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Obsessive-compulsive disorder and the

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Distinction and overlap with major
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Article in Behaviour Research and Therapy November 2002
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Behaviour Research and Therapy 40 (2002) 12051219

www.elsevier.com/locate/brat

Obsessive-compulsive disorder and the five-factor model of

personality: distinction and overlap with major depressive
disorder
N.A. Rector a,b,, K. Hood a,c, M.A. Richter a,b, R. Michael Bagby a,b
a

Mood and Anxiety Program, Centre For Addiction and Mental Health, Clarke Site, 250 College Street, Toronto,
Ontario, Canada M5T 1R8
b
University of Toronto, Toronto, Ontario, Canada
c
Ontario Institute For Studies In Education, Toronto, Ontario, Canada
Accepted 25 January 2002

Abstract
Research on individual differences in obsessive-compulsive disorder (OCD) has focused largely on analogue models with participants experiencing sub-clinical obsessions and/or compulsions. Few studies have
examined the association between normal, dimensional personality traits and obsessive-compulsive symptomatology in a clinical sample. The purpose of this study was to examine personality differences in patients
with a primary diagnosis of OCD (n 98) or major depression (n 98) using the domains and facets of
the five-factor model of personality (FFM). Patients completed the self-report version of the Revised NEO
Personality Inventory (NEO PI-R). When contrasted with community controls (Revised NEO Personality
Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual, Psychological
Assessment Resources, Odessa, FL, 1992), participants with OCD were found to differ across the domains
(and facets) of neuroticism, extraversion, and conscientiousness and the facets of openness and agreeableness. Further, when compared to depressed participants, those with OCD were found to be more
extraverted, agreeable, conscientious and less neurotic. With the exception of the conscientiousness domain
(and facets), these significant differences were maintained even after controlling for depression severity.
These results highlight the unique associations between trait domains and facets of the FFM and OCD.
2002 Elsevier Science Ltd. All rights reserved.
Keywords: OCD; Personality; Depression; Psychopathology

Corresponding author. Tel.: +1-416-535-8501; fax: +1-416-979-8653.

E-mail address: neilFrector@camh.net (N.A. Rector).

0005-7967/02/$ - see front matter 2002 Elsevier Science Ltd. All rights reserved.
PII: S 0 0 0 5 - 7 9 6 7 ( 0 2 ) 0 0 0 2 4 - 4

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N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

1. Introduction
The relation between personality and psychopathology is conceptually complex and different
models have emerged to capture the breadth of the possible associations. One such model, the
predispositional model, posits that personality traits: (a) contribute to the onset of a psychiatric
disorder (vulnerability) and (b) influence the course and symptom expression of the disorder
(pathoplasty). The principal aim of the current investigation was to examine the specific association between the personality domains of the five-factor model of personality (FFM) (Costa &
McCrae, 1992) and obsessive-compulsive disorder (OCD). As a previous study has explored the
vulnerability model by examining personality scores in participants with past (but not necessarily
present) OCD, and these participants first-degree relatives (Samuels et al., 2000), the goal was
to examine personality within a pathoplasty perspective. To this end, we examined the personality
traits of patients with OCD in the active phase of the illness and compared these traits to those
of a sample of patients with major depression who were acutely depressed.
1.1. Personality pathology and OCD
The association between personality traits and the development of obsessive-compulsive symptoms has been debated and refined over the past 100 years. Janet (1903) first described a grouping
of traits that were believed to be associated with the development of OCD. The psychaesthenia
state included feelings of incompleteness, uncertainty, and an inner sense of imperfection. Freud
(1908) asserted that obstinacy, parsimony, and orderliness, all components of the anal character,
represented traits predisposing to obsessional neurosis. These early conceptualizations of personality vulnerability shaped theory and empirical research over much of the past century and still
figure prominently in the current conceptualizations of the obsessive personality. The constellation
of traits comprising obsessive-compulsive personality disorder (OCPD) has been hypothesized to
represent a predisposing vulnerability for the development of OCD. According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association, 1994), OCPD is described as a pervasive pattern of pre-occupation with orderliness, perfectionism, and interpersonal control, at the expense of flexibility, openness, and
efficiency (APA, p. 725). It is widely recognized, however, that the majority of individuals
with OCD do not have a pattern of behavior that meets criteria for OCPD (APA, p. 727). Empirical research on the diagnostic overlap between OCD and OCPD, for example, indicate co-morbidity estimates ranging from 260% with a median of 6% (Summerfeldt, Huta, & Swinson, 1998,
p. 87). Furthermore, several studies have examined the specific item overlap between the two
disorders and found that, typically only one or two items are common to both disorders (Diaferia
et al., 1997). OCD has been shown to be more consistently associated with DSM-IV Axis II
disorders other than OCPD, including the following disorders (rates of co-morbidity in
parentheses): avoidant (30%), dependent (1020%), histrionic (525%), and schizotypal (15%)
(Summerfeldt, Huta, & Swinson, 1998). Although OCD is associated with considerable personality pathology, the defining features of OCPD do not appear to be strongly or specifically associated with the personality characteristics of those with OCD.

