Advertisement

Capacity to Delay Reward Differentiates Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder

Published:November 06, 2013DOI:https://doi.org/10.1016/j.biopsych.2013.09.007

      Background

      Although the relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) has long been debated, clinical samples of OCD (without OCPD) and OCPD (without OCD) have never been systematically compared. We studied whether individuals with OCD, OCPD, or both conditions differ on symptomatology, functioning, and a measure of self-control: the capacity to delay reward.

      Methods

      Twenty-five OCD, 25 OCPD, 25 comorbid OCD + OCPD, and 25 healthy control subjects completed clinical assessments and a validated intertemporal choice task that measures capacity to forego small immediate rewards for larger delayed rewards.

      Results

      OCD and OCPD subjects both showed impairment in psychosocial functioning and quality of life, as well as compulsive behavior, but only subjects with OCD reported obsessions. Individuals with OCPD, with or without comorbid OCD, discounted the value of delayed monetary rewards significantly less than OCD and healthy control subjects. This excessive capacity to delay reward discriminates OCPD from OCD and is associated with perfectionism and rigidity.

      Conclusions

      OCD and OCPD are both impairing disorders marked by compulsive behaviors, but they can be differentiated by the presence of obsessions in OCD and by excessive capacity to delay reward in OCPD. That individuals with OCPD show less temporal discounting (suggestive of excessive self-control), whereas prior studies have shown that individuals with substance use disorders show greater discounting (suggestive of impulsivity), supports the premise that this component of self-control lies on a continuum in which both extremes (impulsivity and overcontrol) contribute to psychopathology.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Albert U.
        • Maina G.
        • Forner F.
        • Bogetto F.
        DSM-IV obsessive-compulsive personality disorder: Prevalence in patients with anxiety disorders and in healthy comparison subjects.
        Compr Psychiatry. 2004; 45: 325-332
        • Pinto A.
        • Mancebo M.C.
        • Eisen J.L.
        • Pagano M.E.
        • Rasmussen S.A.
        The Brown Longitudinal Obsessive Compulsive Study: Clinical features and symptoms of the sample at intake.
        J Clin Psychiatry. 2006; 67: 703-711
        • Pinto A.
        • Liebowitz M.R.
        • Foa E.B.
        • Simpson H.B.
        Obsessive compulsive personality disorder as a predictor of exposure and ritual prevention outcome for obsessive compulsive disorder.
        Behav Res Ther. 2011; 49: 453-458
        • Grant J.E.
        • Mooney M.E.
        • Kushner M.G.
        Prevalence, correlates, and comorbidity of DSM-IV obsessive-compulsive personality disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions.
        J Psychiatr Res. 2012; 46: 469-475
        • Samuels J.
        • Eaton W.W.
        • Bienvenu 3rd, O.J.
        • Brown C.H.
        • Costa Jr, P.T.
        • Nestadt G.
        Prevalence and correlates of personality disorders in a community sample.
        Br J Psychiatry. 2002; 180: 536-542
        • Calvo R.
        • Lazaro L.
        • Castro-Fornieles J.
        • Font E.
        • Moreno E.
        • Toro J.
        Obsessive-compulsive personality disorder traits and personality dimensions in parents of children with obsessive-compulsive disorder.
        Eur Psychiatry. 2009; 24: 201-206
        • Samuels J.
        • Nestadt G.
        • Bienvenu O.J.
        • Costa Jr, P.T.
        • Riddle M.A.
        • Liang K.Y.
        • et al.
        Personality disorders and normal personality dimensions in obsessive-compulsive disorder.
        Br J Psychiatry. 2000; 177: 457-462
        • Torregrossa M.M.
        • Quinn J.J.
        • Taylor J.R.
        Impulsivity, compulsivity, and habit: The role of orbitofrontal cortex revisited.
        Biol Psychiatry. 2008; 63: 253-255
        • Chamberlain S.R.
        • Sahakian B.J.
        The neuropsychiatry of impulsivity.
        Curr Opin Psychiatry. 2007; 20: 255-261
        • Fineberg N.A.
        • Potenza M.N.
        • Chamberlain S.R.
        • Berlin H.A.
        • Menzies L.
        • Bechara A.
        • et al.
        Probing compulsive and impulsive behaviors, from animal models to endophenotypes: a narrative review.
        Neuropsychopharmacology. 2010; 35: 591-604
      1. Lynch TR, Hempel RJ, Clark LA (in press): Flexibility and radical openness: Facilitating self-inquiry in overcontrolled personality disorders. In: Livesley J, Dimaggio G, Clarkin J, editors. Integrated Treatment of Personality Disorder. New York: Guilford.

