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Personality and Individual Differences 71 (2014) 92–97

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Personality and Individual Differences


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Personality and symptom severity in Obsessive–Compulsive Disorder:


The mediating role of depression
Clare S. Rees a,⇑, Lynne D. Roberts a, Patricia van Oppen c, Merijn Eikelenboom c, A.A. Jolijn Hendriks c,
Anton J.L.M. van Balkom b, Harold van Megen b
a
School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
b
Mental Health Care Institute GGZ Centraal, Ermelo, The Netherlands
c
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom

a r t i c l e i n f o a b s t r a c t

Article history: Elevated levels of Neuroticism and lower levels of Extraversion have been reliably shown in patients with
Received 27 February 2014 anxiety and depressive disorders and some studies have demonstrated these patterns amongst patients
Received in revised form 20 July 2014 diagnosed with Obsessive–Compulsive Disorder (OCD). However, because comorbid anxiety and depres-
Accepted 24 July 2014
sion is common in OCD, it is unclear whether the previously observed relationships are due to comorbid
Available online 21 August 2014
anxiety and depression or are more specifically related to the presence of OCD. This study sought to dis-
entangle the relationship between personality and OCD by investigating the relationship between Extra-
Keywords:
version, Neuroticism and OCD symptom severity and illness duration. Additionally, we explored the
Obsessive–Compulsive Disorder
Longitudinal
relationship between these variables and the additional variable of depression. Specifically, we tested
Personality whether depression mediated these relationships amongst a sample of 322 outpatients diagnosed with
Chronicity OCD. We found that depression fully mediated the relationship between personality and OCD symptom
severity but not duration. Indeed, neither personality nor depression could explain illness duration. The
results suggest that depression is an important variable to consider when understanding OCD symptom
severity and trumps personality variables in terms of its explanatory power. The results also suggest that
further work is needed to identify the variables that best explain illness duration in OCD.
Ó 2014 Elsevier Ltd. All rights reserved.

1. Introduction a tendency to experience a wide range of unpleasant emotional


states such as anger, sadness, guilt and fear, whereas PA refers to
A key challenge in improving treatment outcomes for people the tendency to be social, energetic, friendly and gregarious. Stud-
diagnosed with Obsessive–Compulsive Disorder (OCD) is to unra- ies that have applied the five-factor model of personality have con-
vel the factors that might explain higher levels of symptom sever- sistently found high levels of Neuroticism and low levels of
ity and a more chronic duration of illness. It is well documented Extraversion to be associated with both mood and anxiety disor-
that a significant proportion of OCD patients do not respond to ders in community samples (Bienvenu et al., 2001; Brown et al.,
the gold-standard treatments and continue to experience ongoing 1998; Clark & Watson, 1991; Watson et al.,1994).
clinical levels of symptoms (Abramowitz, 2006). Efforts to further Surprisingly few studies have specifically examined personality
understand the specific variables that might explain a more profiles among OCD patients using a dimensional approach like the
chronic course of illness are imperative. One such area of focus is Big Five model of personality. Of the studies conducted to date, the
that of personality. A substantial number of studies have now reli- predominant finding has been that when compared to non-clinical
ably shown a distinct personality profile that broadly distinguishes samples, those with OCD are higher on Neuroticism, lower on
psychiatric patients from non-patients (Bienvenu et al., 2001; Extraversion and generally higher on Agreeableness (Rector,
Brown, Chorpita, & Barlow, 1998; Clark & Watson, 1991; Watson Hood, Richter, & Bagby, 2002; Rees, Anderson, & Egan, 2006;
& Clark, 1984; Watson, Clark, & Harkness, 1994). Fundamentally, Samuels et al., 2000; Wu, Clark, & Watson, 2006). Some criticisms
this pattern consists of high Negative Affect (NA)/Neuroticism (N) of these studies include utilisation of samples where OCD diagnosis
and low Positive Affect (PA)/Extraversion (E). NA simply refers to was not verified or not current (Samuels et al., 2000) or relatively
small sample sizes were utilised (Wu et al., 2006; Rees et al., 2006).
⇑ Corresponding author. Tel.: +41 8 92663442; fax: +41 8 92662464. Rector et al. (2002) attempted to further explore the dimen-
E-mail address: c.rees@curtin.edu.au (C.S. Rees). sional personality traits of OCD patients by controlling for the

