ارتباط وسواس فکری و عملی، اسکیزوتایپی و اختلالات شخصیت مرزی در اختلال وسواس
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|34150||2015||10 صفحه PDF||سفارش دهید||9368 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Anxiety Disorders, Volume 33, June 2015, Pages 15–24
We assessed correlates of obsessive–compulsive (OCPD), schizotypal (SPD) and borderline (BPD) personality disorders in 110 obsessive–compulsive disorder (OCD) patients. We found OCD patients with OCPD (20.9%) to exhibit higher rates of hoarding and bipolar disorders, increased severity of hoarding and symmetry, lower prevalence of unacceptable thoughts involving sex and religion and less non-planning impulsivity. Conversely, OCD patients with SPD (13.6%) displayed more frequently bipolar disorder, increased severity of depression and OCD neutralization, greater prevalence of “low-order” behaviors (i.e., touching), lower low-planning impulsivity and greater “behavioral” compulsivity. Finally, in exploratory analyses, OCD patients with BPD (21.8%) exhibited lower education, higher rates of several comorbid psychiatric disorders, greater frequency of compulsions involving interpersonal domains (e.g. reassurance seeking), increased severity of depression, anxiety and OCD dimensions other than symmetry and hoarding, more motor and non-planning impulsivity, and greater “cognitive” compulsivity. These findings highlight the importance of assessing personality disorders in OCD samples.
The DSM-5 defines personality disorder (PD) as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and lead to distress or impairment” (APA, 2013). Although several studies have shown that patients with obsessive–compulsive disorder (OCD) display an increased prevalence of several PDs in clinical (Baer and Jenike, 1992, Maina et al., 2008 and Pinto et al., 2006) and epidemiological settings (Torres et al., 2006), it is unclear whether PDs or associated traits predispose to, or are a consequence of OCD. One study found that individuals with mixed avoidant, compulsive and dependent features were more likely to have a longer duration of illness leading authors to suggest that lifestyle changes secondary to OCD might end up misshaping and disarranging the personality structure of OCD patients who had no premorbid PDs (Baer et al., 1990). The mitigation of PD traits after successful treatment of OCD has been seen as an evidence supporting the later hypothesis (Ricciardi et al., 1992). However, it has also been demonstrated that one specific PD (obsessive–compulsive personality disorder or OCPD) predicted OCD relapse in the long-term (Eisen et al., 2013). Other studies suggest that the rates of specific PDs in OCD do not differ from those seen in other anxiety disorders (Albert et al., 2004 and Pena-Garijo et al., 2013). Despite the long-standing discussion on the primary vs. secondary nature of PDs in OCD, very few studies have attempted to clarify or characterize the socio-demographic and clinical correlates of different PDs in OCD. In general, these studies typically focus on a single PD, most frequently obsessive–compulsive (Coles et al., 2008, Diaferia et al., 1997, Eisen et al., 2006, Garyfallos et al., 2010, Gordon et al., 2013, Lochner et al., 2011 and Starcevic et al., 2013) or schizotypal PDs (Jenike et al., 1986, Poyurovsky, 2008 and Stanley et al., 1990). This limited focus ignores the fact that in several cases, individuals may fulfill diagnostic criteria for more than one PD at any given time. For instance, OCPD, schizotypal personality disorder (SPD), and borderline personality disorder (BPD) tend to increasingly co-occur as the patients’ illness progresses (Sanislow et al., 2009). Consequently, it is important to investigate the correlates of these PDs in the same sample. Importantly, despite BPD's substantial prevalence, significant disability, disturbing risk of suicide, increased levels of treatment seeking, and major economic burden (Leichsenring, Leibing, Kruse, New, & Leweke, 2011), we are also not aware of any study to date that has investigated the correlates of BPD in OCD. In this study, we examined the socio-demographic and clinical correlates of a sample of PDs judged by Skodol and colleagues (Skodol et al., 2011) to be associated with the most extensive empirical evidence of validity and clinical utility, namely SPD, BPD, and antisocial (APD) PDs. Given its importance to the field of obsessive–compulsive and related disorders, OCPD was also included as a variable of interest. The aforementioned PDs are also recognized to be the representatives of each personality cluster, namely SPD (cluster A), AS/BPD (cluster B), and OCPD (cluster C) (APA, 2013). Therefore, the selected PDs represent a series of conditions covering a substantial range of the entities described as PDs in the DSM system. Broadly speaking, we predicted that OCD patients with personality disorders would be characterized by earlier onset, increased severity of symptoms and lower socio-economic status. More specifically, based on the existing literature, we hypothesized that: (i) patients with OCPD will exhibit an earlier OCD onset age (Starcevic & Brakoulias, 2014), higher rates of hoarding and symmetry symptoms (Starcevic & Brakoulias, 2014), decreased impulsivity and increased compulsivity levels (Fineberg, Sharma, Sivakumaran, Sahakian, & Chamberlain, 2007), (ii) OCD patients with SPD will exhibit an earlier age at OCD onset (Brakoulias et al., 2014 and Sobin et al., 2000), increased rates of hoarding (McDougle et al., 1995), and other “low-order” OCD symptoms (Anagnostou et al., 2011 and McDougle et al., 1995),1 and greater impulsivity (Chapman et al., 1984) and compulsivity (Yamamoto et al., 2012); (ii) OCD patients with BPD will display an earlier OCD onset age (Fontenelle et al., 2005, Lovato et al., 2012 and Matsunaga et al., 2005), greater rates of mood, anxiety, eating, and impulse control disorders (Paris, 2007), increased frequency of OCD symptoms involving some sort of interpersonal interaction (e.g. reassurance seeking) (Storch et al., 2012), and higher impulsivity (Sebastian, Jacob, Lieb, & Tuscher, 2013) and compulsivity levels (Fontenelle, Oostermeijer, Harrison, Pantelis, & Yucel, 2011); and finally (iv) patients with APD will exhibit decreased rates of scrupulous obsessions (e.g. unacceptable religious or sexual thoughts) or compulsions (e.g. need to confess or to be reassured) (O’Neill, Nenzel, & Caldwell, 2009), increased impulsivity levels and, due to its exclusionary criteria (APA, 2013), reduced rates of kleptomania (Grant, 2004), but increased rates of other impulse control disorders (APA, 2013).