N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

1207

1.2. Personality dimensions and OCD

Another approach has been to examine OCD in relation to normal personality traits. In contrast to the DSM-IV Axis II disorders, which are conceptualized as categorical and discrete entities, these broad traits are typically seen as dimensional and continuous in nature, with extreme
scores, when accompanied by personal distress and/or social impairment, reflecting personality
pathology. These traits include higher-order personality domains from comprehensive models of
personality. For instance, elevated neuroticism scores and low extraversion (introversion) scores
from Eysencks three-factor model of personality (PEN) (Eysenck & Eysenck, 1985) are seen to
represent vulnerability for the development of obsessional disorders (Eysenck & Eysenck, 1985;
Gray, 1981; Stanley, Swann, Bowers, Davis, & Taylor, 1991; Zinbarg & Barlow, 1996). Similarly,
high harm avoidance from Cloningers Unified Biosocial Model of personality (Cloninger, 1987)
and low sensation-seeking from Zuckermans Alternative Five-Factor Model (Zuckerman, Kuhlman, Joireman, Teta, & Kraft, 1993) are also thought to contribute to the onset and maintenance
of obsessions and compulsions (Babbitt, Rowland, & Franken, 1990; Pfohl, Black, Noyes,
Kelly, & Blum, 1990; Richter, Summerfeldt, Joffe, & Swinson, 1996). Lower-order personality
traits such as perfectionism and inflated responsibility and their role in OCD have received even
more attention (Freeston, Ladouceur, Gagnon, & Thibodeau, 1992, 1993; Frost, Marten, Lahart, &
Rosenblate, 1990; Frost, Steketee, Cohn, & Griess, 1994; McFall & Wollersheim, 1979; Obsessive-Compulsive Cognitions Working Group, 1997; Rachman & Hodgson, 1980; Salkovskis, 1985;
Summerfeldt, Huta, & Swinson, 1998). Both these higher- and lower-order traits have been shown
to be commonly but not consistently associated with obsessive-compulsive symptoms. Moreover,
a unique relationship between these traits and OCD, as compared with other clinical disorders,
has not been demonstrated conclusively. Further exploration and refinement of personality assessment in OCD is required.
1.3. Five-factor model of personality
Research has demonstrated that the broad constellation of personality traits is well represented
within the FFM (Costa & McCrae, 1992). The five broad personality trait domains composing the
FFM are neuroticism, extraversion, openness-to-experience, agreeableness, and conscientiousness.
These dimensions emerged, initially, from factor analyses of lay adjectives found in different
languages (Digman, 1990). As conceptualized by Costa and McCrae (1992), each of these five
broader personality trait domains consist of six lower-order, correlated traits or facets. Each of
the five broad trait domains and the 30 lower-ordered facet traits have substantial and unique
heritability coefficients (Jang, McCrae, Angleitner, Riemann, & Livesley, 1998). Although the
domain and facet traits of the FFM were derived from normal, non-clinical samples, the same
five domains have been extracted and applied with psychiatric patients (see e.g. Bagby et al.,
1997, 1996; Cox, Borger, Asmundson, & Taylor, 2000).
According to the FFM, neuroticism encompasses the predisposition to experience negative
affectivity such as anxiety, depression, anger, guilt, and disgust. Extraversion includes sociability,
cheerfulness and liveliness. Openness to experience consists of aesthetic sensitivity, intellectual
curiosity, and need for variety. Agreeableness incorporates trust, altruism, and sympathy, and
conscientiousness includes a strict adherence to principles and a desire to achieve goals (Costa &

