White and Gray Matter Abnormalities in Young Adult Females with Dependent Personality Disorder: A Diffusion-Tensor Imaging and Voxel-Based Morphometry Study.

We applied diffusion-tensor imaging (DTI) including measurements of fractional anisotropy (FA), a parameter of neuronal fiber integrity, mean diffusivity (MD), a parameter of brain tissue integrity, as well as voxel-based morphometry (VBM), a measure of gray and white matter volume, to provide a basis to improve our understanding of the neurobiological basis of dependent personality disorder (DPD). DTI was performed on young girls with DPD (N = 17) and young female healthy controls (N = 17). Tract-based spatial statistics (TBSS) were used to examine microstructural characteristics. Gray matter volume differences between the two groups were investigated using voxel-based morphometry (VBM). The Pearson correlation analysis was utilized to examine the relationship between distinct brain areas of white matter and gray matter and the Dy score on the MMPI. The DPD had significantly higher fractional anisotropy (FA) values than the HC group in the right retrolenticular part of the internal capsule, right external capsule, the corpus callosum, right posterior thalamic radiation (include optic radiation), right cerebral peduncle (p < 0.05), which was strongly positively correlated with the Dy score of MMPI. The volume of gray matter in the right postcentral gyrus and left cuneus in DPD was significantly increased (p < 0.05), which was strongly positively correlated with the Dy score of MMPI (r1,2= 0.467,0.353; p1,2 = 0.005,0.04). Our results provide new insights into the changes in the brain structure in DPD, which suggests that alterations in the brain structure might implicate the pathophysiology of DPD. Possible visual and somatosensory association with motor nerve circuits in DPD.

Working through the body in metacognitive interpersonal therapy to change relational patterns in dependent personality disorder: The case of Lia.

Persons with dependent personality disorder (DPD) have difficulties describing their inner world, and in realizing their negative ideas about the self, such as being weak, unworthy or powerless are just ideas. As a consequence, they tend to over-rely on others and may lose control over their emotions. Treating these persons can gain benefits from including body-focused techniques as they can promote a) awareness of internal states, b) better emotion regulation, c) the capacity to consider their negative ideas about themselves as not necessarily true, and d) gain power of and agency. We will describe the therapist used body-focused techniques in the context of Metacognitive Interpersonal Therapy when treating Lia, a 40-year-old woman suffering from DPD who also suffered from generalized anxiety disorder and had difficulties in making autonomous choices. She had a romantic relationship with a man she described as distant and judgmental so she felt lonely and not entitled to express her discomfort or capable to break up. The therapist used body-focused techniques, together with behavioural exposure, mindfulness and guided imagery, to let Lia be more aware of her thoughts and feelings, and then to regulate affects and realize she had previously capacities. At therapy termination anxiety diminished and she could break up with the partner and start a new one where she felt free to express herself. We suggest how bodily-focused techniques can be used to enhance therapy effectiveness in DPD.

Exploring the processes of connection and disconnection in imagery work in a patient with depression and dependent personality disorder.

Imagery work is a useful therapeutic tool in the treatment of depression. It is central in different therapeutic approaches, such as cognitive behavioral therapy and compassion-focused therapy. The clinical case of Cynthia is presented. Cynthia started therapy for severe depression associated with social anxiety and dependent personality disorder. At different key moments in the therapy, the proposed change strategies led to ruptures in the therapeutic alliance. For example, difficulties in accepting depression, fears of being judged by the therapist, guided imagery of compassion and work on the termination of therapy were both triggers of ruptures and spaces for working on the issues linked to the therapeutic relationship. The interactions between different factors of the therapeutic relationship from the perspectives of both the patient and therapist and the implementation of imagery practices in session are presented.

Association Between Personality Traits and Onabotulinumtoxin A Response in Patients With Chronic Migraine.

