Personality disorders in patients with obsessive-compulsive disorder in Japan

Course and clinical correlates of obsessive-compulsive disorder with or without comorbid personality disorder

BACKGROUND

Personality disorders (PDs) are often comorbid with obsessive-compulsive disorder (OCD) which may influence symptom presentation and course. This investigation sought to examine the impact of comorbid PDs on clinical presentation and symptom chronicity in a large, prospective longitudinal OCD study.

METHODS

Participants (n = 263) were treatment-seeking adults with a primary diagnosis of OCD separated into two groups: individuals with and without a co-occurring PD. We conducted two-tailed t-tests to compare symptom severity, functioning, and quality of life between the OCD + PD group (n = 117) and the OCD w/o PD group (n = 146). Chronicity analyses were conducted to compare the amount of time in-episode for OCD and major depressive disorder (MDD) between the two groups.

RESULTS

The OCD + PD group reported greater OCD and depression severity, lower levels of psychosocial functioning and worse quality of life than the OCD w/o PD group. The OCD + PD group exhibited greater OCD and MDD symptom chronicity; over 5 years the OCD + PD group spent 16.2 % weeks longer at full criteria for OCD and three times as many weeks in episode for MDD than the OCD w/o PD group.

LIMITATIONS

Focusing on PDs as a group limited our ability to make observations about specific PDs. Further, the participants in our sample were predominantly White and all were treatment seeking which limits the generalizability of our findings.

CONCLUSIONS

Our results suggest that those with OCD and comorbid PDs present with greater overall impairment and may require additional considerations during treatment conceptualization and planning.

Familial risk of psychosis in obsessive-compulsive disorder: Impact on clinical characteristics, comorbidity and treatment response

BACKGROUND

Family studies in obsessive-compulsive disorder (OCD) indicate higher rates of psychosis among their first-degree relatives (FDRs). However, the etiological and clinical relationships between the two disorders remain unclear. We compared the clinical characteristics and pharmacological treatment response in patients diagnosed with OCD with a family history of psychosis (OCD-FHP), with a family history of OCD (OCD-FHO) and those with sporadic OCD (OCD-S).

METHODS

A total of 226 patients who met DSM-IV criteria for OCD (OCD-FHP = 59, OCD-FHO = 112, OCD-S = 55) were included for analysis. All patients were evaluated using the Mini International Neuropsychiatric Interview (MINI 6.0.0), Yale-Brown Obsessive-Compulsive Scale (YBOCS), and the Family Interview for Genetic Studies (FIGS). Treatment response was characterized over naturalistic follow-up.

RESULTS

The three groups did not differ across any demographic or clinical variables other than treatment response. Patients in the OCD-FHP group were found to have received a greater number of trials with serotonin reuptake inhibitors (SRI) [F (2,223) = 7.99, p < 0.001], were more likely to have failed ≥2 trials of SRIs (χ2 = 8.45, p = 0.014), and less likely to have attained remission (χ2 = 6.57, p = 0.037) CONCLUSIONS: We observed that having a relative with psychosis may predispose to treatment resistance in OCD. Further research on the influence of genetic liability to psychosis on treatment response in OCD may offer novel translational leads.

Schizotypal personality disorder in clinical obsessive-compulsive disorder samples: a brief overview

Obsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder characterized by the presence of obsessions and/or compulsions that cause major distress and impair important areas of functioning. About 9 out of 10 patients with OCD have comorbid psychiatric diagnoses. A high proportion of clinically diagnosed OCD patients fulfill diagnostic criteria of a schizophrenia spectrum disorder, to the point that significant evidence in the literature supports the existence and the clinical relevance of a schizo-obsessive spectrum of disorders, including schizotypal personality disorder (SPD) with OCD (schizotypal OCD). In this paper, we provide a brief but comprehensive analysis of the literature on the clinical coexistence between OCD and SPD. The clinical validity of the so-called schizotypal OCD is analyzed through a comprehensive investigation of the relationship between SPD features and obsessive-compulsive phenomena in clinical OCD samples. This review describes the potential connections between OCD and SPD on the epidemiological, sociodemographic, psychopathological, and clinical levels. SPD is commonly observed in OCD patients: about 10% of OCD patients have a full categorical diagnosis of SPD. Early clinical identification of SPD features-and, more generally, of psychotic features and personality disorders-in OCD patients is strongly recommended. In fact, a proper and early diagnosis with early treatment may have benefits for prognosis. However, although schizotypal OCD seems to have clinical and predictive validity, further neurobiological and genetic studies on etiological specificity are warranted.

Obsessive-Compulsive Personality Disorder Co-occurring in Individuals with Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Assess the rates of co-occurring obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD)• Identify characteristics related to OCD with co-occurring OCPD.

ABSTRACT

The current literature discloses discrepant findings regarding the rates of co-occurring obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD). In addition, it is not clear which characteristics are related specifically to OCD with co-occurring OCPD. We conducted the first systematic review and meta-analysis of the studies of the prevalence of OCPD in patients with OCD. We also investigated potential moderators of the prevalence, including OCD severity, age of onset of OCD, sex, current age, methodological quality, and publication date of the studies. Electronic databases and gray literature were searched by two independent reviewers. A PRISMA systematic review with a random-effect meta-analysis was conducted. Thirty-four studies were included. A significant mean effect size of 0.25 without publication bias indicated that OCPD was present in 25% of patients with OCD, suggesting that the two conditions are distinct clinical entities. This prevalence was higher than the rates found in the literature for any other personality disorders among OCD patients. OCPD that occurs in the context of OCD was more likely to be present in males and to be characterized by a later age of onset of OCD, older age at assessment, and less severe OCD symptoms. Clinicians should consider these findings when assessing and planning treatment of OCD with co-occurring OCPD.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder

Objective:

To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand.

Method:

Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders.

Results:

The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive–behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive–behavioural therapy and pharmacotherapy.

Conclusion:

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand.

Personality disorders in obsessive-compulsive disorder: a comparative study versus other anxiety disorders

Objective. The purpose of this paper is to provide evidence for the relationship between personality disorders (PDs), obsessive compulsive disorder (OCD), and other anxiety disorders different from OCD (non-OCD) symptomatology. Method. The sample consisted of a group of 122 individuals divided into three groups (41 OCD; 40 non-OCD, and 41 controls) matched by sex, age, and educational level. All the individuals answered the IPDE questionnaire and were evaluated by means of the SCID-I and SCID-II interviews. Results. Patients with OCD and non-OCD present a higher presence of PD. There was an increase in cluster C diagnoses in both groups, with no statistically significant differences between them. Conclusions. Presenting anxiety disorder seems to cause a specific vulnerability for PD. Most of the PDs that were presented belonged to cluster C. Obsessive Compulsive Personality Disorder (OCPD) is the most common among OCD. However, it does not occur more frequently among OCD patients than among other anxious patients, which does not confirm the continuum between obsessive personality and OCD. Implications for categorical and dimensional diagnoses are discussed.

Altered gene expression, mitochondrial damage and oxidative stress: converging routes in motor neuron degeneration

Motor neuron diseases (MNDs) are a rather heterogeneous group of diseases, with either sporadic or genetic origin or both, all characterized by the progressive degeneration of motor neurons. At the cellular level, MNDs share features such as protein misfolding and aggregation, mitochondrial damage and energy deficit, and excitotoxicity and calcium mishandling. This is particularly well demonstrated in ALS, where both sporadic and familial forms share the same symptoms and pathological phenotype, with a prominent role for mitochondrial damage and resulting oxidative stress. Based on recent data, however, altered control of gene expression seems to be a most relevant, and previously overlooked, player in MNDs. Here we discuss which may be the links that make pathways apparently as different as altered gene expression, mitochondrial damage, and oxidative stress converge to generate a similar motoneuron-toxic phenotype.

