Exploring the Link Between OCD and Dissociation: What You Need to Know

Have you been diagnosed with OCD, and feel as if you are an “observer” in your own life or body? If so, you are not alone. Obsessive-compulsive disorder (OCD) and dissociation are two mental health conditions that are often misdiagnosed and misunderstood. In some cases, these conditions are not only linked, but can also have a significant impact on a person’s life. In this article, we will explore the link between OCD and dissociation. More specifically, we will explore how these two conditions are connected, and ways to effectively cope with them.

What is OCD?

OCD is an anxiety condition that is characterized by unwanted and uncontrollable intrusive thoughts, such as a fear of contamination or hurting oneself or others, making a mistake, and compulsive behaviors, such as repetitive checking, organizing, counting, cleaning, hoarding, avoiding, etc. Some OCD sufferers engage in repetitive behaviors to stop the intrusive and upsetting thoughts, urges, mental images, and/or fear. The purpose of these behaviors is to quell the OCD thoughts, and reduce the stress and anxiety triggering them.

OCD can be, and often is life-altering. It is considered a “lonely” condition because most OCD sufferers hide this condition from others, especially their loved ones, friends, and co-workers. Because OCD is time-consuming, it can lead to a loss of employment, which could then lead to debt or even homelessness. This anxiety condition could also cause issues in relationships, especially, if a partner feels like they are not receiving the attention and affection they desire – due to OCD thoughts and behaviors.

Comorbidity is also common with OCD. Commorbid or co-occurring conditions can make diagnosing and treating both conditions tricky, but not impossible. A common comorbidity involves OCD and dissociation. Researchers have found that people who experience dissociative thinking and inferential confusion may be prone to developing OCD – or vice versa. An OCD and dissociation comorbidity is usually treated together by an OCD therapist, however, in some cases, the two conditions may be treated consecutively (one at a time and back-to-back).

There are a wealth of available OCD treatments, such as OCD therapies, medications, natural remedies, and self-help tools, like Impulse Therapy, an online OCD treatment program. With the right treatment, most people with OCD go on to live happy and productive lives.

What is Dissociation?

Dissociation is a mental process that involves disconnecting from reality. It is often used as a coping mechanism to deal with difficult emotions or situations. People who dissociate can become disconnected from their thoughts, feelings, memories, and sense of identity. They may feel detached from their body and the world around them, and not remember what happened during that time. These individuals may feel as if they are observing themselves from an “outsider” perspective.

People who have experienced abuse or trauma are also at-risk of dissociating, because the purpose of this act is to help people cope with upsetting events. However, if dissociation continues after the event, for a long time, or indefinitely, it can negatively affect a person’s health, happiness, and quality of life.

Are There Different Types of Dissociation?

Yes, there are different types of dissociation.

Approximately, ⅓ of people have dissociated at least once. And, about 4% of people frequently dissociate or suffer from a severe form of dissociation. Although there are many different types of dissociation, most share features in common.

People who dissociate may appear to…

• Be distracted or not fully present
• Be spaced out” when talking to others
• Be functioning on “autopilot”
• Daydreaming or moving slowly
• Say, respond to, or act out-of-character
• Experience incomplete memories 
• Experience a loss of time

The three main types of dissociation are dissociative identity, dissociative amnesia (i.e., severe dissociative fugue), and depersonalization-derealization. The DSM also includes specified dissociative disorder and unspecified dissociative disorder in this category.

What is the Most Common Dissociative Condition?

The most common dissociative condition is dissociative identity (DID). Approximately, 2% of the general population suffers from DID. DID typically presents during childhood and follows the person into adulthood. People with this condition tend to have multiple identity states, commonly referred to as “alters.” These “alerts” can take over a person’s thoughts and behavior during times of stress, illness, or trauma. When an “alter” takes over, the person is unlikely to remember what happened during that time.

As with other types of dissociation, DID is often a response to something, like illness, trauma, or stress. It is also linked to certain conditions, such as dissociative depression, anxiety, addiction, attention-deficit hyperactivity disorder (ADHD), borderline personality disorder (BPD), and obsessive-compulsive disorder (OCD).

