Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-19T23:28:09.376Z Has data issue: false hasContentIssue false
  • English
  • Français

Do personality disorders predict negative treatment outcome in obsessive–compulsive disorders? A prospective 6-month follow-up study

Published online by Cambridge University Press:  16 April 2020

Susanne Fricke ,
Steffen Moritz ,
Burghard Andresen ,
Dirk Jacobsen ,
Martin Kloss ,
Michael Rufer  and
Iver Hand
Susanne Fricke*
Affiliation:
Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Hospital of Hamburg, Martinistrasse 52, 20246Hamburg, Germany
Steffen Moritz
Affiliation:
Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Hospital of Hamburg, Martinistrasse 52, 20246Hamburg, Germany
Burghard Andresen
Affiliation:
Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Hospital of Hamburg, Martinistrasse 52, 20246Hamburg, Germany
Dirk Jacobsen
Affiliation:
Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Hospital of Hamburg, Martinistrasse 52, 20246Hamburg, Germany
Martin Kloss
Affiliation:
Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Hospital of Hamburg, Martinistrasse 52, 20246Hamburg, Germany
Michael Rufer
Affiliation:
Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Hospital of Hamburg, Martinistrasse 52, 20246Hamburg, Germany
Iver Hand
Affiliation:
Department of Psychiatry and Psychotherapy, Centre of Psychosocial Medicine, University Hospital of Hamburg, Martinistrasse 52, 20246Hamburg, Germany
*
*Corresponding author. Tel.: +49 40 42803 6790; fax: +49 40 42803 5546. E-mail address: [email protected] (S. Fricke).
Get access

Abstract

Background.

Comorbid personality disorders (PDs) are discussed as risk factors for a negative treatment outcome in obsessive–compulsive disorder (OCD). However, studies published so far have produced conflicting results. The present study examined whether PDs affect treatment outcome in patients with OCD.

Methods.

The treatment sample consisted of 55 patients with OCD who were consecutively referred to a Behaviour Therapy Unit for an in-patient or day-clinic treatment. Treatment consisted of an individualised and multimodal cognitive behaviour therapy (CBT, with or without antidepressive medication). Measurements were taken prior and after treatment and 6-month after admission.

Results.

A large percentage of patients benefited from treatment irrespective of the presence of a PD and were able to maintain their improvement at follow-up. Duration of treatment was not prolonged in OCD patients with concomitant Axis II disorders. However, some specific personality traits (schizotypal, passive–aggressive) were baseline determinants for later treatment failure at trend level.

Conclusions.

Results are encouraging for therapists working with patients co-diagnosed with Axis II disorders since these patients are not necessarily non-responders. The results stress the importance of a specifically tailored treatment approach based on an individual case formulation in OCD patients with complex symptomatology and comorbid Axis II disorders.