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N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

McCrae, 1992). The NEO PI-R (Costa & McCrae, 1992) was developed to assess the FFM,
including the broad domains and the six lower-order facets for each of the five domains. The
domains and facets of this self-report inventory are arranged in a way that permits examination
of specific lower-order personality traits (facets) (e.g. order, competence), while still locating these
characteristics within their broader domain (e.g. conscientiousness). Recent investigations have
found these facet level traits to be particularly useful in characterizing various forms of psychopathology (Bagby et al., 1996; Cox, Borger, Asmundson, & Taylor, 2000; Reynolds & Clark,
2001).
1.4. FFM in OCD
To our knowledge, examination of the FFM in OCD has occurred only recently in a single
epidemiological study (Samuels et al., 2000). Participants with a lifetime diagnosis of OCD were
compared with community participants without a lifetime history of OCD and matched on gender,
race, and age. Patients with OCD were found to score higher on neuroticism (all facets) and lower
on extraversion (i.e. assertiveness facet only) versus community controls. In addition, participants
with OCD were found to be less agreeable, although no differences were observed on the domains
of openness and conscientiousness. Higher levels of neuroticism were also observed in the relatives of those with OCD compared to the relatives of the community controls, suggesting a shared
familial diathesis.
The diagnosis of OCD in the study by Samuels and colleagues (2000) was based on a retrospective account of obsessive-compulsive symptoms. The extent to which patients were actively symptomatic at the time of assessment is unknown, although the authors acknowledge that patients
were neither selected for active symptoms, nor were they seeking treatment. While this study
represents an important epidemiological examination of normal trait distribution in individuals
with some lifetime experience of obsessive-compulsive symptoms, its clinical applicability may
be somewhat limited. OCD tends to be characterized by waxing and waning of symptoms rather
than the typical pattern of episode-remission seen in other clinical disorders (Demal, Gerhard,
Mayrhofer, Zapotoczky, & Zitterl, 1993; Rasmussen & Eisen, 1991). It is possible that in the
Samuels et al. (2000) study, the association between personality and obsessive-compulsive symptoms was underestimated due to the inclusion of heterogeneous patient groups of whom some
members were experiencing a breadth of clinically distressing obsessions/compulsions while
others were partially remitted and thus experiencing little distress and impairment at the time
of assessment.
Further, because the FFM measures emotional, interpersonal, and motivational styles that are
relevant to a wide range of diagnoses, the examination of FFM traits in those experiencing acute
obsessive-compulsive symptoms may be especially helpful in identifying traits differentially
linked to the maintenance of obsessions and compulsions. While the study by Samuels et al.
(2000) demonstrated that individuals with a lifetime diagnosis of OCD differed on a number of
higher-order personality domains and lower-order facets, the extent to which these represent
unique associations with OCD or whether, alternatively, they represent shared associations with,
say, depression and other forms of psychopathology, also remains to be tested.

N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

1209

1.5. Current study

There were three aims to the current study. First, the domains and facets of the FFM were
assessed in patients diagnosed with OCD and experiencing clinically significant obsessions and/or
compulsions. Second, we tested whether the configuration of personality in OCD according to
the FFM is distinct from the configuration in major depressive disorder (MDD). There is considerable co-morbidity between OCD and depression (Pigott, LHeureux, Dubbert, Bernstein, & Murphy, 1994) and so this provided a very rigorous comparison for establishing OCD-specific associations. Similarly, in both categorical and dimensional approaches to the study of personality in
OCD, the severity of secondary depression has been shown to impact greatly on personality
ratings. For instance, in a study examining the co-morbidity between personality disorders and
OCD, Tallis and colleagues (Tallis, Rosen, & Shafran, 1996) found that when depressive symptomatology was statistically controlled, the number of co-morbid personality disorders identified
was reduced from nine to two. The comparison of OCD and depressed groups may be particularly
important when examining personality domains that have been implicated as vulnerabilities for
both mood and anxiety disorders. For instance, high neuroticism and low extraversion have been
identified as non-specific vulnerabilities for anxiety and depressive disorders (Costa & McCrae,
1992; Widiger, 1992). Third, in addition to comparing OCD and depressed patient groups, we
aimed to compare the distribution of personality traits while controlling for depression severity
in both groups.

