Standardized Assessment of Personality

Disorders in Obsessive-Compulsive Disorder

Lee Baer, PhD; Michael A. Jenike, MD; Joseph N. Ricciardi II, MEd; Amy D. Holland; Ralph J. Seymour;
William E. Minichiello, EdD; M. Lynn Buttolph, MD, PhD

\s=b\ We assessed 96 patients with obsessive-compulsive disor- relatives regarding the patients' premorbid personalities. Ten
der for DSM-III personality disorder diagnoses with a standard- patients (32%) had "marked obsessional traits," and 4 (13%)
ized interview instrument (Structured Interview for the DSM-III had no obsessional traits. This study concluded that obsession¬
Personality Disorders). Fifty patients (52%) met criteria for at al personality and illness are intimately connected.8 It is likely
least one personality disorder, with mixed, dependent, and histri- that the number of patients without premorbid traits was
onic personality disorders most frequently diagnosed. Compul- underestimated because patients with an early onset of OCD
sive personality disorder was diagnosed in only 6 patients (6%), 5 were eliminated from analysis.
of whom had had onset of obsessive-compulsive symptoms Slade4 reviewed a number of psychometric studies of obses¬
before the age of 10 years, indicating that DSM-III compulsive sive patients and concluded otherwise: "The evidence pre¬
personality disorder is not invariably a premorbid condition for sented seems to support fairly strongly the distinction be¬
the development of obsessive-compulsive disorder. Schizotypal tween obsessional personality traits and obsessional
personality disorder, at 5%, was found to be less common than in neurosis."
past samples, reflecting differences in either assessment meth- A more recent review of the literature led to the conclusion
ods or sampling. that obsessive-compulsive symptoms can be statistically dif¬
(Aren Gen Psychiatry. 1990;47:826-830) ferentiated via factor analysis from obsessive-compulsive
symptoms as distinct phenomena, with obsessive-compulsive
symptoms positively related to measures of neuroticism while
obsessive-compulsive personality was not.5 Pollack6 concluded
years have seen renewed interest in the prevalence that although obsessive-compulsive personality has been re¬
Recentof various personality disorders in obsessive-compulsive
disorder (OCD). Among the reasons for this renewed interest
ported to occur premorbidly, it is neither a necessary nor a
sufficient factor for the development of OCD.
is the suggestion that certain severe personality disorders (eg, The studies reviewed above examined the obsessional per¬
schizotypal) may predict poor outcome to a variety of treat¬ sonality or anal-erotic character described by Freud.8 More
ments. 12 In addition, as interest in the mechanisms and epide¬ recent studies, however, have investigated the DSM-III entity
miology of OCD has grown, the widely held belief that OCD is of compulsive personality disorder, which has been suggested
invariably related to obsessional personality (obsessive-com¬ to be "a much more pathological entity than the classical
pulsive personality disorder in DSM-III-R3) has been ques¬ obsessive-compulsive character. "9
tioned." Schizotypal personality disorder, which, along with schizoid
In the traditional psychoanalytic explanation of obsessional and paranoid personality disorders, forms cluster A of DSM-
disorders, obsessional personality had been seen as a predis¬ III-R personality disorders, has been reported to be geneti¬
posing feature of obsessional neurosis, with the two conditions cally related to schizophrenia.10,n In a retrospective study of 43
existing side by side along a continuum.7 On this continuum consecutive patients with OCD, Jenike et al1 reported that a
(which is assumed to arise from conflicts over bowel training), subgroup of 14 treatment-resistant patients (33%) were found
individuals with obsessional personality (characterized by or¬ by chart review to meet DSM-III criteria for schizotypal
derliness, parsimoniousness, and obstinacy8) differ from those personality disorder, with negative implications for treatment
individuals with obsessive-compulsive symptoms (obsessions outcome.12 Many of these patients had been previously misdi-
and compulsions) only in that they are nonsymptomatic.8 agnosed as schizophrenic and had not benefited from neurolep¬
In an early report, Ingrani8 studied 31 inpatients with OCD tic treatment.12
by means of subjective descriptions by patients, clinicians, and With the availability of more objective criteria for diagnosis
of personality disorders,13 empiric explorations have begun
into the relationship between OCD and a variety of DSM-III
Accepted for publication August 7,1989. personality disorders. In a study of 44 outpatients with OCD,
From the Massachusetts General Hospital and Harvard Medical School,
Boston. Rasmussen and Tsuang14 reported that 29 (66%) manifested an
Reprint requests to WACC-717, Massachusetts General Hospital, Boston, Axis II diagnosis, with 55% meeting criteria for compulsive,
MA 02114 (Dr Baer). 9% for histrionic, 7% for schizoid, 5% for dependent, and 0%

