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Abstract
Previous studies have described co-occurrence between obsessive-compulsive disorder (OCD) and dissociation. We intended to evaluate the phenomenological association between different obsessive-compulsive and dissociative symptoms more precisely. Seventy patients with OCD (DSM-IV) were evaluated with the Hamburg Obsessive-Compulsive Inventory (HZI) and the Dissociation Experience Scale. Correlation and discriminant analysis were performed. The dimensions 'Checking' and 'Symmetry and Ordering' were significantly related to dissociative symptomatology. A clear-cut lack of association was found in 'Washing and Cleaning','Counting and Touching' and 'Aggressive Impulses and Fantasies'. HZI dimensions significantly discriminated patients with high from patients with low dissociative symptomatology. Psychodynamic and therapeutical aspects of these findings are discussed.
Introduction
Obsessive-compulsive disorder (OCD) is a frequent disorder with a lifetime prevalence rate between 1 and 3 % [1] and largely chronic course of illness. In psychodynamic tradition, obsessions and compulsions are generally viewed as a defense mechanism against intolerable drives and wishes [2], but newer research favors a broader psychodynamic function. Predominantly aggressive feelings and fantasies should be controlled by obsessions and compulsions [3], and often these symptoms also serve as a self-stabilizing mechanism in patients with narcissistic deficits [4-6]. Dissociation has been widely related to traumatic events, in particular to childhood abuse [7, 8], emphazising its function as an autohypnotic defense mechanism to maintain the psychological integrity of the individual [9]. Therefore, a symptomatological overlap between OCD and dissociation seems to be likely. Previous studies have described an association between depersonalization [10] and multiple personality with OCD [11]. Additionally, obsessive-compulsive personality traits have been linked to dissociation [ 12-14].
Goff et al. [15] investigated 100 patients with OCD and characterized the group with high levels of dissociation in detail. Eleven of these patients really presented a clear-cut dissociative symptomatology, but in 5 other patients, obsessive-compulsive symptomatology was considered to mimick dissociation mainly in 'checkers'.
Apart from its theoretical and diagnostical implications dissociative symptomatology may significantly interfere with behavioral therapy in OCD. We therefore aimed to assess dissociative symptoms in relation to different subtypes of obsessive-compulsive symptomatology.
Material and Methods
Seventy patients with a DSM-IV diagnosis of OCD, who received treatment in the outpatient department (Department of Psychiatry, University of Bonn) were interviewed with the German version of SADS-LA-IV [16] (DSM-IV) [17] and completed the following rating scales....