DSM-IV Obsessive-Compulsive Personality Disorder:

Prevalence in Patients With Anxiety Disorders and in Healthy

Comparison Subjects
Umberto Albert, Giuseppe Maina, Federica Forner, and Filippo Bogetto

The relationship between obsessive-compulsive dis- to 65 years) without any psychiatric disorder was
order (OCD) and obsessive-compulsive personality recruited from people registered with two general
disorder (OCPD) has not yet been fully clarified. The practitioners (GPs), whether or not they consulted the
aim of the present study was to analyze DSM-IV doctor, in order to evaluate OCPD prevalence rate in
OCPD prevalence rates in OCD and panic disorder (PD) the community. A significant difference was found
patients to test for the specificity of the OCPD-OCD between the prevalence of OCPD in OCD (22.9%) and
link, and to compare them to OCPD prevalence in a in PD (17.1%) on one hand, and that in the comparison
control group of subjects without any psychiatric dis- sample (3.0%) on the other. No differences were
order. A total of 109 patients with a principal diagno- found between the two psychiatric groups, even
sis of DSM-IV (SCID-I) OCD and 82 with PD were when splitting the samples according to gender. Our
interviewed using the Structured Clinical Interview study failed to support the hypothesis of a specific
for DSM-IV Axis II Disorders (SCID-II) in order to as- relationship between OCPD and OCD; we confirmed
sess the prevalence of OCPD. All patients with a co- the higher prevalence rate of this personality disorder
existing axis I diagnosis were excluded from the study in OCD subjects with regard to the general popula-
to eliminate confounding factors when evaluating the tion, but we also confirmed the higher rate of OCPD in
association between prevalence rates of OCPD and another anxiety disorder which is phenomenologi-
anxiety disorder diagnoses. An exclusion criteria was cally well characterized and different from OCD, such
also a Hamilton Depression Rating Scale (HAM-D) as PD.
score >16. A sample of comparison subjects (age 18 © 2004 Elsevier Inc. All rights reserved.

T HE RELATIONSHIP between obsessive-

compulsive personality disorder (OCPD) and
obsessive-compulsive disorder (OCD) has been the
odological differences across different studies;
moreover, DSM-IV diagnostic criteria for OCPD
represent a substantial change from those in DSM-
subject of considerable debate and has been ap- III and even from those in DSM-III-R; the present
proached differently during the course of this cen- version of DSM added four diagnostic criteria to
tury. The Freudian view was that obsessional neu- those of DSM-III and discarded one. Over the
rosis was most likely to develop in an individual years, the percentage of criteria required to make
with an anal character or personality structure, the diagnosis of OCPD has been substantially re-
defined by the specific triad of orderliness, parsi- duced, making it progressively easier for a patient
mony, and obstinacy.1 Obsessive symptoms and to be diagnosed with this disorder and contributing
traits were thought to reflect the operations of to discrepancies of results among different studies.
defense mechanisms against unconscious anxiety. On the basis of these prevalence data, it was
According to this conceptualization and using a concluded that, although the two clinical entities
modern terminology, several authors stated that
bear a surface similarity in terms of shared behav-
OCPD or traits are closely linked to OCD and can
ioral features and defenses, OCPD is neither a
lead to OCD, and placed them on the same psy-
necessary nor sufficient factor in the development
chopathological continuum.2-4
of OCD11-13; nevertheless, it was thought that OCD
Since the introduction of DSM criteria, which
was more frequently associated with premorbid
were greatly influenced by the psychoanalytic ap-
proach and incorporated the anal triad, a number of obsessive-compulsive personality patterns than
studies examined the co-occurrence of OCPD and with other personality patterns. However, analyses
OCD. Using DSM-III criteria, OCPD prevalence
estimates reported from structured interview stud- From the Anxiety and Mood Disorders Unit, Department of
ies ranged from 4% to 28%.5-9 For DSM-III-R Neurosciences, University of Turin, Turin, Italy.
criteria, the frequencies of OCPD reported in OCD Address reprint requests to Professor Giuseppe Maina, Anx-
iety and Mood Disorders Unit, Department of Neurosciences,
patients ranged from 3% to 36%; the only study
University of Turin, Via Cherasco 11-10126 Torino, Italy.
conducted with DSM-IV criteria to date10 reported © 2004 Elsevier Inc. All rights reserved.
a frequency of 32.4% (see Table 1). Such a wide 0010-440X/04/4505-0005$30.00/0
range of OCPD prevalence is mainly due to meth- doi:10.1016/j.comppsych.2004.06.005