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 for schizotypal personality disorder. Diagnosis was based on a cients (based on simultaneous interviews) for specific personality
broad semistructured interview that included symptom disorders ranged from .30 for compulsive to .90 for dependent.19 The
checklists from DSM-III Axis II criteria. reliability ofthe scale is improved when supplemented with a 20- to 45-
Joffee et al15 administered a computer-scored Million Clini¬ minute interview of a relative or close friend after interview of the
cal Multiaxial Inventory to 23 patients with OCD and found subject.20 Comparison of SIDP diagnoses with scores on the Minneso¬
ta Multiphasic Personality Inventory and the Marke-Nyman Tem¬
that 19 (83%) met criteria for a personality disorder, with only perament Scale has provided evidence of the ability of the SIDP to
1 patient (4%) meeting criteria for compulsive personality discriminate between presence and absence of the personality disor¬
disorder and 4 (17%) patients meeting criteria for schizotypal der, as well as among the three DSM-III personality disorder
personality disorder. Avoidant (44%), passive-aggressive clusters.18
(44%), and dependent (35%) personality disorders were most A patient is diagnosed with an Axis II personality disorder if the
common. It is possible that this instrument may have overesti¬ requisite number of criteria specified in DSM-III are met. To qualify
mated sample prevalences of personality disorders since in the for the diagnosis of mixed personality disorder, the subject must have
same report 20 (87%) of 23 patients with a lifetime diagnosis of missed the requisite number of criteria by one, for two or more
major depressive disorder met criteria for at least one person¬ personality disorders, and must not have met full criteria for any
other personality disorder.18 The diagnosis of passive-aggressive per¬
ality disorder.15 sonality disorder is rarely made on the SIDP because the presence of
Steketee16 administered the Personality Diagnostic Ques¬ any other personality disorder disallows this diagnosis in DSM-III.18
tionnaire (PDQ), a self-report instrument, to relatives of 26
patients with OCD and found that only 1 patient (4%) met Procedures
criteria for compulsive personality disorder, and 9 patients
(35%) met criteria for schizotypal personality disorder. De¬ All interviews were performed by one of two research assistants
pendent (39%), histrionic (31%), and avoidant (27%) personal¬ (A. D. ., R. J. S. ), both trained and experienced in the use of the SIDP
ity disorders were also frequently diagnosed. Black et al17 also for double-blind drug trials and both with bachelor's degrees in psy¬
administered the Personality Diagnostic Questionnaire to 21 chology and more than 5 years of experience in inpatient and outpa¬
patients with OCD and 42 age- and sex-matched normal con¬ tient psychiatric settings. Patients were asked to participate in the
trols. These authors found that 52% of the patients with OCD SIDP interview, which was part of a more comprehensive interview
had DSM-III cluster Bls (dramatic) personality diagnoses or lasting approximately 2 to 2V2 hours, to provide additional informa¬
tion for their treatment.
traits, compared with 7% of the controls, a statistically signifi¬ Eighty-seven patients (91%) were interviewed before beginning
cant difference. The two groups did not differ in prevalence of any pharmacologie or behavioral treatment. As a result of scheduling
cluster A (eccentric) or cluster C (anxious) diagnoses or traits. difficulties, 8 of the remaining 9 patients were interviewed within 1
Dependent, histrionic, and borderline personality disorders month, and 1 patient within 2 months, of beginning treatment.
(all 24%) were most frequent. No patient with OCD was Because the interview of an informant (usually a family member) is
diagnosed with compulsive personality disorder, and 3 (14%) often important in the scoring of the SIDP,20 the research assistant
were diagnosed with schizotypal personality disorder. administering the structured interview asked the patient for permis¬
