Structure of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Criteria for Obsessive–Compulsive Personality Disorder in Patients With Binge Eating Disorder

OCPD is a relatively understudied personality disorder despite the highest prevalence rate (7.9%) of all personality disorders in community based studies,1 one of the highest rates (8.7%) in outpatient groups,2 and higher prevalence rates in patients with eating disorders.3 A controlled study4 reported OCPD as significantly more common in patients with BED, than in a comparison group of general psychiatric outpatients (14%, compared with 6%). Despite the high prevalence of OCPD, little empirical attention has been given to the validity and structure of the OCPD construct as outlined in DSM-IV.5 The DSM-IV assumes a unidimensional structure for each of the personality disorder diagnoses. However, clinical views and the limited empirical literature suggest that a multifactorial approach may offer a better understanding of the construct.6 Theoretical underpinnings of OCPD highlight deliberateness and effortfulness,7 control over self and environment,8 and interpersonal rigidity characterized by a demanding and uncompromising stance9 that frequently results in interpersonal conflict.10 Prior examinations suggest that OCPD is a heterogeneous construct encompassing domains of interpersonal control and perfectionism.5,6,11,12 The 2 exploratory examinations of factor structure in OCPD to date revealed 2- and 3-factor solutions that conform to this assertion. Baer12 reported a 2-factor solution with loadings of perfectionism and rigidity on separate factors based on examination of DSM-III OCPD in a homogenous obsessive–compulsive disorder patient group. Grilo,6 in the sole exploratory factor-analytic study of DSM-IV OCPD criteria, reported a 3-factor structure of OCPD in a homogeneous BED patient group in which perfectionism, rigidity, and miserliness factors were identified. The third factor had poor internal reliability leading Grilo6 to question its use. Table 1 summarizes the 1-, 2-, and 3-factor models. For the purpose of this study, Baer’s12 2 factors were extrapolated to DSM-IV criteria. Table 1 The 2- and 3-factor models of OCPD The aim of our study was to test competing models of OCPD by performing a confirmatory factor analysis on DSM-IV OCPD criteria obtained using a reliably administered semi-structured diagnostic interview given to a consecutive series of patients with BED. A confirmatory factor analysis allowed for a more definitive test of the proposed factors and comparison of model fit. We followed the recruitment and assessment methods applied in Grilo’s6 exploratory study to obtain a homogeneous patient study group with current BED, given the high prevalence of cooccurring OCPD4 and previous research highlighting aspects of OCPD as a potential vulnerability factor in eating disorders.3,11,13 Identifying the underlying structure of DSM-IV personality disorders may assist researchers in understanding the maladaptive personality constructs that contribute to personality pathology and offers a potential avenue for integrating current models of personality disorders with dimensional approaches. This is particularly relevant given recent debate over dimensional models of personality disorder14 and the proposition that additional, undetermined, maladaptive traits may better define the personality disorder constructs.15,16