Comprehensive Psychiatry, Vol. 45, No. 5 (September/October), 2004: pp 325-332 325

326 ALBERT ET AL

Table 1. Prevalence of OCPD in OCD Samples According to DSM-III-R and DSM-IV Criteria

No. of Instrument Diagnostic OCPD

Authors Date Patients of Evaluation Criteria (%)

Stanley et al.14 1990 25 SCID-II DSM-III-R 28

Steketee18 1990 26 PDQ-R DSM-III-R 4
Sciuto et al.19 1991 30 SIDP-R DSM-III-R 3
Baer et al.7 1992 59 SIDP-R DSM-III-R 16
Maina et al.20 1993 48 MCMI-II DSM-III-R 29.2
Black et al.9 1993 32 PDQ DSM-III-R 28.1
Sanderson et al.33 1994 21 SCID-II DSM-III-R 5
Torres & Del Porto21 1995 40 SIDP-R DSM-III-R 18
Horesh et al.16 1997 51 SCID-II DSM-III-R 18
Diaferia et al.15 1997 88 SIDP-R DSM-III-R 30.7
Bejerot et al.46 1998 36 KSP DSM-III-R 36
Matsunaga et al.22 1998 75 SCID-II DSM-III-R 13.3
Matsunaga et al.23 2000 94 SCID-II DSM-III-R 16.0
Mataix-Cols et al.17 2000 75 SCID-II DSM-III-R 12.2
Samuels et al.10 2000 72 SIDP-R DSM-IV 32.4
Abbreviations: PDQ-R, Personality Diagnostic Questionnaire Revised; SIDP-R, Structured Interview for DSM-III-R Personality
Disorders-Revised; MCMI-II, Millon Clinical Multiaxial Inventory II; PDQ, Personality Diagnostic Questionnaire; SCID-II, Structured
Clinical Interview for DSM-III-R Axis II Disorders; KSP, Karolinska Scale of Personality.

of the abovementioned studies (Table 1) do not has been performed using DSM-IV criteria com-
fully support this opinion: in some of the studies paring OCPD rates in different anxiety disorders.
OCPD was the most common personality disorder Moreover, none of the abovementioned studies ex-
in OCD patients,10,14-17 but in others it was amined prevalence rates in a healthy comparison
not,7,9,18-23 suggesting caution in the interpretation group.
of the relationship between OCD and OCPD. The aim of the present study was to analyze
A more useful approach to the understanding of DSM-IV OCPD prevalence rates in OCD and PD
this relationship might be to compare OCPD prev- patients to test for the specificity of the OCPD-
alence rates in OCD to those in healthy subjects OCD link, and to compare them to OCPD preva-
and to those in different anxiety disorders, as OCD lence in a group of individuals not known to be
is currently classified within this group of disor- diagnosed with or in treatment for psychiatric dis-
ders. The prevalence of OCPD in the community orders. As some reports suggested a gender effect
has been reported, with DSM-III-R criteria, to in personality disorders prevalences,29,30 our sec-
range from 0.7% and 4.5%24-30; there is no evi- ondary objective was to examine gender-related
dence to date of prevalence research performed distributions of OCPD in the three groups.
using DSM-IV criteria.
Four studies, to our knowledge, comparatively METHOD
evaluated OCPD prevalence in OCD and other Subjects
anxiety disorders; three of them, using DSM- Subjects were recruited from outpatients consecutively re-
III31,32 and DSM-III-R criteria,19,33 failed to sup- ferred to the Anxiety and Mood Disorders Unit (Department of
port the hypothesis of a specific link between Neurosciences, University of Turin, Italy). All patients, aged 18
OCPD and OCD, as the same OCPD prevalence to 65 years, had to meet DSM-IV-TR criteria for a principal
diagnosis of OCD or PD. Diagnoses were confirmed with the
rates were found in OCD, panic disorder (PD),
aims of the Structured Clinical Interview for DSM-IV Disorders
generalized anxiety disorder (GAD), and social (SCID-I). All patients with a coexisting axis I diagnosis were
phobic patients. However, a fourth study using excluded from the study to eliminate confounding factors when
DSM-III-R criteria, from the same group of re- evaluating the association between prevalence rates of OCPD
searchers as Sciuto et al.,19 found a significant and anxiety disorder diagnoses. An exclusion criteria was also
a Hamilton Depression Rating Scale (HAM-D) score ⱖ16. All
excess of OCPD (30.7%) in OCD as compared to
patients had to give their informed consent after the procedure
PD (11.7%) and major depressive disorder of the study had been fully explained.
(13.8%), suggesting a specific association of this A sample of comparison subjects (age 18 to 65 years) without
personality disorder with OCD. Again, no study any psychiatric disorder was recruited from people registered
OCPD IN ANXIETY DISORDERS 327

