [63•]) replicated [26] and others were questioned by inconsistent
attribute the obsessive character formation to parental empirical evidence [74]. Thus, more research should be
Curr Psychiatry Rep (2015) 17: 2 Page 5 of 10 2

Table 2 Characteristics of studies investigating psychotherapy in OCPD

Study Sample Assessment Design Intervention Summary of results

Fiore, Dimaggio, 1 outpatient with SCID-II for DSM-IV Case study 31 weekly individual Patient no longer met full criteria for any
Nicolo, APD + OCPD sessions and 36 personality disorder, but some traits
Semerari, and weekly group were still present.
Carcione (2008) sessions of MIT
[94]
Dimaggio et al. 1 outpatient with SCID-II, not specified Case study 3 years of MIT There was a significant drop in
(2011) [93] OCPD + MDD whether DSM-III-R or depression, personality disorder
IV psychopathology, general distress level
as well as alexithymic symptoms from
pre to post therapy.
Lynch and 1 outpatient with SCID-II for DSM-IV Case study 9 months of weekly The patient no longer met criteria for
Cheavens OCPD + PPD + individual DBT and OCPD or PPD and his Hamilton
(2008) [95] MDD 6 months of weekly Rating Scale for Depression score
DBT group skills decreased from 21 at baseline to 6 at
training follow-up.
Montazeri, 1 inpatient with SCID-I and II for DSM- Case study 16 weekly sessions of Schema therapy was effective in reducing
Neshatdoos, OCPD IV ST OCPD symptoms.
Abedi, and
Abedi (2014)
[91]
Ng (2005) [86] 20 outpatients with SCID-I and II for DSM- Pre–post ∼22 sessions of CT There was a significant drop in
OCPD + IV depression and anxiety from pre to
chronic post therapy. Nine patients no longer
depression fulfilled the DSM-IV diagnosis of
OCPD. Eight patients were also free
from axis I disorders.
Popa, Nirestian, 31 in. and SCID-II for DSM-IV Pre–post 40 sessions of CBT + There were significant improvements in
Ardelean, outpatients with escitalopram anxiety, extroversion, agreeableness
Buicu, and Ile OCPD + GAS and emotional stability from pre to post
(2013) [88] therapy.
Strauss et al. 30 outpatients with SCID-I and II for DSM- Longitudinal ≤52 weekly sessions of Stronger early alliances and rupture–
(2006) [87] OCPD/APD III-R CT repair episodes predicted more
improvement in symptoms of
personality disorder and depression.
Cummings, 27 inpatients with SCID-I and II for DSM- Longitudinal 52 weeks of CT More self-esteem variability during the
Hayes, APD + OCPD III-R; confirmation first 10 weeks of treatment predicted
Cardaciotto, (+ depressive with SCID-II for more improvement in OCPD and
and Newman disorder) DSM-IV depression symptoms at the end of the
(2012) [85••] treatment, beyond baseline and
average self-esteem.
Enero et al. (2012) 116 outpatients Met criteria for an OCPD Longitudinal 10 sessions of group Distress level was identified as a
[89••] with OCPD according to DSM-IV CBT significant predictor of treatment
response.
Barber, Morse, 38 outpatients with SCID-I and II for DSM- Longitudinal 52 weekly sessions of Individuals with OCPD improved
Krakauer, OCPD/APD + III-R, PDE supportive– significantly across time on measures
Chittams, and depressive and/ expressive dynamic of personality disorder symptoms,
Crits-Christoph or anxiety psychotherapy depression, anxiety, general
(1997) [96] disorder functioning and interpersonal
problems. By the end of treatment,
only 15 % of individuals with OCPD
still retained their diagnosis.
Barber and Muenz 239 outpatients Met criteria for MDD RCT ≥12 sessions and Results revealed a superiority of IPT over
(1996) [90] with MDD and according to DSM-IV; 15 weeks of CT or CT in depressed individuals suffering
an elevated level dimensional IPT from elevated OCPD levels regarding
of OCPD/APD assessment of PDs treatment-related reductions in
with the PAF depression.
Bamelis, Evers, 323 outpatients SCID-I and II for DSM- RCT Weekly sessions of ST, ST led to significantly more recoveries
Spinhoven, and with personality IV; DSM-IV COT or TAU; than did COT and TAU. Dropout rates
disorders were also lower compared to TAU. ST
2 Page 6 of 10 Curr Psychiatry Rep (2015) 17: 2

Table 2 (continued)

Study Sample Assessment Design Intervention Summary of results

Arntz (2014) including 89 Personality Disorders different treatment patients had higher general and social
[91] with OCPD Questionnaire durations functioning and lower rates of
depressive disorder at follow-up.

