Obsessive compulsive personality disorder (OCPD) is a prevalent problem in community (Ekselius, Tillfors, Furmark and Fredrikson, 2001 and Torgersen, Kringlen and Cramer, 2001) and clinical samples (Stuart, Pfohl, Bataglia, Bellodi, Grove and Cadoret, 1998 and Wilfley, Friedman, Dounchis, Stein, Welch and Ball, 2000). The current OCPD diagnostic construct in the DSM-IV (APA, 1994) has evolved considerably from earlier editions of the DSM and from the clinical-descriptive literature dating back to the writings of Freud (1908) through modern and broader views (e.g. Millon, 1981 and Salzman, 1980). While considerable attention was paid to the ‘pre-DSM-III-R’ obsessive compulsive personality (reviewed by Pollak, 1979), little empirical attention has been paid to OCPD in the past two decades (Grilo and McGlashan, 1999 and Pfohl and Blum, 1995). Psychometric work on the structure and validity of the current construct of OCPD represents a pressing need (Pfohl & Blum, 1995).
Although empirical analyses of criteria sets for personality disorders (PDs) are important (Blashfield & Druguns, 1976), relatively few empirical efforts have followed. Numerous studies have generally found adequate internal consistency for PDs (e.g. Becker, Grilo, Morey, Walker, Edell and McGlashan, 1999, Grilo, McGlashan, Morey, Gunderson, Skodol, Shea, Sanislow, Zanarini, Bender, Oldham, Dyck and Stout, 2001, Morey, 1988 and Trull, Widiger and Frances, 1987). More specific aspects of the construct validity of PDs, however, require additional methods such as analyses of diagnostic efficiency of their criteria sets.
Diagnostic efficiency refers to the extent to which diagnostic criteria are able to discriminate persons with a given diagnosis from those without that diagnosis, as determined by the application of conditional probabilities (Becker, Grilo, Edell, & McGlashan, 2002). Such analyses can contribute to the continued refinement of criteria sets and have clinical relevance to clinicians to assist in diagnostic decision-making. Such analyses have contributed to the refinement of certain psychiatric disorders (Baldessarini, Finkelstein and Arana, 1983, Faraone, Biederman, Sprich-Buckminster, Chen and Tsuang, 1993, Milich, Widiger and Landau, 1987 and Waldman and Lilienfeld, 1991) and selected PDs (Becker, Grilo, Edell and McGlashan, 2002 and Trull, Widiger and Frances, 1987).
In terms of OCPD diagnostic efficiency, only three studies (with semi-structured diagnostic interviews) have been published, one for DSM-III (Pfohl, Coryell, Zimmerman, & Stangl, 1986) and two for DSM-IV (Farmer and Chapman, 2002 and Grilo, McGlashan, Morey, Gunderson, Skodol, Shea, Sanislow, Zanarini, Bender, Oldham, Dyck and Stout, 2001) criteria. In terms of the DSM-IV studies, while Grilo and colleagues found that all criteria performed better than chance in a large (N=668) patient sample, Farmer and Chapman (2002) found that five criteria failed to perform better than 50/50 chance in a community (N=149) sample. In addition, there exist some findings (sensitivity and specificity) for DSM-III-R criteria from four unpublished data sets reviewed by Pfohl and Blum (1995) as part of the DSM-IV Work Group. Pfohl and Blum (1995) noted considerable variability in the performance of the OCPD criteria within and across the unpublished data sets and stressed the need for additional research given their various methodologic limitations. The relative lack of data is especially noteworthy because the criteria for OCPD in the DSM-IV have undergone significant changes from the DSM-III to DSM-III-R to DSM-IV (1994). Even minor revisions can produce major effects as demonstrated by Blashfield, Blum, and Pfohl (1992).
The purpose of this study was to examine the diagnostic efficiency of the DSM-IV criteria for OCPD. To do this, a study group of patients known to have a sufficient frequency of OCPD was required. For this study, a consecutive series of outpatients with binge eating disorder (BED)—assessed with semi-structured diagnostic interviews—was selected. BED is a new eating disorder category included in the DSM-IV (1994) in Appendix B, reflecting ‘criteria sets and axes provided for further study.’ BED is characterized by recurrent binge eating without the inappropriate compensatory weight-control methods that distinguish bulimia nervosa. Although BED remains a research category, considerable research has been published pertaining to its validity as a diagnosis and its associated psychopathology (Grilo, 1998). Of relevance here, patients with BED have elevated rates of OCPD (Specker, de Zwaan, Raymond and Mitchell, 1994 and Wilfley, Friedman, Dounchis, Stein, Welch and Ball, 2000). For example, Wilfley and colleagues (2000) reported that 14% of BED patients in a clinical trial met DSM-III-R criteria for OCPD, a significantly higher figure than observed among a comparison group of general psychiatric patients. The use of a homogeneous study group removes some variability in Axis I effects that characterizes much of the literature on Axis II PDs (Grilo & McGlashan, 1999).