with two general practitioners (GPs), whether or not they con- for the presence of any lifetime axis I disorder and greater than
sulted the doctor, in order to evaluate OCPD prevalence rate in 0.75 for the presence of any personality disorder.
the community (in Italy all citizens are required to be enrolled
with a GP, so that sampling patients enrolled in such practices Statistical Analyses
approximates sampling the general population). The recruit- Statistical differences in OCPD prevalence rates among the
ment of controls followed a two-phase procedure: (1) eligible three groups of subjects (OCD, PD, and healthy controls) were
subjects were contacted by phone and invited to participate in analyzed using the chi-square test. The three samples were
the study; in case of an affirmative response, they were sched- divided according to gender and a separate statistical analysis
uled for a face-to-face psychiatric interview; and (2) patients was performed for males and for females. A P value less than
presenting to the GP office were instructed about the rationale .05 was considered statistically significant.
and procedure of the study and informed consent was obtained The effect of the coexisting OCPD diagnosis on sociodemo-
before the interview was started. The presence of axis I disor- graphic and clinical characteristics of the sample of patients
ders was evaluated with the SCID-I, which was administered by with OCD or PD was then examined using the t test or chi-
a psychiatrist; subjects who received an axis I diagnosis were square test, for continuous or categorical variables, when ap-
excluded from the present study. This comparison sample was propriate.
then made of individuals not known to be diagnosed with or in
treatment for psychiatric disorders. RESULTS

