Explicating the Dispositional Basis of the OCRDs: a Hierarchical Perspective

Universal personality dimensions and dysfunctional obsessional beliefs in the DSM-5's OCD and related disorders (OCRDs)

This study aimed to determine the extent to which personality and cognitive factors contribute to the identification of shared associations between the DSM-5's OCD and Related Disorders (OCRDs). Participants (n = 239) were treatment-seeking outpatients with a principal diagnosis of obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), trichotillomania (TTM), or excoriation disorder (EXC), as compared to healthy community controls (n = 100). Analyses examined the relationships between diagnostic group, personality dimensions, and obsessive beliefs. Results demonstrated that compared to non-clinical controls, all diagnostic groups scored significantly higher on neuroticism and lower on extraversion and conscientiousness. Few significant differences were found across diagnostic groups: extraversion was higher in the TTM group (vs. all OCRDs), conscientiousness was lower in the HD group (vs. OCD, TTM, EXC), and openness to experience was higher in the TTM and EXC groups (vs. OCD, HD). Obsessional beliefs were significantly elevated in all clinical conditions (vs. controls) except for beliefs surrounding responsibility and threat estimation, which were only significantly higher in OCD and BDD groups. These results highlight shared personality and cognitive vulnerability in the OCRDs as well as unique disorder-specific vulnerabilities related to OCD.

Hair pulling disorder and skin picking disorder have relatively limited associations with negative emotionality: A meta-analytic comparison across obsessive-compulsive and related disorders

The obsessive-compulsive and related disorders (OCRD) chapter in DSM-5 includes two relatively distinct groups of disorders: (1) Compulsive disorders [i.e., obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD)] and (2) grooming disorders [i.e., skin picking disorder (SPD) and hair pulling disorder (HPD)]. The two groups may relate differently with negative emotionality; however, the literature has produced mixed findings. The current study sought to quantify the concurrent association between negative emotionality and each of the five OCRDs. We conducted systematic reviews of research reporting correlations between (1) negative emotionality (i.e., depression, anxiety, stress, negative affect, and neuroticism) and (2) severity of OCRD symptoms in both clinical and non-clinical adult samples. We used three-level meta-analytic models to estimate the size of the correlations. Negative emotionality had robust positive correlation with symptoms of OCD [k = 156, r = 0.44, 95% CI= 0.43-0.46], BDD [k = 58, r = 0.45, 95% CI= 0.43-48], and HD [k = 67, r = 0.39, 95% CI= 0.36-0.42] but significantly smaller correlation with SPD [k = 31, r = 0.31, 95% CI= 0.27-0.34] and HPD [k = 24, r = 0.28, 95% CI= 0.25-0.32]. Overall, the results indicate that grooming disorders have relatively limited associations with negative emotionality. Implications for classification of OCRDs within the broader taxonomy of psychopathology are discussed.

Prevalence and Correlates of Hair Pulling Disorder and Skin Picking Disorder in an Acute Psychiatric Sample

Hair pulling disorder (HPD; trichotillomania) and skin picking disorder (SPD; excoriation disorder) are understudied psychiatric disorders. The aim of this study was to examine the prevalence and correlates of HPD and SPD in an acute psychiatric sample. Semistructured interviews and self-report measures were administered to patients in a psychiatric partial hospital (N = 599). The past-month prevalence of HPD and SPD was 2.3% and 9%, respectively. HPD and SPD had highly similar clinical characteristics and a strong co-occurrence. Patients with HPD/SPD were significantly younger than other patients and more likely to be female. Logistic regression controlling for age and sex showed that diagnosis of HPD/SPD was not significantly associated with suicidal ideation, suicidal behaviors, nonsuicidal self-injury, or emotional disorder diagnoses (e.g., borderline personality disorder, major depressive disorder). HPD/SPD status was significantly associated with an increased risk of generalized anxiety disorder. However, patients with HPD/SPD did not differ from other patients on self-report measures of generalized anxiety, depression, and distress intolerance. HPD and SPD are common and frequently co-occurring disorders in psychiatric settings.

Profiling Hoarding Within the Five-Factor Model of Personality and Self-Determination Theory

This study investigated the dispositional profile associated with hoarding symptoms by applying a personality and motivational trait perspective. A community sample oversampling high hoarding symptoms (N = 649, ages 18-74 years) completed an online questionnaire assessing hoarding, the five-factor model of personality, and general causality orientations drawn from self-determination theory. Personality aspects (10 traits), a level of measurement intermediate to factors (5 traits) and facets (30 traits), were assessed to provide greater specificity than a factor-level approach. Hoarding was correlated with neuroticism and conscientiousness. Aspects predicting hoarding were industriousness (C), orderliness (C), withdrawal (N), and assertiveness (E). Hoarding was significantly related to impersonal and control orientations, albeit with only slight (1.4%) incremental validity for general causality orientations above personality aspects in predicting hoarding. These findings may not generalize to a clinical treatment sample, and possible configurative interactions between traits were not assessed. This study extended the existing literature by reporting aspect-level personality and general causality orientation correlates of hoarding. These data may inform preventative monitoring and intervention programs, as well as predicting meaningful personality characteristics of hoarding clients.