2. Method
2.1. Participants
Participants were 196 psychiatric outpatients with primary diagnoses of either OCD (n 98)
or MDD (n 98). Participants were referrals to either the Anxiety Disorders Clinic or the
Depression Clinic; both of which are part of the Mood and Anxiety Program, Centre for Addiction
and Mental Health. The MAP is a university affiliated (Department of Psychiatry, University of
Toronto) tertiary care facility. Both clinics provide consultation and treatment for physician
referrals within the Greater Toronto Area (population 3,000,000). All participants met DSM-IV
criteria for either primary OCD or primary MDD based on the Structured Clinical Interview for
DSM-IV Disorders (Version 2.0/Patient Form) (SCID-I/P; First, Spitzer, Gibbon, & Williams,
1996) and consented to be part of a clinical database. Well-trained and experienced graduate
students who had received formal training in its administration administered all SCID-I/P interviews. All assessors met in weekly case supervision to discuss SCID-I/P assessments and to arrive
at consensus ratings where required.
Criteria for entry into the Anxiety Disorders Clinic database were as follows: (a) a diagnosis
of primary OCD according to DSM-IV (American Psychiatric Association, 1994) and (b) no
concurrent diagnosis of substance use disorders, schizophrenia, bipolar disorder or active neurological illness. Criteria for entry into the Depression Clinic database were as follows: (a) a diagnosis of non-psychotic, major depression according to DSM-IV (American Psychiatric Associ-

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N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

ation, 1994) and (b) no concurrent diagnosis of substance use disorders, schizophrenia, bipolar
disorder or active neurological illness.
2.2. Measures
2.2.1. The revised NEO personality inventory (NEO PI-R)
The NEO PI-R (Costa & McCrae, 1992) is a self-report questionnaire designed to assess the
FFM. The measure consists of 240 self-report items rated on a five-point Likert scale ranging
from strongly agree to strongly disagree and includes five scales measuring the following
personality domains: neuroticism, extraversion, openness, agreeableness, and conscientiousness.
Each domain also comprises six separate scales that measure facet traits of the domains (for a
list of the facets within each domain, see Table 2). The T-scores for the five domains and 30
facets were calculated according to standardized reference means and standard deviations (Costa &
McCrae, 1992). Distributions have a mean of 50 and a standard deviation of 10. Scores have
been categorized as follows: average (4555), low (less 3645), very low (less than 36), high
(5665) and very high (greater than 65).
2.2.2. Beck depression inventory revised (BDI-II)
The BDI-II (Beck & Steer, 1987) is a 21-item (four-point scale) self-report instrument, designed
to assess the severity of depressive symptoms over the preceding week. The BDI has been shown
to be a reliable and well-validated measure of depressive symptomatology (Beck & Steer, 1987;
Kendall, Hollon, Beck, Hammen, & Ingram, 1987).
3. Results
3.1. Sample characteristics
Depressed patients were matched to OCD participants on gender and age. The mean age of
the sample was 36.5 years (SD 9.3) and 58% were female. In terms of education, 11% did not
complete high school; 15% completed high school; 23% completed some college/university; 39%
completed college/university; and 12% completed at least some graduate school. With respect to
marital status, 22% were married, 32% were divorced or separated, and 44% were single.
3.2. Associations among dimensions of the NEO PI-R
The zero-order correlations among the dimensions of the five-factor model by diagnosis group
can be seen in Table 1. In both groups, neuroticism was found to be moderately and inversely
correlated with extraversion, agreeableness and conscientiousness. Further, extraversion was found
to be positively associated with agreeableness in both groups. While extraversion was unrelated
to conscientiousness in the OCD sample, there was a significant and positive correlation between
these domains in the MDD sample. Finally, agreeableness was positively correlated with conscientiousness in both samples. Notwithstanding the moderate correlations between some of the dimensions, the average measure interclass correlation for the five domains for the entire sample was

N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

1211

Table 1
Zero-order correlations among the NEO PI-R domains

1.
2.
3.
4.
5.