OCPD = obsessive–compulsive personality disorder, APD = avoidant personality disorder, MDD = major depressive disorder, PPD = paranoid
personality disorder, GAS = generalized anxiety disorder, SCID = Structured Clinical Interview for DSM Disorders, DSM = Diagnostic and Statistical
Manual for Mental Disorders, PD = personality disorder, PAF = Personality Assessment Form, PDE = Personality Disorder Examination, RCT =
randomized controlled trial, CT = cognitive therapy, CBT = cognitive–behavioural therapy, IPT = interpersonal psychotherapy, MIT = metacognitive
interpersonal therapy, DBT = dialectical–behavioural therapy, ST = Schema Therapy, COT = Clarification-Oriented Therapy, TAU = Treatment as Usual

conducted to attain more consistent results on relevant genetic Main treatments for OCPD include pharmacological and
and neurobiological mechanisms in OCPD. psychological treatments (for an overview of studies on psycho-
Further biological models which try to explain the devel- therapy, see Table 2; for studies on pharmacotherapy, see Ta-
opment of OCPD include amongst others the hypothesis that ble 3). As for pharmacological treatments, there are only few
neurological regions of the limbic system are especially dense research findings until now. The little research that has been
and well branched amongst individuals with OCPD [75]. conducted provides preliminary evidence for the efficacy of
However, this hypothesis is not consistent with the findings carbamazepine and fluvoxamine in reducing OCPD traits in
by Reetz and colleagues (2008) [76] who have conducted the individuals suffering from OCPD only [82, 83] and for
only study in this field so far. They found the grey matter citalopram in individuals suffering from OCPD and depressive
volume in the limbic cingulate to be reduced in individuals symptoms [84]. Regarding the efficacy of psychological treat-
with OCPD compared to healthy controls. ments, more research has been conducted. However, these
Next to this hypothesis, in the context of biological causes, studies mostly consist of case studies or uncontrolled longitudi-
it has been stated that characteristic OCPD traits may repre- nal designs with individuals suffering from comorbid disorders
sent, at least in part, compensatory tactics in response to pre- in addition to OCPD. Thus, there is a great need of randomized
existing cognitive deficits [77], and finally it has been hypoth- controlled trials with individuals solely suffering from OCPD.
esized that individuals suffering from OCPD show a de- Most recent studies investigating psychological treatments
creased activity in the so called empathizing system (an evo- for OCPD have examined cognitive therapy (CT) or cogni-
lutionary system that enables comprehension of intentional tive–behavioural therapy (CBT). Studies investigating the
motivated behaviour characteristics of humans) and an in- efficacy of CT suggest that it is effective in reducing symptom
creased activity in the so called systemizing mechanism (a severity of personality disorder, depression and anxiety from
system that enables comprehension for lawful and non- pre to post [85••, 86, 87]. Moreover, findings suggest that
intentional events) [16]. Even though the latter three theories variability in self-esteem as well as the therapeutic alliance, if
provide at least some explanation for the development of handled well, is associated with significant improvement in
OCPD, all of them have been criticized for positing proximate cognitive therapy [85••, 87]. Group CBT combined with
but not ultimate explanations as well as for their failures in escitalopram also showed to lead to improvements in anxiety,
reckoning the heritability of OCPD traits themselves and in extroversion, agreeableness and emotional stability from pre
applying evolutionary thought and theory [63•]. to post [88], and distress level was identified as a significant
predictor of CBT response [89••].
In spite of this at least moderate support for CT or CBT in the
Treatment Seeking and Treatments in OCPD treatment of OCPD, interpersonal psychotherapy has been
proven to be even superior to CT in reducing depressive symp-
Regarding treatment-seeking behaviour in individuals suffer- toms in a randomized controlled trial [90]. Moreover, schema
ing from OCPD, evidence is mixed. Some findings suggest therapy was shown to be superior to a clarification-oriented
that individuals suffering from OCPD often seek treatment on psychotherapy and a treatment-as-usual condition at follow-up
their own and receive more treatment than, for example, in terms of decreasing depressive disorders and increasing
individuals suffering from depression [78–80], whilst other social and occupational functioning [91]. Finally, few case
studies suggest the opposite [66, 81]. However, from a theo- studies also provide at least some evidence for the efficacy of
retical perspective, decreased treatment-seeking behaviour in schema therapy [92], as well as further psychological treat-
individuals with OCPD might be easily explained by the ments, such as metacognitive interpersonal therapy [93, 94],
egosyntonic character of OCPD as well as the great need of an adapted version of dialectical behaviour therapy [95], as well
individuals with OCPD for independence and control [66, 81]. as supportive–expressive dynamic psychotherapy [96] on
Curr Psychiatry Rep (2015) 17: 2 Page 7 of 10 2

Table 3 Characteristics of studies investigating pharmacotherapy in OCPD

Study Sample Assessment Design Intervention Summary of Results

Greve and 1 outpatient with Not specified Case study ∼8 months of There was a substantial drop in OCPD traits
Adams OCPD + features carbamazepine from pre to post therapy.
(2002) [83] of OCD (100–200 mg/day)
Ansseau, 46 outpatients with a Met criteria for a Quasi- 8 weeks of Results demonstrated significantly greater
Troisfontaines, MDD including MDD (and experimental fluvoxamine (100– decreases of depressive symptoms in the
Papart, and 24 with a OCPD) 200 mg/day) subgroup with OCPD than in the non-
Frenckell comorbid OCPD according to compulsive subgroup.
(1991) [82] DSM-III
Ekselius and 308 outpatients with SCID screening RCT 24 weeks of sertraline In the citalopram group, there was a significant
Von Knorring OCPD + MDD + questionnaire (50–150 mg/day) reduction in OCPD diagnoses after 24 weeks
(1998) [84] OCD vs. citalopram (20– of treatment. In addition, the number of OCPD
60 mg/day) traits decreased significantly in both groups,
the citalopram group being the most effective.