OBJECTIVE: The aim of this study was to analyze the potential association between personality traits and onabotulinumtoxin A (onabotA) response in patients with chronic migraine (CM). BACKGROUND: Previous studies from a categorial perspective show that patients with CM have anxious or obsessive personality according to the Salamanca screening test. However, the influence of personality traits in onabotA response in patients with CM has not yet been studied. We hypothesize that cluster C personality traits may be associated with non-response to onabotA. METHODS: This case-control observational study includes patients with CM who received at least 2 treatment cycles of onabotA in 2 headache units between January and May 2018. onabotA response was defined as a reduction of at least 50% in the number of monthly migraine days. Personality traits were evaluated using the Salamanca questionnaire, a validated categorial inventory assessing 11 personality traits. RESULTS: One hundred and twelve patients, 100/112 (89.6%) females, mean age (standard deviation): 43 (11) years, were recruited. 96/112 (85.7%) achieved response to onabotA. Dependent trait was significantly associated with non-response to onabotA (P = .008; OR: 0.223 [95%CI: 0.074 to 0.675]). Significant association with other personality traits or confounders was not found. CONCLUSIONS: To the best of our knowledge, this is the first study showing personality traits may predict onabotA response in patients with CM. The presence of dependent personality trait in patients with CM is associated with non-response to onabotA.

Dimensional clinical personality inventory-2: investigating key factors on the assessment of dependent personality disorder.

Dimensional literature reinforces the relevance of specific Dependent personality disorder (DPD) traits, as submissiveness, insecurity and avoidance of abandonment. In this paper we measured these traits through the Dimensional Clinical Personality Inventory-2 (IDCP-2). This study aims to verify the capacity of IDCP-2 factors to discriminate and predict DPD related symptoms. From a dataset with 4,503, a total of 305 people was divided in three groups: the community group (n = 200), the non-DPD group (N = 84), and the DPD group (n = 21). We administered six factors from IDCP-2, Insecurity, Abandonment Avoidance, Self-devaluation, Submissiveness, Masochism, and Self-driven Hopelessness. Groups comparison were significant, showing high effects in mostly cases. Multiple regression analysis showed the best predictors of the groups, i.e. Abandonment Avoidance and Self-driven Hopelessness. The findings of this study demonstrate that IDCP-2 covers the core traits of DPD, therefore, being a valid and applicable measure to discriminate DPD, which is particularly relevant in clinical settings. Although our findings suggested two factors as the most relevant measures to discriminant DPD patients from non-DPD/community samples, we did not suggest the restrict use of the Abandonment Avoidance and Self-driven Hopelessness factors for DPD screening. Limitations of the study were discussed.

Unhealthy dependency in victims and perpetrators of child maltreatment: A meta-analytic review.

OBJECTIVE: Theoretical conceptualizations of interpersonal dependency and dependent personality disorder suggest that (a) high levels of dependency in parents may increase risk for perpetration of child abuse and neglect and (b) children who are victimized may show elevated levels of dependency later in life. This study used meta-analytic techniques to examine these hypothesized links. METHOD: A systematic search of psychological and medical online databases revealed 14 published studies (21 effect sizes) examining the link between parental dependency and perpetration of abuse or neglect (overall N of perpetrators = 1,321), and 14 published studies (25 effect sizes) assessing dependency in victims of child abuse and neglect (overall N of victims = 38,265). RESULTS: The dependency-abuse effect size (d) for perpetrators collapsed across all moderating variables was 0.36, which is considered to be in the medium range. The dependency-victimization effect size (d) collapsed across all moderating variables was 0.29, also a medium effect size. CONCLUSION: These results support and extend analyses of the relationship between dependency and child maltreatment, and suggest that dependency may be both a precipitant of child maltreatment and consequence of victimization. Theoretical and clinical implications are discussed, with suggestions for further research outlined.

[Links between depressive disorders and dependent personality disorders: The important effect of locus of control]. / Liens entre la dépression et la dépendance interpersonnelle : l'importance du locus de contrôle.