Keywords

Obsessive–compulsive disorderComorbid personality disorderMultimodal cognitive behaviour therapyOutcome
Type
Original articles
Information
European Psychiatry , Volume 21 , Issue 5 , July 2006 , pp. 319 - 324
Copyright
Copyright © Elsevier SAS 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association Diagnostic and statistical manual for mental disorders. 4th edWashington, DC: American Psychiatric Association; 1994.Google Scholar
Andresen, B.Inventar Klinischer Persönlichkeitsakzentuierungen (IKP). Göttingen: Hogrefe; 2005.Google Scholar
AuBuchon, P.G., Malatesta, V.J.Obsessive–compulsive patients with comorbid personality disorder: associated problems and response to a comprehensive behavior therapy. J. Clin. Psychiatry 1994;55(10):448–453.Google ScholarPubMed
Baer, L., Jenike, M.A.Personality disorder in obsessive–compulsive disorder. In: Jenike, M.A., Baer, L., Minichiello, W.E.Obsessive–compulsive disorders: theory and management. St. Louis: Mosby Year Book; 1990. p. 76–88.Google Scholar
Baer, L., Jenike, M.A., Black, D.W., Treece, C., Rosenfeld, R., Greist, J.Effect of Axis II diagnoses on treatment outcome with clomipramine in 55 patients with obsessive–compulsive disorder. Arch. Gen. Psychiatry 1992;49(11):862–866.CrossRefGoogle ScholarPubMed
Black, D.W., Noyes, R. Jr.Obsessive–compulsive disorder and Axis II. Int. Rev. Psychiatry 1997;9:111–118.CrossRefGoogle Scholar
Beck, A.T., Freeman, A.Cognitive therapy for personality disorders. New York: The Guilford Press; 1990.Google Scholar
Bronisch, T., Hiller, W., Mombour, W., Zaudig, M.Internationale Diagnosen Checkliste für Persönlichkeitsstörungen nach ICD-10 und DSM-IV (IDCL-P). Bern: Huber; 1995.Google Scholar
Bronisch, T., Mombour, W.Comparison of a diagnostic checklist with a structured interview for the assessment of DSM-III-R and ICD-10 personality disorders. Psychopathology 1994;27(6):312–320.CrossRefGoogle ScholarPubMed
Collegium Internationale Psychiatriae Scalarum. Internationale Skalen für Psychiatrie. Göttingen: Beltz; 1996.Google Scholar
De Haan, E., Van Oppen, P., van Balkom, A.J., Spinhoven, P., Hoogduin, K.A., Van Dyck, R.Prediction of outcome and early vs. late improvement in OCD patients treated with cognitive behaviour therapy and pharmacotherapy. Acta Psychiatr. Scand 1997;96(5):354–361.CrossRefGoogle ScholarPubMed
Derogatis, L.R.SCL-90-R. Administration, scoring and procedures manual—I. Baltimore: John Hopkins; 1977.Google Scholar
Dreessen, L., Hoekstra, R., Arntz, A.Personality disorders do not influence the results of cognitive and behavior therapy for obsessive–compulsive disorder. J. Anxiety Disord 1997;11(5):503–521.CrossRefGoogle Scholar
Drummond, L.M.The treatment of severe, chronic, resistant obsessive–compulsive disorder. An evaluation of an in-patient programme using behavioural psychotherapy in combination with other treatments. Br. J. Psychiatry 1993;163:223–229.CrossRefGoogle ScholarPubMed
Fals-Stewart, W., Lucente, S.An MCMI cluster typology of obsessive–compulsives: a measure of personality characteristics and its relationship to treatment participation, compliance and outcome in behavior therapy. J. Psychiatr. Res 1993;27(2):139–154.CrossRefGoogle ScholarPubMed
Franke, G.H.Die Symptom-Checkliste von Derogatis. Göttingen: Hogrefe; 1995.Google Scholar
Fricke, S.Einfluss von Persönlichkeitsstörungen und Persönlichkeitsakzentuierungen auf den Erfolg einer multimodalen Verhaltenstherapie bei Zwangserkrankungen. Kassel: Kassel University Press; 2003.Google Scholar
Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C., Fleischmann, R.L., Hill, C.L.et al.The Yale-Brown Obsessive–Compulsive Scale. I. Development, use, and reliability. Arch. Gen. Psychiatry 1989;46(11):1006–1011.CrossRefGoogle ScholarPubMed
Hamilton, M.A rating scale for depression. J. Neurol. Neurosurg. Psychiatry 1960;23:56–62.CrossRefGoogle ScholarPubMed