Interviews The sample of psychiatric patients included in

All subjects (patients and controls) enrolled in this study the present study comprised 109 OCD subjects and
were asked about sociodemographic characteristics such as age, 82 PD patients. Sociodemographic and clinical
level of education (expressed in years), and marital status by characteristics of the sample (OCD and PD pa-
using a semistructured interview. Clinical characteristics of the tients) are summarized in Table 2.
disorder were collected for OCD and PD patients, who were
The comparison sample without mental disor-
also evaluated with the Yale-Brown Obsessive-Compulsive
Scale (Y-BOCS) and the Sheehan Clinician Rated Anxiety ders included 101 subjects: 50 (49.5%) males and
Scale (SCRAS), respectively; in addition, the Hamilton Anxiety 51 (50.5) females. The mean age of the sample was
Rating Scale (HAM-A) and the HAM-D were also included in 35.27 (⫾13.35) years and the mean level of edu-
the assessment of patients. cation, expressed in years of school, was 12.83
The presence of personality disorders was assessed by using
(⫾4.27); concerning the marital status, 59 (58.4%)
the Structured Clinical Interview for DSM-IV Axis II Disorders
(SCID-II); this evaluation was guided by items previously af- subjects were singles and 42 (41.6%) were mar-
firmed by the subjects on the SCID-Personality Questionnaire ried.
(SCID-PQ). Items not affirmed on the SCID-PQ were assumed OCPD prevalence rates in OCD, PD, and non-
to be true negatives. However, if an interviewer had any reason psychiatrically ill control group are reported in
to believe these were false negatives, further items were as-
Table 3, along with statistical comparisons be-
sessed. This method is in accordance with instructions for using
the SCID-II, and enabled personality disorder symptomatology tween the whole samples and the subgroups of
to be based on clinical contact combined with a structured males and females.
clinical interview. The raters for this interview were also care- Tables 4 and 5 show sociodemographic and clin-
fully instructed to challenge subjects who endorsed items, ask- ical characteristics of OCD and PD patients with
ing that they be certain that such traits were unrelated to the
and without comorbid OCPD.
symptomatology of the axis I disorder.
DISCUSSION
Interviewers
All semistructured interviews were conducted in person by The aim of the present study was to analyze
three investigators: two psychiatrists (G.M. and U.A.) and a OCPD prevalence rates in OCD and PD patients to
clinical psychologist (F.F.). The two psychiatrists, each with at test for the specificity of the OCPD-OCD link, and
least 4 years of postgraduate clinical experience, conducted the to compare these prevalence rates to that found in
SCID-I to confirm the principal diagnosis and exclude from the a group of subjects not known to be diagnosed with
study subjects with actual comorbid disorders. Any investigator
administered the SCID-II and all other rating scales. or in treatment for psychiatric disorders. Our sec-
In the early phase of the study, inter-rater agreement between ondary objective was to examine gender-related
rater pairs on the diagnosis of axis I and axis II disorders were distributions of this personality disorder in the
ascertained. For all evaluations, relevant clinical data concern- three groups.
ing OCD, or PD, or axis II diagnoses were eventually submitted Results of our study indicated a significant dif-
to the main investigator (F.B.) who, following an abbreviated
face-to-face clinical interview with the patient, assigned defin- ference in OCPD prevalence rate between OCD
itive diagnoses. The inter-rater reliability of DSM-IV diagnoses and PD patients on one hand (23% and 17%,
was found to be good: kappa coefficients were greater than 0.80 respectively), and healthy comparison subjects on
328 ALBERT ET AL

Table 2. Sociodemographic and Clinical Characteristics of OCD and PD Samples

Variable OCD (N ⫽ 109) PD (N ⫽ 82)

Sex
Male (N, %) 51 46.8% 29 35.4%
Female (N, %) 58 53.2% 53 64.6%
Age, yr (mean ⫾ SD) 33.21 ⫾ 11.09 36.89 ⫾ 10.16
Years of education (mean ⫾ SD) 11.70 ⫾ 3.59 11.63 ⫾ 3.56
Marital status
Single (N, %) 61 56% 30 36.6%
Married (N, %) 43 39.4% 46 56.1%
Divorced (N, %) 4 3.7% 4 4.9%
Widowed (N, %) 1 0.9% 2 2.4%
Age at onset, yr (mean ⫾ SD) 22.95 ⫾ 8.01 32.34 ⫾ 10.71
Y-BOCS:
Total (mean ⫾ SD) 26.08 ⫾ 6.79
Obsession (mean ⫾ SD) 14.06 ⫾ 3.03
Compulsion (mean ⫾ SD) 12.47 ⫾ 4.24
SCRAS (mean ⫾ SD) 46.54 ⫾ 8.51
HAM-D (mean ⫾ SD) 12.19 ⫾ 6.13 12.33 ⫾ 3.37
HAM-A (mean ⫾ SD) 13.20 ⫾ 6.51 22.63 ⫾ 4.92
Abbreviations: Y-BOCS, Yale-Brown Obsessive-Compulsive Scale; SCRAS, Sheean Clinician Rated Anxiety Scale; HAM-D, Ham-
ilton Rating Scale for Depression; HAM-A, Hamilton Rating Scale for Anxiety.

