Baer L, Jenike M A
Department of Psychiatry, Harvard Medical School, Massachusetts.
Psychiatr Clin North Am. 1992 Dec;15(4):803-12.
Standardized structured interview personality scales are now available that provide better reliability than clinician interview, but are still imperfect. These scales diagnose DSM III-R personality disorders, which are more illness-oriented than Freudian notions. Use of these scales has found that the majority of patients with OCD have at least one Axis II personality disorder, with most falling in cluster C. Obsessive compulsive personality disorder, as described in DSM-III-R, is, in most samples studied, present in the minority of patients with OCD, and is often less common than other personality disorders such as mixed, dependent, avoidant, and histrionic. The prevalence of this personality disorder as modified in DSM-III-R (making it easier for a patient to qualify for this personality disorder diagnosis) appears to be higher, although still present in a minority of patients with OCD. Obsessive compulsive personality disorder (along with the other cluster B and C personality disorders) has not been reported to have a consistent relation to treatment outcome. There is evidence that in some cases, obsessive compulsive personality disorder may be secondary to OCD. Swedo et al hypothesized that some children may develop compulsive personality traits as an adaptive mechanism to deal with OCD. This hypothesis is in accord with our finding that OCD often predates compulsive personality disorder and that mixed personality disorder may develop over time, possibly secondary to OCD. We found in our sample of 96 adult patients with OCD that the presence of mixed personality disorder was more likely with longer duration of OCD, suggesting that patients who do not have premorbid personality disorders may develop significant personality traits (especially avoidant, compulsive, and dependent), which may be related to behavioral and life-style changes that are secondary to OCD. This hypothesis is strengthened by our finding that patients with one of these personality disorders at baseline tended to no longer meet criteria for them following successful treatment of their OCD. It now appears that schizotypal personality disorder, which is thought to be related genetically to schizophrenia (e.g., in three male identical twin pairs concordant for OCD but discordant for schizophrenia or schizoaffective disorder, the nonpsychotic co-twins all had schizotypal personality disorder), is the only consistent personality disorder predictor of poorer outcome in OCD. These traits may help explain other proposed poor predictors of treatment outcome such as overvalued beliefs, poor compliance, and chaotic family situations.(ABSTRACT TRUNCATED AT 400 WORDS)
现在已有标准化的结构化访谈人格量表，其可靠性优于临床医生的访谈，但仍不尽完美。这些量表用于诊断《精神疾病诊断与统计手册》第三版修订本（DSM III-R）中的人格障碍，这些人格障碍比弗洛伊德的概念更以疾病为导向。使用这些量表发现，大多数强迫症患者至少患有一种轴II人格障碍，其中大多数属于C类。在大多数研究样本中，DSM-III-R中描述的强迫型人格障碍在少数强迫症患者中存在，并且通常不如其他人格障碍常见，如混合型、依赖型、回避型和表演型人格障碍。DSM-III-R中修改后的这种人格障碍的患病率（使患者更容易符合这种人格障碍的诊断标准）似乎更高，尽管在少数强迫症患者中仍然存在。强迫型人格障碍（以及其他B类和C类人格障碍）与治疗结果之间尚未报告有一致的关系。有证据表明，在某些情况下，强迫型人格障碍可能继发于强迫症。斯韦多等人推测，一些儿童可能会发展出强迫性人格特质，作为应对强迫症的一种适应机制。这一假设与我们的发现一致，即强迫症往往先于强迫型人格障碍出现，而且混合型人格障碍可能会随着时间的推移而发展，可能继发于强迫症。我们在96名成年强迫症患者的样本中发现，强迫症病程越长，出现混合型人格障碍的可能性就越大，这表明没有病前人格障碍的患者可能会发展出显著的人格特质（尤其是回避型、强迫型和依赖型），这可能与强迫症继发的行为和生活方式改变有关。我们的这一发现强化了这一假设，即基线时患有这些人格障碍之一的患者在强迫症得到成功治疗后往往不再符合其标准。现在看来，分裂型人格障碍被认为在基因上与精神分裂症有关（例如，在三对同卵双胞胎男性中，他们都患有强迫症，但在精神分裂症或分裂情感性障碍方面不一致，非精神病性的双胞胎都患有分裂型人格障碍），是强迫症预后较差的唯一一致的人格障碍预测因素。这些特质可能有助于解释其他提出的治疗结果不佳的预测因素，如超价观念、依从性差和家庭情况混乱。（摘要截选至400字）
