Dissociative symptoms and dissociative disorder comorbidity in patients with obsessive-compulsive disorder Hasan Belli a, ⁎ , Cenk Ural a , Melek Kanarya Vardar a , Sema Yesılyurt b , Fatıh Oncu b a Department of Psychiatry, Bagcilar Education and Research Hospital, Istanbul, Turkey b Department of Psychiatry, Bakırkoy Mazhar Osman Education and Research Hospital for Mental Health and Neurological Diseases, Istanbul, Turkey Abstract The present study attempted to assess the dissociative symptoms and overall dissociative disorder comorbidity in patients with obsessive- compulsive disorder (OCD). In addition, we examined the relationship between the severity of obsessive-compulsive symptoms and dissociative symptoms. All patients admitted for the first time to the psychiatric outpatient unit were included in the study. Seventy-eight patients had been diagnosed as having OCD during the 2-year study period. Patients had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD. Most (76.9%; n = 60) of the patients were female, and 23.1% (n = 18) of the patients were male. Dissociation Questionnaire was used to measure dissociative symptoms. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders interviews and Yale-Brown Obsessive Compulsive Checklist and Severity Scale were used. Eleven (14%) of the patients with OCD had comorbid dissociative disorder. The most prevalent disorder in our study was dissociative depersonalization disorder. Dissociative amnesia and dissociative identity disorder were common as well. The mean Yale-Brown score was 23.37 ± 7.27 points. Dissociation Questionnaire scores were between 0.40 and 3.87 points, and the mean was 2.23 ± 0.76 points. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex dissociative disorder. Clinicians may overlook an underlying dissociative process in patients who have severe symptoms of OCD. However, a lack of adequate response to cognitive-behavioral and drug therapy may be a consequence of dissociative process. © 2012 Elsevier Inc. All rights reserved. 1. Introduction Dissociation refers to disruptions in the usually integrated functions of consciousness, such as memory, identity, and perceptions of the environment. Dissociation has been widely related to traumatic events, in particular to childhood abuse [1,2], emphasizing its function as an autohypnotic defense mechanism to maintain the psychological integrity of the individual [3]. Dissociative disorders constitute a group of clinical syndromes covering disturbances attributed to 1 or more of these domains. Dissociation may be sudden or gradual, transient, or chronic. Being the most chronic and complex type of dissociative disorders, dissociative identity disorder constitutes an overarching syndrome covering all dissociative phenomena. Depersonalization disorder, disso- ciative amnesia, and dissociative fugue are further categories of dissociative disorders. Dissociative conditions that do not fit the diagnostic criteria of these specific categories are diagnosed as dissociative disorder not otherwise specified. Besides constituting a diagnostic category on its own, dissociative symptoms may accompany almost all psychiat- ric disorders [4] including borderline personality disorder [5,6], conversion disorder [7], and obsessive-compulsive disorder (OCD) [8]. Obsessive-compulsive disorder is a frequent disorder with a lifetime prevalence rate between 1% and 3% [1] and, largely, chronic course of illness. This disorder is character- ized by recurrent obsessions or compulsions that are severe enough to be time consuming, cause marked distress, or lead Available online at www.sciencedirect.com Comprehensive Psychiatry 53 (2012) 975 – 980 www.elsevier.com/locate/comppsych Conflicts of interest: There are no conflicts of interest. Role of funding source: None of the authors have received funding for this article. ⁎ Corresponding author. Bağcılar Eğitim ve Araştırma Hastanesi, Istanbul, Turkey. Tel.: +90 212 440 40 00; fax: +90 212 440 40 02. E-mail address: hasanbelli@mynet.com (H. Belli). 0010-440X/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.comppsych.2012.02.004