http://dx.doi.org/10.1016/j.paid.2014.07.025
0191-8869/Ó 2014 Elsevier Ltd. All rights reserved.
C.S. Rees et al. / Personality and Individual Differences 71 (2014) 92–97 93

influence of depression. They argued that because the finding of The following hypotheses were proposed:
elevated Neuroticism and low Extraversion has been identified as
a non-specific vulnerability to anxiety and depressive disorders, H1. Participants will have significantly lower scores on Emotional
controlling for depression could help to elucidate the unique rela- Stability as compared to a normative sample (note: Emotional
tionship between OCD and these personality traits. They compared Stability is equivalent to Neuroticism, thus low Emotional Stabil-
98 patients diagnosed with primary OCD to 98 patients diagnosed ity = high Neuroticism).
with primary Major Depressive Disorder (MDD). Using the Revised
NEO Personality Inventory (NEO PI-R, Costa & McCrae, 1992) they
found that although both clinical groups had the expected pattern H2. Participants will have significantly lower scores on Extraver-
of high Neuroticism and low Extraversion, the MDD group had sig- sion as compared to a normative sample.
nificantly higher scores on Neuroticism and significantly lower
scores on Extraversion than the OCD group. This finding suggests
H3. Scores on Emotional Stability will be significantly correlated
that the high Neuroticism and low Extraversion personality profile,
with OCD symptom severity and illness duration.
regarded as a non-specific vulnerability to all anxiety and depres-
sive disorders, may in fact vary between specific disorder groups
and that depression is an important variable to consider. The asso- H4. Scores on Extraversion will be significantly correlated with
ciation between personality and depression was also demonstrated OCD symptom severity and illness duration.
in another study that utilised a categorical approach to examining
the relationship between OCD and personality. Tallis, Rosen, and
H5. Depression will fully mediate the relationship between per-
Shafran (1996) examined comorbidity between OCD and personal-
sonality factors (Emotional Stability and Extraversion) and OCD
ity disorder diagnosis. They found that when depressive symptom-
symptom severity.
atology was controlled, the number of OCD patients with comorbid
personality disorder diagnoses reduced significantly. The results of
these studies suggest that high Neuroticism and low Extraversion H6. After controlling for age, depression will fully mediate the
may be a vulnerability to depression, but not necessarily to OCD. relationship between personality factors (Emotional Stability and
Depression is a highly important variable to consider in its own Extraversion) and OCD duration (see Figs. 1 and 2).
right when studying OCD because up to 50% of patients present
with an additional diagnosis of major depression (MDD) (Crino &
2. Method
Andrews, 1996). OCD patients with comorbid depression who do
not respond to treatment have been found to have higher OCD
2.1. Study design
symptom severity than those without the additional diagnosis
(Abramowitz & Foa, 1998). It is important to acknowledge the
This study is part of a large multicentre longitudinal study car-
influence of affective temperaments and their potential pathoplas-
ried out by the Netherlands Obsessive Compulsive Disorder Associ-
tic role in the etiology and clinical characteristics of OCD. Work by
ation (NOCDA). The NOCDA study aims to investigate the
Hantouche and Demonfaucon (2008) revealed a constellation of
biological, psychological and social determinants of chronicity in
unstable affective temperaments (cyclothymic, irritable and
OCD by studying patients over a 6-year period (for a full descrip-
depressive) being associated with treatment-resistant OCD. Stud-
tion of the NOCDA study see Schuurmans et al., 2012).
ies investigating the temporal relationship between OCD and
All patients diagnosed with OCD who were referred to one of
MDD show that OCD symptoms precede symptoms of depression
the participating mental health care centres were asked permis-
(Bellodi, Scioto, Diaferia, Ronchi, & Smiraldi, 1992; Demal, Lenz,
sion to be contacted for research purposes during the intake proce-
Mayrhofer, Zapotoczky, & Zitterl, 1993). Bartz and Hollander
dure. All patients who consented were contacted and invited to
(2006) draw from this the conclusion that it is unlikely that OCD
participate in the study, irrespective of the stage of the disorder,
and depression share an etiological relationship.
the OCD subtype, the presence of co-morbidity and the stage of
Whilst extant studies reveal that a diagnosis of OCD is associ-
chronicity. Personality, depression and OCD were assessed at
ated with elevated Neuroticism and low Extraversion, no studies
base-line. Specially trained clinical research staff conducted the
have investigated the relationship between these personality traits
baseline interview including the SCID and received a two-day
and OCD symptom severity or illness duration. It may be that those
course and regular follow-up one-day training sessions by the
patients with more severe and/or chronic OCD have a different per-
fieldwork coordinator. All interviews were constantly monitored
sonality profile. Furthermore, it is necessary to conduct such an
by randomly checking at least 10% of all taped interviews.
investigation with a large sample of currently diagnosed patients
to have sufficient power for the analysis and to improve upon
the generalizability of findings. Also, given the interrelationship
between OCD and depression it is imperative to further investigate
this particularly with regard to how it relates to personality fea- Extraversion
tures, symptom severity and course of illness. There is no doubt
that the presence of depression in addition to OCD is associated
with greater occupational and functional disability (Markarian
et al., 2010).
Depression Symptom
Important questions emerging from the current literature is: Severity
Does depression mediate the relationship between personality
and OCD? Can depression account for the previously observed dif-
ferences in levels of Neuroticism and Extraversion? If depression Emotional
does account for the differences in Neuroticism and Extraversion Stability
between OCD patients and non-OCD patients it would suggest that
a diagnosis of OCD is not uniquely related to particular personality Fig. 1. Proposed model with depression mediating the relationship between
vulnerabilities. personality factors and OCD symptom severity.
94 C.S. Rees et al. / Personality and Individual Differences 71 (2014) 92–97

