Soffer-Dudek Nirit
The Consciousness and Psychopathology Laboratory, Department of Psychology, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
Front Psychol. 2023 Mar 22;14:1132800. doi: 10.3389/fpsyg.2023.1132800. eCollection 2023.
A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.
强迫症或症状（OCD/S）与分离体验倾向（如人格解体-现实解体、专注和想象投入）之间存在的强烈且特定的联系无法用创伤来解释，且目前对此了解甚少。本文的理论阐述提出了五种不同的模型来概念化这种关系。根据模型1，分离体验是由OCD/S通过内向型注意力和重复导致的。根据模型2，分离性专注通过某种程度上的能动性缺失，因果性地导致了OCD/S以及相关的认知风险因素，如思维-行动融合。其余模型强调了共同的潜在因果机制：颞顶叶异常损害具身性和感觉统合（模型3）；睡眠改变导致嗜睡、梦样思维或混合睡眠-觉醒状态（模型4）；以及一个过度活跃、侵入性的意象系统，具有图像化思维倾向（模型5）。后一种模型与适应不良白日梦有关，这是一种被认为与强迫症谱系有紧密联系的分离性综合征。这五种模型指出了未来研究的潜在方向，因为这些理论解释可能有助于这两个领域相互作用，从而使双方受益。最后，确定了几条基于分离理论的路径，以进一步发展强迫症的临床干预。