OCPD = obsessive–compulsive personality disorder, MDD = major depressive disorder, OCD = obsessive–compulsive disorder, SCID = Structured
Clinical Interview for DSM Disorders, RCT = randomized controlled trial, DSM = Diagnostic and Statistical Manual for Mental Disorders

various outcome measures, such as personality disorder symp- emphasize the need of further identifying elements belonging
toms, depression, anxiety, general functioning, and interperson- specifically to OCPD (especially when opposed to OCD) and
al problems. However, more research is needed to support these of verifying the recently suggested alternative set of criteria of
preliminary findings. the DSM-5 in order to reach a unified diagnostic set that can
be applied both in clinical practice and research and might
lead to more conclusive findings regarding epidemiology,
Conclusions course and co-occurrences of OCPD. Standardized
(semi-)structured interviews should be used as well as longi-
Recent theoretical developments and empirical findings have tudinal designs to further elucidate the relationship between
come up with important knowledge, particularly regarding the OCPD and OCD. Finally, research involving large random-
concept and associated diagnostic criteria of OCPD, as well as ized controlled trials should continue evaluating the suggested
potentially effective treatments of OCPD. Rigidity, self- etiological models of OCPD as well as treatments such as
control and conscientiousness might be key components of metacognitive interpersonal therapy and schema therapy.
OCPD (especially when compared to OCD) [8•], and the
patient–therapist alliance, state anxiety as well as self-esteem Compliance with Ethics Guidelines
variability might constitute important predictors of the effica-
Conflict of Interest Alice Diedrich and Ulrich Voderholzer declare that
cy of cognitive(–behavioural) treatments in OCPD [85••, 87, they have no conflict of interest.
89••]. These findings are of particular interest and value for the
theoretical and clinical understanding of OCPD. From a clin- Human and Animal Rights and Informed Consent This article does
ical perspective, it might be concluded that OCPD is a distinct not contain any studies with human or animal subjects performed by any
of the authors.
disorder (when conceptualized correctly) that can be best
treated with cognitive(–behavioural) treatments [C(B)T] (in
combination with citalopram or fluvoxamin). Moreover, it
might be reasoned that intense habitual anxiety and rigidity References
(in self-esteem) of individuals suffering from OCPD as well as
a dysfunctional therapeutic relationship might decrease treat- Papers of particular interest, published recently, have been
ment outcome. However, findings also indicate that a special highlighted as:
focus on the therapeutic alliance as well as the distress level • Of importance
and (self-esteem) variability might improve treatment out- •• Of major importance
come in C(B)T.
However, we must conclude that overall research on 1. Freud S. Character and anal eroticism. In: Strachey J, editor. The
OCPD is still scant. Moreover, findings on epidemiology, standard edition of the complete psychological works of Sigmund
Freud, vol. 9. London: Hogarth; 1908. p. 169–75.
course and co-occurring disorders are partly inconsistent. 2. American Psychiatric Association. Diagnostic and Statistical
Given that the heterogeneity of the concept of OCPD might Manual of Mental Disorders. Washington, DC: American
have had some impact on these diverging results, we Psychiatric Association; 1952.
2 Page 8 of 10 Curr Psychiatry Rep (2015) 17: 2