The above conflicting studies used various standardized and sion to interview an informant in person or, if this was impossible, via
nonstandardized assessment methods for measuring person¬ telephone. In 54 (56%) of 96 cases, an interview with the informant
was conducted. Of the 42 patients whose SIDP interviews were
ality traits and disorders. All standardized scales used previ¬ scored without an informant interview, 20 refused permission to
ously had employed self-report; the use of structured inter¬ interview an informant, 21 informants could not be reached by tele¬
views keyed to DSM-III criteria for diagnosis of personality phone after three or more attempts, and one informant was unable to
disorders may help in overcoming the traditional problems of provide the required information.
low reliability and validity in personality diagnosis18 and may To assess reliability, 16 patients were interviewed by one rater and
assist in clarifying this area. simultaneously rated by a second rater, who sat in the room while the
In the present study we used the Structured Interview for other interviewed the subject and later the informant.
the DSM-III Personality Disorders (SIDP)*20 in a systematic In the week before the SIDP interview, patients completed the self-
administered Maudsley Obsessional-Compulsive Questionnaire and
investigation of the prevalence of DSM-III Axis II personality the 21-item Beck Depression Inventory. On the day of the SIDP
disorders in a consecutive sample of patients meeting DSM-
III criteria for OCD. Our interest was in clarifying the fre¬
interview, patients were administered the Yale-Brown Obsessive
Compulsive Scale, and age at onset and duration of OCD symptoms
quency of occurrence of various personality disorders in OCD, were determined during a semistructured clinical interview.
with particular attention to compulsive and schizotypal per¬
sonality disorders. RESULTS
Frequency of Personality Disorders
SUBJECTS AND METHODS
Patients Fifty (52%) of 96 patients received one or more Axis II personality
disorder diagnosis on the basis of the SIDP interview. If mixed
A total of 96 consecutive outpatients seeking either pharmacologie personality disorder is excluded, 35 patients (36%) met full criteria for
or behavioral treatment were evaluated in the OCD Clinic and Re¬ one or more of the personality disorders. Patients had a mean ± SD
search Unit at Massachusetts General Hospital, Boston. Those meet¬ Yale-Brown Obsessive Compulsive Scale score of 21.1 ± 7.2 and mean
ing DSM-III criteria for OCD were interviewed. The sample included Maudsley Obsessional-Compulsive Questionnaire score of 14.7 ±6.2
46 men (48%) and 50 women (52%), ranging in age from 19 to 75 years at the time of interview, indicating moderate OCD symptoms. Mean
(mean ± SD, 37.1 ± 11.2 years). Patients had a mean age at onset of Beck Depression Inventory score was 17.6 ±10.0, indicating mild to
OCD of 18.1 ± 11.0 years and a mean duration of OCD symptoms of moderate depression.
18.2 ±11.7 years. The Figure illustrates frequencies for all DSM-III personality dis¬
order diagnoses. Mixed personality disorder (personality not other¬
Personality Questionnaire wise specified in DSM-III-R) was most frequently diagnosed (15%),
followed in frequency by dependent (12%), histrionic (9%), compul¬
The SIDP is a structured interview designed specifically to diag¬ sive (6%), and, with equal frequencies, schizotypal, paranoid, and
nose all DSM-III personality disorders.18 It consists of 160 questions, avoidant personality disorders (5% each). No patients received a
which are asked by a trained interviewer, and requires 60 to 90 diagnosis of antisocial, narcissistic, or passive-aggressive personality
minutes to complete.18 This instrument has been demonstrated to disorders. The Figure divides the personality disorders into the three
have adequate interrater reliability for presence of any personality clusters introduced in DSM-III, illustrating that the majority of
disorder ( .71 for simultaneous interviews with two raters and
=
diagnoses were within cluster C (patients described in DSM-III as
=
.66 for separate interviews in a test-retest format). The coeffi- "anxious or fearful"13).