CONTEXT: Empirical researches have proved that there are powerful correlations between dependent personality and depression. Different hypotheses were described to conceptualize links between these two entities. The dysfunction of attributive style seems to be linked to dependency and to depression. Interpersonal dependency can be considered to be a mode of adaptation to the external direction of the locus of control. The self-esteem so subjected to the climate of social interactions can lead, by the discontinuity of its protective relations, to the depression. In a coordinated model, this study explores psychopathological aspects between depressive cognition, self-esteem and interpersonal dependency. OBJECTIVE: This study tries to support the hypothesis that depression and dependency are consequences of an external locus of control, secondary in deterioration of the self-esteem and the main objective is to highlight correlations between external locus of control, interpersonal dependency, hopelessness and depressive affect. METHOD: The regrouping of 42 patients in a protocol of psychotherapeutic practices allowed the realization of this retrospective study, multicentric within different hospitals or ambulant psychiatric structures of the agglomeration of Lille, during a period of 6 months. The administration of questionnaires (Beck Depression Inventory/Dependent Personality Questionnaire by Tyrer, translated by Loas/Hopelessness Scale by Beck/Powerful others and Chance Scale [IPC] of Levenson, translated by Loas) was included into clinical practice. RESULTS: The main results indicate that external locus of control "powerful others" is significantly correlated with pathological dependency (P<0.0001), depression (P<0.0001) and hopelessness (P=0.02). In addition, the pathological dependency seems to be correlated with external locus "chance" (P<0.05) and external locus "powerful others" (P<0.0001). CONCLUSION: We explored in this study the powerful links joining pathological dependency with depression. These correlations confirm and specify data found in literature. This work is in favor of a conception of external locus of control as a psychopathologic component between depression and dependent personality. This cognitive aspect manifests vulnerability in the depression of the patients suffering from pathological dependency. Also, the place of external locus of control ("powerful others" and "chance") seems to be a cognitive dimension more pathogenic than the internal locus of control. It will be necessary to investigate other psychopathological dimensions such as self-esteem in a longitudinal report. Without neglecting neurobiological vulnerability in depression, it is pertinent to identify this cognitive fragility to optimize the psychotherapies.

One-year follow-up study of first suicide attempts in first episode psychosis: Personality traits and temporal pattern.

OBJECTIVES: The highest suicide rates occur after psychiatric hospitalization or soon after discharge. In addition to other factors, personality traits have been suggested as predictors of suicide attempts (SA) after first episode psychosis (FEP). In this study we examined their temporal pattern and the influence of personality traits on first suicide attempts (fSA) during one year after FEP. METHOD: One-year follow-up of 65 FEP patients. Bivariate and multivariable analyses were performed to explore the relationship between personality traits and fSA. This analysis was also adjusted for a set of sociodemographic, clinical and psychopathological variables. RESULTS: fSAs in the six months following FEP were predicted by higher scores in passive-dependent personality traits (OR = 2.42, 95% CI = 1.15-5.09) and severity of symptoms at onset (OR = 2.00, 95% CI = 1.07-3.76). Severity of symptoms at onset (OR = 2.71, CI = 1.15-6.39) was the most significant predictor of fSA from six to twelve months after FEP. Seventy percent of fSA occurred during the first six months after FEP, decreasing considerably afterwards. CONCLUSIONS: Our study suggests that personality traits play a role in fSA after FEP. Specifically, passive-dependent personality traits emerged as a predictor of fSA in the six months following FEP. Severity of symptoms at onset predicted early and late first suicide attempts. We also found that risk of fSA is highest during the six months following FEP. These results can contribute to the implementation of prevention program.

[On the relationship between emotional dependency and abuse]. / La relation entre la dépendance affective et la maltraitance.