3. Costa P, Samuels J, Bagby M, Daffin L, Norton H. Obsessive- 18. Samuel DB, Widiger TA. Conscientiousness and obsessive-
compulsive personality disorder: a review. In: Mai M, Akiskal HS, compulsive personality disorder. Personal Disord Theory Res
Mezzich JE, Okasha A, editors. Personality disorders (pp. 405– Treat. 2011;2:161–74. doi:10.1037/a0021216.
478). West Sussex, England: John Wiley; 2005. 19. American Psychiatric Association. Diagnostic and statistical man-
4. American Psychiatric Association. Diagnostic and Statistical ual of mental disorders. 5th ed. Arlington, VA: American
Manual of Mental Disorders (4th ed., text revision). Washington, Psychiatric Publishing; 2013.
DC: American Psychiatric Association; 2000. 20. Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV
5.• de Reus RJM, Emmelkamp PMG. Obsessive–compulsive person- personality disorders in the National Comorbidity Survey
ality disorder: a review of current empirical findings. Personal Ment Replication. Biol Psychiatry. 2007;62:553–64. doi:10.1016/j.
Health. 2012;6:1–21. doi:10.1002/pmh. This review provides the biopsych.2006.09.019.
reader with an overview of current empirical findings on 21. Albert U, Maina G, Forner F, Bogetto F. DSM-IV obsessive–com-
epidemiology, course, comorbidities, construct validity, theoretical pulsive personality disorder: prevalence in patients with anxiety
models, costs and treatment of OCPD. disorders and in healthy comparison subjects. Compr Psychiatry.
6.•• Grant JE, Mooney ME, Kushner MG. Prevalence, correlates, and 2004;45:325–32. doi:10.1016/j.comppsych.2004.06.005.
comorbidity of DMS-IV obsessive-compulsive personality disor- 22. Samuels J, Nestadt G, Bienvenu OJ, Costa Jr PT, Riddle MA, Liang
der: results from the National Epidemiologic Survey on Alcohol K-Y, et al. Personality disorders and normal personality dimensions
and Related Conditions. J Psychiatr Res. 2012;46:469–75. doi:10. in obsessive-compulsive disorder. Br J Psychiatry. 2000;177:457–
1016/j.jpsychires.2012.01.009. This paper provides an excellent 62. doi:10.1192/bjp.177.5.457.
current report on prevalence, epidemiology, correlates and 23. Zimmerman M, Rothschild L, Chemlinski I. The prevalence of
comorbidities of OCPD. DSM-IV personality disorders in psychiatric outpatients. Am J
7. Mancebo MC, Eisen JL, Grant JE, Rasmussen SA. Obsessive Psychiatr. 2005;162:1911–8. doi:10.1176/appi.ajp.162.10.1911.
compulsive personality disorder and obsessive compulsive disor- 24. Rossi A, Marinangeli MG, Butti G, Kalyvoka A, Petruzzi C. Pattern
der: clinical characteristics, diagnostic difficulties, and treatment. of comorbidity among anxious and odd personality disorders: the
Ann Clin Psychiatry. 2005;17:197–204. doi:10.1080/ case of obsessive–compulsive personality disorder. CNS
10401230500295305. Spectrums. 2000;5:23–6.
8.• Pinto A, Steinglass JE, Greene AL, Weber EU, Simpson HB. 25. Coid J, Yang M, Tyrer P, Roberts A, Ullrich S. Prevalence and
Capacity to delay reward differentiates obsessive-compulsive dis- correlates of personality disorder in Great Britain. Br J Psychiatry.
order and obsessive-compulsive personality disorder. Biol 2006;188:423–31. doi:10.1192/bjp.188.5.423.
Psychiatry. 2014;75:653–9. doi:10.1016/j.biopsych.2013.09.007. 26. Light KJ, Joyce PR, Luty SE, Mulder RT, Frampton CM, Joyce LR.
This is a very interesting paper demonstrating important Preliminary evidence for an association between a dopamine D3
empirical differences between OCPD and OCD. receptor gene variant and obsessive-compulsive personality disor-
9. Skodol AE, Gunderson JG, McGlashan TH, Dyck IR, Stout RL, der in patients with major depression. Am J Med Genet B
Bender DS. Functional impairment in patients with schizotypal, Neuropsychiatr Genet. 2006;141B:409–13. doi:10.1002/ajmg.b.