the other (3%), confirming an excess of this per- between 0.7% and 4.5%.24-30 Our study confirms
sonality disorder among subjects with these two the low prevalence of OCPD in the general popu-
anxiety disorders. lation and, to our knowledge, is the only one that
Rates of OCPD found among OCD patients are used DSM-IV criteria, although our control group
within the wide range of prevalences reported by should not be regarded as representative of the
previous studies that used DSM-III-R criteria, and general population (being drawn from individuals
similar to that detected by the only study to date required to be enrolled with a general practitioner
that used DSM-IV criteria (see Table 1). With as all Italian citizens, sampling patients enrolled in
regard to OCPD co-occurrence in PD samples, such practices approximates only sampling the
literature data report a wide range between 4.8% general population). Moreover, the number of sub-
and 30.3%33-39: our result of a 17% prevalence rate jects in the comparison group is small, so that our
confirms then the excess of OCPD among subjects results in this sample do not reflect findings com-
with PD found when using DSM-III-R criteria and parable to an epidemiological population study.
expand results from a previous study of our group The variability in personality disorder preva-
that used DSM-IV criteria in an independent sam- lences detected by different studies both in OCD
ple of PD subjects.40 The prevalence of OCPD in and PD samples is to be attributed to differences in
the community with DSM-III-R criteria ranged methodologies used, but might be also due to the

Table 3. OCPD Prevalence in Patients With OCD and PD, and in a Sample of Healthy Subjects

Statistic
Males Females Total (␹2) M v F

OCD (N ⫽ 109) 8/51 15.7% 17/58 29.3% 25/109 22.9% P ⫽ .091

PD (N ⫽ 82) 5/29 17.2% 9/53 17.0% 14/82 17.1% P ⫽ .976
Controls (N ⫽ 101) 2/50 4.0% 1/51 2.0% 3/101 3.0% P ⫽ .546

Statistics
OCD v controls ␹2 ⫽ 3.865;df ⫽ 1; ␹2 ⫽ 14.724; df ⫽ 1; ␹2 ⫽ 18.084; df ⫽ 1;
P ⫽ .049 P ⫽ .000 P ⫽ .000
PD v controls ␹2 ⫽ 3.985; df ⫽ 1; ␹2 ⫽ 6.747; df ⫽ 1; ␹2 ⫽ 10.682; df ⫽ 1;
P ⫽ .046 P ⫽ .009 P ⫽ .001
OCD v PD P ⫽ .856 P ⫽ .126 P ⫽ .320
OCPD IN ANXIETY DISORDERS 329

Table 4. Sociodemographic Characteristics and Clinical Features of OCD Patients With and Without OCPD

Variable OCD ⫹ OCPD (N ⫽ 25) OCD ⫺ OCPD (N ⫽ 84) Statistics

Sex
Males (N, %) 8 32.0% 43 51.2% P ⫽ .091
Females (N, %) 17 68.0% 41 48.8%
Age, yr (mean ⫾ SD) 33.92 ⫾ 12.48 33.0 ⫾ 10.71 P ⫽ .718
Years of education (mean ⫾ SD) 12.52 ⫾ 3.16 11.45 ⫾ 3.69 P ⫽ .193
Marital status
Single (N, %) 17 68.0% 44 52.4% ␹2 ⫽ 10.383; df ⫽ 3; P ⫽ .016
Married (N, %) 5 20.0% 38 45.2%
Divorced (N, %) 3 12.0% 1 1.2%
Widowed (N, %) 00 1 1.2%
Age at onset, yr (mean ⫾ SD) 22.68 ⫾ 7.38 23.04 ⫾ 8.22 P ⫽ .846
Duration of the illness, yr (mean ⫾ SD) 11.64 ⫾ 12.24 9.96 ⫾ 9.15 P ⫽ .461
Symptoms age at onset, yr (mean ⫾ SD) 14.91 ⫾ 6.12 18.11 ⫾ 8.38 P ⫽ .092
Type of onset
Sudden (N, %) 8 32% 16 19% P ⫽ .17
Insidious (N, %) 17 68% 68 81%
Course
Chronic (N, %) 20 80% 60 71.4% P ⫽ .165
Episodic (N, %) 3 12% 16 19.0%
With deterioration (N, %) 2 8% 8 9.5%
Family history for OCD (N, %) 2 8% 14 16.9% P ⫽ .274
Y-BOCS
Total (mean ⫾ SD) 27.28 ⫾ 8.21 25.73 ⫾ 6.32 P ⫽ .317
Obsession (mean ⫾ SD) 14.12 ⫾ 3.65 14.05 ⫾ 2.84 P ⫽ .917
Compulsion (mean ⫾ SD) 14.0 ⫾ 4.15 12.01 ⫾ 4.18 t ⫽ 2.091; df ⫽ 107; P ⫽ .039
HAM-D (mean ⫾ SD) 12.20 ⫾ 7.34 12.18 ⫾ 5.76 P ⫽ .989
HAM-A (mean ⫾ SD) 14.08 ⫾ 6.92 12.93 ⫾ 6.4 P ⫽ .44

