Impact of Personality Profile on Patients with Obsessive Compulsive Disorder in an Egyptian Sample

Personality is manifest at all levels of the clinical practice in psychiatry. When discussing the etiology, diagnosis, assessment, management and outcome of any psychiatric disorder; the influence of personality status needs to be considered. Sporadic Egyptian studies estimated the prevalence rates of obsessive compulsive disorder (OCD) patients to be 2.6-3%, so this study was set out to assess personality in OCD, both as categorical personality disorders and as dimensional personality traits, and to explore the impact of personality factors on patients with OCD as regards the severity and expression of obsessive-compulsive symptoms, onset, course, duration, as well as the level of functioning and quality of life . This comparative study has enrolled 60 male and female patients aged over 18 years, with a primary diagnosis of OCD using DSM-IV-TR criteria, by convenient sampling. They were assessed using: 1. Structured Clinical Interview for DSM-IV-TR axis I disorders clinical version (SCID –I-CV) to diagnosis OCD and to exclude comorbid axis I disorders. 2. Medical and neurological history and examination to exclude concomitant medical or neurological illnesses. 3. Detailed history of the OCD condition. 4. Y-BOCS symptom checklist and Y-BOCS severity scale. 5. Structured Clinical Interview for DSM-IV-TR axis II disorders (SCID-II) scale. 6. Temperament and Character Inventory-Revised (TCI-R) scale. 7. Rotter Internal – External control scale. 8. Self-esteem scale. 9. PCASEE Quality of Life scale. 10. Global Assessment of Functioning scale (GAF). 11. Modified Social Score of Egyptian Community. Of the 60 OCD patients, 31 (51.7%) received one or more personality disorder (PD) diagnoses. Obsessive-compulsive personality disorder was the most frequently occurring PD in the OCD sample, however, with no specific relation between the two disorders. Presence of any cluster (B) PD was associated with higher symptoms severity. Presence of any cluster (A) PD suggested the presence of multiple PDs which in turn had a greater negative impact on many OCD features. Personality disorder comorbidity and the Self-Directedness character trait were the most important personality variables affecting almost all OCD features in the form of symptoms severity, expression, course, overall duration of the illness, time passed before initiating treatment, compliance, and most importantly, the functioning and quality of life of OCD patients. Lower scores of self-esteem and higher (external) locus of control scoring were associated with higher total Y-BOCS severity. The personality profile in the form of comorbid personality disorders, pathological temperament and character traits, self-esteem, and locus of control; besides their own pattern of significant clinical distress and impairment in social and occupational functioning; they have, in addition, a significant negative impact on the clinical characteristics of obsessive-compulsive disorder.