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 Dependent 3 Table 2.—Personality Features of 15 Patients With
Compulsive Cluster C Mixed Personality Disorder
Avoidant
Patient Diagnoses
Passive-Aggressive |
1 Avoidant, dependent
Histrionic 2 Avoidant, schizoid
3 Borderline, schizotypal
Borderline 4 Compulsive, histrionic
Cluster
Narcissistic 5 Compulsive, histrionic
6 Borderline, schizotypal
Antisocial 7 Avoidant, dependent, compulsive, schizoid
8 Avoidant, compulsive, schizotypal, paranoid
Schizotypal 9 Avoidant, dependent, compulsive, schizotypal, paranoid
Cluster A
10 Avoidant, compulsive
Paranoid 11 Avoidant, dependent
12 Avoidant, compulsive, histrionic, passive-aggressive
Schizoid
13 Compulsive, dependent
14 Avoidant, dependent
Mixed 12 15 Histrionic, schizotypal

0 2 4 6 8 10 12 14 16
Frequency, %
Frequency and percentage of diagnosis
of all DSM-III Table 3.—Results for 16 Simultaneous Reliability Interviews
personality disorders in a sample of 96 patients with obsessive-
compulsive disorder by Structured Interview for the DSM-III Diagnosis
Personality Disorders assessment. Clusters A, B, and C are Patient Rater 1 Rater 2
groupings of related personality disorders specified in DSM-III.
1-7 None None
8 Borderline, dependent, Borderline, dependent
schizoid, compulsive
9 Dependent Dependent
Table 1.—Personality Disorders Diagnosed in Six Patients 10 None Mixed
Meeting Criteria for Multiple Disorders 11 Mixed Mixed
Patient Diagnoses 12 Dependent Dependent
1 Avoidant, paranoid 13 Schizotypal, borderline, Schizotypal, borderline,
2 Borderline, dependent, schizotypal dependent dependent
3 Borderline, dependent 14 Avoidant Avoidant
4 Compulsive, histrionic, paranoid, schizoid 15 Avoidant Mixed
5 Dependent, histrionic
6 Avoidant, borderline, schizotypal 16 Histrionic Histrionic

Presence of a personality disorder was not sex related. Twenty-five of personality diagnoses and for mixed personality disorder. No sig¬
(54%) of the 46 men and 25 (50%) of the 50 women received an Axis II nificant relationship was found between duration of OCD and frequen¬
diagnosis ( 2[1] 0.2, not significant).
=
cy of either cluster A, B, or C diagnoses. There was, however, a highly
To determine whether patients assessed with and without infor¬ significant relationship between duration of OCD and frequency of
mant interview the
frequencies of personality disorders in
differed, diagnosis of mixed personality disorder; this diagnosis was present in
these two groups were also analyzed separately and compared via 2 2 patients (4%) with OCD of less than 20 years' duration and in 12
test. The two groups did not significantly differ on the presence or patients (30%) with OCD of greater than 20 years' duration
absence of any personality disorder ( 2[1] 0.13, not significant), the
=
(X2[l] 11.7, P=.001).
=

presence of compulsive personality disorder (corrected 2[1] 0.55, =

Unlike duration, age at onset of OCD was not significantly related
not significant), or the presence of schizotypal personality disorder to the presence of a personality disorder. Patients with onset before
(corrected 2[1] 0.41, not significant).
=
the age of 20 years were not significantly more likely to have a
Six patients (6%) met criteria for two or more personality disorders. personality disorder than were those with onset at 20 years of age or
The personality disorders codiagnosed in these patients are listed in later (58% vs 42%, 2[1] 2.4, F=.ll). Similarly, age at onset was not
=

Table 1. All three patients diagnosed with borderline personality significantly related to presence of mixed personality disorder
disorder also met criteria for at least one other personality disorder. ( [1] 2.1, not significant).
=

Fifteen patients (15%) met criteria for mixed personality disorder. Among the six patients diagnosed with compulsive personality
The significant personality features in these patients are listed in disorder, five had onset of OCD symptoms before the age of 10 years,
Table 2, which indicates that avoidant (n 9), compulsive (n 8),= =
and the sixth had onset at 19 years.
dependent (n 6), and schizotypal (n 5) features were most
= =
The severity of OCD symptoms was not significantly related to the
common. presence of a personality disorder: patients with Yale-Brown Obses¬
sive Compulsive Scale scores below 20 did not have significantly more
personality disorder diagnoses than did those with scores of 20 or
Relation to Other Factors above ( 2[1] 0, not significant).
=

Presence of a personality disorder was found to be related to

duration of OCD; patients with duration of OCD of 20 years or more
Reliability
were significantly more likely to have at least one Axis II diagnosis
than were those with durations less than 20 years (65% vs 41%, Table 3 shows the results of 16 reliability interviews performed by
respectively; 2[1] 5.1, =
.02). =
the two raters. The overall agreement for the presence or absence of
To clarify this relationship to duration of OCD, separate contingen¬ at least one Axis II disorder was 15 of 16 (94%), yielding an acceptable
cy analyses were conducted for each of the three DSM-III-R clusters of .88.21 In 13 (81%) of the 16 interviews, the two raters agreed