DID can cause extreme emotional distress, strain, and pain. People with this mental health condition are also at-risk of self-harm and suicidal ideation (thoughts and attempts). People with DID struggle to maintain their identity, and fear what their “alters” may do while in control. Being unable to remember what happened while their “altars” were in control also frustrates these individuals.

How is Dissociation Treated?

Dissociation is normally treated with therapy. The most effective dissociation treatments include cognitive-behavioral therapy (CBT), psychodynamic psychotherapy, dialectical behavior therapy (DBT), and eye movement desensitization and reprocessing (EMDR). However, when therapy alone is ineffective or detrimental to a person’s health and well-being, medication(s) are usually added to the treatment plan.

Medications, like SSRI antidepressants, anti-anxiety medications, and antipsychotics, may also be prescribed when severe depression and/or anxiety symptoms accompany the dissociation. However, there is no “official” medication for dissociation. Keep in mind, however, that the most effective dissociative disorders treatments not only address dissociative disorders, but also comorbidities and unresolved trauma.

Are OCD and Dissociation Linked?

Yes, OCD is linked to dissociation.

Although OCD and dissociation are two separate and distinct conditions, researchers suggest that they are linked. Thus, OCD sufferers have an increased risk of dissociating, especially those who have a history of abuse or trauma. Because dissociation involves “escaping” something, OCD sufferers are susceptible to developing this condition. Some OCD sufferers dissociate to cope with their intrusive and upsetting thoughts, fears, and doubts and compulsive and ritualistic behaviors.

Dissociation provides a temporary “escape” from the stress and anxiety, caused by their obsessive thoughts and/or compulsive behaviors. So, while dissociation is a distinct condition, it can also be a symptom of OCD. Thus, people with OCD may dissociate so they do not have to deal with their obsessions and compulsions. Dissociating helps these individuals “block out” their obsessions and/or compulsion, so they can focus on something else.

Comorbid conditions, like OCD and trichotillomania, also have a higher than normal risk of experiencing dissociation. Researchers also found that people with OCD and trichotillomania have an increased risk of dissociating. Severe dissociative symptoms are common in a large proportion of people diagnosed with these conditions.

Causes of OCD and Dissociation

The cause(s) of OCD and dissociation are not fully understood at this time. However, there are certain factors that may play a role in the development of both conditions. These include genetic factors, neurological factors, environmental factors, and psychological factors.

Genetics

Genetic factors may play a role in the development of OCD and dissociation. Studies suggest that people with a family history of OCD or dissociation are more likely to develop the other condition. More specifically, people with a sibling, parent, or child, who also has OCD or a dissociative condition are more likely to develop it themselves, especially if a relative developed the condition during childhood. It is still unclear as to how OCD and dissociation are inherited.

Neurological Factors

Neurological factors, like genetic mutations or brain chemistry changes, may contribute to the development of OCD and dissociation. Some researchers believe that various genetic mutations may play a role in how these OCD and dissociation traits are passed down, however the jury is still out on this possible cause.

Environmental Factors

Environmental factors, like stress, trauma, or a history of abuse, may increase one’s risk of developing OCD or a dissociative condition. Researchers found that childhood trauma (i.e., the loss of a family member during childhood, abuse, neglect, etc.) may precipitate or trigger dissociation in adults.

Psychological Factors

Psychological factors, like depression or anxiety, may increase one’s risk of developing OCD and dissociation. According to a 2010 study, people who suffer from severe anxiety, depression, and OCD have a higher likelihood of experiencing dissociation.

Other factors that could contribute to the development of OCD and dissociation include:

• Addiction or Substance Abuse
• Mental Illness
• Learned Behaviors
• Combat
• Torture
• Accidents (i.e., Traumatic Falls, Plane or Vehicle Accidents, etc.)
• Illness or Infection
• Relationship Problems

Symptoms of OCD and Dissociation

OCD and dissociation symptoms vary from person to person, however, there are some common ones linked to both OCD and dissociation.

