This material was presented in the 25th European Congress of Psychiatry which was organised by the European Psychiatry Association in Florence, Italy from 1-4th April 2017. I had access to the material as I attended the full Congress. Please note that this material remains the intellectual property of the European Psychiatry Association and its authors and any citation should include a full reference to it. For more information on the EPA and how to become a member, please visit: http://www.europsy.net/

1. BACKGROUND
Obsessive Compulsive Personality Disorder and Autism Spectrum Disorder
Traits in the Obsessive Compulsive Disorder Clinic
Gadelkarim, W.¹’², Shahper, S.², Reid, J.², Wikramanayake M.², Kaur, S.², Kolli,S.², Osman, S.², Fineberg. N.²
¹North Essex Partnership University NHS Foundation Trust, Harlow,²Highly Specialised OCD/BDD Services, Hertfordshire Partnership
University NHS Foundation Trust, Welwyn Garden City, AL8 6HG.
• To investigate the distribution of OCPD traits within a cohort of
treatment-seeking OCD patients.
• To evaluate the overlap between OCPD, OCD and ASD
symptomatology in this sample.
• To test the hypotheses that increased severity of OCPD traits
correlates positively with OCD and ASD severity, impaired
insight and treatment resistance.
• The study was approved by the local research ethics committee.
• We approached 101 consecutive OCD patients attending a UK
Specialised OCD Service, of whom 73 consented to be
interviewed.
• The sample included a subgroup of highly treatment resistant
cases (n=22).
• We evaluated the severity of OCPD traits using the observer-
rated Compulsive Personality Assessment Scale (CPAS)4 that
evaluates each of the eight DSM-5 diagnostic criteria on a scale
of 0-4 (maximum total CPAS =32).
• Consistent with the DSM-5, we operationally defined a diagnosis
of OCPD as a score of 3 (severe) or 4 (very severe) on at least
4 CPAS items.
• We measured OCD symptom severity on the Yale–Brown
Obsessive Compulsive Scale (YBOCS) 5 ASD traits on the Adult
Autism Spectrum Quotient (AQ)6 and insight on the Brown
Assessment of Beliefs Scale (BABS) 7
• 67 consenting individuals (52.2 % female; mean age 44.5 y,
SD+/- 11.47) completed the CPAS.
• 24 patients (36%) met operational criteria (see methods) for a
diagnosis of OCPD.
• The frequency of total CPAS scores within the study sample,
representing the complement of OCPD traits, followed a normal
distribution (figure 1) with a mean score of 13.79, SD+/- 7.7.
• OCPD was not over-represented in the highly resistant OCD
subgroup (chi squared p= 0.667).
N=67 AQ
total
Social
skills
Attention
switching
Attention
to detail
Communication Imagination
CPAS total
Pearson Correlation
Sig.(2-tailed)
.401**
.001
.200
.104
.458**
.000
.379**
.002
.283*
.020
.066
.595
• Obsessive Compulsive (Anankastic) Personality Disorder
(OCPD) is common, highly comorbid and associated with
considerable utilisation of psychological therapy services.
• OCPD has been subjected to comparatively little research and
no evidence based treatments exist.
• OCPD overlaps in phenomenology (preoccupation with detail,
need for completeness, perfection or interpersonal control and
hoarding) and neuro-psychology (behavioural and cognitive
rigidity) with Obsessive Compulsive and Related Disorders
(OCRDs) such as Obsessive Compulsive Disorder (OCD)1 and
neurodevelopmental disorders such as Autism Spectrum
Disorder (ASD)2.
• OCPD, OCD and ASD often occur together and cluster in
families3.
• Comorbid OCPD is known to be associated with poorer CBT
outcomes in OCD patients.
• Greater understanding of the relationship between OCPD, OCD
and ASD would provide new insights into the diagnostic
classification of OCPD in relation to the OCRDs and ASD, and
would generate new research and treatment heuristics for these
disabling disorders.
0
10
20
30
40
50
60
Frequency
Percentage
• Disabling OCPD traits, are common in the treatment-seeking
OCD population.