borderline, avoidant, or obsessive–compulsive personality disorder. 30308.
Am J Psychiatr. 2002;159:276–83. doi:10.1176/appi.ajp.159.2.276. 27. Shea MT, Stout R, Gunderson J, Morey LC, Grilo C, McGlashan T.
10. Soeteman DI, Hakkaart-van Roijen L, Verheul R, Busschbach JJ. Short-term diagnostic stability of schizotypical, borderline,
The economic burden of personality disorders in mental health care. avoidant, and obsessive–compulsive personality disorders. Am J
J Clin Psychiatry. 2008;69:259–65. doi:10.4088/JCP.v69n0212. Psychiatr. 2002;159:2036–41. doi:10.1176/appi.ajp.159.12.2036.
11.•• Starcevic V, Brakoulias V. New diagnostic perspectives on 28. Grilo CM, Sanislow CA, Gunderson JG, Pagano ME, Yen S,
obsessive-compulsive personality disorder and its links with other Zanarini MC. Two-year stability and change of schizotypal, bor-
conditions. Curr Opin Psychiatry. 2014;27:62–7. doi:10.1097/ derline, avoidant, and obsessive-compulsive personality disorders.
YCO.0000000000000030. This excellent review provides an J Consult Clin Psychol. 2004;72:767–75. doi:10.1037/0022-006X.
overview of new diagnostic perspectives of OCPD, of its 72.5.767.
epidemiology as well as of co-occurrences with other mental dis- 29. Devanand DP, Turret N, Moody BJ, Fitzsimons L, Peyser S, Mickle
orders including OCD. K. Personality disorders in elderly patients with dysthymic disorder.
12. American Psychiatric Association. Diagnostic and Statistical Am J Geriatr Psychiatry. 2000;8:188–95. doi:10.1097/00019442-
Manual of Mental Disorders. 4th ed. Washington, DC: American 200008000-00002.
Psychiatric Association; 1994. 30. Rinsma ES, Colon EJ. De prevalentie van persoonlijkheidsstoornissen
13.• Hertler, S. C. (2013). Understanding obsessive-compulsive person- bij ouderen kritisch bekeken. Tijdschr Psychiatr. 1997;39:866–74.
ality disorder. SAGE Open, 3. doi:10.1177/2158244013500675. 31. Ullrich S, Coid J. The age distributions of self-reported personality
This is a comprehensive review on problems of specificity and disorder traits in a household population. J Personal Disord.
sensitivity of DSM-IV diagnostic criteria. 2009;23:187–200. doi:10.1521/pedi.2009.23.2.187.
14. Crego C, Samuel DB, Widinger TA. The FFOCI and other mea- 32. Grilo CM, Skodol AE, Gunderson JG, Sanislow CA, Stout RL,
sures and models of OCPD. Assessment. 2014;23:1–17. doi:10. Shea MT. Longitudinal diagnostic efficiency of DSM-IV criteria for
1177/1073191114539382. obsessive–compulsive personality disorder: a 2-year prospective
15. Fossati A, Beauchaine TP, Grazioli F, Borroni S, Carretta I, De study. Acta Psychiatr Scand. 2004;110:64–8. doi:10.1111/j.1600-
Vecchi C. Confirmatory factor analyses of DSM-IV Cluster C 0447.2004.00311.x.
personality disorder criteria. J Personal Disord. 2006;20:186–203. 33. McGlashan TH, Grilo CM, Sanislow CA, Ralevski E, Morey LC,
doi:10.1521/pedi.2006.20.2.186. Gunderson JG, et al. Two-year prevalence and stability of individ-
16. Hummelen B, Wilberg T, Pedersen G, Karterud S. The quality of ual DSM-IV criteria for schizotypal, borderline, avoidant, and
the DSM-IVobsessive-compulsive personality disorder construct as obsessive-compulsive personality disorders: toward a hybrid model
a prototype category. J Nerv Ment Dis. 2008;196:446–55. doi:10. of axis II disorders. Am J Psychiatr. 2005;162:883–9. doi:10.1176/
1097/NMD.0b013e3181775a4e. appi.ajp.162.5.883.
17. Popa CO, Buicu G, Ardelean M. The obsessive-compulsive per- 34. Zanni G. The graying of personality disorders: persistent but dif-
sonality disorder, approached by cognitive-behavioural therapy. ferent. Consult Pharm. 2007;22:995–1003. doi:10.4140/TCP.n.
Acta Med Transilvanica. 2012;2:251–2. 2007.995.
Curr Psychiatry Rep (2015) 17: 2 Page 9 of 10 2

35. Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, compulsive disorder with obsessive–compulsive personality disor-
et al. Co-occurrence of 12-month mood and anxiety disorders and der: does it imply a specific subtype of obsessive–compulsive
personality disorders in the US: results from the National disorder? Psychiatry Res. 2010;177(1–2):156–60. doi:10.1037/
Epidemiologic Survey on Alcohol and Related Conditions. J t18597-000.
Psychiatr Res. 2005;39:1–9. doi:10.1016/j.jpsychires.2004.05.004. 51. Lochner C, Serebro P, van der Merwe L, Hemmings S, Kinnear C,
36. Grant BF, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering Seedat S, et al. Comorbid obsessive-compulsive personality disor-
RP. Co-occurrence of 12-month alcohol and drug use disorders and der in obsessive-compulsive (OCD): a marker of severity. Prog
personality disorders in the United States: results from the National Neuro-Psychopharmacol Biol Psychiatry. 2011;35:1087–92. doi:
Epidemiologic Survey on Alcohol and Related Conditions. Arch 10.1016/j.pnpbp.2011.03.006.
Gen Psychiatry. 2004;61:361–8. doi:10.1001/archpsyc.61.4.361. 52. Gordon OM, Salkovskis PM, Oldfield VB, Carter N. The associa-
37. Preuss UW, Johann M, Fehr MJ, Koller G, Wodarz N, Hesselbrock tion between obsessive compulsive disorder and obsessive compul-
V. Personality disorders in alcohol-dependent individuals: relation- sive personality disorder: prevalence and clinical presentation. Br J
ship with alcohol dependence severity. Eur Addict Res. 2009;15: Clin Psychol. 2013;52:300–15. doi:10.1111/bjc.12016.
188–95. doi:10.1159/000228929. 53. Pinto A, Liebowitz MR, Foa EB, Simpson HB. Obsessive compul-
38. Fallon BA, Harper KM, Landa A, Pavlicova M, Schneier FR, sive personality disorder as a predictor of exposure and ritual
Carson A. Personality disorders in hypochondriasis: prevalence prevention outcome for obsessive compulsive disorder. Behav
and comparison with two anxiety disorders. Psychosomatics. Res Ther. 2011;49:453–8. doi:10.1016/j.brat.2011.04.004.
2012;53:566–74. doi:10.1016/j.psym.2012.02.002. 54. Pinto A, Mancebo MC, Eisen JL, Pagano ME, Rasmussen SA. The
39. Garyfallos G, Adamopoulou A, Karastergiou A, Voikli M, Brown Longitudinal Obsessive Compulsive Study: clinical features
Ikonomidis N, Donias S. Somatoform disorders: comorbidity with and symptoms of the sample at intake. J Clin Psychiatry. 2006;67:
other DSM-III-R psychiatric diagnosis in Greece. Compr 703–11. doi:10.4088/JCP.v67n0503.
Psychiatry. 1999;40:299–307. doi:10.1016/S0010-440X(99) 55. Black DW, Noyes R. Obsessive-compulsive disorder and axis II. Int
90131-1. Rev Psychiatr. 1997;9:111–8. doi:10.1080/09540269775637.
40. Halmi K, Tozzi F, Thornton LM, Crow S, Fichter MM, Kaplan AS. 56. Konermann J, von Hammerstein A, Zaudig M, Tritt K. Prävalenz
The relation among perfectionism, obsessive–compulsive person- und Komorbidität von Persönlichkeitsstörungen in
ality disorder and obsessive–compulsive disorder in individuals psychosomatischen /psychotherapeutischen Kliniken.
with eating disorders. J Eat Disord. 2005;38:371–4. doi:10.1002/ Persönlichkeitsstörungen Theorie und Therapie. 2006;10:3–17.
eat.20190. 57. Zaudig M. Heterogenität und Komorbidität der Zwangsstörung.
41. Schiavone P, Dorz S, Conforti D, Scarso C, Borgherini G. Nervenarzt. 2011;82:290–8. doi:10.1007/s00115-010-2966-z.
Comorbidity of DSM-IV personality disorders in unipolar and 58. Diaferia G, Bianchi I, Bianchi ML, Cavedini P, Erzegovesi S,
bipolar affective disorders: a comparative study. Psychol Rep. Bellodi L. Relationship between obsessive–compulsive personality
2004;95:121–8. doi:10.2466/pr0.95.1.121-128. disorder and obsessive–compulsive disorder. Compr Psychiatry.
42. Stuart S, Pfohl B, Battaglia M, Bellodi L, Grove W, Cadoret R. The 1997;38:38–42. doi:10.1016/S0010-440X(97)90051-1.