Neuroticism
Extraversion
Openness
Agreeableness
Conscientiousness

0.48
0.00
0.25
0.40

0.33

0.36
0.04
0.31

0.18
0.35

0.12
0.01

0.31
0.04
0.17

0.24

0.51
0.17
0.09
0.31

Note. Upper right section of matrix represents the correlations for the OCD sample (n 98) and the bottom left (and
bolded) section of the matrix represents the correlations for the MDD sample (n 96).p 0.05. p 0.01.

low (0.16) and non-significant (F(195,776) 0.86, p 0.89ns), suggesting that the domains of
the NEO PI-R represent non-redundant indices of trait personality. In contrast, the average measure interclass correlation for the facets of neuroticism (0.83, F(195,975) 5.70, p0.0001),
extraversion (0.76, F(195,975) 4.19, p0.0001), openness (0.70, F(195,975) 3.34, p
0.0001),
agreeableness
(0.79, F(195,975) 4.66,
p0.0001),and
conscientiousness
(0.87, F(195,975) 7.57, p0.0001) was large and statistically significant, suggesting a high
degree of covariation among the facets of a given trait domain.
The data analytic approach was therefore, to conduct five separate multivariate analysis of
variance (MANOVA) tests for the facets of each of the five domains. Given the exploratory nature
of this study, as well as the interest in examining trait facet differences between the two groups,
a two-tailed alpha set at the traditional p0.05 was employed for the determination of multivariate
significance at the domain level. However, to correct potential Type I error, a Bonferroni correction was applied for the determination of significance for the univariate analyses within each of
the five domains (a 0.05 / 5 tests 0.01).
3.3. Trait personality in OCD and MDD
Table 2 displays the T-Score means, standard deviations, and significance values for the differences between patient groups on each of the facets of the five domains, respectively. The score
distributions are also represented graphically in Fig. 1. Patients with OCD and MDD were found
to have very high neuroticism and very low extraversion scores; average openness and agreeableness scores; and low conscientiousness scores.
When comparing patients with OCD and MDD overall multivariate effects were observed
across four of the five dimensions of the FFM. Patients with OCD demonstrated significantly
higher extraversion (Wilks 0.86, F(6,189) 5.26, p0.001), agreeableness (Wilks
0.92, F(6,189) 2.80, p0.01) and conscientiousness (Wilks 0.93, F(6,189) 2.51,
p0.05) scores than did those with MDD, whereas patients with MDD scored significantly higher
on neuroticism (Wilks 0.74, F(6,189) 11.27, p0.001) than did patients with OCD.
As seen in Table 2, when considering the facets comprising neuroticism, patients with OCD
scored higher on anxiety (N1) and lower on depression (N3) in comparison to those with MDD.
Further, patients with OCD scored significantly higher than patients with MDD on several facets

Note. p 0.05, p 0.01, p 0.001.

Neuroticism
N1 Anxiety
N2 Angry hostility
N3 Depression
N4 Self-consciousness
N5 Impulsiveness
N6 Vulnerability
Extraversion
E1 Warmth
E2 Gregariousness
E3 Assertiveness
E4 Activity
E5 Excitement-seeking
E6 Positive emotions
Openness
O1 Openness to fantasy
O2 Aesthetics
O3 Feelings
O4 Actions
O5 Ideas
O6 Values
Agreeableness
A1 Trust
A2 Straightforwardness
A3 Altruism
A4 Compliance
A5 Modesty
A6 Tender-mindedness
Conscientiousness
C1 Competence
C2 Order
C3 Dutifulness
C4 Achievement striving
C5 Self-discipline
C6 Deliberation

70.08
68.71
60.72
67.80
64.69
57.15
70.52
39.83
41.64
42.64
42.24
44.78
47.70
38.19
51.44
54.93
50.78
53.93
42.29
49.80
51.70
47.79
39.43
49.94
48.45
46.05
53.73
54.88
40.61
40.04
48.80
44.71
42.08
32.89
50.09

