OBSESSIVE–COMPULSIVE PERSONALITY DISORDER: EVIDENCE FOR TWO DIMENSIONS
Corresponding Author
Mark A. Riddle M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Correspondence to: Mark Riddle, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 203, Baltimore, MD 21205, E-mail: [email protected]Search for more papers by this authorBrion S. Maher M.D.
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorYing Wang Ph.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorMarco Grados M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorO. Joseph Bienvenu M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorFernando S. Goes M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorBernadette Cullen M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorDennis L. Murphy M.D.
Laboratory of Clinical Science, National Institute of Mental Health, National Institute of Health, Bethesda, Maryland
Search for more papers by this authorScott L. Rauch M.D.
Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorBenjamin D. Greenberg M.D.
Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, Rhode Island
Search for more papers by this authorJames A. Knowles M.D.
Department of Psychiatry, University of Southern California School of Medicine, Los Angeles, California
Search for more papers by this authorJames T. McCracken M.D.
Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California Los Angeles, Los Angeles, California
Search for more papers by this authorAnthony Pinto Ph.D.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York City, New York
Search for more papers by this authorJohn Piacentini Ph.D.
Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California Los Angeles, Los Angeles, California
Search for more papers by this authorDavid L. Pauls Ph.D.
Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorSteven A. Rasmussen Ph.D.
Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, Rhode Island
Search for more papers by this authorYin Yao Shugart Ph.D.
Unit of Statistical Genomics, Division of Intramural Research, National Institute of Mental Health, National Institute of Health, Bethesda, Maryland
Search for more papers by this authorGerald Nestadt M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorJack Samuels Ph.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorCorresponding Author
Mark A. Riddle M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Correspondence to: Mark Riddle, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 203, Baltimore, MD 21205, E-mail: [email protected]Search for more papers by this authorBrion S. Maher M.D.
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Search for more papers by this authorYing Wang Ph.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorMarco Grados M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorO. Joseph Bienvenu M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorFernando S. Goes M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorBernadette Cullen M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorDennis L. Murphy M.D.
Laboratory of Clinical Science, National Institute of Mental Health, National Institute of Health, Bethesda, Maryland
Search for more papers by this authorScott L. Rauch M.D.
Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorBenjamin D. Greenberg M.D.
Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, Rhode Island
Search for more papers by this authorJames A. Knowles M.D.
Department of Psychiatry, University of Southern California School of Medicine, Los Angeles, California
Search for more papers by this authorJames T. McCracken M.D.
Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California Los Angeles, Los Angeles, California
Search for more papers by this authorAnthony Pinto Ph.D.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York City, New York
Search for more papers by this authorJohn Piacentini Ph.D.
Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California Los Angeles, Los Angeles, California
Search for more papers by this authorDavid L. Pauls Ph.D.
Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Search for more papers by this authorSteven A. Rasmussen Ph.D.
Department of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital, Providence, Rhode Island
Search for more papers by this authorYin Yao Shugart Ph.D.
Unit of Statistical Genomics, Division of Intramural Research, National Institute of Mental Health, National Institute of Health, Bethesda, Maryland
Search for more papers by this authorGerald Nestadt M.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorJack Samuels Ph.D.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
Search for more papers by this authorContract grant sponsor: National Institute of Mental Health; Contract grant sponsor: NIH; Contract grant sponsor: NARSAD; Contract grant sponsor: Seaside Therapeutics; Contract grant sponsor: Roche; Contract grant sponsor: Shire Contract grant sponsor: Dart Neuroscience; Contract grant numbers: R01MH50214, MH071507, MH079489, MH079487, MH079488, and MH079494.
Abstract
Background
To determine possible dimensions that underlie obsessive–compulsive personality disorder (OCPD) and to investigate their clinical correlates, familiality, and genetic linkage.