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 perfectly on specific personality disorder. Too few patients were Schizotypal Personality Disorder
diagnosed with specific personality disorders to allow calculation of
individual values for specific personality disorders. Only 5% of our sample met criteria for schizotypal personal¬
ity disorder. This sample prevalence is lower than those in
COMMENT several previous reports.1,15,16 This relatively low prevalence
may reflect either a difference between methods used to
Axis II disorders, as diagnosed by a standardized assess¬ diagnose this personality disorder or a sampling bias. In at¬
ment instrument, occurred in 52% of our patients with OCD, tempting to explain the lower prevalence of schizotypal per¬
with mixed, dependent, histrionic, and compulsive personal¬ sonality disorder in the present sample vs an earlier sample in
ity disorders being most common. Mavissakalian and Ha¬ our clinic,1 we hypothesize that this difference may be in part
mann22 found dependent, avoidant, and histrionic personality due to the fact that we are seeing a healthier population of
disorders to be most common in a sample of 60 agoraphobic patients and see fewer of these "sicker" patients at present
patients.22 Dependent and histrionic personality disorders than wedid in the past, when treatments for this disorder
may be relatively common in a variety of anxiety disorders, were less readily available. With the recent publicity concern¬
although in neither sample was the frequency of any of these ing OCD, we are seeing a broader spectrum of patients who
personality disorders greater than 15%. No patient in our are often self-referred. Our findings, together with those of
sample met criteria for narcissistic, antisocial, or passive- past studies, confirm that schizotypal personality disorder
aggressive personality disorders. and features occur in a significant proportion of patients with
The finding that the presence ofmixed personality disorder OCD. When all cluster A personality disorders are combined,
was more likely with longer duration of OCD suggests that our sample prevalence was 11%. This relationship is of inter¬
patients who do not have premorbid personality disorders est because of the familial link between these personality
may develop significant personality traits (especially avoid¬ disorders and schizophrenia.10,n
ant, compulsive, and dependent), which may be related to
behavioral and life-style changes that are secondary to OCD.
Since our purpose in the present study was to describe the Differences Between DSM-III and DSM-III-R
prevalence of personality disorders in a consecutive sample Personality Disorder Criteria
for outpatients with OCD, we made no attempt to assess a
control group with other psychiatric diagnoses. When the The SIDP generates diagnoses for DSM-III Axis II disor¬
results in our sample are compared with those of the group of ders rather than for the current DSM-III-R.3 Significant
131 nonpsychotic psychiatric patients used to assess reliabil¬ changes have been made in the DSM-III-R diagnostic criteria
ity and validity of the SIDP, no significant differences were for many of the personality disorders; among the greatest
found in the presence of at least one personality disorder (52% changes have been in criteria for compulsive personality disor¬
vs 51%, respectively; [1] 0), the prevalence of compulsive
=
der (obsessive-compulsive personality disorder in DSM-I1I-
personality disorder (6% vs 5%, respectively; 2[1] 0.1), or
=
R). Rather than the DSM-III requirement of four of five
the prevalence of schizotypal personality disorder (5% vs 9%, criteria, DSM-III-R requires five of nine criteria to meet the
respectively; 2[1] 1.2).
=
diagnosis. New criteria have been also added for overconsci-
We did not compare SIDP diagnoses with those of experi¬ entiousness and scrupulosity, lack of generosity, and hoarding
enced clinicians because the reliability of Axis II diagnoses of unimportant objects.
made by experienced clinicians on the basis of clinical inter¬ Because such changes in criteria may affect the prevalence
view is pooi^3,24 and, according to the developers of the SIDP, of this and other personality disorders in the OCD population,
provides "an unacceptable standard for comparison with the we have begun to administer a version of the SIDP that has
SIDP"18 Specifically, the for presence of a personality been revised to generate DSM-III-R diagnoses (SIDP-R)
disorder has been reported to be between .4123 and . ß24 for (Bruce Pfohl, MD, personal communication, February 3,
experienced clinicians; both reliabilities are lower than the 1989). To date we have administered the SIDP-R to an addi¬
of .66 reported for the SIDP administered in separate inter¬ tional 59 consecutive patients meeting criteria for OCD and
views.18 Thus, as yet there remains no accepted "gold stan¬ found that 15 (25%) met criteria for obsessive-compulsive
dard" for personality diagnosis. personality disorder, which is significantly higher than the
prevalence of 6 (6%) of 96 in the present study ( 2[1] 11.5,
=

Compulsive Personality Disorder P<.001).

