Are trauma and dissociation related to treatment resistance in patients with obsessive–compulsive disorder?
- 536 Downloads
Previous research has indicated a relation between obsessive–compulsive disorder (OCD), childhood traumatic experiences and higher levels of dissociation that appears to relate to negative treatment outcome for OCD. The aim of the present study is to investigate whether childhood trauma and dissociation are related to severity of OCD in adulthood. We also intend to examine the association between treatment resistance, dissociation, and each form of trauma.
Participants included 120 individuals diagnosed with OCD; 58 (48.3 %) of them met the criteria for treatment-resistant OCD (resistant group), whereas the other 62 (51.7 %) were labeled as responder group. The intensity of obsessions and compulsions was evaluated using Yale-brown obsessive–compulsive scale (Y-BOCS). All patients were assessed with the traumatic experiences checklist, dissociative experiences scale, beck depression inventory, and beck anxiety inventory.
Controlling for clinical variables, resistant group had significantly higher general OCD severity, anxiety, depression, trauma, and dissociation scores than the responders. Correlation analyses indicated that Y-BOCS scores were significantly related to severity of dissociation, anxiety, depression, and traumatic experiences. In a logistic regression analysis with treatment resistance as a dependent variable, high dissociation levels, long duration of illness, and poor insight emerged as relevant predictors, but gender, levels of anxiety, depression, and traumatic experiences did not.
Our results suggest that dissociation may be a predictor of poorer treatment outcome in patients with OCD; therefore, a better understanding of the mechanisms that underlie this phenomenon may be useful. Future longitudinal studies are warranted to verify if this variable represents predictive factors of treatment non-response.
KeywordsObsessive–compulsive disorder Treatment resistance Childhood trauma Dissociation
Conflict of interest
On behalf of all the authors, the corresponding author states that there is no conflict of interest.
- 3.Goodman WK, Ward HE, Kablinger AS, Murphy TK (2000) Biological approaches to treatment-resistant obsessive-compulsive disorder. In: Goodman WK, Rudorfer MV, Maser JD (eds) Obsessive-compulsive disorder: contemporary issues in management. Lawrence Erlbaum Associates, London, pp 333–369Google Scholar
- 11.Caspi A, Vishne T, Sasson Y, Gross R, Livne A, Zohar J (2008) Relationship between childhood sexual abuse and obsessive-compulsive disorder: case control study. Isr J Psychiatry Rel Sci 45:177–182Google Scholar
- 21.First MB, Spitzer RL, Gibbon M, Williams JBW (1997) Structured clinical interview for DSM-IV Axis I disorders: clinical version (SCIDCV). American Psychiatric Press, Washington, DCGoogle Scholar
- 25.Semiz UB, Basoglu C, Ebrinc C, Ergun BM, Noyan CO, Cetin M (2005) Body dysmorphic disorder, trauma, and dissociation in patients with borderline personality disorder: a preliminary study. Bull Clin Psychopharmacol 15:65–70Google Scholar
- 26.Hisli N (1989) Reliability and validity of BECK depression inventory among university students. J Turk Psychol 7:3–13 (in Turkish)Google Scholar
- 29.Ulusoy M, Erkmen H, Sahin N (1998) Turkish version of the beck anxiety inventory: psychometric properties. J Cogn Psychother 12:163–172Google Scholar
- 30.Yargic LI, Tutkun H, Sar V (1995) The reliability and validity of the Turkish version of the dissociative experiences scale. Dissociation 8:10–13Google Scholar
- 34.Cromer KR, Schmidt NB, Murphy DL (2006) An investigation of traumatic life events and obsessive-compulsive disorder. Behav Res Ther 4:1683–1691Google Scholar
- 44.Kluft RP (1993) Multiple personality disorder. In: Spiegel DA (ed) Dissociative disorders: a clinical review. Sidran Press, Lutherville, pp 17–44Google Scholar
- 51.Pica M, Beere D, Maurer L (1997) The overlap between dissociative and obsessive-compulsive disorders: a theoretical link. Dissociation 10:38–43Google Scholar