Obsessive-compulsive disorder: boundary issues

The boundaries between obsessive-compulsive disorder (OCD) and other neuropsychiatric disorders remain unresolved and may well differ from one disorder to another. Endophenotypes are heritable, quantitative traits hypothesized to more closely represent genetic risk for complex polygenic mental disorders than overt symptoms and behaviors. They may have a role in identifying how closely these disorders are associated with another and with other mental disorders with which they share major comorbidity. This review maps the nosological relationships of OCD to other neuropsychiatric disorders, using OCD as the prototype disorder and endophenotype markers, such as cognitive, imaging, and molecular data as well as results from demographic, comorbidity, family, and treatment studies. Despite high comorbidity rates, emerging evidence suggests substantial endophenotypic differences between OCD and anxiety disorders, depression, schizophrenia, and addictions, though comparative data is lacking and the picture is far from clear. On the other hand, strong relationships between OCD, Tourette syndrome, body dysmorphic disorder, hypochondriasis, grooming disorders, obsessive-compulsive personality disorder, and pediatric autoimmune neuropsychiatric disorders associated with streptococcus are likely. Studies designed to delineate the cause, consequences, and common factors are a challenging but essential goal for future research in this area.

Obsessive-compulsive spectrum disorders: cross-national and ethnic issues

Epidemiological and clinical data from a variety of cultural and geographic settings on obsessive-compulsive disorder (OCD), and many of the obsessive-compulsive spectrum disorders, suggest that this is a group of disorders with a good degree of transcultural homogeneity. However, the content and themes that predominate in patients with these disorders, and the course of illness, can be shaped by cultural, ethnic, and religious experiences. Across cultures, OCD is commonly comorbid with mood, anxiety, and impulse-control disorders. However, little is known about the mechanisms by which culture and ethnicity may affect the expression of OCD and related disorders. Cross-national comparative studies exploring culturally influenced differences in clinical course, treatment outcome, including ethnogenetic differences in drug response, and prognosis are needed.

Obsessive-compulsive disorder and personality disorder: evidence from the British National Survey of Psychiatric Morbidity 2000

BACKGROUND

Previous studies indicate that most individuals with obsessive-compulsive disorder (OCD) have comorbid personality disorders (PDs), particularly from the anxious cluster. However, the nature and strength of this association remains unclear, as the majority of previous studies have relied heavily on clinical populations. We analysed the prevalence of screen positive personality disorder in a representative sample of adults with OCD living in private households in the UK.

METHODS

A secondary analysis of data from the 2000 British National Survey of Psychiatric Morbidity. The prevalence of PD, as determined by the SCID-II questionnaire, was compared in participants with OCD, with other neuroses and non-neurotic controls. Within the OCD group we also analysed possible differences relating to sex and subtypes of the disorder.

RESULTS

The prevalence of any screen positive PD in the OCD group (N=108) was 74%, significantly greater than in both control groups. The most common screen positive categories were paranoid, obsessive-compulsive, avoidant, schizoid and schizotypal. Compared to participants with other neuroses, OCD cases were more likely to screen positively for paranoid, avoidant, schizotypal, dependent and narcissistic PDs. Men with OCD were more likely to screen positively for PDs in general, cluster A PDs, antisocial, obsessive-compulsive and narcissistic categories. The presence of comorbid neuroses in people with OCD had no significant effect on the prevalence of PD.

CONCLUSIONS

Personality pathology is highly prevalent among people with OCD who are living in the community and should be routinely assessed, as it may affect help-seeking behaviour and response to treatment.