unreliability of personality disorder diagnoses. For tic groups within a given sample. To test for the
this reason, the absolute prevalence rates may be specificity of the association between OCPD and
inaccurate and comparisons of prevalence rates OCD, we chose to compare OCPD prevalence rate
across studies are less valuable than comparison of in OCD to that in another well-characterized anx-
the relative prevalence rates between two diagnos- iety disorder such as PD. The exclusion criterion

Table 5. Sociodemographic Characteristics and Clinical Features of PD Patients With and Without OCPD

Variable PD ⫹ OCPD (N ⫽ 14) PD ⫺ OCPD (N ⫽ 68) Statistics

Sex
Males (N, %) 9 64.3% 24 35.3% P ⫽ .976
Females (N, %) 5 35.7% 44 64.7%
Age, yr (mean ⫾ SD) 35.29 ⫾ 10.18 37.22 ⫾ 10.21 P ⫽ .52
Years of education (mean ⫾ SD) 14.29 ⫾ 4.14 11.09 ⫾ 3.20 t ⫽ 3.23; df ⫽ 80; P ⫽ 0.002
Marital status
Single (N, %) 6 42.9% 24 35.3% P ⫽ .701
Married (N, %) 8 57.1% 38 55.9%
Divorced (N, %) 4 5.9%
Widowed (N, %) 2 2.9%
Age at onset, yr (mean ⫾ SD) 32.25 ⫾ 10.94 32.35 ⫾ 10.76 P ⫽ .975
Age at first panic attack, yr (mean ⫾ SD) 29.25 ⫾ 10.93 29.40 ⫾ 11.12 P ⫽ .965
Duration, yr (mean ⫾ SD) 2.42 ⫾ 1.89 5.15 ⫾ 7.93 P ⫽ .242
Agoraphobia (N, %) 7 58.3% 29 58.0% P ⫽ .983
SCRAS (mean ⫾ SD) 46.08 ⫾ 8.42 46.63 ⫾ 8.59 P ⫽ .832
HAM-D (mean ⫾ SD) 12.21 ⫾ 4.0 12.35 ⫾ 3.26 P ⫽ .284
HAM-A (mean ⫾ SD) 22.43 ⫾ 5.29 22.68 ⫾ 4.88 P ⫽ .873
330 ALBERT ET AL

