Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice

Abstract

A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.

Posttraumatic symptoms and poor sleep are independent pathways to agency disruptions and dissociation: A longitudinal study with objective sleep assessment.

“…When this mechanism goes awry, there is an aberrant, redundant focus on one’s internal inputs, which may prompt an experience of self-detachment or a split between an operating self and a self who is observing the action, that is, depersonalization (Ciaunica et al, 2022). Indeed, dissociative depersonalization has been recently theorized to be driven by excessive inwards-focused attention (Soffer-Dudek, 2023; Soffer-Dudek & Somer, 2022). Similarly, the dissociative factor of absorption and imaginative involvement is characterized by a restricted field of attention and neglect of the surrounding environment (Soffer-Dudek et al, 2015), also suggesting excessive inwards-attention.…”

Intense Imagery Movements May Lead to Maladaptive Daydreaming: A Case Series and Literature Review

“…In recent years it is becoming evident that trauma explains only some, rather than all, of the variance of dissociation. [10][11][12] For example, dissociation and decreased sense of agency both seem to play central roles in OCD, whereas trauma does not. 12 There is currently a paucity of research exploring the neurobiological and cognitive mechanisms underlying IIM/MD.…”

“…[10][11][12] For example, dissociation and decreased sense of agency both seem to play central roles in OCD, whereas trauma does not. 12 There is currently a paucity of research exploring the neurobiological and cognitive mechanisms underlying IIM/MD. For most individuals, visual imagery plays a crucial role in daydreaming.…”

“…In recent years it is becoming evident that trauma explains only some, rather than all, of the variance of dissociation. 10 , 11 , 12 For example, dissociation and decreased sense of agency both seem to play central roles in OCD, whereas trauma does not. 12 …”

Exploring the Interplay between Complex Post-Traumatic Stress Disorder and Obsessive–Compulsive Disorder Severity: Implications for Clinical Practice

“…Similarly, childhood exposure to trauma has been linked to unfavorable outcomes across a range of psychiatric disorders, including functional impairment, a more severe illness trajectory, and an increased risk of chronic fatigue or pain [ 33 ]. Traumatic experiences, particularly those occurring during childhood, represent the most extensively studied etiological factor in the development of dissociation [ 43 ]. In clinical contexts, dissociation constitutes a core symptom across various disorders, including obsessive–compulsive disorder and Complex Post-traumatic Stress Disorder [ 44 ].…”