Abuse is a complex psychosocial issue with multiple implications. This paper takes a look at the physical and psychological manifestations of domestic violence, i.e. between adult (romantic) partners as well as abuse of the elderly. Past studies have looked at the relationship between emotional dependency, the occurence and sustainability of abuse and the likehood that a victimized person will terminate a relationship. Indeed, individuals with Dependent Personality Disorder (DPD) or with dependent characteristics present a higher risk of becoming abusive (both physically and mentally) as well as becoming a victim of abuse. Regarding the elderly, the concept of "reverse violence"--where the current abuser was the victim of the senior who is being abused-, also entails dependent relationships. We identified three concepts that are necessary in the understanding of how dependent relationships underpin abuse: Rusbult's model of commitment in intimate relationships, the notion of dependency-possessiveness and Murphy et al's notion of escalating affective dependency. Thus, it is imperative that future studies in the field of domestic violence look at the dynamics of dyads rather than the individuals alone.

Self esteem, dependency, self-efficacy and self-criticism in social anxiety disorder.

BACKGROUND: Social anxiety disorder (SAD) is characterized by fear and avoidance in social situations where one perceives being in danger of scrutiny by others. Low self-esteem, low self-efficacy, high self-criticism and high dependency are additional potential features of SAD, and thus their examination is warranted, as is the elucidation of their inter-relationship. METHOD: Thirty-two SAD subjects diagnosed with the Mini-International Neuropsychiatric Interview and 30 healthy controls, were administered the Liebowitz Social Anxiety Scale (LSAS), the Rosenberg Self Esteem Scale, the Depressive Experiences Questionnaire (DEQ) that assesses self-criticism, dependency and self-efficacy, and a socio-demographic questionnaire. We hypothesized that the SAD group would present higher scores of dependency and self-criticism and lower self-esteem and self-efficacy. We also hypothesized that low self-esteem, low self-efficacy, high self-criticism and high dependency will predict the severity of SAD. RESULTS: In line with the hypotheses, SAD patients had higher scores of self-criticism and dependency and lower scores of self-esteem. The social anxiety score correlated negatively with self-esteem and self-efficacy, and positively with dependency and self-criticism. Self-criticism, but not the other measures, predicted the total LSAS score. CONCLUSIONS: Self-esteem, self-criticism, dependency and self-efficacy are related to SAD and their relations should be examined in future studies that will employ larger samples. It is suggested to search for ways to affect these factors through cognitive-behavioral interventions and additional psychotherapeutic treatments. Research should also focus on the specific role of self-criticism in SAD.

Homicidal behaviour among people with avoidant, dependent and obsessive-compulsive (cluster C) personality disorder.

BACKGROUND: Despite a growing forensic psychiatry literature, no previous study has examined in detail homicidal behaviour among offenders with cluster C personality disorders - the avoidant, dependent or obsessional personality disorders. AIMS: This study aims to compare homicide offenders with cluster C personality disorders with those with other personality disorders on criminal history, offender-victim relationship and post-offence reaction variables. METHODS: The sample was drawn from all Finnish homicide cases of 1996-2004 for whom a forensic psychiatric evaluation had been conducted. Data were extracted from forensic psychiatric and crime reports. RESULTS: In a nationwide sample of 593 homicide offenders, 21 had at least one cluster C personality disorder. These offenders had significantly shorter criminal histories than the others. Offender-victim relationship did not differ between the groups, but confession to the crime and feelings of remorse were more common among people with cluster C disorders. In addition, compared with other personality disorder clusters, co-morbid depression was more common. CONCLUSIONS: Cluster C personality disorders are rare, but not nonexistent, among homicide offenders. Observed differences in their backgrounds and post-offence behaviours indicate that they may have special needs.

Prediction of attachment status from observation of a clinical intensive psychotherapy interview.