These common symptoms include:

• Obsessions and/or compulsions (repetitive behaviors) targeted towards specific topics or tasks
• A feeling of being an “outsider looking in” on one’s life or a feeling of being out-of-control of one’s thoughts and behaviors 
• Excessive or chronic stress 
• A need to “escape” or avoid someone or something
• Confusion
• Indecisiveness
• Anxiety
• Depression
• False, missing, or inaccurate memories – One OCD type involves false memories – or an obsession that revolves around an event or experience that never happened.

Researchers suggest that there may be a link between “checking behaviors” and OCD-related dissociation. They also suggest that OCD-related “checking compulsions” may be linked to amnestic dissociation. Moreover, an 2014 study also found that dissociation not only exacerbates OCD symptoms, but also serves as an “escape” or adaptive coping mechanism.

Researchers have also found that people with severe dissociation have more severe OCD symptoms, are more depressed, and are more likely to have a personality disorder, than people with low milder dissociation. Keep in mind that even though OCD sufferers were more likely to experience and report dissociative symptoms, the reverse can also be said with people with dissociative symptoms or conditions more likely to experience OCD or OCD-like symptoms.

Diagnosing OCD and Dissociation

Diagnosing OCD and dissociation can be difficult, as both conditions can have similar symptoms. The most diagnostic methods include structured interviews, self-reports, psychological assessments, and clinical observation. A mental health professional can help to diagnose and treat OCD and dissociation, so it is important to seek professional help, if you are experiencing symptoms that you think may be linked to OCD or dissociation.

Treating OCD and Dissociation

Treating OCD and dissociation can be challenging, but doable. Like OCD, the most common treatment for dissociation is cognitive-behavioral therapy (CBT). CBT involves helping a person identify and change their thoughts and behaviors. More specifically, it involves altering the way a person thinks in order to change the way they behave. And, like OCD, when therapy alone does not work for some reason, medication(s) are prescribed. The most common medication used to treat both conditions is SSRI antidepressants.

Other therapies and medications that can be used to treat OCD and dissociative conditions include: antipsychotics, serotonin-norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, monoamine oxidase inhibitors (MAOIs), or tricyclic and tetracyclic antidepressants, benzodiazepines, dialectical behavior therapy (DBT), psychodynamic psychotherapy, hypnotherapy/hypnosis, eye movement desensitization and reprocessing (EMDR), and schema therapy (a mental framework that a person develops to help them interpret their experiences).

Many times people with OCD and DID experienced trauma, abuse, and/or neglect during childhood, causing them to develop negative or damaging schemas and unhealthy coping skills and mechanisms. Although treating OCD can be challenging, treating dissociation can be even more difficult. Dissociation involves helping people reconnect to their memories and emotions, while treating OCD is to reduce the intrusive thoughts and emotions, causing them to perform certain rituals or routines. It is important to seek professional help if you are experiencing any symptoms of dissociation.

Coping with OCD and Dissociation

Coping with OCD and dissociation will take effort, persistence, and patience. Fortunately, there are certain strategies that can help you accomplish this feat. The first step is to create a plan for managing your symptoms. This may include: setting realistic goals, creating a daily routine, and engaging in self-care activities. It may also include natural remedies, and self-help tools, like mindfulness meditation, OCD workbooks, lifestyle changes, support groups, healthy coping skills and strategies, and an online OCD recovery treatment program, like Impulse Therapy. 

The most important way to cope with OCD and dissociation is to ask for help, if you find yourself struggling. OCD and dissociative conditions can be extremely lonely and confusing, but you do not have to tackle them alone. A great way to get support and process your thoughts and feelings is to talk to someone you trust, like a close friend or relative. Moreover, if you feel like you need additional help, schedule an appointment with a mental health professional.

Conclusion

OCD and dissociation are serious mental health conditions that can have a significant impact on a person’s life. Therefore, it is important to not only understand how OCD and dissociation are intertwined, but also how to effectively cope with them. If you are experiencing symptoms of one or both conditions, it is important to seek professional help.

References

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