OCD with comorbid OCPD: A subtype of OCD?

Objective: The current study examined the validity of using comorbid obsessive-compulsive personality disorder (OCPD) to identify a subtype of individuals with obsessive-compulsive disorder (OCD). Method: Data for the current study were drawn from an ongoing, longitudinal study of the course of OCD and include intake assessments for 238 subjects with primary and current DSM-IV OCD who were treatment seeking. Results: More than one fourth of the subjects (N = 65, 27%) met criteria for comorbid OCPD. As compared to OCD - OCPD subjects, the OCD + OCPD subjects had a significantly younger age at onset of first OC symptoms (p = 0.013), and a higher rate of symmetry and hoarding obsessions, and cleaning, ordering, repeating, and hoarding compulsions (all p's < 0.01). Individuals with OCD + OCPD had higher rates of comorbid anxiety disorders (p = 0.007) and avoidant personality disorder (p = 0.006). The OCD + OCPD subjects also had significantly lower ratings of global functioning (p = 0.001) and more impaired social functioning (p = 0.004), despite a lack of significant differences on overall severity of OCD symptoms. Conclusions: Our findings indicate that individuals with both OCD and OCPD have distinct clinical characteristics in terms of age at onset of initial OC symptoms, the types of obsessions and compulsions they experience, and psychiatric comorbidity. Our findings, coupled with data from family studies showing a higher than expected frequency of OCPD in first degree relatives of OCD probands, suggest that OCD associated with OCPD may represent a specific subtype of OCD. Additional research is warranted to further establish the validity of this subtype.