cooccurrence of DSM-III-R personality disorders. J Personal 59. Eisen JL, Coles ME, Shea MT, Pagano ME, Stout RL, Yen S, et al.
Disord. 1998;12:302–15. doi:10.1521/pedi.1998.12.4.302. Clarifying the convergence between obsessive–compulsive person-
43. Pasquini M, Celletti C, Berardelli I, Roselli V, Mastroeni S, Castori ality disorder criteria and obsessive compulsive disorder. J Personal
M. Unexpected association between joint hypermobility syndrome/ Disord. 2006;20:294–305. doi:10.1521/pedi.2006.20.3.294.
Ehlers-Danlos syndrome hypermobility type and obsessive- 60. Crino RD, Andrews G. Personality disorder in obsessive–compul-
compulsive personality disorder. Rheumatol Int. 2013;34:631–6. sive disorder: a controlled study. J Psychiatr Res. 1996;30:29–38.
doi:10.1007/s00296-013-2901-2. doi:10.1016/0022-3956(95)00043-7.
44. Nicoletti A, Luca A, Raciti L, Contrafatto D, Bruno E, Dibilio V. 61. Starcevic V, Berle D, Brakoulias V, Sammut P, Mosses K, Milicevic
Obsessive compulsive personality disorder and Parkinson’s disease. D, et al. Obsessive-compulsive personality disorder co-occurring
PLoS ONE [PLoS One]. 2013;8:e54822. doi:10.1371/journal.pone. with obsessive-compulsive disorder: conceptual and clinical impli-
0054822. cations. Aust N Z J Psychiatry. 2013;47:65–73. doi:10.1177/
45. McGlashan TH, Grilo CM, Skodol AE, Gunderson JG, Shea MT, 0004867412450645.
Morey LC. The collaborative longitudinal personality disorders 62. Cavedini P, Erzegovesi S, Ronchi P, Bellodi L. Predictive value of
study: baseline axis I/II and II/II diagnostic co-occurrence. Acta obsessive-compulsive personality disorder in antiobsessional phar-
Psychiatr Scand. 2000;102:256–64. doi:10.1034/j.1600-0447. macological treatment. Eur Neuropsychopharmacol. 1997;7:45–9.
2000.102004256.x. doi:10.1016/S0924-977X(96)00382-3.
46. Wu KD, Clark LA, Watson D. Relations between obsessive–com- 63.• Hertler SC. A review and critique of obsessive-compulsive person-
pulsive disorder and personality: beyond axis i-axis II comorbidity. ality disorder etiologies. Eur J Psychol. 2014;10:168–84. doi:10.
Anxiety Disord. 2006;20:695–717. doi:10.1016/j.janxdis.2005.11. 5964/ejop.v10i1.679. This review provides a comprehensive
001. overview on psychological and biological aetiological models of
47. Pinto A, Eisen JL. Personality features of OCD and spectrum OCPD.
conditions. In: Steketee G, editor. The Oxford Handbook of 64. Pollak JM. Obsessive-compulsive personality: a review. Psychol
Obsessive Compulsive and Spectrum Disorders. New York, USA: Bull. 1979;86:225–41. doi:10.1037/0033-2909.86.2.225.
Oxford University Press; 2011. p. 189–208. doi:10.1093/oxfordhb/ 65. Nordahl HM, Stiles TC. Perceptions of parental bonding in patients
9780195376210.013.0038. with various personality disorders, lifetime depressive disorders,
48. Baer L. Factor analysis of symptom subtypes of obsessive compul- and healthy controls. J Personal Disord. 1997;11:391–402. doi:10.
sive disorder and their relation to personality and tic disorders. J 1521/pedi.1997.11.4.391.
Clin Psychiatry. 1994;55:18–23. 66. Perry JC, Bond M, Roy C. Predictors of treatment duration and
49. Coles ME, Pinto A, Mancebo MC, Rasmussen SA, Eisen JL. OCD retention in a study of long-term dynamic psychotherapy: child-
with comorbid OCPD: a subtype of OCD? J Psychiatr Res. hood adversity, adult personality, and diagnoses. J Psychiatr Pract.
2008;42:289–96. doi:10.1016/j.jpsychires.2006.12.009. 2007;13:221–32. doi:10.1097/01.pra.0000281482.11946.fc.
50. Garyfallos G, Katsigiannopoulos K, Adamopoulou A, Papazisis G, 67. Reichborn-Kjennerud T, Czajkowski N, Neale MC, Orstavik RE,
Karastergiou A, Bozikas VP. Comorbidity of obsessive– Torgersen S, Tambs K, et al. Genetic and environmental influences
2 Page 10 of 10 Curr Psychiatry Rep (2015) 17: 2

