Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns

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Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns Antoine Pelissolo a,n, Albert Moukheiber a, Luc Mallet a,b a b

AP-HP, Service de Psychiatrie, Hôpital Henri-Mondor, Université Paris-Est Créteil, INSERM U955, Fondation FondaMental, Créteil, France Behaviour, Emotion, and Basal Ganglia, UPMC – INSERM UMR 975 – CNRS UMR 7225, ICM – Brain & Spine Institute, Pitié-Salpêtrière Hospital, Paris, France

art ic l e i nf o

a b s t r a c t

Article history: Received 16 July 2014 Received in revised form 14 July 2015 Accepted 12 August 2015

Even though obsessive-compulsive disorders (OCD) and anxiety disorders (AD) have been separated in the taxonomy adopted by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, many issues remain concerning the physiopathological similarities and differences between those categories. Our objective was therefore to explore and compare their personality and emotional features, with the assumption that the distinction of two independent spectrums should imply the existence of two partially distinct temperamental profiles. We used the Temperament and Character Inventory (TCIR) and the Positive and Negative Emotionality (PNE) scale to compare two groups of patients with OCD (n ¼227) or AD (n ¼827). The latter group included patients with social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. Most temperament, character and emotionality measures showed no significant differences between both groups. In the personality measures results, only the self-directedness score (TCI-R) was significantly lower in OCD patients but this difference was not significant when the comparison was adjusted for the depressive scale score and age. Only lower PNE positive affects scores were obtained in OCD patients in the adjusted comparisons. These findings suggest that OCD and AD are not really distinguishable from the point of view of associated personality traits. & 2015 Elsevier Ireland Ltd. All rights reserved.

Keywords: Anxiety Compulsion Emotionality Obsession Personality Phobia Temperament

1. Introduction An important change in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM5) (American Psychiatric Association, 2013) when compared to previous DSM versions in the domain of affective and neurotic disorders was the creation of the obsessive compulsive and related disorders (OCRD) category which effectively moved obsessive-compulsive disorder (OCD) out of the anxiety disorders category. Various arguments have been given in favor of this evolution and they have been summarized by Stein et al. (2010). The two categories of disorders vary mainly on clinical (different symptoms and comorbidities) and neurobiological (different brain circuits and neuropsychological deficit) elements as well as the types of therapy used to treat them (different pharmacotherapy and psychotherapy methods). However, Stein et al. (2010) also underlined the fact that most of these arguments are mitigated because of partial overlaps and similarities in clinical, epidemiological, neurobiological, neuropsychological, and therapeutic features of OCD and anxiety n

Corresponding author. E-mail address: [email protected] (A. Pelissolo).

disorders. An international survey conducted on 187 OCD experts showed that 40% of them did not support moving OCD out of the anxiety disorders section (Mataix-Cols et al., 2007). Therefore, even if the OCRD category has been validated for the DSM5 classification, this discussion is still open in the psychiatric community in particular in the perspective of the future ICD-11 classification. Personality, temperament and emotionality are very important clinical and psychopathological features that have to be taken into account in the comparison of OCD and anxiety disorders. They are also potent markers of biopsychological vulnerability to psychiatric disorders (Rihmer et al., 2010; Laceulle et al., 2014) and, therefore, useful to progress towards a more scientific and etiological taxonomy (Watson, 2005). Indeed, temperament and emotionality refer to endogenous basic tendencies of thoughts, affects, and behaviors which can be linked to neurotransmitter dysregulation, genetic vulnerabilities, and brain circuit particularities (Whittle et al., 2006). Various observations of differences or similarities, concerning personality and affective traits, have been made in subjects with OCD and anxiety disorders. For example, behavioral inhibition and neuroticism are key antecedents and personality traits associated with anxiety and phobic disorders but are also prevalent in OCD patients (Coles et al., 2006; Lahey, 2009). Perfectionism is associated with OCD and other OCRD such as

http://dx.doi.org/10.1016/j.psychres.2015.08.020 0165-1781/& 2015 Elsevier Ireland Ltd. All rights reserved.