Clinical picture of obsessive-compulsive disorder with poor insight: a regression model

DSM-IV included a type of obsessive-compulsive disorder (OCD) with poor insight in the official classification. The present study was performed using a continuous measure of the level of insight to analyze the association between this variable and characteristics of the disorder. Seventy-four consecutive OCD outpatients (DSM-IV criteria) were assessed using: a semistructured interview for sociodemographic and clinical features, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive-Compulsive Scale (NIMH-OCS), the Hamilton Depression and Anxiety Rating Scales (HDRS, HARS), and the Overvalued Ideas Scale (OVIS) as a continuous measure of the level of insight. Stepwise multiple regression analysis revealed that demographic and clinical factors were related to the OVIS score. The following four factors were found to be significantly related to the OVIS score: the Y-BOCS score for compulsions, OCD chronic course, and family history of OCD were positively related, while obsessive-compulsive personality disorder was negatively related. These results suggest that poor insight identifies a group of OCD patients with distinct clinical characteristics.

Impulsive disorders in Japanese adult patients with obsessive-compulsive disorder

In this study, we sought to characterize obsessive-compulsive disorder (OCD) patients with impulsive features, and to determine whether they constitute a distinct subtype of OCD. Therefore we systematically assessed impulse control disorders and other impulsive conditions categorized as obsessive-compulsive spectrum disorders (OCSDs) in 153 Japanese adult patients with OCD. Forty-five subjects (29%) had concurrent impulsive disorders, and they were differentiated from other OCD patients on a range of demographic features (e.g., younger age at onset), and clinical features (e.g., pervasive and severe psychopathology, and poor treatment outcome). However, on logistic regression, none of these variables predicted comorbid impulsivity. The findings appear to support the argument that OCD patients with impulsive features constitute a subtype of OCD. However, further research is necessary to determine whether impulsivity should be conceptualized as lying on a spectrum with compulsivity or as a dimension that is orthogonal to compulsivity.

DSM-IV obsessive-compulsive personality disorder: prevalence in patients with anxiety disorders and in healthy comparison subjects

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

Axis I and II comorbidity in a large sample of patients with obsessive-compulsive disorder

BACKGROUND

No study has reported yet on the prevalence of both comorbid DSM-IV axis I and personality disorders in a large cohort of OCD patients, and little is known about differences in clinical characteristics between OCD patients with and without comorbid symptoms.

OBJECTIVE

To examine the cross-sectional prevalence of comorbid DSM-IV axis I, and personality disorders in a population of patients with primary obsessive-compulsive disorder (OCD).

METHOD

420 outpatients with OCD were evaluated for comorbid pathology, demographic, and clinical characteristics.

RESULTS

Forty-six percent of the patients were diagnosed with a comorbid disorder. Twenty-seven percent met the criteria for at least one comorbid axis I disorder, 15.6 percent for a comorbid personality disorder, and 20.4 percent for both a comorbid axis I disorder and a personality disorder.

LIMITATIONS

A limitation of the current study is that the sample was drawn from a psychiatric department specialised in anxiety disorders, which might have underestimated the rate of comorbid diagnoses.

CONCLUSION

Comorbid diagnoses occur less frequently than would be expected on the basis of comparable comorbidity studies in OCD. Associated axis I comorbidity did not affect clinical severity of OCD, but was related to higher levels of depression and anxiety, whereas axis II comorbidity impaired to a higher extent the overall functioning.

Patterns of Axis-II comorbidity in a Turkish OCD sample

OBJECTIVE Obsessive-compulsive disorder (OCD) patients frequently present with Axis-II disorders, particularly Cluster C (anxiety spectrum) and Cluster A (schizophrenic spectrum) personality disorders. The present study examined patterns of Axis-II comorbidity in a Turkish OCD sample. In addition, we explored the impact of personality disorder symptoms on OCD-symptom severity and symptom profile. METHOD Structured psychiatric interviews and self-report measures of OCD symptoms and Axis-II disorders were administered to patients with OCD and control subjects. RESULTS Patients with OCD obtained significantly higher scores on measures of Cluster A and Cluster C personality disorders. Patients with OCD also achieved significantly higher scores on the BPD Subscale; however, they did not obtain significantly higher scores on other Cluster B subscales. Group differences on measures of Cluster A and C disorders were marked. CONCLUSIONS Findings are consistent with prior work demonstrating an increased incidence of Axis-II disorders among patients with OCD.