Hand, I.Out-patient, multi-modal behaviour therapy for obsessive–compulsive disorder. Br. J. Psychiatry 1998;173(35, Suppl):45–52 [35].CrossRefGoogle Scholar
Hand, I., Büttner-Westphal, H.Die Yale-Brown Obsessive–Compulsive Scale (Y-BOCS): Ein halbstrukturiertes Interview zur Beurteilung des Schweregrades von Denk- und Handlungszwängen. Verhaltenstherapie 1991;1(3):223–225.CrossRefGoogle Scholar
Hermesh, H., Shahar, A., Munitz, H.Obsessive–compulsive disorder and borderline personality disorder. Am. J. Psychiatry 1987;144(1):120–122.Google ScholarPubMed
Hiller, W., Zaudig, M., Mombour, W., Bronisch, T.Routine psychiatric examinations guided by ICD-10 diagnostic checklists (International Diagnostic Checklists). Eur. Arch. Psychiatry Clin. Neurosci 1993;242(4):218–223.CrossRefGoogle Scholar
Hohagen, F., Winkelmann, G., Rasche-Räuchle, H., Hand, I., König, A., Münchau, N.et al.Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Results of a multicentre study. Br J Psychiatry 1998;173 35, Suppl:71–78 [35].CrossRefGoogle Scholar
Jenike, M.A., Baer, L., Minichiello, W.E., Schwartz, C.E., Carey, R.J. Jr.Concomitant obsessive–compulsive disorder and schizotypal personality disorder. Am. J. Psychiatry 1986;143(4):530–532.Google ScholarPubMed
Kaiser, H.F.An index of factorial simplicity. Psychometrika 1974;39:31–36.CrossRefGoogle Scholar
Mavissakalian, M., Hamann, M.S., Jones, B.DSM-III personality disorders in obsessive–compulsive disorder: changes with treatment. Compr. Psychiatry 1990;31(5):432–437.CrossRefGoogle ScholarPubMed
McKay, D., Neziroglu, F., Todaro, J., Yaryura-Tobias, J.A.Changes in personality disorders following behaviour therapy for obsessive–compulsive disorder. J. Anxiety Disord 1996;10(1):47–57.CrossRefGoogle Scholar
Minichiello, W.E., Baer, L., Jenike, M.A.Schizotypal personality disorder: a poor prognostic indicator for behavior therapy in the treatment of obsessive–compulsive disorder. J. Anxiety Disord 1987;1:273–276.CrossRefGoogle Scholar
Moritz, S., Fricke, S., Jacobsen, D., Kloss, M., Wein, C., Rufer, M.et al.Positive schizotypal symptoms predict treatment outcome in obsessive–compulsive disorder. Behav. Res. Ther 2004;42(2):217–227.CrossRefGoogle ScholarPubMed
Perry, J.C.Problems and considerations in the valid assessment of personality disorders. Am. J. Psychiatry 1992;149(12):1645–1653.Google ScholarPubMed
Rasmussen, S., Tsuang, M.T.Obsessive–compulsive disorder and borderline personality disorder. Am. J. Psychiatry 1987;144(1):121–122.CrossRefGoogle Scholar
Ravizza, L., Barzega, G., Bellino, S., Bogetto, F., Maina, G.Predictors of drug treatment response in obsessive–compulsive disorder. J. Clin. Psychiatry 1995;56(8):368–373.Google ScholarPubMed
Rufer, M., Hand, I., Alsleben, H., Braatz, A., Ortmann, J., Katenkamp, B.et al.Long-term course and outcome of obsessive–compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo. Eur. Arch. Psychiatry Clin. Neurosci 2005;255:121–128.CrossRefGoogle ScholarPubMed
Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E.et al.The MINI International Neuropsychiatric Interview (M.I.N.I.). The development and validation of a structured diagnostic psychiatric interview. J. Clin. Psychiatry 1998;59(20, Suppl):22–23.Google ScholarPubMed
Steketee, G.Personality traits and disorders in obsessive–compulsives. J. Anxiety Disord 1990;4:351–364.CrossRefGoogle Scholar
Steketee, G., Chambless, D.L., Tran, G.Q.Effects of Axis I and II comorbidity on behavior therapy outcome for obsessive–compulsive disorder and agoraphobia. Compr. Psychiatry 2001;42(1):76–86.CrossRefGoogle ScholarPubMed
Steketee, G., Eisen, J., Dyck, I., Warshaw, M., Rasmussen, S.Predictors of course in obsessive–compulsive disorder. Psychiatry Res 1999;89(3):229–238.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.