Please cite this article as: Pelissolo, A., et al., Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.08.020i

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body dysmorphic disorder but may also be seen in other anxious or depressive disorders (Sassaroli et al., 2008). The psychobiological personality model developed by Cloninger is one of the most used models in psychiatry mainly because of its’ originality since it allows the study of seven fundamental dimensions of personality: four reflecting the biological and hereditary traits (temperament) and three representing the cognitive maturity levels acquired through learning (character) (Cloninger et al., 1993). The Temperament and Character Inventory (TCI) allows a precise and reproducible evaluation of these seven dimensions (Cloninger et al., 1994). Many studies have used the TCI or the Tridimensional Personality Questionnaire (created by Cloninger prior to the TCI to evaluate temperament) in order to describe the personality of patients suffering from OCD when compared to controls. These studies show high Harm Avoidance (Pfohl et al., 1990; Bejerot et al., 1998; Kusunoki et al., 2000; Lyoo et al., 2001; Alonso et al., 2008; Kim et al., 2009) as well as low Self-Directedness and Cooperativeness scores in OCD patients (Bejerot et al., 1998; Kusunoki et al., 2000; Lyoo et al., 2001; Alonso et al., 2008; Kim et al., 2009). This profile is also frequently observed in other anxiety and phobic disorders (Pelissolo et al., 2002; Wachleski et al., 2008). Furthermore, some studies have shown low Novelty Seeking (Bejerot et al., 1998; Kusunoki et al., 2000; Lyoo et al., 2001; Alonso et al., 2008) and Reward Dependence scores (Kim et al., 2009) in OCD patients. These profiles are not classically found in patients with anxiety disorders and it is interesting to note that, in Cloningers' model, Novelty Seeking scores are linked to dopaminergic system activation levels. Neurobiological models of OCD are linked to dysfunctional dopaminergic systems (Bloch et al., 2006) which is not the case in most anxiety disorder models. To further our understanding on the temperamental differences between OCD and anxiety disorders, we need comparative studies between TCI profiles of both pathologies. To the best of the authors’ knowledge, no studies of this type have been published. Indirect comparisons have been made using mainly the five factors model and a meta-analysis of these studies has shown that anxiety disorders and OCD present a very similar profile marked by high neuroticism and low extraversion traits (Kotov et al., 2010). There is, however, no head to head comparison and, although some dimensions are shared by both models (De Fruyt et al., 2006), most of the Cloninger model dimensions do not exist in the five factor model. For example, correlations between novelty seeking and extraversion are low at 0.36 for a non-clinical sample and 0.46 for a clinical sample (Cloninger et al., 1994). To test the construct validity of the taxonomy chosen for the DSM5, our study aims at comparing the personality profiles, based on the Cloninger model, of OCD and anxiety disorder patients. The hypothesis was that the main personality features will be significantly different since both disorders belong to two distinct spectrum. For example, we could predict differences in Novelty Seeking scores due to neurobiological hypotheses on OCD. Conversely, a lack of difference in the personality profiles of OCD and AD patients should be an argument against the complete distinction of both disorders. As a secondary objective, but for the same reasons, we also have studied emotionality measures that constitute an important temperamental expression as it reflects a state instead of a trait (Watson et al., 1988; Watson, 2000), especially in the context of affective disorders.