Transdiagnostic dimensions in obsessive-compulsive and related disorders: associations with internalizing and externalizing symptoms

BACKGROUND

Hierarchical structural models of psychopathology rarely extend to obsessive-compulsive spectrum disorders. The current study sought to examine the higher-order structure of the obsessive-compulsive and related disorders (OCRDs) in DSM-5: obsessive-compulsive disorder (OCD), hoarding disorder (HD), body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder; HPD) and excoriation (skin-picking) disorder (SPD).

METHODS

Adult patients in a partial hospital program (N = 532) completed a dimensional measure of the five OCRDs. We used confirmatory factor analysis to identify the optimal model of the comorbidity structure. We then examined the associations between the transdiagnostic factors and internalizing and externalizing symptoms (i.e. depression, generalized anxiety, neuroticism, and drug/alcohol cravings).

RESULTS

The best fitting model included two correlated higher-order factors: an obsessions-compulsions (OC) factor (OCD, BDD, and HD), and a body-focused repetitive behavior (BFRB) factor (HPD and SPD). The OC factor, not the BFRB factor, had unique associations with internalizing symptoms (standardized effects = 0.42-0.66) and the BFRB factor, not the OC factor, had small marginally significant unique association with drug/alcohol cravings (standardized effect = 0.22, p = 0.088).

CONCLUSIONS

The results mirror findings from twin research and indicate that OCD, BDD, and HD share liability that is significantly associated with internalizing symptoms, but this liability may be relatively less important for BFRBs. Further research is needed to better examine the associations between BFRBs and addictive disorders.

The relationship between obsessive-compulsive spectrum disorders and DSM-5 dysfunctional personality domains in a nonclinical sample of Italian women

To evaluate the usefulness of the DSM-5 maladaptive personality domains in explaining the similarities and differences among four disorders included in the obsessive-compulsive spectrum, 428 Italian community-dwelling women (mean age = 31.96 years, SD = 12.30 years) were administered the Obsessive-Compulsive Spectrum Disorder Scales and the Personality Inventory for DSM-5-Short Form as part of an ongoing online survey on women's health. Multiple Indicators Multiple Causes (MIMIC) confirmatory bifactor analysis results showed that the OCSD general factor (i.e., obsessive-compulsive spectrum factor) was positively associated with Negative Affectivity, whereas Body Dysmorphic Disorder (BDD), Hoarding Disorder (HD), and Skin-Picking Disorder (SPD) specific factors showed significant and substantial differential relationships with dysfunctional personality domains. Specifically, BDD was positively associated with Negative Affectivity, Detachment and Psychoticism domains; HD was associated with high Negative Affectivity and Psychoticism; and SPD was associated with Detachment. © 2020 John Wiley & Sons, Ltd.

Personality traits and their clinical associations in trichotillomania and skin picking disorder

BACKGROUND

Despite being discussed in the psychiatric literature for decades, very little is known about personality features associated with trichotillomania and skin picking disorder (known as body focused repetitive behavior disorders, BFRBs); and the contribution of personality traits to their clinical presentations.

AIM

The present study assessed personality traits in a large and well-characterized sample of adults with either trichotillomania or skin picking disorder or both.

METHODS

Adults (n = 98, aged 18-65 years), with trichotillomania (n = 37), skin picking disorder (n = 32), both trichotillomania and skin picking disorder (n = 10), and controls (n = 19) were enrolled. Participants completed self-report questionnaires to quantify personality (NEO Personality Inventory), as well as extent/severity of picking/pulling symptoms, mood and anxiety, impulsive and perfectionistic tendencies, and neurocognitive functioning. Group differences were characterized and correlations with other measures were examined.

RESULTS

In comparison to controls, BFRBs had elevated neuroticism scores (p < 0.001), lower extraversion scores (p = 0.023), and lower conscientiousness scores (p = 0.007). Neuroticism was significantly related to both hair pulling (r = 0.24, p < 0.001) and skin picking severity (r = 0.48, p < 0.001), as well as elevated perceived stress, worse anxiety and depressive symptoms, and poorer quality of life. Introversion (i.e. lower extraversion) was significantly associated with worse picking severity, higher perceived stress, and higher depression. Lack of conscientiousness was significantly associated with more depression, impulsivity, and perceived stress.

DISCUSSION

Personality traits of neuroticism, introversion, and lack of conscientiousness are heightened in individuals with BFRBs and show strong associations with a number of clinically relevant features of illness. The holistic understanding and treatment of these disorders is likely to require consideration of dimensional traits such as these.