1996). Total scores range from 0 to 63. The reliability of the BDI-
Extraversion
II within the Dutch community has previously been demonstrated
through high internal consistency of items (a = 95, N = 7500;
Roelofs et al., 2013).

Depression OCD
Duration 4. Results

4.1. Participant sample


Emotional
Stability Of these 322 participants, 181 (56.2%) were female and 141
(43.8%) were male. The age at baseline interview ranged from 18
Fig. 2. Proposed model with depression mediating the relationship between to 79 years (M = 36.27 years, SD = 11.15 years). The majority
personality factors and OCD duration after controlling for age. (98.4%) were Dutch nationals. Years of education completed ran-
ged from 5 to 18 (M = 12.47, SD = 3.09 years). The majority
(60.2%) had never married, one third (32.6%) were currently mar-
2.2. Participants
ried, 6.5% were divorced and .6% widowed.
The age of onset of OCD ranged from four to 46 years
The starting pool of participants were 419 adults with a Life-
(M = 18.10 years, SD = 9.47 years). The duration of OCD at the time
time diagnosis of OCD as determined by the administration of
of recruitment ranged from 0 to 64 years (M = 18.18 years,
the SCID-I (First, Spitzer, Gibbon, & Williams, 1996) who were part
SD = 12.36 years). The number of current diagnoses ranged from
of the NOCDA longitudinal study. Participants who did not have a
1 to 7 (M = 1.93, SD = 1.13; 45.0% = 1 diagnosis), and the number
current diagnosis of OCD at the time of recruitment into the study
of lifetime diagnoses ranged from 1 to 8 (M = 2.74, SD = 1.47;
(N = 37), did not have an age of onset recorded (N = 36), who had
21.7% = 1 diagnosis). Just over one third (36.6%) had a concurrent
not completed the personality (N = 19) or depression measures
diagnosis of anxiety disorder and almost half (46.9%) had a lifetime
(N = 3) were excluded, leaving a sample of 322 participant cases
diagnosis of anxiety disorder. Just under one fifth (18%) had a con-
for analysis. This sample size is sufficient for detecting small to
current diagnosis of major depressive disorder and more than half
medium size effects with a power of .8 at an alpha level of .05
(56.5%) had a lifetime diagnosis of major depressive disorder.
(G⁄Power 3.1; Faul, Erdfelder, Buchner, & Lang, 2009.
Descriptive statistics of scores and categories on the key mea-
sures are presented in Tables 1–3. Approximately three-quarters
of the participants experienced moderate to extreme obsessions
3. Measures and compulsions and mild to severe depression. At the time of
recruitment into the study approximately half (49.7%) of partici-
3.1. Demographic questionnaire pants were currently receiving psychotherapy, one in five (20.5%)
were receiving treatment at a hospital (admitted, daytime or
A structured questionnaire was used to gather information part-time) and three in ten (29.2%) were receiving more than one
regarding a number of demographic variables including: age, gen- type of treatment. The percentage of participants taking a range
der, and level of education. of doctor prescribed medications in the previous two weeks is
Structured Clinical Interview for DSM-IV (SCID-I; First et al., 1996) presented in Table 4. Approximately two thirds of participants
is a widely used clinician administered interview for diagnosing were prescribed psychotropic medications and two thirds
psychiatric disorders according to DSM-IV. The Dutch version has antidepressants.
good inter-rater reliability (Lobbestael, Leurgans, & Arntz, 2011). The personality scores of participants can be compared to the
The Five Factor Personality Inventory (FFPI; Hendriks, Hofstee, & normative sample used for establishing norms for the FFPI
De Raad, 1999a, 1999b) assesses the Big Five factors of personality (Hendriks et al., 1999a, 2011). The personality scores indicate that
using 100 brief and concrete items. As well as generating the five our OCD sample scores below the general population mean on
personality factors it is also possible to compute 40 bipolar facet Extraversion and Emotional Stability. To test the H1, that OCD par-
scores that are blends of the Big Five factors. The five factors mea- ticipants in this sample have significantly lower scores on Emo-
sured by the FFPI are Extraversion (I), Agreeableness (II), Conscien- tional Stability as compared to a normative sample, a one-sample
tiousness (III), Emotional Stability (IV) and Autonomy (V). Each of t-test was conducted. Participants in this OCD sample scored sig-
the factor scores have shown moderate to high reliability and good nificantly lower (M = .81, SD = 1.16) than the adult normative
construct validity in a variety of samples (Hendriks, Hofstee, & De sample score (M = 0.82, SD = 1, Hendriks et al., 1999a, 2011):
Raad, 2002; Hendriks, Hofstee, & De Raad, 2011; Hendriks et al., t(321) = 25.25, p < .001, d = 1.41, large effect.
1999a). In the present sample, the internal consistency reliabilities To test H2, that OCD participants in this sample have signifi-
were .86 for Extraversion, .83 for Agreeableness, .82 for Conscien- cantly lower scores on Extraversion as compared to a normative
tiousness, .81 for Emotional Stability, and .76 for Autonomy.
Yale Brown Obsessive–Compulsive Scale (Y-BOCS; Goodman, Price,
Rasmussen, Mazure, Fleischmann, et al., 1989). The Y-BOCS is a clini- Table 1
cian-rated, 10-item severity scale, with each item rated from 0 (no Mean, standard deviation and range of scores on key measures (N = 322).

symptoms) to 4 (extreme symptoms) (total range 0–40). The scale Measure Mean SD Range
has excellent inter-rater reliability and high internal consistency Y-BOCS
(Goodman, Price, Rasmussen, Mazure, Fleischmann, et al., 1989) Severity obsessions 10.43 3.99 0–20
as well as good convergent and discriminative validity Severity compulsions 10.67 4.34 0–20
(Goodman, Price, Rasmussen, Mazure, Delgado, et al., 1989) Severity total score 21.11 7.07 7–40
Beck Depression Inventory 15.94 10.02 0–51
Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996).
The BDI-II is a 21-item multiple-choice self-report inventory and it FFPI
Extraversion .10 1.29 3.39 to 3.03
is one of the most widely used instruments for measuring the
Emotional Stability .81 1.16 4.24 to 2.46
severity of depression and clinical improvements (Beck et al.,
C.S. Rees et al. / Personality and Individual Differences 71 (2014) 92–97 95