on dimensional representations of DSM-IV cluster C personality Clin Neurosci. 2002;56:207–8. doi:10.1046/j.1440-1819.2002.

disorders: a population-based multivariate twin study. Psychol 00946.x.
Med. 2007;37:645–53. doi:10.1017/S0033291706009548. 84. Ekselius L, von Knorring L. Personality disorder comorbidity with
68. Torgersen S, Lygren S, Øien PA, Skre I, Onstad S, Edvardsen J, major depression and response to treatment with sertraline or
et al. A twin study of personality disorders. Compr Psychiatry. citalopram. Int Clin Psychopharmacol. 1998;13:205–11. doi:10.
2000;41:416–25. doi:10.1053/comp.2000.16560. 1097/00004850-199809000-00003.
69. Karch S, Pogarell O. Neurobiologie der Zwangsstörungen. 85.•• Cummings JA, Hayes AH, Cardaciotto L, Newman CF. The dy-
Nervenarzt. 2011;82:299–307. doi:10.1007/s00115-010-2964-1. namics of self-esteem in cognitive therapy for avoidant and
70. Pauls DL, Abramovitch A, Rauch SL, Geller DA. Obsessive– obsessive-compulsive personality disorders: an adaptive role of
compulsive disorder: an integrative genetic and neurobiological self-esteem variability? Cogn Ther Res. 2012;36:272–81. doi:10.
perspective. Nat Rev Neurosci. 2014;15:410–24. doi:10.1038/ 1007/s10608-011-9375-x. This important study demonstrates the
nrn3746. impact of self-esteem variability on the efficacy of cognitive therapy
71. Joyce PR, Rogers GR, Miller AL, Mulder RT, Luty SE, Kennedy in individuals with avoidant and obsessive-compulsive personality
MA. Polymorphisms of DRD4 and DRD3 and risk of avoidant and disorder.
obsessive personality traits and disorders. Psychiatry Res. 86. Ng RMK. Cognitive therapy for obsessive-compulsive personality
2003;119:1–10. doi:10.1016/S0165-1781(03)00124-0. disorder—a pilot study in Hong Kong Chinese patients. Hong
72. Blom RM, Samuels JF, Riddle MA, Bienvenu OJ, Grados MA, Reti Kong J Psychiatry. 2005;15:50–3.
IM. Association between a serotonin transporter promoter polymor- 87. Strauss JL, Hayes AM, Johnson SL, Newman CF, Brown GK,
phism (5HTTLPR) and personality disorder traits in a community Barber JP. Early alliance, alliance ruptures, and symptom change
sample. J Psychiatr Res. 2011;45:1153–9. doi:10.1016/j.jpsychires. in a nonrandomized trial of cognitive therapy for avoidant and
2011.03.003. obsessive-compulsive personality disorders. J Consult Clin
73. Stein DJ, Trestman RL, Mitropoulou V, Coccaro EF, Hollander E, Psychol. 2006;74:337–45. doi:10.1037/0022-006X.74.2.337.
Siever LJ. Impulsivity and serotonergic function in compulsive 88. Popa CO, Nireştean A, Ardelean M, Buicu G, Ile L. Dimensional
personality disorder. J Neuropsychiatr Clin Neurosci. 1996;8:393– personality change after combined therapeutic intervention in the
8. obsessive-compulsive personality disorders. Acta Med
74. Perez M, Brown JS, Vrshek-Schallhorn S, Johnson F, Joiner Jr TE. Transilvanica. 2013;2:290–2.
Differentiation of obsessive-compulsive-, panic-, obsessive- 89.•• Enero C, Soler A, Ramos I, Cardona S, Guillamat R, Valles V.
compulsive personality-, and non-disordered individuals by varia- 2783—distress level and treatment outcome in obsessive-
tion in the promoter region of the serotonin transporter gene. compulsive personality disorder (OCPD). Eur Psychiatry.
Anxiety Disord. 2006;20:794–806. doi:10.1016/j.janxdis.2005.09. 2013;28:1. doi:10.1016/S0924-9338(13)77373-5. This is a large
001. study investigating the efficacy of group CBT as well as the
75. Millon T, Davis RD. Disorders of personality DSM-IVand beyond. predictive impact of distress level on treatment outcome in
New York, NY: John Wiley & Sons; 1996. individuals suffering from OCPD without any comorbid disorder.
76. Reetz K, Lencer R, Steinlechner S, Gaser C, Hagenah J, Büchel C. 90. Barber JP, Muenz LR. The role of avoidance and obsessiveness in
Limbic and frontal cortical degeneration is associated with psychi- matching patients to cognitive and interpersonal psychotherapy:
atric symptoms in PINK1 mutation carriers. Biol Psychiatry. empirical findings from the treatment for depression collaborative
2008;64:241–7. doi:10.1016/j.biopsych.2007.12.010. research program. J Consult Clin Psychol. 1996;64:951–8. doi:10.
77. Aycicegi-Dinn A, Dinn WM, Caldwell-Harris CL. Obsessive- 1037/0022-006X.64.5.951.
compulsive personality traits: compensatory response to executive 91. Bamelis LL, Evers SM, Spinhoven P, Arntz A. Results of a multi-
function deficit? Int J Neurosci. 2009;119:600–8. doi:10.1080/ center randomized controlled trial of the clinical effectiveness of
00207450802543783. schema therapy for personality disorders. Am J Psychiatr.
78. Bender DS, Dolan RT, Skodol AE, Sanislow CA, Dyck IR, 2014;171:305–22.
McGlashan TH, et al. Treatment utilization by patients with per- 92. Montazeri MS, Neshatdoost HT, Abedi MR, Abedi A.
sonality disorders. Am J Psychiatr. 2001;158:295–302. doi:10. Effectiveness of schema therapy on symptoms intensity reduction
1176/appi.ajp.158.2.295. and anxiety in a special case with obsessive compulsive personality
79. Bender DS, Skodol AE, Pagano ME, Dyck IR, Grilo CM, Shea MT. disorder. Zahedan J Res Med Sci. 2014;16:92–4.
Brief reports: prospective assessment of treatment use by patients 93. Dimaggio G, Carcione A, Salvatore G, Nicolò G, Sisto A, Semerari
with personality disorders. Psychiatr Serv. 2006;57:254–7. doi:10. A. Progressively promoting metacognition in a case of obsessive-
1176/appi.ps.57.2.254. compulsive personality disorder treated with metacognitive inter-
80. Chessick R. OCD, OCPD: acronyms do not make a disease. personal therapy. Psychol Psychother Theory Res Pract. 2011;84:
Psychoanal Inq. 2001;21:183–208. doi:10.1080/ 70–83. doi:10.1348/147608310X527240.
07351692109348931. 94. Fiore D, Dimaggio G, Nicolo G, Semerari A, Carcione A.
81. Cullen B, Samuels JF, Pinto A, Fyer AJ, McCracken JT, Rauch SL, Metacognitive interpersonal therapy in a case of obsessive–com-
et al. Demographic and clinical characteristics associated with pulsive and avoidant personality disorders. J Clin Psychol.
treatment status in family members with obsessive-compulsive 2008;64:168–80. doi:10.1002/jclp.20450.
disorder. Depression Anxiety. 2008;25:218–24. doi:10.1002/da. 95. Lynch TR, Cheavens JS. Dialectical behavior therapy for comorbid
20293. personality disorders. J Clin Psychol. 2008;64:154–67. doi:10.
82. Ansseau M, Troisfontaines B, Papart P, Von Frenckell R. 1002/jclp.20449.
Compulsive personality as predictor of response to serotoninergic 96. Barber JP, Morse JQ, Krakauer ID, Chittams J, Crits-Christoph K.
antidepressants. Br Med J. 1991;303:760–1. Change in obsessive-compulsive and avoidant personality disorders
83. Greve KW, Adams D. Treatment of features of obsessive- following time-limited supportive-expressive therapy.
compulsive personality disorder using carbamazepine. Psychiatry Psychotherapy. 1997;34:133–43. doi:10.1037/h0087774.

View publication stats