• OCPD traits are strongly associated with ASD traits, suggesting a
neurodevelopmental origin, but less strongly associated with
OCD severity and, contrary to prediction, do not appear related
to poor insight or highly treatment-resistant forms of OCD.
• The impact of OCPD on OCD treatment outcomes requires
further study.
• Translational research methods e.g. neuropsychological tests or
brain imaging analysis, may help to further clarify the neuro-
psychological relationship between OCPD and ASD.
• Severe or very severe (CPAS score >=3 out of 4) traits of
perfectionism, over-conscientiousness, preoccupation with
detail, rigidity and the need for control were endorsed
commonly i.e. by 53.7%, 53.7%, 40%, 41.7% and 34% of the
OCD sample, respectively.
• Severe or very severe hoarding was endorsed by 26.4% of the
sample (figure 2).
Fig.1; Distribution of OCPD severity in the OCD sample,
• The total CPAS scores correlated with total AQ (P=.401) and with
selected AQ domain scores, including attention-switching
(P=.458), attention to detail (P=.379) (all correlations significant
at the p<.01 level (2-tailed)), and communication (P =.284, p
<.05) (Table 1).
• There was a borderline significant correlation between the total
CPAS and the total Y-BOCS (P=.228, p=.070) but no significant
correlation between the total CPAS and the BABS (P=.09,
p=.469).
Table 1: Relationship between total CPAS scores and AQ domains
1. Eisen, J. L., Sibrava, N.J., Boisseau, C.L., Mancebo, M.C., Stout, R. L.,Pinto, A. ,Rasmussen, S. A. (2013). Five-year course of obsessive-compulsive disorder:
Predictors of remission and relapse. Journal of Clinical Psychiatry, 74 (3), 233-239.
2. Fineberg, N.A., Reghunandanan, S., Kolli, S., Atamca, M.(2014). Obsessive-compulsive (anankastic) personality disorder: toward the ICD-11 classification. Revista
brasileira de psiquiatria (São Paulo, Brazil : 1999), 36 (1); 40-50, 1809-452X
3. Bienvenu, O.J., Samuels, J.F., Wuyek, L.A., Liang, K.-Y., Wang, Y. et al ( 2012). Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are
spectrum conditions? A family study perspective . Psychological Medicine. 42 (1), 1-13.
4. Fineberg, N.A., Sharma, P, Sivakumaran, T., Sahakian, B., Chamberlain, S.(2007). Does Obsessive-Compulsive Personality Disorder Belong Within the
Obsessive-Compulsive Spectrum? CNS Spectrum, 12(6):467-474,477-482
5. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS. (1989) The Yale-Brown Obsessive Compulsive
Scale.Development, Use, and Reliability. Arch Gen Psychiatry. 6(11):1006-1011
6. Baron-Cohen, S, Wheelwright, S., Skinner, R., Martin, J. & Clubley, E. ( 2001). The Autism –Spectrum Quotient (AQ): evidence from Asperger Syndrome/high-
functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders,31,5-17.
7 Eisen, J, Phillips, KA, Baer, L, Beer, DA, Atala, KD, Rasmussen, SA (1998) . The Brown Assessment of Beliefs Scale: Reliability and Validity. American Journal of
Psychiatry 155:1, 102-108
REFERENCES and DISCLOSURES
OBJECTIVES
METHODS
RESULTS
CONCLUSIONS
This work did not receive funding from external sources. In the past several years, Dr. Fineberg has received research support from Lundbeck, Glaxo-SmithKline, European College of
Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire,
EU (FP7), Shire. Dr Fineberg has received honoraria for lectures at scientific meetings from Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of
Mental Health Pharmacists, British Association for Psychopharmacology (BAP). Dr Fineberg has received financial support to attend scientific meetings from RANZCP, Shire, Janssen,
Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioural Addiction, CINP, IFMAD,
ECNP, BAP, World Health Organization, Royal College of Psychiatrists. Dr Fineberg has received financial royalties for publications from Oxford University Press and payment for editorial duties
from Taylor and Francis.
Figure 2: CPAS values in OCD population N = 67
**Correlation is significant at the 0.01 level (2-tailed)
*Correlation is significant at the 0.05 level (2- tailed) {In bold)
RESULTS (cont)