Table 2 r = .24, p < .001; small to medium effect size), but not with illness
FFPI scores by presence/absence of current major depressive disorder (N = 322). duration (r = .11, p = .06), partially supporting hypothesis 3.
No current major Current major Total Extraversion was significantly negatively correlated with both
depressive depressive symptom severity (r = .20, p < .001; small to medium effect size)
disorder disorder and illness duration (r = .21, p < .001; small to medium effect
N = 264 N = 58
size) supporting hypothesis four.
Extraversion .01 (1.28) .61 (1.20) .10 (1.29) In order to test mediation, a number of assumptions need to be
Emotional Stability .62 (1.11) 1.66 (.97) .81 (1.16)
met (Baron & Kenny, 1986). The independent, mediator and depen-
dent variables must be significantly associated. As displayed in
Table 5, both independent variables (Extraversion and Emotional
Table 3
Severity categories on Y-BOCS and Beck Depression Inventory (N = 322). Stability) were significantly negatively correlated with the media-
tor variable (depression scores) and one dependent variable (sever-
Category Frequency Percent
ity of symptoms). The mediator was also associated with both
a
Y-BOCS dependent variables. However, as previously noted Emotional Sta-
Subclinical 5 1.6
bility was not significantly associated with the second dependent
Mild 72 22.4
Moderate 118 36.6
variable (duration).
Severe 102 31.7 One standard and one hierarchical multiple regression analysis
Extreme 25 7.8 was conducted to test hypothesis five (see Table 6). The results
BDIb from the standard hierarchical regression demonstrate that in
Normal 96 29.8
combination, the two personality variables, Extraversion and Emo-
Mild to moderate 114 35.4
Moderate to severe 79 24.5 tional Stability, accounted for 52% of the variance in the proposed
Severe 33 10.2 mediator, BDI total depression scores, R2 = .52, F(2, 319) = 173.11,
a p < .001. On step one of the hierarchical multiple regression the
Categories from Goodman, Price, Rasmussen, Mazure, Fleischmann, et al.
(1989). two personality variables accounted for 7.9% of the variance in
b
Categories from Beck et al. (1996). OCD symptom severity scores R2 = .08, F(2, 319) = 13.72, p < .001.
Both Extraversion and Emotional Stability contributed significant
unique variance. On step two of the hierarchical multiple regres-
Table 4 sion BDI depression scores were entered and accounted for a fur-
Percentage of participants taking doctor prescribed med- ther 16.1% of the variance in symptom severity, DR2 = .09, F(1,
ications in previous two weeks by medication type.
318) = 34.40, p < .001. In total, the three predictor variables
Medication type % accounted for 16.9% of the variance in symptom severity,
Psychotropic 67.1 R2 = .17, F(3, 318) = 21.57, p < .001. Depression was a significant
Antipsychotic 17.7 predictor of symptom severity, but neither Extraversion nor Emo-
Antidepressant 62.4 tional Stability contributed significant unique variance any longer,
Benzodiazepines 16.8
indicating depression mediated the relationship between personal-
ity and OCD symptom severity. Sobel test-statistics confirm that
depression significantly mediated the relationship between Extra-
sample, a one-sample t-test was conducted. Participants in this version and symptom severity (t = 5.22, p < .001) and Emotional
OCD sample scored significantly lower (M = .10, SD = 1.29) than Stability and symptom severity (t = 5.94, p < .001). To further
the adult normative sample score (M = 0.39, SD = 1, Hendriks clarify the relationships, path analysis was conducted using LISREL
et al., 1999a, 2011): t(321) = 6.81, p < .001, d = 0.38, small-to- (version 8.8). The path model (see Fig. 3) clearly demonstrates that
medium effect. Table 2 provides a breakdown of FFPI Extraversion the impact of the personality variables on symptom severity is
and Emotional Stability scores by whether or not the participant fully mediated by depression.
had a current major depressive disorder at the time of inclusion As age was significantly correlated with OCD duration (see
in the study. Participants with a current major depressive order Table 4), partial correlations between variables, controlling for
scored significantly lower than those who did not on both age were conducted. The results are presented in Table 7. As Extra-
Extraversion (t(320) = 3.36, p = .001) and Emotional Stability version and depression are no longer significantly correlated with
(t(320 = 6.61, p < .001). OCD duration when partialling out age, hypothesis six cannot be
To test hypotheses three and four, that scores on Emotional Sta- supported. After controlling for age, there is no significant relation-
bility and Extraversion were significantly correlated with OCD ship between Extraversion, depression and OCD duration.
symptom severity and illness duration, a correlation matrix was To further investigate the role of depression, the data file was
produced (Table 5). Emotional Stability was significantly nega- split into participants with minimal/normal symptom levels on
tively correlated with symptom severity (Y-BOCS total score; the BDI (<13 n = 96) and levels indicating depression (>13

Table 5
Correlation matrix of key variables (N = 322).