The higher prevalence of obsessive-compulsive personality
Compulsive personality disorder was diagnosed in six pa¬ disorder using DSM-III-R criteria may be attributed to at
tients (6%), all with onset of OCD before the age of 20 years. least two factors. First, as noted above, DSM-III-R requires
These results replicate two earlier studies15,16 in finding that only five (56%) of nine criteria to make the diagnosis, com¬
compulsive personality disorder is less frequent in OCD than pared with four (80%) of five required by DSM-III. We exam¬
was once thought. The prevalence of compulsive personality ined the effect of this change by computing the number of
disorder of 4% to 6% in outpatients with OCD in these studies patients in our present study who missed a diagnosis of com¬
indicates that compulsive personality disorder, as defined by pulsive personality disorder by one criterion on the SIDP
DSM-III, is not a necessary condition for the development of (that is, they satisfied three of five criteria). We found that 24
OCD and, in fact, is not the most common personality disorder (25%) of our 96 patients fell in this category, which was
in OCD. When patients with significant compulsive features identical to the prevalence of obsessive-compulsive personal¬
are combined with this personality disorder diagnosis (ie, ity disorder using the SIDP-R (25%) ( 2[1] 0, not signifi¬
=

including the mixed personality disorder with compulsive cant). Thus, the difference in prevalence between the two
features), our sample prevalence increased to only 14%. versions oí DSM-III may be at least partly due to raising the
These conclusions are limited to the DSM-III diagnosis of number of criteria provided to make the diagnosis.
compulsive personality disorder, rather than the traditional An alternative explanation for the increased prevalence
psychodynamic concept of obsessional personality. As noted with DSM-III-R is that the three new criteria move the
below, changes in the diagnostic criteria in DSM-III-R3 have personality disorder somewhat closer to the traditional psy-
moved the diagnostic entity of obsessive compulsive person¬ chodynamic entity of obsessional character, by assessing the
ality disorder somewhat closer to the traditional concept.9 traits of orderliness and parsimony.9 As noted above, three

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 new criteria have been added that partly overlap these traits. CONCLUSION
In summary, it appears that changes in DSM-III-R person¬
ality disorder criteria may affect the prevalence of various We assessed 96 patients with obsessive-compulsive disor¬
personality disorders due to changes in specific criteria as well der for DSM-III personality disorder diagnoses with a stan¬
as in the number of criteria required to make each diagnosis. dardized interview instrument (SIDP). Fifty patients (52%)
met criteria for at least one personality disorder, with mixed,
Dimensional Approach to Personality dependent, and histrionic personality disorders most fre¬
quently diagnosed. Compulsive personality disorder was di¬
Recently, the dimensional concept of personality assess¬ agnosed in only 6 patients (6%), 5 of whom had onset of
ment was proposed by Cloninger25 as an alternate method to obsessive-compulsive symptoms before the age of 10 years,
the standard personality disorder approach as used in DSM- indicating that the DSM-III entity of compulsive personality
III and DSM-III-R. In this approach, three dimensions of disorder is not invariably a premorbid condition for the devel¬
personality are defined in terms of novelty seeking, harm opment of obsessive-compulsive disorder. Comparison of our
avoidance, and reward dependence. These dimensions are sample of patients with OCD with a previous sample of pa¬
assessed by means of a self-report scale, the Tridimensional tients with mixed nonpsychotic diagnoses found no higher
Personality Questionnaire.25 Underlying genetic and neuro¬ prevalence of compulsive personality disorder among patients
anatomic bases for these dimensions have also been with OCD, indicating no linkage between this DSM-III per¬
proposed.25 sonality disorder and OCD. Schizotypal personality disorder,
Recently, Pfohl et al26 applied this dimensional concept of at 5%, was found to be less common than in past samples of
personality to OCD and tested the prediction that low novelty patients with OCD, reflecting either differences in assess¬
seeking and high harm avoidance would predispose to OCD. ment methods or sampling.
These researchers used the Tridimensional Personality Ques¬ The use of standardized and reliable instruments for diagno¬
tionnaire to compare patients with OCD with nonpsychiatric sis of Axis II disorders is an important step toward examining
controls and found significant differences in the predicted both the prevalence and the use of personality disorders as
direction on these two dimensions, although they did not find predictors of treatment choice and outcome in OCD. As yet
evidence of the neurotransmitter mechanisms underlying this there remains no "gold standard" for comparison of personal¬
theory. Future comparisons of patients with OCD and those ity diagnosis, and changes from DSM-III to DSM-III-R may
with other anxiety disorders by means of the Tridimensional affect prevalence rates for individual diagnoses.
Personality Questionnaire will indicate whether these dimen¬ We are currently using this structured interview method to
sions predispose to development of OCD specifically. We are relate DSM-III-R personality disorders to treatment response
currently examining the relationship between a dimensional in double-blind clinical trials and to determine whether personal¬
approach and the standard approach to personality assess¬ ity disorders, diagnosed by standardized interview, are modi¬
ment in OCD. fied in patients with OCD after response to treatment.

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