2. Materials and methods 2.1. Subjects 1054 new consecutive outpatients seeking treatment at an

anxiety clinic in a university hospital department of psychiatry in Paris, France, were enrolled in this study, between December 2009 and February 2013. Eligible patients were older than 18 years of age and had confirmed OCD (n ¼227) or one of the three main anxiety disorders (social anxiety disorder, panic disorder with or without agoraphobia, or generalized anxiety disorder) diagnosis (n ¼827) according to the DSM-IV. OCD or anxiety disorders had to be the primary complaints and diagnoses of these patients. Patients with comorbid (current or lifetime) OCD and anxiety disorders were excluded and it was the case of 171 of the approached subjects. Past or current drug medications or therapy were authorized and information on these treatments was not recorded. After providing written informed consent, participants were evaluated by trained psychiatrists with the Mini International Neuropsychiatric Interview (MINI), a semi-structured interview for the DSM-IV (Sheehan et al., 1998). Exclusion criteria were refusal to participate, schizophrenia or other psychotic disorders, delirium or dementia, linguistic difficulties or a double diagnosis of OCD and anxiety disorders according to DSM-IV criteria. Thirty-nine patients were excluded for these reasons from the consecutive population. In the studied sample, 853 (81%) were referred by a psychiatrist or another physician, while 201 (19%) patients were self-referred. 2.2. Instruments Diagnosis of DSM-IV OCD, anxiety disorders, and lifetime major depressive disorder were done using an adapted version of the MINI 5.0.0 (Sheehan et al., 1998). For the main goal of this study, all the patients responded to the Temperament and Character Inventory-Revised (TCI-R), exploring Cloninger's psychobiological model of personality (Cloninger et al., 1993; Pelissolo et al., 2005). This model relies on the definition of four temperament traits that are supposed to be biologically determined heritable and stable dimensions, and three character traits which reflect individual differences in levels of maturity influenced by social learning and life experience. The temperament traits are the following: 1. Novelty seeking (NS), defined as a hereditary tendency to respond actively to novel stimuli with frequent exploratory activity in response to novelty or impulsive decision making. 2. Harm avoidance (HA), viewed as a heritable bias in the inhibition of behaviors, such as pessimistic worry, passive dependent behaviors or rapid fatigability. 3. Reward dependence (RD), a heritable bias in the maintaining or continuation of ongoing behaviors, which is manifested as sentimentality and social attachment or dependence. 4. Persistence (P), defined as a hereditary tendency to perseverance despite frustration and fatigue. The character traits are: 1. Self-directedness (SD), referring to self-determination or “willpower”, to self-esteem and to the ability of an individual to control, regulate and adapt his behavior in concordance with personal goals and values. 2. Cooperativeness (C), reflecting individual differences in identification with and acceptance of other people (agreeability, compassion, empathy, etc.). 3. Self-transcendence (ST), referring to spiritual maturity, transpersonal identification and self-forgetfulness. The TCI-R is a 240-item self-administered questionnaire with a 1–5 Likert response scale. Its results include the seven temperament and character main scores, and 29 subscales representing

Please cite this article as: Pelissolo, A., et al., Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.08.020i

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Table 1 Means (and standard deviations) of scales measuring anxiety, depression, phobia, OCD symptoms, functioning, and emotionality in OCD (n¼ 227) and AD (n ¼827) groups. OCD

Anxiety disorders

Effect size

t test t

p

0.16 0.31

1.88 5.85

0.064 o 0.001

HAD

Anxiety Depression

12.5 (4.6) 9.3 (4.7)

11.8 (4.1) 7.4 (4.4)

Y-BOCS

Total Obsessions Compulsion

24.4 (7.5) 12.7 (4.1) 11.8 (5.1)

– – –

40.4 (21.6)

19.2 (14.4)

1.18

12.8

o .001

OTL

FQ

Agoraphobia Medical Social Impairment

9.7 (9.6) 10.3 (9.4) 11.2 (8.9) 5.3 (2.6)

12.4 (10.1) 9.5 (8.1) 19.5 (10.1) 5.9 (1.95)

 0.27 0.09  0.87  0.26

3.29 1.07 10.34 3.64

o 0.001 0.28 o 0.001 0.002

SDS

Work Social Family

6.0 (3.0) 6.5 (2.6) 6.7 (2.6)

6.0 (2.7) 6.1 (2.5) 4.4 (2.9)

0 0.16 0.84

0.28 1.59 10.73

0.78 0.11 o .001

49.4 (9.0)

55.5 (7.9)

 0.72

8.24

o .001

50.0 (21.9) 53.8 (20.3)

50.1 (20.8) 48.0 (19.7)

0 0.29

0.17 3.8

0.99 o 0.001

GAF

PNE

Positive affects Negative affects

HAD: Hospital Anxiety and Depression scale. Y-BOCS: Yale–Brown Obsessive Compulsive Scale. OTL: Obsessive Thoughts List. FQ: Fear Questionnaire. SDS: Sheehan Disability Scale. GAF: Sheehan Disability Scale. PNE: Positive and Negative Emotionality scale.