OBJECTIVE: The present study addresses whether it is possible to accurately determine a subject's Adult Attachment Interview (AAI) classification by observing a video-recorded clinical psychotherapy discussion that uses the principles of Intensive Short-Term Dynamic Psychotherapy (ISTDP). METHOD: A random sample of eight of the author's (Robert J. Nebrosky) private practice patients participated in an AAI administered by an experienced interviewer. The authors were blind to the results of the AAI, which were scored and classified by Erik Hesse, PHD (consultant and expert in AAI coding and classification). The authors used the Adult Attachment Clinical Rating Scale (AA-CRS), which is an adapted version of the AAI "states-of-mind scales," in conjunction with the structured ISTDP interview to obtain main classifications and subclassifications. The authors determined the pathway of unconscious anxiety according to the procedures described by Davanloo (1995, 2001) and ten Have-de Labije (2006), beginning with the structured ISTDP interview, then categorized the patient's defenses and quality of the patient's observing and attentive ego, discussed the clinican's knowledge of the patient's attachment history, and from this data drew first the major gateway of attachment using the AA-CRS. Then the authors categorized the subclassifications using the AA-CRS. RESULTS: The authors predicted seven out of eight AAI main classifications correctly, and five out of eight AAI subclassifications correctly, indicating that there was a statistically significant relationship between predicted and expected values for main classifications and subclassifications. CONCLUSIONS: The authors conclude that the systematic ISTDP inquiry at the level of the stimulus (current, past, and therapeutic relationship) and response (defence, anxiety, and impulse/feeling) and combined with the clinician's knowledge of the patient's clinical history can effectively substitute for the AAI interview and therefore, yield an experiential reference from which to explore the patient's state of mind using the Adult Attachment Clinical Rating Scale (AA-CRS). The authors speculate that the differences in subclassification could be accounted for by variations and/or differences in biographical knowledge obtained by the the clinician versus that of the AAI coder (Hesse).

[Affective dependency]. / La dépendance affective.

Affective dependency is characterized by emotional distress (insecure attachment) and dependency to another person with a low self-esteem and reassurance need. The paper proposes a reflection on the definition of emotional dependency and the confusion caused by various denominations. Overprotective and authoritarian parenting, cultural and socio-environmental factors may contribute to the development of dependent personality. Psychological epigenetic factors, such as early socio-emotional trauma could > on neuronal circuits in prefronto-limbic regions that are essential for emotional behaviour.We also focus on the interrelations between dependent personality, domestic violence and addictions. The objective for the clinician is to propose a restoration of self-esteem and therapeutic strategies focused on autonomy.

The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire.

OBJECTIVE: Personality disorders (PDs) have been shown to be modestly heritable. Accurate heritability estimates are, however, dependent on reliable measurement methods, as measurement error deflates heritability. The aim of this study was to estimate the heritability of DSM-IV avoidant and dependent personality disorder, by including two measures of the PDs at two time points. METHOD: Data were obtained from a population-based cohort of young adult Norwegian twins, of whom 8045 had completed a self-report questionnaire assessing PD traits. 2794 of these twins subsequently underwent a structured diagnostic interview for DSM-IV PDs. Questionnaire items predicting interview results were selected by multiple regression, and measurement models of the PDs were fitted in Mx. RESULTS: The heritabilities of the PD factors were 0.64 for avoidant PD and 0.66 for dependent PD. No evidence of common environment, that is, environmental factors that are shared between twins and make them similar, was found. Genetic and environmental contributions to avoidant and dependent PD seemed to be the same across sexes. CONCLUSION: The combination of both a questionnaire- and an interview assessment of avoidant and dependent PD results in substantially higher heritabilities than previously found using single-occasion interviews only.

A five-factor measure of dependent personality traits.