eliminating patients with comorbid axis I disorders sidered in the interpretation of results, which re-
allows comparison of the correlation of OCPD flect difficulties emerging when approaching the
with a different anxiety disorder, although the investigation of personality disorders. First, studies
meaningfulness of the results should be considered of personality disorders in axis I diagnoses suffer
with some precaution since comorbidity is the rule from the possible confusion of state variables with
rather than the exception in clinical populations. trait variables. In the case of OCPD, behavioral
Notwithstanding these limitations, our study expressions of OCD may be confused with traits
failed to demonstrate a specific association be- linked to an OCPD diagnosis. Consistent with this
tween OCPD and OCD, as the same OCPD prev- possibility are reports from two studies that found
alence rate was found among OCD and PD sam- changes in axis II diagnoses following treatment in
ples (22.9% in OCD and 17% in PD); the fact that OCD patients.41,42 We would have expected, with
we previously excluded from the present study this regard, a higher prevalence of OCPD in OCD
patients with more than one axis I disorder patients; however, and this was not true in our
strengthen our results and confirms results of com- study. Another possible cause of confusion in the
parative studies performed with DSM-III or DSM- interpretation of literature data on the prevalence
III-R criteria without a healthy comparison of personality disorders arises from the lack of
group.19,31-33 Only one study found a significant prospective studies; it is not possible, then, to make
excess of OCPD in OCD with regard to PD15; a assumptions about the nature of the relationship
possible explanation for their results, in contradic- between a personality disorder and an axis I dis-
tion to ours, is that they found a higher prevalence order. In the case of OCPD, in fact, some authors
of OCPD in OCD (30.7%) than that found by the speculated that some children with early-onset
majority of other studies, and a lower prevalence in OCD (without OCPD) might have developed ob-
PD (11.4%) than that found by other authors. An- sessive-compulsive traits as part of an adaptive
other source of discrepancy is the different meth- coping pattern, as suggested by findings from a
odology and criteria used by these investigators. follow-up study of a community-based sample.43,44
When considering gender-related distribution of Children with OCD, however, are not more likely
OCPD within each diagnostic category, we failed than controls to develop OCPD according to an-
to detect any difference according to sex; our re- other follow-up study,45 raising more questions
sults confirm the few studies that addressed this about the nature of such a relationship. Our study
question in OCD23 and PD.40 Two studies exam- is not a prospective one and thus suffers from
ined the gender-related distribution of OCPD in the methodological limitations; moreover, we did not
general population and found an excess of this control for the effect of treatments on axis II diag-
personality disorder in males.29,30 Our prevalence noses. However, when administering the SCID-II,
rates in males and females approximate those the raters were carefully instructed to challenge
found by the abovementioned authors29,30; how- subjects who endorsed items, asking that they be
ever, we failed to confirm this significantly higher certain that such traits were unrelated to the symp-
prevalence in males, because our sample size pre- tomatology of the axis I disorder, in an attempt to
vented us from having a sufficient statistical power. control for the possible confusion of state variables
When examining differences in prevalence rates with trait ones.
between OCD, PD, and control subjects in the Mixed results in previous studies of prevalence
subgroups of males and females, we confirmed of personality disorders in OCD might also be
results obtained in the whole sample: a statistically explained, at least in part, by differences in the
significant difference was found between OCPD constitution of the groups studied: it has been
rates in OCD and PD (which did not differ, con- shown in OCD patients, for example, that the prev-
firming the lack of specificity of the link OCPD- alence of hoarding symptoms in each cohort, or the
OCD) and in healthy comparison subjects. We are relative prevalence of washing versus checking
not aware of any study comparing OCPD preva- symptoms is associated with a different profile of
lence rates between two diagnostic entities within personality disorders.16,17 The aim of the present
anxiety disorders in patients selected according to study was only to compare OCPD prevalence rates
gender. in two anxiety disorders; therefore we did not
Several limitations of our study have to be con- perform a separate analysis to test for the possible
OCPD IN ANXIETY DISORDERS 331

association of OCPD with a symptomatologically ity disorder in OCD subjects with regard to the
defined subgroup of OCD subjects. general population, but we also confirmed the
Despite several limitations, which affect the vast higher rate of OCPD in PD, another anxiety disor-
majority of studies on personality disorders, our der which is phenomenologically well character-
study failed to support the hypothesis of a specific ized and different from OCD. We therefore con-
relationship between OCPD and OCD; we con- clude that OCPD and OCD are two distinct entities
firmed the higher prevalence rate of this personal- that can coexist but are not specifically linked.
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