Assessment of DSM-IV personality disorders in obsessive-compulsive disorder: comparison of clinical diagnosis, self-report questionnaire, and semi-structured interview

In patients with obsessive-compulsive disorder, personality disorders are not many times assessed according to DSM-IV criteria. The purpose of the present study is to examine the prevalence of personality disorders diagnosed according to the DSM-IV in a severely disordered OCD population (n=65) with three different methods of assessing personality disorders (structured interview, questionnaire, and clinical diagnoses). Furthermore, correspondence between these different methods was investigated and their construct validity was examined by relating the three methods to external variables. Each method resulted in a predominance of Cluster C personality disorders, and obsessive-compulsive personality disorder had the highest prevalence. However, there was generally low correspondence regarding which patient had which personality disorder. Results concerning the relation of external variables were the most promising for the structured clinical interview.

A comparative study of clinical features between pure checkers and pure washers categorized using a lifetime symptom rating method

The current study assessed lifetime obsessive-compulsive disorder (OCD) symptoms in 156 Japanese patients with OCD in order to investigate clinical differences between pure lifetime checkers and pure lifetime washers. Fifty subjects (32%), who had no lifetime history of washing or checking compulsions, or who had a principal symptom other than washing or checking compulsions, were initially excluded. The remaining 106 subjects were divided into three groups: 43 pure lifetime washers (W), 33 pure lifetime checkers (C) and 30 subjects who had experienced both checking and washing compulsions over their lifetime (WC). No differences in clinical characteristics were observed between the W and C groups, suggesting that the lifetime washer-checker distinction may not be useful in subtyping OCD. However, subjects in the WC group differed from other subjects in a number of respects including poorer level of insight, more severe psychopathology and global dysfunction. Thus, they can be generally distinguished by more pervasive and severe psychopathological features, and may constitute a valid subgroup of OCD. Further work from a multidimensional perspective is required to verify the clinical significance of a typology based on lifetime symptoms.

Phenomenology of obsessive-compulsive disorder in Taiwan

This study was designed to assess the phenomenology, comorbidities, correlation with depressive disorders, and gender differences in obsessive-compulsive disorder (OCD) in Taiwan. Two hundred outpatients who fulfilled the diagnostic criteria of OCD according to DSM-IV were included. Patient characteristics, age at onset, symptom profile, and Axis I comorbidity were recorded. Gender differences, age at onset, and comorbidity of depressive disorders among different subtypes of OCD were compared. The most common obsession was contamination, followed by pathological doubt, and need for symmetry. The most common compulsion was checking, followed by washing, and orderliness compulsions. More men than women presented with the obsession of need for symmetry. Eighty-three (41.5%) subjects had comorbid depressive disorders. Women had more major depressive disorder. Patients with somatic obsessions were more likely to have major depressive disorder. Most clinical characteristics of OCD in Taiwan were similar to that of previous studies in other countries.

Personality traits and smoking in patients with obsessive-compulsive disorder

As opposed to other psychiatric populations, subjects with obsessive-compulsive disorder (OCD) smoke less than the general population. The present study aims at further investigating the relationship between smoking in OCD subjects and personality traits. Sixty-four subjects with OCD were interviewed concerning their smoking habits. Personality traits were evaluated using the Karolinska Scales of Personality, and specific obsessive-compulsive personality traits were elicited through self-report questionnaires. Non-smokers were more easily fatigued, more inclined to worry, more remorseful, less self-confident, less impulsive and became uneasy more frequently when urged to speed up, than smokers with OCD. Additionally, non-smokers fulfilled significantly more obsessive-compulsive personality disorder criteria as compared to the smokers (P < 0.001). We propose a clinical subtype of OCD related to non-smoking, psychasthenia, anxiety, and pronounced obsessive-compulsive personality disorder traits.