This study provides convergent, discriminant, and incremental validity data for a new measure of dependent personality traits from the perspective of the five-factor model (FFM). Dependent personality trait scales were constructed as maladaptive variants of FFM facets (e.g., Gullibility as a maladaptive variant of FFM trust). Based on responses from 383 undergraduates, the convergent validity of the Five-Factor Dependency Inventory (FFDI) scales was tested with respect to 2 measures of the FFM, 6 dependency trait scales, and 4 measures of dependent personality disorder. Discriminant validity was tested with respect to FFM facets from alternative domains. Incremental validity was tested with respect to the ability of the FFM dependent personality trait scales to account for variance in 2 established measures of dependency, after variance accounted for by respective FFM facet scales and other measures of DPD was first removed. The results of this study provided support for the validity of the FFDI assessment of dependency from the perspective of the FFM.

Illuminating a neglected clinical issue: societal costs of interpersonal dependency and dependent personality disorder.

OBJECTIVES: To determine the degree to which patients with high levels of trait dependency or dependent personality disorder (DPD) engage in behaviors that harm themselves and others (e.g., domestic violence, child abuse). METHOD: Six domains of literature were reviewed: (a) dependency as a risk factor for physical illness; (b) health care utilization and expenditures; (c) global and domain-specific functional impairment; (d) violence toward others; (e) victimization by others; and (f) self-harm. RESULTS: High levels of trait dependency and DPD are associated with elevated risk for physical illness, partner and child abuse, and suicidality, as well as with high levels of functional impairment and increased health care expenditure. CONCLUSIONS: Contrary to clinical lore, trait dependency and DPD are associated with behaviors that lead to myriad negative consequences for the dependent person, those close to them, and society as a whole. These patterns have noteworthy implications for assessment and treatment of dependent patients and suggest that DPD should be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition.

Factor structure of self-reported clinical disorders and personality disorders: a review of the existing literature and a factor analytical study.

OBJECTIVES: The aim of this research is to add to the current understanding of the latent factor structure of personality disorders by performing a review of the existing literature (Study 1) and a factor analytical study on the factor structure and the relationship between self-reported Axis I and Axis II psychopathology (Study 2). DESIGN: The current research (Study 2) is cross-sectional and multicenter. RESULTS: We found support for the assumption that the borderline personality disorder is a multidimensional construct. Second, we found evidence for a single-factor structure of the narcissistic, dependent as well as the avoidant personality disorder. Third, we found support for the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) distinction between Axis I and Axis II, Axis I psychopathology being explained by the factor neuroticism and Axis II disorders to be further subdivided into the higher order factors of internalizing and externalizing pathology. CONCLUSIONS: An adaptation to the current DSM-IV borderline personality criteria should be made, while various findings show that the borderline construct is multidimensional. Second, deletion of the dependent and narcissistic personality in the DSM-V might be unjust. Third, Axis I psychopathology can be explained by the factor neuroticism, and Axis II disorders should be further subdivided into the higher order factors of internalizing and externalizing pathology.

Effects of personality disorder and impulsivity on emotional adaptations in prison among women offenders.

The present study sought to better understand the influence of personality disorders and impulsivity on women's ability to adapt to incarceration. We analyzed the influence of personality disorders as screened with the structured clinical interview for personality disorders, and impulsivity as assessed with the Barratt impulsivity scale on depression and anxiety, sleeping problems, and feeling afraid of being attacked in prison among a large sample of women incarcerated in a Virginia prison. Results from regression models indicated that schizotypal, borderline, avoidant and dependent personality disorders and cognitive impulsivity were significant predictors of symptoms of anxiety and depression net of demographic covariates. Women possessing a diagnosis of paranoid personality disorder were at increased odds of having difficulty sleeping in prison and borderline, dependent, and paranoid personality disorder were at increased odds of experiencing fear in prison. Women who had been in prison before were significantly less likely to experience these problems. Implications of study findings for policies and practices involving women offenders are discussed.

[Dependent patient and interpersonal dependency: psychotherapeutic strategies]. / Personnalité dépendante et dépendance affective : stratégies psychothérapeutiques.