        • Pinto A.
        • Eisen J.L.
        • Mancebo M.C.
        • Rasmussen S.A.
        Obsessive compulsive personality disorder.
        in: Abramowitz J.S. McKay D. Taylor S. Obsessive-Compulsive Disorder: Subtypes and Spectrum Conditions. Elsevier, New York2008
        • Mischel W.
        • Shoda Y.
        • Rodriguez M.I.
        Delay of gratification in children.
        Science. 1989; 244: 933-938
        • Cardinal R.N.
        Neural systems implicated in delayed and probabilistic reinforcement.
        Neural Netw. 2006; 19: 1277-1301
        • Kirby K.N.
        One-year temporal stability of delay-discount rates.
        Psychon Bull Rev. 2009; 16: 457-462
        • Kirby K.N.
        • Petry N.M.
        Heroin and cocaine abusers have higher discount rates for delayed rewards than alcoholics or non-drug-using controls.
        Addiction. 2004; 99: 461-471
        • Lawrence K.A.
        • Allen J.S.
        • Chanen A.M.
        Impulsivity in borderline personality disorder: Reward-based decision-making and its relationship to emotional distress.
        J Pers Disord. 2010; 24: 786-799
        • McClure S.M.
        • Laibson D.I.
        • Loewenstein G.
        • Cohen J.D.
        Separate neural systems value immediate and delayed monetary rewards.
        Science. 2004; 306: 503-507
        • Steinglass J.E.
        • Figner B.
        • Berkowitz S.
        • Simpson H.B.
        • Weber E.U.
        • Walsh B.T.
        Increased capacity to delay reward in anorexia nervosa.
        J Int Neuropsychol Soc. 2012; 18: 773-780
        • Lilenfeld L.R.
        • Wonderlich S.
        • Riso L.P.
        • Crosby R.
        • Mitchell J.
        Eating disorders and personality: A methodological and empirical review.
        Clin Psychol Rev. 2006; 26: 299-320
        • Weissman M.M.
        • Wickramaratne P.
        • Adams P.
        • Wolk S.
        • Verdeli H.
        • Olfson M.
        Brief screening for family psychiatric history: The family history screen.
        Arch Gen Psychiatry. 2000; 57: 675-682
        • First M.B.
        • Spitzer R.L.
        • Gibbon M.
        • Williams J.B.W.
        Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P, Version 2.0).
        Biometrics Research Department, New York State Psychiatric Institute, New York1996
        • First M.B.
        • Gibbon M.
        • Spitzer R.L.
        • Williams JBW
        • Benjamin L.S.
        Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II).
        American Psychiatric Press, Washington, DC1997
        • Wechsler D.
        Wechsler Test of Adult Reading. The Psychological Corporation, San Antonio, TX2001
        • Uttl B.
        North American Adult Reading Test: Age norms, reliability, and validity.
        J Clin Exp Neuropsychol. 2002; 24: 1123-1137
        • Hamilton M.
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
        • Goodman W.K.
        • Price L.H.
        • Rasmussen S.A.
        • Mazure C.
        • Fleischmann R.L.
        • Hill C.L.
        • et al.
        The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability.
        Arch Gen Psychiatry. 1989; 46: 1006-1011
        • Foa E.B.
        • Huppert J.D.
        • Leiberg S.
        • Langner R.
        • Kichic R.
        • Hajcak G.
        • Salkovskis P.M.
        The Obsessive-Compulsive Inventory: Development and validation of a short version.
        Psychol Assess. 2002; 14: 485-496
        • Huppert J.D.
        • Walther M.R.
        • Hajcak G.
        • Yadin E.
        • Foa E.B.
        • Simpson H.B.
        • Liebowitz M.R.
        The OCI-R: Validation of the subscales in a clinical sample.
        J Anxiety Disord. 2007; 21: 394-406
        • Weissman M.M.
        • Bothwell S.
        Assessment of social adjustment by patient self-report.
        Arch Gen Psychiatry. 1976; 33: 1111-1115
        • Endicott J.
        • Nee J.
        • Harrison W.
        • Blumenthal R.
        Quality of Life Enjoyment and Satisfaction Questionnaire: A new measure.
        Psychopharmacol Bull. 1993; 29: 321-326
        • Weber E.U.
        • Johnson E.J.
        • Milch K.F.
        • Chang H.
        • Brodscholl J.C.
        • Goldstein D.G.
        Asymmetric discounting in intertemporal choice: A query-theory account.
        Psychol Sci. 2007; 18: 516-523
        • Pinto A.
        • Eisen J.L.
        • Mancebo M.C.
        • Greenberg B.D.
        • Stout R.L.
        • Rasmussen S.A.
        Taboo thoughts and doubt/checking: A refinement of the factor structure for obsessive compulsive disorder symptoms.
        Psychiatry Res. 2007; 151: 255-258
        • Pinto A.
        • Greenberg B.D.
        • Grados M.A.
        • Bienvenu 3rd, O.J.
        • Samuels J.F.
        • Murphy D.L.
        • et al.
        Further development of YBOCS dimensions in the OCD Collaborative Genetics Study: Symptoms vs. categories.
        Psychiatry Res. 2008; 160: 83-93