Age Extraversion Emotional Stability BDI total Y-BOCS total OCD duration
Age 1
Extraversion .23** 1
Emotional Stability .09 .19** 1
BDI total .14* .54** .57** 1
Y-BOCS total .04 .20** .24** .41** 1
OCD duration .68** .21** .11 .14* .06 1
*
Significance level of p < .05.
**
Significance level of p < .01.
96 C.S. Rees et al. / Personality and Individual Differences 71 (2014) 92–97

Table 6 looking at correlations between the presence of a diagnosis of


Results of standard multiple regression predicting (1) depression scores and (2) OCD and personality, we examined correlations between OCD
symptom severity scores.
symptom severity and personality and found this relationship
Predictor B[95%CI] B sr2 was completely accounted for by level of depressive symptomatol-
(1) Depression scores ogy. This would suggest that an individual diagnosed with OCD
Extraversion 3.48[ 4.08, 2.87] .45 .19 may well be exhibiting heightened levels of Neuroticism and lower
Emotional Stability 4.23[ 4.90, 3.56] .49 .23 levels of Extraversion but that this is better explained by the addi-
(2) Symptom severity tional presence of significant levels of depression and not just OCD
Step 1 alone. This finding is consistent with Rector et al. (2002) who found
Extraversion .86[ 1.45, .27] .16 .02
Emotional Stability 1.27[ 1.92, .61] .21 .04
that depression was the variable most strongly related to elevated
Step 2 levels of Neuroticism and low Extraversion rather than OCD specif-
Extraversion .21[ .46,.87] .04 .00 ically. The same non-significance of personality variables was
Emotional Stability .03[ .73, .79] .01 .00 found when we split the sample into those with minimal versus
Depression (BDI) .31[.20, .41] .43 .09
those with elevated levels of depression. The former group evi-
Note: B = unstandardized regression coefficient, CI = confidence interval, B = stand- denced no relationship between personality and OCD symptom
ardised regression coefficient and sr2 = squared semi-partial correlation. severity or duration, whereas the latter group showed significant
correlations between both Extraversion and Neuroticism (low
Emotional Stability) and OCD.
Extraversion Interestingly, once age was controlled for in the analyses none
of the personality variables or level of depression was associated
.02
with symptom duration. This finding suggests that duration is
-.45** apparently independent of Neuroticism and Extraversion suggest-
.19 Depression Symptom ing that in the etiology of OCD, personality variables do not play an
.48** Severity important role. However, the strength of this conclusion must be
-.49** tempered by the fact that our measure of duration (age–age of
.00
onset) does not provide information as to possible periods of time
Emotional
during which an individual may have been symptom free.
Stability
The strength of this study is that it is one of the largest investi-
gations carried out to date in which personality has been investi-
Fig. 3. Path analysis results testing model with depression mediating the relation-
ship between personality factors and OCD symptom severity. All path coefficients gated with a large sample of OCD patients with a current
shown are standardised. ⁄⁄ indicates p < .001. diagnosis reliably established using a structured clinical interview.
This strengthens the generalisability of the current findings. How-
ever, the strength of findings could have been improved by the
Table 7 inclusion of an additional commonly used personality measure
Partial correlation matrix of key variables for predicting OCD duration (N = 322).
and we recommend this action for future studies.
Extraversion BDI total OCD duration The main implication of our results is that the further study of
Extraversion 1 personality and OCD should take into account the influence of
BDI total .53⁄⁄ 1 depressive symptoms. In particular, it is possible that the eleva-
OCD duration .08 .06 1 tions seen in previous studies examining personality traits could
⁄⁄
indicates p < .001. be state-dependent and may not represent particular vulnerabili-
ties to OCD but rather may be more transient and dependent on
depressive symptoms. A further potential explanation for the
n = 226) using established cut-off scores (Beck et al., 1996). In the results is that the personality profile related to OCD (high N, Low
minimal/normal group, there were no significant relationships E) is in fact mediated not by state levels of depression but by the
between the personality variables and OCD symptom severity. In influence of an underlying affective temperament. The present
contrast, in the ‘depressed’ group Extraversion was significantly data suggest that research on the influence of personality profiles
negatively correlated with OCD symptom severity (r = .14, on the development of OCD should include the measurement of
p = .03) and duration (r = .21, p < . 01) and Emotional Stability comorbid levels of depression as well, in order to be able to make
was significantly negatively correlated with OCD symptom sever- proper conclusions on the importance of personality variables in
ity (r = .20, p < .01). the aetiology of OCD.

