Evaluating the DSM-5 Alternative Model of Personality Disorders for Obsessive-Compulsive Personality Disorder
Date
2017
Authors
Liggett, Jacqueline Marguerite
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Abstract
Obsessive-compulsive personality disorder (OCPD) is a
severe mental health condition estimated to affect 2-7% of the
population (American Psychiatric Association [APA], 2013; Grant
et al., 2004), making it one of the most common personality
disorders (PDs). It is currently operationalised by reference to
several behavioural symptoms, including a preoccupation with
details, rules and orderliness, over-conscientiousness,
perfectionism, hoarding, excessive devotion to work and
productivity, reduced capacity to express warmth and emotion, and
mental and interpersonal control at the expense of flexibility,
openness and efficiency (APA, 2013). The disorder has a long
history in the clinical literature, being included in all
versions of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) (APA, 1952|2013). Despite its history, prevalence
and severity, OCPD has been the subject of only limited research.
DSM-5 Section III (APA, 2013) includes a newly developed hybrid
dimensional-categorical diagnostic model for PDs: the Alternative
Model of Personality Disorders (AMPD). The AMPD operationalises
PDs using disorder-specific constellations of maladaptive
personality traits and functional impairment. Studies assessing
the personality traits relevant to OCPD have had inconsistent
results, and research into the impairment profile of OCPD is
limited. Additional research is required to refine the
alternative model of OCPD. This research project aimed to help
meet this need. Study One examined the validity of a newly
developed disorder-specific impairment scale for OCPD. Although
the measure showed initial promise in its ability to
measure-disorder specific impairment, results indicated that it
may not be useful to maintain the distinction, made in the AMPD,
between personality impairment in the self and interpersonal
domains. Study Two evaluated the extent to which specific
personality traits, and scores on the measure of OCPD-specific
impairment from Study One, accounted for variance in scores on
measures of traditional OCPD (as operationalised in DSM-5 Section
II). Results showed that three of the four AMPD traits, as well
as two additional traits uniquely accounted for a large
proportion of variance in a latent variable of traditional OCPD.
Study Three examined the extent to which the trait criteria in
the alternative model of OCPD corresponded with the traditional
operationalisation of OCPD with a particular focus on the
individual OCPD criteria, in a Danish clinical sample. Results
revealed that the AMPD traits aligned only partially with the
traditional conceptualisation of OCPD, and that additional traits
may be relevant to further capture the nuances of this
personality disorder. Study Four investigated the extent to which
self-report and informant data of personality psychopathology
correspond, the optimal trait profile for OCPD in the AMPD, and
whether an OCPD-specific measure of impairment is more
diagnostically useful than measures of general impairment in
personality functioning. Results showed that self-report data
moderately corresponded with informant data and that rigid
perfectionism can be considered a core trait of OCPD.
OCPD-specific impairment accounted for more variance in
traditional OCPD than general measures of impairment. While
additional research into the utility of the AMPD is required,
taken together, these studies generally support the use of the
hybrid dimensional-categorical approach in the assessment and
diagnosis of OCPD.
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Obsessive-compulsive, personality disorders, DSM-5, alternative model
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Thesis (PhD)
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