10.21
9.40
12.01
9.97
10.65
10.29
12.29
10.59
11.77
11.37
11.40
10.95
10.25
13.32
10.74
11.15
10.12
10.86
10.84
12.04
9.71
13.70
14.21
12.23
11.10
14.65
12.49
10.78
13.27
13.63
12.40
12.21
12.74
13.57
11.93

72.26
65.21
65.90
74.22
65.74
57.23
74.07
36.37
34.81
44.07
41.86
41.57
47.53
32.56
52.70
54.16
52.21
53.40
46.16
49.86
54.05
45.06
35.87
48.76
43.08
44.58
56.55
52.03
36.07
34.84
44.22
41.63
38.91
31.68
47.01

11.60
10.34
12.31
8.45
13.58
10.60
13.58
12.71
14.75
12.91
11.31
10.88
10.37
12.49
10.85
11.53
10.16
10.49
12.23
11.16
9.89
14.29
16.79
12.01
12.97
13.47
12.08
12.81
14.35
14.56
12.97
11.95
14.98
13.93
12.39

SD

SD

Unipolar depressed (n 98)

Obsessive compulsive (n 98)

Table 2
Means and standard deviations of the trait domains and facets of the NEO PI-R

0.93

0.92

0.95

0.86

0.74

Wilks

11.275
6.137
1.575
23.636
0.363
0.003
3.669
5.262
2.765
0.680
0.114
4.642
0.048
9.840
1.560
0.461
0.896
0.207
5.161
0.007
2.796
2.804
2.564
0.460
9.686
0.534
2.574
2.837
2.511
6.676
6.357
3.195
2.536
0.379
3.155

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N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

Fig. 1.

1213

NEO PI-R scores for patient groups.

of extraversion including warmth (E1), activity (E3), and positive emotions (E6). Considering the
facets of agreeableness, patients with OCD were found to be more altruistic (A3) than patients
with MDD. Finally, in considering the facet scores of consciousness, patients with OCD scored
significantly higher on facets of competence (C1) and order (C2) than patients with MDD.
3.4. Personality differences controlling for depression severity
To assess whether personality differences were attributable to different levels of depression
between patient groups or if important differences were masked as a result of state depression,
the trait facet score comparisons for patient groups were repeated controlling for depression severity. Of the original 98 participants with OCD, 78 also completed the BDI. In an attempt to control
for gender and age effects, 78 OCD patients (from the original 98) were closely matched with
78 MDD patients. The mean age for this OCD patient sample was 36.0 years (SD 10.1) versus
36.5 years (SD 10.0) for patients with MDD and this difference was not significant,
t (154) 0.30, p0.77. Further, 44% of the OCD, and 38% of the MDD patient samples were
male and this difference was not significant, X2(1,N 156) 0.66,p0.42). Finally, the mean
BDI score for this OCD patient sample was 21.4 (SD 10.45) and 29.8 (SD 9.70) for the
MDD sample, and this difference was significant, t(154) 5.23, p0.001.
Five separate MANOVAs were repeated for the facets of the five domains of the FFM with
BDI scores as the covariate. As before, patients with OCD were still found to have higher extraversion (Wilks 0.88, F(6,148) 3.33, p0.01) and agreeableness (Wilks 0.92,
F(6,148) 2.13, p0.05) scores although not consciousness scores (Wilks 0.94,
F(6,148) 1.69, p 0.13). Further, after controlling for depression severity, patients with OCD
were still found to be lower on neuroticism than were patients with MDD (Wilks 0.73,

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N.A. Rector et al. / Behaviour Research and Therapy 40 (2002) 12051219

F(6,148) 9.36, p0.001). At the facet level, two neuroticism facets remained significantly different, with anxiety (N1) remaining higher in OCD and depression (N3) remaining higher in
MDD. On the extraversion facets, only warmth (E1) remained higher in OCD than in MDD.
Patients with OCD scored higher than patients with MDD on the agreeableness facet altruism
(A4).