Acknowledgments
5. Discussion
The research infrastructure needed to complete the baseline
As expected, our large sample of participants with a current measurements (including personnel and materials) was financed
diagnosis of OCD showed the typical personality pattern of high almost exclusively by the participating organizations: Academic
Neuroticism (low Emotional Stability) and Introversion (low Extra- department VU Medical Centre/GGZ inGeest, Amsterdam, The
version). However, as depression is highly comorbid with OCD and Netherlands; Innova Research Centre, Mental Health Care Institute
because previous studies had found an influence of depression on GGZ Centraal, Marinade Wolf Anxiety Research Centre, Ermelo, The
observed personality outcomes, we sought to further explore the Netherlands; Center for Anxiety Disorders ‘‘Overwaal’’, Lent, The
relationship between personality, depression and OCD. Our Netherlands; Dimence, GGZ Overijssel; Department of Psychiatry,
hypothesis, that depression would mediate the relationship Leiden University Medical Centre, Leiden, The Netherlands; ‘Vin-
between Extraversion, Neuroticism and OCD symptom severity cent van Gogh institute’ Mental Health Care Centre Noorden Mid-
was supported. This indicates that simply concluding that high den-Limburg, Venray, The Netherlands; Academic Anxiety Center,
Neuroticism and low Extraversion is significantly associated with PsyQ Maastricht University, Division Mental Health and Neurosci-
OCD does not provide an accurate picture. Instead of simply ence, Maastricht, The Netherlands, except for the fieldwork coordi-
C.S. Rees et al. / Personality and Individual Differences 71 (2014) 92–97 97