Clinical features of obsessive-compulsive disorder

The past decade has seen tremendous strides in the knowledge about the cause, epidemiology, and treatment of OCD. Research on clinical characteristics of the disorder have focused on several areas, including identification of subtypes, the role of insight, and patterns of comorbidity. Several studies looking at course of illness in OCD have found that, for adults with this disorder, the course is usually chronic, but increasing evidence shows that a subtype of OCD characterized by an episodic course may exist, and research is focusing on delineating that subtype more specifically. Another hypothesized subtype, which may be related to rheumatic fever, involves patients with both OCD and chronic tic disorders. Certain obsessions and compulsions are more common in patients with these two disorders; together with the familial transmission and treatment data, this suggests that these patients may represent a meaningful subtype. Another area of focus over the past 10 years has been the role of insight. Increasing evidence shows that a range of insight exists in patients with OCD. Whether patients with poor insight have a different treatment response or different course than do patients with better insight remains to be seen. Finally, comorbidity between OCD and schizophrenia has been an area of interest. Emerging evidence shows that obsessions and compulsions are more common in patients with schizophrenia than was previously thought. The effect of obsessions and compulsions on schizophrenia in terms of treatment response and course is being investigated. Despite tremendous advances in treatment of this potentially debilitating disorder, a significant percentage of patients do not respond to standard treatment. Continued research to identify meaningful subtypes in OCD is necessary to unravel important questions concerning cause and to develop specific treatment strategies for refractory patients.

Prevalence and symptomatology of comorbid obsessive-compulsive disorder among bulimic patients

This study sought to assess the prevalence and symptomatology of comorbid obsessive-compulsive disorder (OCD) among Japanese subjects who met the DSM-III-R criteria for bulimia nervosa (BN). The Structured Clinical Interview for DSM-III-R Patient Version was used to distinguish 26 BN patients with concurrent OCD from 52 BN patients without OCD. Obsessive-compulsive symptoms in BN subjects with concurrent OCD were evaluated using the Japanese version of the Yale-Brown Obsessive-Compulsive Scale. There were no differences in the prevalence of concurrent OCD between BN subjects with and without a lifetime history of anorexia nervosa. Among BN subjects with concurrent OCD, symptoms related to symmetry and order were most frequently identified, followed by contamination and aggressive obsessions, and checking and cleaning/washing compulsions. Bulimia nervosa subjects with concurrent OCD were more likely than subjects without OCD to have more severe mood and core eating disorder psychopathology. Comorbid OCD is a common phenomenon in Japanese bulimics (33%) similar to that suggested in BN subjects in the Western countries. Obsessive-compulsive symptoms related to symmetry and order were most frequently observed in BN subjects with concurrent OCD, which was a similar finding to that reported among restricting anorexic subjects.

A comparison of clinical features among Japanese eating-disordered women with obsessive-compulsive disorder

Clinical features, such as obsessive-compulsive disorder (OCD) symptoms, were investigated in Japanese women with DSM-III-R eating disorders (EDs) and concurrent OCD in comparison to age-matched women with OCD. Sixteen women with restricting anorexia nervosa (AN), 16 with bulimia nervosa (BN), and 16 with both AN and BN (BAN) showed commonality in a more elevated prevalence of OCD symptoms of symmetry and order compared with 18 OCD women. Among the personality disorders (PDs), likewise, obsessive-compulsive PD (OCPD) was more prevalent in each ED group compared with the OCD group. However, aggressive obsessions were more common in both BN and BAN subjects compared with AN subjects. Subjects with bulimic symptoms were also distinguished from AN subjects by impulsive features in behavior and personality. Thus, an elevated prevalence of aggressive obsessions along with an admixture of impulsive and compulsive features specifically characterized the clinical features of bulimic subjects with OCD.