4. Discussion
This study aimed to assess trait personality domains and facets according to the FFM in participants diagnosed with OCD in comparison to patients diagnosed with major depression, with
and without depressive severity scores controlled.
4.1. FFM configuration in OCD
Patients with OCD were found to be very high on neuroticism, very low on extraversion, and,
surprisingly, low on conscientiousness. The neuroticism and extraversion domain scores were
approximately two standard deviations (higher for neuroticism and lower for extraversion) from
the normative means (Costa & McCrae, 1992). For the facet traits of neuroticism, patients with
OCD were most distinguished by elevations on trait anxiety and vulnerability. Trait anxiety has
been shown to be elevated in OCD (Andrews, Pollock, & Stewart, 1989) and strongly associated
with dimensional measures of obsessive-compulsive symptoms (Zinbarg & Barlow, 1996).
Another facet of neuroticism, impulsiveness, was the lowest facet score and only slightly elevated
above the normal range. It has been proposed that OCD is similar to other disorders of impulse
control (Lopez-Ibor, 1990), yet our findings are consistent with many previous reports that have
employed diverse measures indicating that impulsiveness is in the average range in OCD (Richter,
Summerfeldt, Joffe, & Swinson, 1996). Further, patients with OCD were found to be in the
average range for openness and agreeableness, although specific facets of these domains, such as
the actions facet of openness and the tender-mindedness facet of agreeableness, were in the low
and high range, respectively. The openness facet actions, reflects a willingness to try different
activities, go to new places, or try new foods, and high scorers on this scale have been found to
prefer novelty whereas low scorers tend to find change difficult (Costa & McCrae, 1992). These
findings are consistent with past research that has found patients with OCD to be low in sensationseeking (Babbitt et al., 1990).
The finding of low conscientiousness scores in this study is particularly surprising. Self-reported
efficiency, thoroughness, persistence, organization, and industriousness, trait descriptors often
associated with the diagnosis of OCD, and captured in the facets of the conscientiousness domains,
were found to be in the low to very low range. The lowest facet score of the conscientiousness
domain, self-discipline, which tended to be in the very low range (and indeed the lowest T-score
of all 30 facets), may provide some explanation for this curious finding. It may be that despite
the desire for order, organization, and thoroughness, the ability of the patient with clinical OCD
to co-ordinate resources and achieve task completion to their satisfaction (i.e. exceedingly high
standards) becomes reduced. Alternatively, it may be that the presence of severe obsessions and

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time-consuming and distressing compulsions influences the persons perception of their competence, thoroughness, and self-discipline.
The comparison of the results from this study, which included patients with acute and clinically
significant obsessive-compulsive symptoms, to the results reported by Samuels et al. (2000), in
which patients may have been largely unsymptomatic, may be informative regarding the influence
of symptom state on the reporting of obsessional traits. If the T-scores for the domains from the
Samuels and colleagues (2000) study are compared with the T-scores in the present study, there
are striking differences. For instance, neuroticism scores in the present study are nearly two standard deviations higher and extraversion scores nearly one standard deviation lower than those
reported by Samuels and colleagues. Conscientiousness scores are also considerably lower,
approaching one standard deviation difference. On the other hand, openness and agreeableness
domain scores are nearly identical for patients in both studies thus suggesting greater stability in
the face of acute obsessional psychopathology. Agreeableness and openness have been also found
to be largely independent of symptom severity in depression (Bagby, Joffe, & Parker, 1995). The
results from the present study not only replicate the findings of Samuels et al. (2000) pointing to
low conscientiousness scores in those with OCD but also suggest that the presence of acute
obsessions and compulsions is associated with even lower conscientiousness scores. These score
differences between community- and clinic-based patients with OCD may reflect increased personality vulnerability and/or more severe OCD symptomatology in those seeking treatment.
4.2. Personality specificity in OCD and depression
Notwithstanding the similarities in the overall personality configuration of those with OCD and
MDD when contrasted with community samples reported in the standardization of the NEO PIR (Costa & McCrae, 1992), there were significant differences at the trait domain and facet level
between the two disorders, which may speak to relative disorder-specific associations with personality.
In terms of neuroticism, patients with OCD showed greater elevations on trait anxiety and less
on trait depression when compared to MDD patients even after controlling for severity of
depression. Patients with OCD were found to be more extraverted, including significant facet
differences in their warmth and ability to experience positive emotions compared to patients with
MDD. The ability to experience positive emotions appears to be moderated by the presence of
secondary depression symptoms in OCD as this effect was nullified when depression severity
was controlled.
Patients with OCD were also found to be more agreeable and conscientious than patients with
MDD. The differences pertaining to conscientiousness appeared to be mostly accounted for by
the presence of secondary depression, as these significant between-group effects were lost when
depression severity was controlled.
4.3. Limitations
There are limitations to the current study. First, we did not control for the effects of Axis I
co-morbidity, including secondary depressive disorders in those with primary OCD nor secondary
OCD in those with primary MDD. Epidemiological studies have documented the naturally occur-