Methods
Participants were selected from 844 adults assessed with the Structured Instrument for the Diagnosis of DSM-IV Personality Disorders (SIDP) in the OCD Collaborative Genetics Study (OCGS) that targeted families with obsessive–compulsive disorder (OCD) affected sibling pairs. We conducted an exploratory factor analysis, which included the eight SIDP-derived DSM-IV OCPD traits and the indecision trait from the DSM-III, assessed clinical correlates, and estimated sib–sib correlations to evaluate familiality of the factors. Using MERLIN and MINX, we performed genome-wide quantitative trait locus (QTL) linkage analysis to test for allele sharing among individuals.
Results
Two factors were identified: Factor 1: order/control (perfectionism, excessive devotion to work, overconscientiousness, reluctance to delegate, and rigidity); and Factor 2: hoarding/indecision (inability to discard and indecisiveness). Factor 1 score was associated with poor insight, whereas Factor 2 score was associated with task incompletion. A significant sib–sib correlation was found for Factor 2 (rICC = .354, P < .0001) but not Factor 1 (rICC = .129, P = .084). The linkage findings were different for the two factors. When Factor 2 was analyzed as a quantitative trait, a strong signal was detected on chromosome 10 at marker d10s1221: KAC LOD = 2.83, P = .0002; and marker d10s1225: KAC LOD = 1.35, P = .006.
Conclusions
The results indicate two factors of OCPD, order/control and hoarding/indecision. The hoarding/indecision factor is familial and shows modest linkage to a region on chromosome 10.
Supporting Information
Disclaimer: Supplementary materials have been peer-reviewed but not copyedited.
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REFERENCES
- 1Torgersen S, Kringlen E, Cramer V. The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 2001; 58: 590–596.
- 2Samuels J, Eaton WW, Bienvenu OJ, et al. Prevalence and correlates of personality disorders in a community sample. Br J Psychiatry 2002; 180: 536–542.
- 3Grant BF, Hasin DS, Stinson FS, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2004; 65: 948–958.
- 4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Press; 2013.
10.1176/appi.books.9780890425596 Google Scholar
- 5 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 1st ed. Washington, DC: American Psychiatric Press; 1952.
- 6 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 2nd ed. Washington, DC: American Psychiatric Press; 1968.
- 7 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Press; 1980.
- 8 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Revised). 3rd ed. Washington, DC: American Psychiatric Press; 1987.
- 9 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.
- 10 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision. Washington, DC: American Psychiatric Press; 2000.
- 11Gordon OM, Salkovskis PM, Oldfield VB, Carter N. The association between obsessive compulsive disorder and obsessive compulsive personality disorder: prevalence and clinical presentation. Br J Clin Psychol 2013; 52: 300–315.
- 12Samuels JF, Bienvenu OJ, Grados MA, et al. Prevalence and correlates of hoarding behavior in a community-based sample. Behav Res Ther 2008; 46: 836–844.
- 13Lewis A. Problems of obsessional illness. Proc R Soc Med 1936; 29: 325–336.
- 14Hummelen B, Wilberg T, Pedersen G, Karterud S. The quality of the DSM-IV obsessive-compulsive personality disorder construct as a prototype category. J Nerv Ment Dis 2008; 196: 446–455.
- 15Pfohl B, Blum N. Obsessive-compulsive personality disorder: a review of available data and recommendations for DSM-IV. J Personal Disord 1991; 5: 363–375.
- 16Nurnberg GH, Martin GA, Pollack S. An empirical method to refine personality disorder classification using stepwise logistic regression modeling to develop diagnostic criteria and thresholds. Compr Psychiatry 1994; 35: 409–419.
- 17Timpano KR, Exner C, Glaesmer H, et al. The epidemiology of the proposed DSM-5 hoarding disorder: exploration of the acquisition specifier, associated features, and distress. J Clin Psychiatry 2011; 72: 780–786.
- 18Nestadt G, Hsu FC, Samuels J, et al. Latent structure of the DSM-IV personality disorder criteria. Compr Psychiatry 2006; 47: 54–62.
- 19Livesley WJ, Jackson DJ, Schroeder ML. A study of the factorial structure of personality pathology. J Personal Disord 1989; 3: 292–306.
10.1521/pedi.1989.3.4.292 Google Scholar
- 20Livesley WJ, Jackson DJ, Schroeder ML. Dimensions of personality pathology. Can J Psychiatry 1991; 36: 557–562.
