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The Impact of Obsessive Compulsive Personality Disorder on Cognitive Behaviour Therapy for Obsessive Compulsive Disorder

  • Olivia M. Gordon (a1), Paul M. Salkovskis (a2) and Victoria Bream (a3)

Background: It is often suggested that, in general, co-morbid personality disorders are likely to interfere with CBT based treatment of Axis I disorders, given that personality disorders are regarded as dispositional and are therefore considered less amenable to change than axis I psychiatric disorders. Aims: The present study aimed to investigate the impact of co-occurring obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) on cognitive-behavioural treatment for OCD. Method: 92 individuals with a diagnosis of OCD participated in this study. Data were drawn from measures taken at initial assessment and following cognitive-behavioural treatment at a specialist treatment centre for anxiety disorders. Results: At assessment, participants with OCD and OCPD had greater overall OCD symptom severity, as well as doubting, ordering and hoarding symptoms relative to those without OCPD; however, participants with co-morbid OCD and OCPD demonstrated greater treatment gains in terms of OCD severity, checking and ordering than those without OCPD. Individuals with OCD and OCPD had higher levels of checking, ordering and overall OCD severity at initial assessment; however, at post-treatment they had similar scores to those without OCPD. Conclusion: The implications of these findings are discussed in the light of research on axis I and II co-morbidity and the impact of axis II disorders on treatment for axis I disorders.

Corresponding author
Reprint requests to Olivia Gordon, Centre for Anxiety Disorders and Trauma, 99 Denmark Hill, London SE5 8AZ, UK. E-mail:
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Abramowitz, J. S. (1998). Does cognitive-behavioral therapy cure obsessive-compulsive disorder? A meta-analytic evaluation of clinical significance. Behavior Therapy, 29, 339355.
Albert, U., Maina, G., Forner, F. and Bogetto, F. (2004). DSM-IV obsessive-compulsive personality disorder: prevalence in patients with anxiety disorders and in healthy comparison subjects. Comprehensive Psychiatry, 45, 325332.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.
Baer, L., Jenike, M. A., Ricciardi, J. N., Holland, A. D., Seymour, R. J. and Minichiello, W. E. (1992). Standardised assessment of personality disorders in obsessive-compulsive disorders. Archives of General Psychiatry, 47, 826830.
Beck, A. T., Freeman, A., Davis, D. and Associates (2004). Cognitive Therapy of Personality Disorders. New York: Guilford Press.
Beck, A. T. and Steer, R. A. (1993). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.
Beck, A. T., Steer, R. A. and Brown, G. K. (2005). Manual for the Beck Depression Inventory II. San Antonio, TX: Psychological Corporation.
Cavedini, P., Erzegovesi, S., Ronchi, P. and Bellodi, L. (1997). Predictive value of obsessive-compulsive personality disorder in antiobsessional pharmacological treatment. European Neuropsychopharmacology, 7, 4549.
Challacombe, F., Oldfield, V. B. and Salkovskis, P. M. (2011). Break Free From OCD: overcoming obsessive compulsive disorder with CBT. London: Vermilion.
Dreessen, L. and Arntz, A. (1998). The impact of personality disorders on treatment outcome of anxiety disorders: best evidence synthesis. Behaviour Research and Therapy, 36, 483504.
Dreessen, L., Arntz, A., Luttels, C. and Sallaerts, S. (1994). Personality disorders do not influence the results of cognitive behaviour therapies for anxiety disorders. Comprehensive Psychiatry, 35, 265274.
Dreessen, L., Hoekstra, R. and Arntz, A. (1997). Personality disorders do not influence the results of cognitive and behavioural therapy for obsessive compulsive disorder. Journal of Anxiety Disorders, 11, 503521.
Foa, E. (1979). Failures in treating obsessive compulsives. Behaviour Research and Therapy, 17, 169176.
First, M. B., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (1996). Stuctured Clinical Interview for DSM-IV Axis I Disorders, Clinical Version (SCID – CV). Washington, DC: American Psychiatric Press.
First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W. and Benjamin, L. (1997). Structured Clinical Interview for DSM-IV Personality Disorders (SCID II). Washington, DC: American Psychiatric Press.
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E. and Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: the Obsessive-Compulsive Inventory. Psychological Assessment, 10, 206214.
Gordon, O., Salkovskis, P., Oldfield, V. B. and Carter, N. (2013). The association between obsessive compulsive disorder and obsessive compulsive personality disorder: prevalence and clinical presentation. British Journal of Clinical Psychology, 52, 300315. doi:10.1111/bjc.12016
Guidano, V. F. and Liotti, G. (1983). Cognitive Processes and Emotional Disorders. New York: Guilford Press.
McGlashan, T., Grilo, C. M., Sanislow, C. A., Ralevski, E., Morey, L. C., Gunderson, J. G., et al. (2005). Two- year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. American Journal of Psychiatry, 162, 883889.
Mennin, D. S. and Heimberg, R. G. (2000). The impact of comorbid mood and personality disorders in the cognitive-behavioural treatment of panic disorder. Clinical Psychology Review, 20, 339357.
Pinto, A., Liebowitz, M. R., Foa, E. B. and Simpson, H. B (2011). Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder. Behaviour Research and Therapy, 49, 453458.
Rachman, S. (1983). Obstacles to the successful treatment of obsessions. In Foa, E. and Emmelkamp, P. M. G. (Eds.), Failures in Behaviour Therapy. New York: John Wiley and Sons.
Reich, J. (2003). The effect of axis II disorder on the outcome of treatment of anxiety and unipolar depressive disorders: a review. Journal of Personality Disorders, 17, 387405.
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy, 19, 619.
Salkovskis, P. M. (1996). Cognitive-behavioural approaches to the understanding of obsessional problems. In Rapee, R., Current Controversies in the Anxiety Disorders. New York: Guilford.
Salkovskis, P. M. and Forrester, E. (2002). Responsibility . In Frost, R. O. and Steketee, G., Cognitive Approaches to Obsessions and Compulsions: theory assessment and treatment (pp.4561). Oxford: Pergamon.
Salkovskis, P. M., Forrester, E. Richard, H. C. and Morrison, N. (1998). The devil is in the detail: conceptualising and treating obsessional problems. In Tarrier, N., Wells, A. and Haddock, G. (Eds.), Treating Complex Cases: the cognitive behavioural approach. Chichester: John Wiley.
Salkovskis, P. M., Wroe, A., Gledhill, A., Morrison, N., Forrester, E., Richards, H. C., et al. (2000). Responsibility attitudes and interpretations are characteristic of obsessive-compulsive disorder. Behaviour Research and Therapy, 38, 347372.
Steketee, G., Chambless, D. L. and Tran, G. Q. (2001). Effects of Axis I and II comorbidity on behaviour therapy outcome for obsessive-compulsive and agoraphobia. Comprehensive Psychiatry, 42, 7686.
van den Hout, M., Brouwers, C. and Oomen, J. (2006). Clinically diagnosed axis II co-morbidity and the short term outcome of CBT for axis I disorders. Clinical Psychology and Psychotherapy, 13, 5663.
Watson, J. P. and Marks, I. M. (1971). Relevant and irrelevant fear in flooding: a cross-over study of phobic patients. Behaviour Therapy, 2, 275295.
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Behavioural and Cognitive Psychotherapy
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