facets of these main dimensions. The French version of the TCI-R has been validated in psychiatric populations similar to that included in the present study, with Cronbach alpha coefficients of 0.80 or more for all scales, a well-defined factorial structure, and a good test-retest reliability (Pelissolo et al., 2005). Emotionality, the second area we wanted to explore in this study, was assessed with the positive and negative emotionality (PNE) questionnaire, developed by Diener and adapted and validated in French by Rolland and Pelissolo (Diener et al., 1995; Pelissolo et al., 2007). This is a 31-item self-rated questionnaire exploring the frequency, during the last month, of 31 basic or more elaborated separate emotions or affects. Three main scores are calculated: a positive emotionality score (10 items), a negative emotionality score (18 items), and a surprise score (3 items). We did not take into account the surprise score since it was not relevant to our study. The questionnaire has five subscores: two positive emotions facets (joy and affection), and four negative emotions facets (anger, fear, shame and sadness). The French version of the PNE has been validated in a psychiatric population, with Cronbach alpha coefficients between 0.80 and 0.95 for the main scores and a well-defined factorial structure (Pelissolo et al., 2007). Other scales were used to compare both groups on general clinical measures. The 10-item semi-structured Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess current OCD severity with scores ranging from 0 to 40 (Goodman et al., 1989; Mollard et al., 1989). This scale was only used for the OCD group. All other scales were completed for both groups. The Obsessive thoughts list (OTL), a self-rated inventory of 28 obsessions was used to measure the intensity of OCD symptoms, with scores ranging from 0 to 140 (Bouvard et al., 1989). Patient-reported disability was measured using the Sheehan Disability Scale (SDS) (Leon et al., 1997). The patients were also rated for the Global Assessment of Functioning (GAF) (Endicott et al., 1976), with higher scores reflecting the best levels of mental health and functioning. Depression and general anxiety symptoms were

measured using the Hospital Anxiety and Depression Scale (HAD) (Zigmond and Snaith, 1983; Bocéréan and Dupret, 2014), and phobic avoidances using the Fear Questionnaire (Marks and Mathews, 1979; Cottraux et al., 1987). 2.3. Statistical analyses Both groups (OCD and AD for anxiety disorders) were compared from a demographic and clinical perspective using a t-test for continuous variables and a χ2 test for categorical ones. We explored the bivariate correlations between TCI-R scores and other measures (Pearson coefficient). Since the known correlation between depressive symptoms and various personality dimensions reflects a partial state effect on personality measure (Pelissolo et al., 2002), the HAD-D (depression) subscore was used as a covariate in comparisons between both groups using a general linear model (GLM). This correlation is common in this type of population and was verified in this study prior to its use as a covariate. In the same way, age was also used as a covariate in the GLM analysis because of its impact on some personality measures. Due to the high number of variables used in comparing OCD and AD groups, a correction for multiple comparisons (Bonferroni correction) was taken into account and the significance threshold value was set to p r.05.

3. Results OCD and AD groups were not significantly different in gender (respectively 48% and 42.7% of males; χ2 ¼ 2.1; p ¼0.15) but OCD patients were slightly older than AD patients (38.4 713.0 vs 36.3 713.4; t¼ 2.16; p ¼ 0.03). In the AD group, social anxiety disorder was the most frequent diagnosis (n ¼554; 67%), followed by panic disorder and/or agoraphobia (n ¼280; 33.9%) and generalized anxiety disorder (n ¼151; 18.3%), some patients having two (n ¼141; 17%) or all three (n ¼16; 1.9%) of these diagnoses.

Please cite this article as: Pelissolo, A., et al., Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.08.020i

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Table 2 Lifetime psychiatric comorbidity, explored with the MINI, in both groups. OCD

Major depression Mania Addictions Eating disorders

Anxiety disorders

162 (71.1%) 8 (3.6%) 33 (14.7%) 28 (12.7%)

456 (56.0%) 31 (3.8%) 121 (15%) 43 (5.3%)

Table 4 Means (and standard deviations) and non-adjusted comparison of TCI-R dimensions in OCD (n¼ 227) and AD (n ¼827) groups.

