Cognitive Therapy for Obsessive-compulsive Personality Disorder - A Pilot Study in Hong Kong Chinese Patients.

Abstract Objective: To assess the efficacy of cognitive therapy for outpatients with refractory depression and obsessive-compulsive personality disorder according to the Diagnostic and Statistical Manual of Mental Disorders-IV. Patients and Methods: Patients with refractory depression and obsessive- compulsive personality disorder attending the outpatient department were enrolled in the study. All patients had moderate degrees of anxiety and depression, as well as high levels of hopelessness. The diagnoses were made according to the Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders-IV Axis I disorder and Axis II personality disorders. All patients completed the following self-report questionnaires: Beck Depression Inventory, Beck Anxiety Inventory, Beck Hopelessness Scale, and Personality Belief Questionnaire prior to commencement of cognitive therapy. At the last session, the Personality Belief Questionnaire, and the Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders-IV Axis I disorder and Axis II personality disorders were re-administered to assess the severity of the personality disorders after cognitive therapy. Medication doses were kept constant throughout the trial period. Results: There were no significant differences in the clinical outcome parameters (depressive and anxiety scores and personality scores) between intake and commencement of cognitive therapy (3 months), suggesting that the participants were relatively stable in symptoms before commencement of therapy. After a mean of 22.4 sessions, there was a significant drop in all outcome parameters, suggesting that symptoms of depression and anxiety improved with therapy. Nine patients no longer fulfilled the Diagnostic and Statistical Manual of Mental Disorders-IV diagnosis of obsessive-compulsive personality disorder. Eight patients were also free from Axis 1 disorders. Conclusions: This preliminary study suggested that cognitive therapy might be an effective psychological treatment for obsessive-compulsive personality disorder. However, further largescale randomised controlled trials are needed before definitive conclusions can be drawn. Key words: Asian continental ancestry group, Cognitive therapy, Hong Kong, Personality disorders Introduction Obsessive-compulsive personality disorder (OCPD) is prevalent in the community (1) and among psychiatric patients. (2) Personality disorders are an overlooked and under-appreciated source of psychiatric morbidity. (3) In a recent multi-site naturalistic collaborative longitudinal personality disorders study, patients with schizotypal and borderline personality disorder were found to have significant impairment in work and social relations. (4) When a traditional Diagnostic and Statistical Manual of Mental Disorders (DSM) categorical model was used to measure personality disorders, each personality disorder was found to have high rates of diagnostic stability. (4) Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacological treatment. (5) Current research data strongly suggest that OCPD remains unchanged in the absence of intervention. There are some emerging research data that suggest OCPD is amenable to psychological intervention. In a randomised controlled trial, 81 patients with predominantly cluster C disorders (70%) showed significant improvement for measures of distress and social functioning after 40 sessions of 2 forms of dynamic psychotherapy. (6) Gains were maintained at follow-up after 18 months. In another uncontrolled study, 38 patients with avoidant and OCPD were treated with brief expressive-supportive psychotherapy. (7) Patients showed significant improvement in measures of distress, interpersonal problems, and personality functioning. In a recent randomised controlled trial that compared the effectiveness of brief psychodynamic psychotherapy and cognitive therapy for cluster C personality disorders, both groups were found to have significant improvement in symptoms, personality functioning, and interpersonal problems. …