OBJECTIVES: This article is a review of psychotherapies for patients suffering from dependent personality and interpersonal dependency. METHOD: We synthesized articles making reference to this question, notably those written by Bornstein, author who refers to the dependent personality. We highlighted the psychotherapies that have been the object of an evaluation. The research on the subject is sparse: only eight studies permitting assessment of psychotherapies in this indication in 2005. Besides these psychotherapies, we detailed other approaches which are used by practitioners in these indications. RESULTS: The therapy does not aim at autonomy "at all costs", but that the patient finds a dependence "adapted" to his/her environment. Before starting a therapy, an evaluation is useful to specify the type of dependence. First of all, is there a "pathological" dependence? Is the suffering of the patient secondary to his personality or not supportive enough? Does insight exist? What is the reaction of the patient if we suggest the hypothesis of a dependence on his/her part? Does he/she consider this idea or reject it? Finally, is the dependence primary or secondary? For that purpose, it is necessary to study the biography of the patient and the appearance of the comorbidity over time. The primary dependence is seen in childhood and precedes the other psychological disorders. The secondary dependence follows after the comorbidity and events of life that alter self-esteem (depression, for example). Various therapeutic strategies arise from various currents. The therapies of analytical inspiration recommend replaying the relationship of object and explicitly evoking the transfer. The behavioural and cognitive psychotherapies aim at making the patient identify the cognitions which underlie the dependence, then leading the patient to modify his/her cognition and to behave in a more autonomous way, using the theory of learning. The humanist therapies aim at a therapeutic relationship of acceptance and respect for the patient, so that he/she increases self-esteem and finds autonomy. The brief systemic therapy develops tools to deviate from the relationship of dependence in the therapy. It aims at the change through a modification in the beliefs of the patient. The dependence can be envisaged as a way of adapting itself, of compensating for altered self-esteem. In this way, the psychotherapy must also attempt to restore self-esteem in an implicit or explicit way. CONCLUSION: The evaluation of the type of dependence helps the therapeutic approach. It is necessary to look for the comorbidity and its appearance over time with regard to the dependence. So, in primary dependence, the therapy focuses on the increase of self-esteem. In the secondary dependence, the therapy focuses on the adaptation to this event, the treatment of the mental illness, and then to the accompaniment in restoring and autonomy. If the patient doesn't have insight, it is necessary either to enhance it, or to work in an indirect way.

Separation anxiety disorder in OCD.

BACKGROUND: A history of separation anxiety disorder (SAD) is frequently reported by patients with obsessive-compulsive disorder (OCD). The purpose of this study was to determine if there are clinical differences between OCD-affected individuals with, versus without, a history of SAD. METHODS: Using data collected during the OCD Collaborative Genetic Study, we studied 470 adult OCD participants; 80 had a history of SAD, whereas 390 did not. These two groups were compared as to onset and severity of OCD, lifetime prevalence of Axis I disorders, and number of personality disorder traits. RESULTS: OCD participants with a history of SAD were significantly younger than the non-SAD group (mean, 34.2 versus 42.2 years; P<.001). They had an earlier age of onset of OCD symptoms (mean, 8.0 versus 10.5 years; P<.003) and more severe OCD, as measured by the Yale-Brown Obsessive Compulsive Scale (mean, 27.5 versus 25.0; P<.005). In addition, those with a history of SAD had a significantly greater lifetime prevalence of agoraphobia (odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.4-4.6, P<.003), panic disorder (OR = 1.84, CI = 1.03-3.3 P<.04), social phobia (OR = 1.69, CI 1.01-2.8, P<.048), after adjusting for age at interview, age at onset of OCD, and OCD severity in logistic regression models. There was a strong relationship between the number of dependent personality disorder traits and SAD (adjusted OR = 1.42, CI = 1.2-1.6, P<.001). CONCLUSIONS: A history of SAD is associated with anxiety disorders and dependent personality disorder traits in individuals with OCD.