        • MacKillop J.
        • Amlung M.T.
        • Few L.R.
        • Ray L.A.
        • Sweet L.H.
        • Munafo M.R.
        Delayed reward discounting and addictive behavior: A meta-analysis.
        Psychopharmacology (Berl). 2011; 216: 305-321
        • Didie E.R.
        • Walters M.M.
        • Pinto A.
        • Menard W.
        • Eisen J.L.
        • Mancebo M.
        • et al.
        A comparison of quality of life and psychosocial functioning in obsessive-compulsive disorder and body dysmorphic disorder.
        Ann Clin Psychiatry. 2007; 19: 181-186
        • Eisen J.L.
        • Mancebo M.C.
        • Pinto A.
        • Coles M.E.
        • Pagano M.E.
        • Stout R.
        • Rasmussen S.A.
        Impact of obsessive compulsive disorder on quality of life.
        Compr Psychiatry. 2006; 47: 270-275
        • Lochner C.
        • Mogotsi M.
        • du Toit P.L.
        • Kaminer D.
        • Niehaus D.J.
        • Stein D.J.
        Quality of life in anxiety disorders: A comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder.
        Psychopathology. 2003; 36: 255-262
        • Simpson H.B.
        • Foa E.B.
        • Liebowitz M.R.
        • Ledley D.R.
        • Huppert J.D.
        • Cahill S.
        • et al.
        A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder.
        Am J Psychiatry. 2008; 165: 621-630
        • Soeteman D.I.
        • Hakkaart-van Roijen L.
        • Verheul R.
        • Busschbach J.J.
        The economic burden of personality disorders in mental health care.
        J Clin Psychiatry. 2008; 69: 259-265
        • Ansell E.B.
        • Pinto A.
        • Crosby R.D.
        • Becker D.F.
        • Anez L.M.
        • Paris M.
        • Grilo C.M.
        The prevalence and structure of obsessive-compulsive personality disorder in Hispanic psychiatric outpatients.
        J Behav Ther Exp Psychiatry. 2010; 41: 275-281
        • Ansell E.B.
        • Pinto A.
        • Edelen M.O.
        • Grilo C.M.
        Structure of DSM-IV criteria for obsessive-compulsive personality disorder in patients with binge eating disorder.
        Can J Psychiatry. 2008; 53: 863-867
        • Diaconu G.
        • Turecki G.
        Obsessive-compulsive personality disorder and suicidal behavior: Evidence for a positive association in a sample of depressed patients.
        J Clin Psychiatry. 2009; 70: 1551-1556
        • Harwood D.
        • Hawton K.
        • Hope T.
        • Jacoby R.
        Psychiatric disorder and personality factors associated with suicide in older people: A descriptive and case-control study.
        Int J Geriatr Psychiatry. 2001; 16: 155-165
        • Dombrovski A.Y.
        • Szanto K.
        • Siegle G.J.
        • Wallace M.L.
        • Forman S.D.
        • Sahakian B.
        • et al.
        Lethal forethought: Delayed reward discounting differentiates high- and low-lethality suicide attempts in old age.
        Biol Psychiatry. 2011; 70: 138-144
        • Figner B.
        • Knoch D.
        • Johnson E.J.
        • Krosch A.R.
        • Lisanby S.H.
        • Fehr E.
        • Weber E.U.
        Lateral prefrontal cortex and self-control in intertemporal choice.
        Nat Neurosci. 2010; 13: 538-539
        • Bender D.S.
        • Dolan R.T.
        • Skodol A.E.
        • Sanislow C.A.
        • Dyck I.R.
        • McGlashan T.H.
        • et al.
        Treatment utilization by patients with personality disorders.
        Am J Psychiatry. 2001; 158: 295-302
        • Crockett M.J.
        • Clark L.
        • Lieberman M.D.
        • Tabibnia G.
        • Robbins T.W.
        Impulsive choice and altruistic punishment are correlated and increase in tandem with serotonin depletion.
        Emotion. 2010; 10: 855-862
        • Cavedini P.
        • Erzegovesi S.
        • Ronchi P.
        • Bellodi L.
        Predictive value of obsessive-compulsive personality disorder in antiobsessional pharmacological treatment.
        Eur Neuropsychopharmacol. 1997; 7: 45-49
        • Chamberlain S.R.
        • Fineberg N.A.
        • Blackwell A.D.
        • Robbins T.W.
        • Sahakian B.J.
        Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania.
        Am J Psychiatry. 2006; 163: 1282-1284
        • Chamberlain S.R.
        • Fineberg N.A.
        • Menzies L.A.
        • Blackwell A.D.
        • Bullmore E.T.
        • Robbins T.W.
        • Sahakian B.J.
        Impaired cognitive flexibility and motor inhibition in unaffected first-degree relatives of patients with obsessive-compulsive disorder.
        Am J Psychiatry. 2007; 164: 335-338
        • Gillan C.M.
        • Papmeyer M.
        • Morein-Zamir S.
        • Sahakian B.J.
        • Fineberg N.A.
        • Robbins T.W.
        • de Wit S.
        Disruption in the balance between goal-directed behavior and habit learning in obsessive-compulsive disorder.
        Am J Psychiatry. 2011; 168: 718-726