Personality Dimensions in Pathological Gambling Disorder and Obsessive᎐Compulsive Disorder

Psychiatry Research 104Ž. 2001 205᎐212

Personality dimensions in pathological gambling disorder and obsessive᎐compulsive disorder

Suck Won KimU, Jon E. Grant Department of Psychiatry, Uniërsity of Minnesota School of Medicine, F256r2A West, 2450 Riërside Aënue, Minneapolis, MN 55454-1495, USA

Received 24 February 2001; received in revised form 15 August 2001; accepted 19 September 2001

Abstract

This study was conducted to investigate the similarities and differences in the personality dimensions of patients with pathological gambling disorderŽ. PGD and obsessive᎐compulsive disorder Ž. OCD . Thirty-three subjects with PGD, 41 with OCD and 40 normal controls were assessed with the Tridimensional Personality QuestionnaireŽ. TPQ , which assesses three personality dimensions: novelty seeking, reward dependence, and harm avoidance. Compared with OCD subjects, PGD subjects expressed significantly greater novelty seeking, impulsiveness, and extravagance. The PGD subjects also reported significantly less anticipatory worry, fear of uncertainty, and harm avoidance than the OCD subjects. Compared with controls, the PGD subjects expressed significantly greater novelty seeking, impulsiveness, and extravagance. These results suggest that the personality dimensions of pathological gamblers may differ significantly from both those of OCD patients and normal controls. ᮊ 2001 Elsevier Science Ireland Ltd. All rights reserved.

Keywords: Tridimensional Personality Questionnaire; Impulsiveness; Obsessive᎐compulsive disorder

1. Introduction 2001. . Gambling activities, like OCD compulsions, are often experienced as uncontrollable Pathological gambling, a disorder characterized and anxiety- or tension-relieving, may be resisted, by persistent and recurrent maladaptive patterns are often followed by self-reproach, and are often of gambling behavior, is classiﬁed as an impulse deniedŽ. McElroy et al., 1994 . Furthermore, treat- control disorder in DSM-IV, but has been noted ment data suggest that pathological gambling dis- to have similarities to obsessive᎐compulsive dis- orderŽ. PGD , like OCD, may respond to sero- orderŽ.Ž OCD McElroy et al., 1993; Blanco et al., tonin reuptake inhibitorsŽ Hollander et al., 2000; Kim and Grant, 2001. . U There is, however, scant and contradictory lit- Corresponding author. Tel.: q1-612-273-9805; fax: q1- 612-273-9779. erature concerning OCD or OCD traits in sub- E-mail address: [email protected]Ž. S. Won Kim . jects with PGD. Two epidemiological studies are

0165-1781r01r$ - see front matter ᮊ 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 5 - 1 7 8 1Ž. 0 1 00327-4 206 S. Won Kim, J.E. Grant rPsychiatry Research 104() 2001 205᎐212 inconclusive concerning the rates of comorbid Little has been published on the prevalence of OCD in pathological gamblers. One study failed categorical personality disorders in subjects with to find an increased odds ratio for OCD in sub- PGD. A study of 30 subjects with PGD found jects with PGDŽ Cunningham-Williams et al., high rates of obsessive᎐compulsive personality 1998. , whereas the other study concluded that the disorderŽ. 59% , avoidant personality disorder relative risk for OCD in PGD was 7.2Ž Bland et Ž.50% , and schizoid and schizotypal personality al., 1993. . One study looking at rates of OCD in a disordersŽ.Ž 33 and 30%, respectively Black and small sample Ž.Ns25 of pathological gamblers Moyer, 1998. . One other study found that 93% of found that perhaps 20% suffered from comorbid a group of subjects seeking gambling treatment OCDŽ. Linden et al., 1986 . met criteria for at least one personality disorder Reviewing the literature on OCD traits in Ž.Blaszczynski and Steel, 1998 . pathological gamblers is also inconclusive. One This study was conducted to investigate the study examining obsessions and compulsions similarities and differences in the personalities of Ž.using the Padua Inventory in subjects with PGD patients with PGD and OCD. Unlike categorical found that pathological gamblers scored signifi- assessments of personality disorders, the unified cantly higher on obsessive᎐compulsiveness than biosocial model of personality proposed by normal controls, particularly on the element of Cloninger identifies three heritable personality ‘impaired control over mental activities’Ž Blaszc- dimensions, each hypothesized to represent an zynski, 1999. . These results, however, may high- independent behavioral response disposition light the obsessionality in pathological gamblers Ž.Cloninger, 1986, 1987 . The Tridimensional Per- or may simply reflect adequate insight by subjects sonality QuestionnaireŽ. TPQ operationalizes with PGD concerning their PGD symptoms these dimensions: novelty seeking; harm avoid- Ž.Blanco et al., 2001 . ance; and reward dependence. When assessing rates of comorbid PGD in sub- Individuals who score high on the novelty seek- jects with OCD, however, the results do not sup- ing dimension of the TPQ are thought to be port a strong association between the disorders. A impulsive, extravagant and disorderlyŽ Pfohl et al., study of 701 subjects with OCD found that less 1990; Svrakic et al., 1991. . High avoidance scores than 1% had a lifetime diagnosis of PGDŽ Hol- are associated with anticipatory worry, fear of lander et al., 1997. . A second study of 80 subjects uncertainty, shyness and fatigabilityŽ Pfohl et al., with OCD found that no one had a current or 1990; Svrakic et al., 1991. . The harm avoidance lifetime diagnosis of PGDŽ. Bienvenu et al., 2000 . scale serves as a modulating influence on Even studies looking at first-degree relatives of reward-seeking behaviorŽ. Cloniger, 1986 . Per- subjects with OCD have found virtually no one sons scoring high on the reward dependence scale who carries a diagnosis of PGDŽ Black et al., tend to be sentimental, socially sensitive, and 1994; Bienvenu et al., 2000. dependent, and they readily form attachments to Obsessive᎐compulsive disorder and impulsivity othersŽ. Pfohl et al., 1990; Svrakic et al., 1991 . may not be mutually exclusive, and impulsivity Personality features may predispose an individ- may instead index a subgroup of subjects with ual to, result from, or modify the clinical presen- OCDŽ. Blanco et al., 2001 . One study found that tation of psychiatric illnesses such as PGD and subjects with OCD and a history of impulsiveness OCD. Also, comorbid personality disorders are scored higher on the Barratt Impulsiveness Scale often associated with poorer medication and ther- than subjects with OCD and no history of impul- apy response as well as a poorer long-term prog- sivenessŽ. Hoehn-Saric and Barksdale, 1983 . Sup- nosisŽ. Battaglia et al., 1996 . Thus, a dimensional porting the view of OCD subjects as being harm assessment of personality in patients with PGD avoidant, however, one study found that subjects and OCD may have both diagnostic and treat- with OCD did not score higher than normal con- ment implications. trols on the Barratt Impulsiveness ScaleŽ Stein et We hypothesized that PGD subjects would al., 1994. . score significantly higher than OCD subjects and