χ2 test χ2

p

16.9 0.86 0.007 14.5

o 0.001 0.52 0.51 o 0.001

OCD

Anxiety disorders

Novelty seeking Harm avoidance

96.6 (16.4) 114.0 (20.1) Reward dependence 101.0 (15.8) Persistence 110.4 (22.6) Self-directedness 124.1 (18.6) Cooperativeness 129.2 (16.1) Self-transcendence 28.2 (7.5)

In Table 1 are presented the mean scores of the current psychopathological, functioning and emotionality scales. It shows a significantly higher depressive symptomatology (HAD-D) in patients with OCD but no differences in general anxiety (HAD-A). As expected, OCD symptoms (OTL) were more pronounced in OCD group and phobia symptoms (FQ) were higher in AD group. The global functioning (GAF) was more impaired in the OCD group in which a higher disability in family life (SDS-F) was observed when compared to AD patients. Table 2 shows psychiatric lifetime comorbidity in OCD and AD groups concerning four important diagnoses: history of major depression, mania, addictive disorders and eating disorders. Significant differences were found for major depression and eating disorders, both being more prevalent in patients with OCD. Table 3 shows the correlation matrix of all TCI-R scores, HAD anxiety and depression, GAF, FQ, and OTL. In Table 4 are shown the non-adjusted comparisons of TCI-R personality dimensions between OCD and AD groups. Only one trait, self-directedness (SD), was significantly lower in OCD patients. However, this difference disappeared in the ANCOVA (GLM analysis) when the HAD depression score and age were taken into account as a covariate (F¼0.38; p ¼0.54). Concerning the subscores of the SD dimension, SD1 (Responsibility; t¼2.7; p ¼0.007), SD2 (Purposefulness; t¼ 1.98, p ¼0.048), and SD5 (Enlightened second nature; t¼ 4.69, p o0.001) were significantly lower in OCD patients. However, in the GLM analysis with HAD-D and age as covariate, only SD5 showed a significant difference (F¼7.5; p ¼0.006). The current emotionality showed a distinct pattern for positive and negative affects (Table 1). In non-adjusted comparisons, no between groups difference was observed for the positive affects PNE score while a significantly higher negative affects score was found in the OCD group when compared to AD patients. However, when depressive symptoms and age were taken into account (HAD-D and age as covariates in GLM analysis), significant differences were found for positive affects (D¼ 10.6; p¼ 0.001), with higher scores in AD patients, and no significant differences were

Effect size t test t

p

99.7 (14.5) 116.6 (18.8)

 0.05  0.13

2.76 1.08

0.011 0.073

98.8 (14.6)

0.14

 0.19

0.051

108.9 (20.8)

0.07

 0.95 0.34

128.4 (20.2)

 0.22

2.92

0.002

131.2 (15.4)

 0.13

1.73

0.084

27.6 (7.0)

0.08

 1.23

0.22

found for negative affects (D¼1.53; p ¼0.21).

4. Discussion To our knowledge, this study is the first comparative study of personality and emotionality characteristics between two large samples of OCD and anxiety disorders adult patients. One of the main challenges was to recruit patients with pure forms of the disorders – without OCD-AD comorbidity – even if subthreshold symptoms could have been present in some patients. Our main result is the wide similarity between both profiles for almost all temperament and character traits and emotional dimensions – except for positive affects – when adjusted for depressive symptoms. Contrary to our hypothesis, we found no significant differences in any of the four temperament traits. This shows that, from a personality point of view, OCD and AD are not really distinguishable. Naturally, this observation is not a definitive argument against DSM5 taxonomy but should reflect a common vulnerability diathesis of both spectrums and could explain their frequent comorbidity (Stein et al., 2010). This observation can be also interesting from a therapeutic point of view since psychotherapeutical and pharmacological treatments of OCD and AD have to take into account the associated personality traits. Both samples were similar concerning sex ratio but not for mean ages with OCD patients being slightly older than AD patients. This can reflect a longer and poorer evolution of OCD and/or a younger age of first consultation for patients with AD. Concerning symptomatology, we found some expected differences

Table 3 Correlation matrix (pearson coefficient) of TCI-R scores and other measures.

Novelty Seeking (NS) Harm Avoidance (HA) Reward Dependence (RD) Persistence (P) Self-Directedness (SD) Cooperativeness (C) Self-Transcendence (ST) FQ Agoraphobia FQ Medical Phobia FQ Social Phobia Obsessive Thoughts List (OTL) Global Ass. of Funct. (GAF) HAD Anxiety HAD Depression