- 21Nestadt G, Addington A, Samuels J, et al. The identification of OCD-related subgroups based on comorbidity. Biol Psychiatry 2003; 53: 914–920.
- 22Nestadt G, Samuels J, Riddle M, et al. A family study of obsessive-compulsive disorder. Arch Gen Psychiatry 2000; 57: 358–363.
- 23Samuels JF, Bienvenu OJ, 3rd, Pinto A, et al. Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. Behav Res Ther 2007; 45: 673–686.
- 24Samuels J, Bienvenu OJ, 3rd, Riddle MA, et al. Hoarding in obsessive compulsive disorder: results from a case-control study. Behav Res Ther 2002; 40: 517–528.
- 25Samuels J, Nestadt G, Bienvenu OJ, et al. Personality disorders and normal personality dimensions in obsessive-compulsive disorder. Br J Psychiatry 2000; 177: 457–462.
- 26Samuels JF, Riddle MA, Greenberg BD, et al. The OCD collaborative genetics study: methods and sample description. Am J Med Genet B Neuropsychiatr Genet 2006; 141: 201–207.
- 27Mannuzza S, Fyer AJ, Klein DF, Endicott J. Schedule for affective disorders and schizophrenia—lifetime version modified for the study of anxiety disorders (SADS-LA): rationale and conceptual development. J Psychiatr Res 1986; 20: 317–325.
- 28Fyer AJ, Mannuzza S, Gallops MS, et al. Familial transmission of simple phobias and fears: a preliminary report. Arch Gen Psychiatry 1990; 47: 252–256.
- 29Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46: 1006–1011.
- 30Spitzer RL, Williams JB, Gibbon M, First MB. The structured clinical interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry 1992; 49: 624–629.
- 31Pfohl B, Blum N, Zimmerman M. Structured Interview for DSM-IV Personality (SIDP-IV). Iowa City, IA: Department of Psychiatry, University of Iowa; 1995.
- 32Costa PT, McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources; 1992.
- 33Shugart YY, Samuels J, Willour L, et al. Genome-wide linkage scan for obsessive-compulsive disorder: evidence for susceptibility loci on chromosomes 3q, 7p, 15q, 6q, and 1q. Mol Psychiatry 2006; 11: 763–770.
- 34Broman KW, Weber JL. Estimation of pairwise relationships in the presence of genotyping errors. Am J Hum Genet 1998; 63: 1563–1564.
- 35O'Connell JR, Weeks DE. PedCheck: a program for identification of genotype incompatibilities in linkage analysis. Am J Hum Genet 1998; 63: 259–266.
- 36Douglas JA, Skol AD, Boehnke M. Probability of detection of genotyping errors and mutations as inheritance inconsistencies in nuclear-family data. Am J Hum Genet 2002; 70: 487–495.
- 37Abecasis GR, Cherny SS, Cookson WO, Cardon LR. Merlin-rapid analysis of dense genetic maps using sparse gene flow trees. Nat Gen 2002; 30: 97–101.
- 38S.A.G.E. 6.3. Statistical Analysis for Genetic Epidemiology, Release 6.3; 2012. Available at: http://darwin.cwru.edu.
- 39Mathew G, Song Y, Elston RC. Interval estimation of familial correlations from pedigrees. Stat Appl Genet Mol Biol 2011; 10: 1–29.
- 40Ferreira MA, O'Donovan MC, Meng YA, et al. Collaborative genome-wide association analysis supports a role for ANK3 and CACNA1C in bipolar disorder. Nat Gen 2008; 40: 1056–1058.
- 41Athanasiu L, Mattingsdal M, Kähler AK, et al. Gene variants associated with schizophrenia in a Norwegian genome-wide study are replicated in a large European cohort. J Psychiatr Res 2010; 44: 748–753.
- 42Chen DT, Jiang X, Akula N, et al. Genome-wide association study meta-analysis of European and Asian-ancestry samples identifies three novel loci associated with bipolar disorder. Mol Psychiatry 2013; 18: 195–205.
