Publications of Interest

OCD, Trauma, and Dissociation

The topic of June 2021’s publications of interests is obsessive-compulsive disorder (OCD) and its role in the trauma response and related dissociative states. Multiple theories exist regarding the mechanisms at play in the complex psychological and physiological setting of OCD, trauma, and dissociation. The articles below explore psychological aspects including: emotional dysregulation, rumination, attachment, dissociation, and the posttraumatic stress symptoms characteristic of OCD, the contribution of environmental and interpersonal predictors on the long-term outcome of OCD, the role of the obsessive beliefs as predictors of the different dissociative symptom severities, and the role of attachment and attachment-related processes in context of treatment, and how attempts at cognitive control are impacted by fear-of-self vs. other-generated distractor thoughts.

Boger, S., Ehring, T., Berberich, G., & Werner, G. G. (2020). Impact of childhood maltreatment on obsessive-compulsive disorder symptom severity and treatment outcome. European Journal of Psychotraumatology, 11(1), 1753942.

Childhood maltreatment (CM) is associated with enhanced symptom severity of obsessive-compulsive disorder (OCD). However, little is known about the mechanisms underlying this relationship. In order to improve treatment for CM survivors suffering from OCD, it is important to understand the psychological processes mediating the putative association between CM and OCD.

The aim of the study was to investigate the role of emotion regulation difficulties, rumination, attachment, dissociation, and posttraumatic stress symptoms as potential mediators between CM and OCD symptom severity in a clinical sample of OCD patients (N = 68). Participants completed self-report questionnaires and standardized clinical diagnostic interviews while attending specialized inpatient treatment for OCD. To test hypothesis-based mediation models, mediation analyses were calculated using a regression-based approach.

As predicted, all hypothesized factors were found to mediate the association between CM and OCD symptom severity. Additionally, more severe CM leads to increased difficulties in emotion regulation, anxiety in close relationships, rumination, dissociative symptoms, and posttraumatic symptoms, which subsequently leads to more severe OCD symptoms.

The findings point towards psychological processes that might be responsible for the well-studied relationship between CM and OCD. Implications for future research and clinical management of OCD in CM survivors are discussed.

Tibi, L., van Oppen, P., van Balkom, A., Eikelenboom, M., Hendriks, G. J., & Anholt, G. E. (2020). Childhood trauma and attachment style predict the four-year course of obsessive compulsive disorder: Findings from the Netherlands obsessive compulsive disorder study. Journal of affective disorders264, 206–214.

Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder where most patients do not reach full symptomatic remission. Identifying predictors of course can improve patients’ care by informing clinicians on prognosis and enhancing treatment strategies. Several predictors associated with improved outcome of OCD were identified. However, research focused mainly on clinical, illness-related predictors of the course of OCD. This study examined the contribution of environmental and interpersonal predictors on the long-term outcome of OCD, in addition to the previously identified clinical indicators.                                               

*OPEN ACCESS* Pozza, A., & Dèttore, D. (2019). “Was it real or did I imagine it?” Perfectionistic beliefs are associated with dissociative absorption and imaginative involvement in obsessive-compulsive disorder. Psychology research and behavior management, 12, 603–607.

In the literature there are inconsistent data regarding the role of dissociation in OCD. No study explored the association between obsessive beliefs and dissociative symptoms in OCD. It is important to understand which clinical factors are related to dissociation in OCD as more severe dissociative symptoms, particularly absorption, have been found to be predictors of treatment non-response. In the present short report, we describe the results of an exploratory study aimed to investigate the role of the obsessive beliefs as predictors of the different dissociative symptoms controlling for anxiety and OCD severity in a group of OCD patients.

Doron, G. (2020). Self-vulnerabilities, attachment and obsessive compulsive disorder (OCD) symptoms: Examining the moderating role of attachment security on fear of self, Journal of Obsessive-Compulsive and Related Disorders, 27,

Recently, feared self-perceptions and attachment insecurities have been shown to be associated with obsessive compulsive disorder (OCD) symptoms and cognitions. In the current study, we examined the moderating role of attachment security in the form of low dispositional attachment anxiety and attachment avoidance on the link between fear of self and OCD symptoms. Two hundred and thirty-nine community participants completed a battery of questionnaires online. Consistent with our hypothesis, the link between fear of self and OCD symptoms was moderated by dispositional attachment security. Specifically, participants showing high fear of self-tendencies, but scoring low on both dispositional attachment anxiety and attachment avoidance showed less OCD symptoms than participants with high fear of self but showing either high attachment anxiety or attachment avoidance. We discuss the role of attachment and attachment-related processes within the proposed theoretical model and explore its implications to our understanding of OCD symptoms and their treatment.