nator, which was financed for the duration of one year by a Hantouche, E. G., & Demonfaucon, C. (2008). Resistant obsessive–compulsive
disorder (ROC): Clinical picture, protective factors and influence of affective
research grant from the Stichting Steun.
temperaments. L’Encephale, 34(6), 611–617.
Hendriks, A. A. J., Hofstee, W. K. B., & De Raad, B. (1999a). Handleiding bij de five-
References factor personality inventory (FFPI) (The five-factor personality inventory:
Professional manual). Lisse: Swets Test Services.
Abramowitz, J. S. (2006). The psychological treatment of obsessive–compulsive Hendriks, A. A. J., Hofstee, W. K. B., & De Raad, B. (1999b). The five-factor personality
disorder. Canadian Journal of Psychiatry, 51(7), 407–416. inventory (FFPI). Personality and Individual Differences, 27, 307–325.
Abramowitz, J. S., & Foa, E. B. (1998). Worries and obsessions in individuals with Hendriks, A. A. J., Hofstee, W. K. B., & De Raad, B. (2011). Handleiding bij de five-factor
obsessive–compulsive disorder with and without generalized anxiety disorder. personality inventory II (FFPI-II) (The five-factor personality inventory II:
Behaviour Research and Therapy, 36, 695–700. Professional manual). Houten: Bohn Stafleu van Loghum.
Bartz, J. A., & Hollander, E. (2006). Is obsessive–compulsive disorder an anxiety Hendriks, A. A. J., Hofstee, W. K. B., & De Raad, B. (2002). The five-factor personality
disorder? Progress in Neuro-psychopharmacology & Biological Psychiatry, 30, inventory: Assessing the big five by means of brief and concrete statements. In
338–352. B. de Raad & M. Perugini (Eds.), Big five assessment (pp. 79–108). Göttingen:
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in Hogrefe & Huber.
social psychological research: Conceptual, strategic and statistical Lobbestael, J., Leurgans, M., & Arntz, A. (2011). Inter-rater reliability of the
considerations. Journal of Personality and Social Psychology, 51, 1173–1182. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression Disorders (SCID II). Clinical Psychology & Psychotherapy, 18, 75–79. http://
inventory-II. San Antonio, TX: Psychological Corporation. dx.doi.org/10.1002/cpp.693.
Bellodi, L., Scioto, G., Diaferia, G., Ronchi, P., & Smiraldi, E. (1992). Psychiatric Markarian, Y., Larson, M. J., Aldea, M. A., Baldwin, S. A., Good, D., Berkeljon, A., et al.
disorders in families of patients with obsessive compulsive disorder. Psychiatry (2010). Multiple pathways to functional impairment in obsessive–compulsive
Research, 42, 111–120. disorder. Clinical Psychology Review, 30(1), 78–88.
Bienvenu, O. J., Nestadt, G., Samuels, J. F., Costa, P. T., Howard, W. T., & Eaton, W. W. Rector, N. A., Hood, K., Richter, M. A., & Bagby, R. M. (2002). Obsessive–compulsive
(2001). Phobic, panic and major depressive disorders and the five-factor model disorder and the five-factor model of personality: Distinction and overlap with
of personality. The Journal of Nervous and Mental Disease, 189, 154–161. major depressive disorder. Behaviour, Research and Therapy, 40, 1205–1219.
Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among Rees, C. S., Anderson, R. A., & Egan, S. J. (2006). Applying the five-factor model of