NS

HA

RD

P

SD

C

ST

FQ Ago

FQ Med

FQ Soc

OTL

GAF

HAD Anx

 0.41 0.28 0.04 0.09  0.1  0.14  0.13  0.06  0.18  0.17 0.13  0.07  0.22

 0.19  0.36  0.54  0.1 0.14 0.33 0.2 0.5 0.26  0.32 0.40 0.42

0.18 0.16 0.45 0.14  0.09  0.06  0.29  0.07 0.12  0.02  0.23

0.27 0.23 0.29  0.06 0.04  0.14 0.15 0.13 0.02  0.17

0.39  0.15  0.19  0.17  0.34  0.39 0.33  0.4  0.46

0.04  0.02  0.04  0.09  0.12 0.13  0.11  0.2

0.09 0.14  0.07 0.31  0.1 0.16 0.002

0.44 0.31 0.25  0.37 0.38 0.35

0.23 0.34  0.18 0.30 0.22

0.09  0.12 0.28 0.25

 0.44 0.44 0.39

 0.36  0.45

0.49

Significant correlations (po 0.005) are in bold.

Please cite this article as: Pelissolo, A., et al., Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.08.020i

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such as higher obsessive and compulsive symptoms (OTL scale) in the OCD group and more phobic symptoms (agoraphobia and social phobia FQ scores) in AD patients. Lifetime depressive comorbidity was high in both groups (71.1% and 56%) although with a significantly higher rate in OCD patients. The OCD patients also had a significantly more serious current depressive symptomatology. This pattern of mood disorder comorbidity reflects the global symptomatic severity of the disorders in both groups due to the clinical setting in which the recruitment was made (Stein, 2002; Fehm et al., 2005). OCD patients also had more comorbid eating disorders. GAF and SDS scores reflected high levels of impairment in both groups, congruent with the severity of anxiety symptoms. However, we observed a worst general functioning score (GAF score) in patients with OCD and their disability in family life (SDS sub score) was greater than that of AD patients. TCI-R scores comparisons showed no significant differences concerning temperament dimensions and SD was the sole character trait for which the two groups differed with a lower score in OCD patients. In Cloninger's model, a low self-directedness score is an indicator of poor individual maturity and of an enhanced risk of personality disorder without specificity to the underlying types of personality (Svrakic et al., 1993). Other studies have already shown that this trait is lower for OCD patients when compared to healthy subjects (Bejerot et al., 1998; Kusunoki et al., 2000; Lyoo et al., 2001; Alonso et al., 2008; Kim et al., 2009; Cruz-Fuentes et al., 2004) as well as subjects with social phobia (Pelissolo et al., 2002), panic disorder (Wachleski et al., 2008) or post-traumatic stress disorder (Evren et al., 2010) although without direct comparisons between these groups. However, in our study, the SD difference between AD and OCD groups seems to be due to a state effect and it is no longer significant when depressive symptoms (and age) are taken into account. Among the self-directedness sub-scores, Enlightened second nature (SD5) remained significantly lower in patients with OCD when compared to those with AD even after adjustment for depression symptoms and age. As described by Cloninger et al. (1994), low scorers on SD5 manifest habits that are counterproductive to their goals and usually have a lack of willpower to overcome temptations or obstacles in their lives. To complete this discussion, it is interesting to note that a prospective study showed that, even after improvement of OCD symptoms, the mean SD scores of patients were not significantly improved (Lyoo et al., 2003), suggesting that this trait is not only influenced by a state effect. In the literature, patients with OCD and AD have been shown to have relatively high rates of personality disorders. These rates vary between 35 and 100% depending on the populations with a majority of cluster C and avoidant personality disorders (Baer and Jenike, 1992; Noyes, 2001; Starcevic et al., 2008; Reich, 2009; Gordon et al., 2013). In the absence of direct head-to-head comparisons of comorbidity rates in patients with OCD versus AD, it is not possible to know specifically if they are different but our data on SD scores were in favor of a similar risk level of personality disorders in both groups or of a slight tendency towards a higher risk in the OCD group. The TCI-R temperament dimensions being similar in both groups, the typology of potent personality disorders is the same for patients with OCD and AD. Previous studies have shown a marked increase of harm avoidance scores when compared to healthy controls in patients with OCD (Bejerot et al., 1998; Lyoo et al., 2001; Cruz-Fuentes et al., 2004; Alonso et al., 2008; Kim et al., 2009), social phobia (Pelissolo et al., 2005), GAD and panic disorder (Starcevic et al., 1996; Wachleski et al., 2008). Even though this feature is known to be partially state-dependent (Lyoo et al., 2003), it is in line with a high rate of avoidant personality disorder patients which is defined in Cloninger's model by high HA, low NS and high RD (Svrakic et al., 1993; Cloninger et al., 1994).