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ring high rates of co-morbidity of these two disorders in the community. In the ECA study (Reiger
et al., 1988) 31.7% of OCD patients were diagnosed as having a co-morbid MDD. In the National
Collaborative Group (Weissman et al., 1994) the lifetime co-morbidity of MDD in this group
extended to 60.3% depending on the country. In addition to categorical assessment of diagnosable
co-morbid major depression, it has been estimated that upwards of 75% of patients with OCD
(Black, Noyes, Goldstein, & Blum, 1992) experience sub-clinical depressive states. Given the
emphasis in this study on the pathoplasty model of personality, we aimed to maintain clinical
realism by not excluding patients with co-morbid Axis I conditions. On the other hand, in the
second set of analyses we addressed directly the potential impact of depressive states on the
reporting of personality by statistically controlling for dimensional depression severity scores.
One possibility, however, is that the distinctiveness of personality ratings would be even more
pronounced if patients with only pure OCD were examined.
A second and related issue, is that we did not assess for Axis II co-morbidity and so it is
possible that differences observed between the OCD and depressed patient groups are accounted
for by the presence of personality disorders. This is unlikely, however, as the majority of DSMIV personality disorders have been shown to be well represented by the domains and facets of
the FFM (OConnor & Dyce, 1998). Moreover, there is considerable symptom/trait conflation
between some Axis I and Axis II disorders (Schneier, Johnson, Hornig, Liebowitz, & Weissman,
1992) whereas, the personality traits of the FFM were not derived from psychopathological content
domains and show comparatively less thematic overlap with Axis I disorders.
Third, while dimensions and facets of the FFM were found to distinguish clinical groups, the
extent to which specific personality traits relate to specific obsessional and compulsive symptoms
was not examined. Future research could provide a more refined analysis of whether certain
personality features are likely to predict the particular content of obsessions (i.e. need for symmetry versus aggressive obsessions) and the particular form of compulsions (i.e. mental versus
behavioral).
Fourth, the results of this study are limited by their cross-sectional nature and cannot determine
the temporal relationships between personality and OCD symptomatology. Finally, as indicated
earlier, the purpose of the present study was to examine the influence of personality traits on the
expression of psychopathological symptoms (pathoplasty) and differences in the personality traits
of patients with MDD and OCD do not, therefore, necessarily represent disorder specific vulnerability markers for these disorders. Nonetheless, many of the personality trait differences that
emerged between the patients with OCD and MDD were found on traits that are not influenced
by the presence of acute psychiatric symptomatology.
4.4. Summary
This study identified unique associations between the personality domains and facets of the
FFM and clinically significant obsessive-compulsive symptoms. The extent to which these personality associations represent enduring vulnerability for the relapse and recurrence of symptoms or
whether they are state dependent, and therefore contingent on the waxing and waning of obsessivecompulsive symptoms will require further examination. From a clinical perspective, past research
has demonstrated that abnormal personality traits can be ameliorated following successful
response to cognitive-behavioral therapy (McKay, Neziroglu, Todaro, & Yaryura-Tobias, 1996;

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1217

Ricciardi, Baer, Jenike Fischer, Sholtz, & Buttolph, 1992). Surprisingly little attention has focused
on whether personality change on dimensional traits mediate clinical response to CBT for OCD,
although similar studies in CBT for depression have demonstrated the interdependency between
personality change and mood change (DeRubeis & Feeley, 1990; Rector, Bagby, Segal, Joffe, &
Levitt, 2000; see Whisman, 1993 for review). The examination of the interplay of personality
and symptom expression in OCD may also help to refine psychological treatments for those who
show only minimal benefit.
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