dimensions of the DSM-IV anxiety and mood disorders and dimensions of personality to the exploration of the construct of risk-taking in obsessive–
negative affect, positive affect, and autonomic arousal. Journal of Abnormal compulsive disorder. Behavioural and Cognitive Psychotherapy, 34(1), 31–42.
Psychology, 107, 179–192. Roelofs, J., van Breukelen, G., de Graaf, L. E., Beck, A. T., Arntz, A., & Huibers, M. J. H.
Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: (2013). Norms for the beck depression inventory (BDI-II) in a large Dutch
psychometric evidence and taxonomic implications. Journal of Abnormal community sample. Journal of Psychopathology and Behavioral Assessment, 35,
Psychology, 100, 316–336. 93–98.
Costa, P. T., & McCrae, R. R. (1992). The five-factor model of personality and its Samuels, J., Nestadt, G., Bienvenu, O. J., Costa, P. T., Riddle, M. A., Liang, K. Y., et al.
relevance to personality disorders. Journal of Personality Disorders, 6, 360–371. (2000). Personality disorders and normal personality dimensions in obsessive–
Crino, R. C., & Andrews, G. (1996). Obsessive–compulsive disorder and axis I compulsive disorder. British Journal of Psychiatry, 177, 457–462.
comorbidity. Journal of Anxiety Disorders, 10, 37–46. Schuurmans, J., Van Balkom, A. J. L. M., Van Megen, H. J. G. M., Smit, J. H.,
Demal, U., Lenz, G., Mayrhofer, A., Zapotoczky, H.-G., & Zitterl, W. (1993). Eikelenboom, M., Cath, D. C., et al. (2012). The Netherlands Obsessive
Obsessive–compulsive disorder and depression: A retrospective study on Compulsive Disorder Association (NOCDA) study: Design and rationale of a
course and interaction. Psychopathology, 26, 145–150. longitudinal naturalistic study of the course of OCD and clinical characteristics
Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses of the sample at baseline. International Journal of Methods in Psychiatric Research,
using G⁄Power 3.1: Tests for correlation and regression analyses. Behavior 21(4), 273–285.
Research Methods, 41, 1149–1160. Tallis, F., Rosen, K., & Shafran, R. (1996). Investigation into the relationship between
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (1996). Structured clinical personality traits and OCD: A replication employing a clinical population.
interview for DSM–IV–TR axis I Disorders, patient edition (SCID-I/P, version 2.0). Behaviour Research & Therapy, 34(8), 649–653.
New York: Biometrics Research, New York States Psychiatric Institute. Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. aversive emotional states. Psychological Bulletin, 96, 465–490.
R., et al. (1989). The Yale-brown obsessive–compulsive scale: II. Validity. Watson, D., Clark, L. A., & Harkness, A. R. (1994). Structures of personality and their
Archives of General Psychiatry, 46(11), 1012–1016. relevance to psychopathology. Journal of Abnormal Psychology, 103, 18–31.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. Wu, K. D., Clark, L. A., & Watson, D. (2006). Relations between obsessive–compulsive
L., et al. (1989). The Yale-brown obsessive compulsive scale: I. Development, disorder and personality: Beyond axis I–axis II comorbidity. Journal of Anxiety
use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011. Disorders, 20, 695–717.