5

Concerning emotionality, OCD and AD patients showed, in nonadjusted analyses, no differences in mean scores of positive affects but significantly higher mean scores of negative emotionality. However, PNE scales assess current and recent emotionality states (past month) and these types of measure are known to be highly correlated with a depressive state (Watson et al., 2005; Pelissolo, 2011). Thus, it is not surprising that modified patterns appeared in the adjusted comparison when HAD depression scores and age were taken into account. In the adjusted analysis, negative affects results remained unchanged. However, positive affects were significantly lower in OCD patients. The literature concerning affectivity in anxiety disorders and OCD is relatively poor. Generally, in the Watson and Clark's tripartite model of affectivity, anxiety disorders are characterized by high levels of negative affects and physiological hyperarousal and normal levels of positive affects (Watson, 2000). This profile is different from that of depressive disorders, which are characterized by low levels of positive affects and high levels of negative affects. Many studies have confirmed the general tendencies featured in the tripartite model with high negative and normal positive affectivity for anxiety disorders as a whole (Watson et al., 1995; Joiner and Lonigan, 2000; Kring et al., 2007). Only a few studies have explored the possible particularities of each diagnosis. Using the Positive and Negative Affect Scale (PANAS), Watson et al. (1988) showed that panic, phobic, and obsessive compulsive symptoms were significantly correlated with negative affect scores but not with positive affects scores. Other results converged to suggest low positive affects in patients with social anxiety disorders even in the absence of a depressive disorder (Kashdan and Breen, 2008). This category is considered an exception amongst anxiety disorders. Specific information on OCD emotional patterns is very limited. Through a tetrachoric correlation analysis conducted in a sample of military veterans, Watson (2005) showed that symptoms of obsessive intrusions and compulsions were clear markers of the Fear factor, as part of a threefactor solution (Anxious-misery, Externalizing, and Fear) along with symptoms of panic, agoraphobia, social phobia, and specific phobia. However, this study did not explore emotionality specifically. Furthermore, the same type of analysis conducted in another sample failed to replicate this result (Watson, 2005). We can draw from the present study that personality profiles of AD and OCD are very similar but that the (state) emotional patterns can be partially different. These results, with such a relatively large and well-characterized clinical sample, had not been studied in the literature previously. However, three limitations should be underlined and taken into account in future studies. First, the generalizability of our results is limited due to the highly specific type of population we studied since they were all recruited in a hospital anxiety clinic. The high rate of depressive comorbidity could be a consequence of this specific setting. Another limitation of the selection process is the exclusion of patients with an OCD and AD comorbidity. Second, the fact that only transversal assessments have been made could cause possible biases arising from trait-state confusion especially for depressive symptoms which are highly comorbid with the studied conditions. Third, only self-rated and subjective measures have been performed to assess personality and emotional variables. Nevertheless, and even though the instruments used in the present study have been previously validated, it would be interesting in future studies to include longitudinal designs with repeated assessments and objective measures via physiological and brain imaging markers. A comparison with a sample of matched healthy subjects will be also useful to assess personality dysfunctions of OCD and AD patients. 5. Conclusion From a personality point of view, the data of the present study

Please cite this article as: Pelissolo, A., et al., Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.08.020i

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are not totally in line with the DSM5s choice of a new taxonomy distinguishing the OCD spectrum from anxiety and fear disorders. Negative affects, which can be considered as the specific emotional core of anxiety disorders, are similar in both groups. Positive affects are slightly reduced in OCD patients but this tendency has been also observed in the literature in subjects with social anxiety disorder. Further research based on longitudinal studies and neurobiological explorations should lead to a more precise insight in the understanding of similarities and differences between both disorders.

Conflict of interest None of the authors have competing interests.

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Please cite this article as: Pelissolo, A., et al., Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.08.020i

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Please cite this article as: Pelissolo, A., et al., Obsessive-compulsive disorders and anxiety disorders: A comparison of personality and emotionality patterns. Psychiatry Research (2015), http://dx.doi.org/10.1016/j.psychres.2015.08.020i