Elsevier

Psychiatry Research

Volume 129, Issue 1, 30 November 2004, Pages 21-27
Psychiatry Research

High sensitivity to punishment and low impulsivity in obsessive-compulsive patients with hoarding symptoms

https://doi.org/10.1016/j.psychres.2004.02.017Get rights and content

Abstract

Recent factor-analytic studies involving over 2000 patients have reduced the symptoms of obsessive-compulsive disorder (OCD) into a few dimensions or potentially overlapping syndromes. Hoarding consistently emerged as a separate factor in all these studies. This study investigated the relationship between OCD symptom dimensions and normal personality traits in a sample of 56 OCD patients. They were administered the Sensitivity to Punishment and Sensitivity to Reward Questionnaire and the Eysenck Personality Questionnaire, derived from Gray's and Eysenck's personality models, respectively. The personality scores were correlated with previously identified symptom dimensions from the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (Y-BOCS-SC), controlling for overall illness severity. High scores on the hoarding dimension of the Y-BOCS-SC were positively correlated with scores on the Sensitivity to Punishment scale and negatively with Eysenck's Psychoticism scale. While high sensitivity to punishment is a personality feature common to many OCD patients, it is more strongly pronounced in patients with hoarding symptoms. These patients also appear to be less impulsive or novelty seeking as reflected by low scores on Eysenck's Psychoticism scale. High sensitivity to punishment and low novelty seeking in OCD hoarders might explain their poor compliance and response to conventional treatments, but this question needs to be explored further in a prospective treatment study.

Introduction

The role of personality disorders and normal personality variables in obsessive-compulsive disorder (OCD) has been a topic of debate for years (see Summerfeldt et al., 1998, for a review), but there have been relatively few studies of normal personality features in individuals with OCD.

Studies using Cloninger's model of personality (Cloninger et al., 1993) as a framework have consistently found that OCD subjects higher scores than normal controls on harm avoidance (Pfohl et al., 1990, Richter et al., 1996, Bejerot et al., 1998, Kusunoki et al., 2000, Lyoo et al., 2001), but results of these studies have been less consistent regarding two of the other temperamental dimensions of the model: novelty seeking and reward dependence. While some studies found that OCD patients have lower scores on novelty seeking than controls (Bejerot et al., 1998, Kusunoki et al., 2000, Lyoo et al., 2001), others did not (Pfohl et al., 1990, Richter et al., 1996). Likewise, one study found OCD subjects to be more reward-dependent than controls (Pfohl et al., 1990), while more recent studies did not (Richter et al., 1996, Bejerot et al., 1998, Lyoo et al., 2001).

Samuels et al. (2000) assessed normal personality dimensions in OCD according to the Five-Factor Model of personality (Costa and McRae, 1992). OCD patients had higher neuroticism and agreeableness scores and lower extraversion scores than controls, while no differences were found in the openness and conscientiousness scales. One of the facets of neuroticism that was found to be elevated in OCD subjects was “impulsiveness.” This finding contrasted with the results of Pfohl et al. (1990) andRichter et al. (1996), who did not find differences in novelty seeking—a construct related to impulsivity—between OCD subjects and controls.

Finally, using the personality theories of Gray (Gray, 1982, Gray and McNaughton, 2000) and Eysenck (Eysenck, 1967, Eysenck and Eysenck, 1985) as a framework, Fullana et al. (2004) found that OCD patients scored higher than controls on Gray's Sensitivity to Punishment and Eysenck's Neuroticism and Psychoticism scales. Patients were also more introverted than controls. Interestingly, in this study, psychoticism—a construct that overlaps with impulsivity and novelty seeking—was the variable that better separated patients from controls.

The imperfect replication of these previous findings could in part be related to the use of different instruments, which assess only partially overlapping constructs, to measure normal personality traits. Another possible explanation relates to the notable clinical heterogeneity of OCD (Baer, 1994, Leckman et al., 1997, Mataix-Cols et al., in press, Calamari et al., 1999, Summerfeldt et al., 1999, Mataix-Cols et al., 1999). Indeed, recent research suggests that some personality disorders (assessed categorically) are more likely to be associated with certain OCD symptom dimensions. Specifically, patients with hoarding symptoms are more likely than patients without these symptoms to present one or more personality disorders, especially form the anxious-fearful cluster (Baer, 1994, Frost et al., 2000, Mataix-Cols et al., 2000).

In the present study we reanalyzed data fromFullana et al. (2004) to assess the relationship between normal personality traits according to Gray's and Eysenck's models of normal personality and previously identified OCD symptom dimensions (Mataix-Cols et al., 1999). Based on previous findings (Baer, 1994, Frost et al., 2000, Mataix-Cols et al., 2000), we predicted that the presence of hoarding symptoms would correlate with (1) high scores on Gray's Sensitivity to Punishment scale, (2) low scores on Gray's Sensitivity to Reward scale, and (3) low scores on Eysenck's Extroversion and Psychoticism scales. If these hypotheses are confirmed, they could provide a basis for understanding why patients with hoarding symptoms show poor adherence (Mataix-Cols et al., 2002a) and response to conventional treatments (Black et al., 1998, Mataix-Cols et al., 1999, Mataix-Cols et al., 2002a, Winsberg et al., 1999, Saxena et al., 2002, Abramowitz et al., 2003).

Section snippets

Subjects

The sample consisted of 56 patients (41% women) with a primary diagnosis of OCD, as determined by semi-structured interviews with experienced psychiatrists or clinical psychologists according to DSM-IV. They were referred for assessment and treatment to the Department of Psychiatry of the Bellvitge Hospital in Barcelona, Catalonia. Their mean age was 28.3 years (SD=8). Ten patients (22%) also fulfilled criteria for major depressive disorder. The mean Yale-Brown Obsessive-Compulsive Scale

Results

Table 1 shows the frequencies of the present and major symptoms of the Y-BOCS-SC in the current sample. These frequencies are similar to those found in large clinical epidemiological studies (Rasmussen and Eisen, 1988).

At the bivariate level, the only significant positive correlation between the dimensions derived from the Y-BOCS-SC and personality or state variables was between the “hoarding” dimension and sensitivity to punishment (SP) scores (r=0.319, P=0.027).

Results of the multiple

Discussion

This study's main finding is that the presence of hoarding symptoms in OCD is associated with higher scores on Gray's Sensitivity to Punishment scale and lower scores on Eysenck's Psychoticism scale. These results suggest that while behavioural inhibition and harm avoidance are normal personality features common to most OCD patients (Pfohl et al., 1990, Richter et al., 1996, Bejerot et al., 1998, Kusunoki et al., 2000, Lyoo et al., 2001, Fullana et al., 2004), they tend to be more strongly

Acknowledgments

Dr. David Mataix-Cols was funded by a Marie Curie fellowship from the EU.

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