It is believed that 1% of the population of the United States has dissociative identity disorder that is caused by repeated, severe childhood trauma. However, many who live with the diagnosis of DID have the double whammy of obsessive-compulsive disorder (OCD).
What obsessive-compulsive disorder and what are its symptoms, causes, and treatments? Plus, how are OCD and DID connected?
What is Obsessive-Compulsive Disorder?
The Mayo Clinic offers this definition of OCD:
“Obsessive-compulsive disorder (OCD) features a pattern of unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). These obsessions and compulsions interfere with daily activities and cause significant distress.”
Those living with OCD cannot ignore nor stop their obsessive behavior and trying to do so increases their anxiety and distress driving them to perform compulsive acts to ease the distress. Bothersome thoughts or urges get worse with attempts to ignore them as well leading to more ritualistic behavior. Thus spins the wheel of obsessive-compulsive disorder.
The need to check and recheck things and/or wash obsessively or other unusual behaviors and thoughts associated with obsessive-compulsive disorder is highly disruptive to the lives of those who live with the condition.
What Causes OCD?
Three main theories for the cause of OCD have been identified including:
Each set of causes brings with it their own theory description of how obsessive-compulsive disorder.
Biological Theory. This theory focuses on the circuit in the brain that regulates primitive aspects of behavior such as aggressive, bodily excretions, and sexuality. When these circuits are damaged, it causes repetitive behaviors (compulsions) and uncontrollable thoughts (obsessions).
Genetic Theory. Since OCD tends to run in families, one theory proposes that the disorder is somehow written in and passed on through inherited genes. Work on this theory has only just begun, however here is a link to a paper describing one study for more information.
Environmental Theory. Parenting styles and stress are environmental factors that are blamed in this theory for the cause of OCD. However, to date, no research has proven definitively that poor parenting or an abusive home causes obsessive-compulsive disorder.
Risk Factors for OCD
There are some risk factors that increase the chances of triggering or forming obsessive-compulsive disorder. These factors include:
- Stressful Life Events
- Family History
- Other Mental Health Disorders
Stressful Life Events. Traumatic or stressful events, for an unknown reason, triggers the intrusive thoughts, rituals, and emotional distress of OCD. These stressful life events may include childhood trauma which is also a cause of dissociative identity disorder.
Family History. As with the genetic theory, having a parent or other family member who has obsessive-compulsive disorder increases the risk of developing the disorder.
Other Mental Health Disorders. Obsessive-compulsive disorder might be related to other mental health conditions like anxiety, depression, or substance abuse disorders.
OCD and DID Can Be Co-Occurring
While obsessive-compulsive disorder and dissociative identity disorder are two different diagnoses, they overlap in many cases giving those who have both double trouble.
A study conducted in 2012 by Belli, Ural et. al. found that when clinicians observe dissociative symptoms in their clients with OCD are dealing with chronic and underlying dissociative disorders.1 One of these disorders may be dissociative identity disorder.
The study went on to conclude that there is a lack of adequate responsive responses to chemical and behavioral therapies that may be caused by a co-occurring underlying dissociative disorder.
This bleed over between OCD and DID (or any other dissociative disorder) may be one reason so many people are diagnosed incorrectly as having only one or the other diagnosis.
In a study conducted at the Department of Psychiatry, Harvard Medical School, in Boston Massachusetts, found the following:
“Patients with elevated dissociation scores had more severe OCD symptoms, were more depressed, and were more likely to have a personality disorder than patients with low dissociation scores. Although dissociative symptoms were frequently reported by OCD patients, symptoms of OCD may also mimic dissociation in some patients.”2
These findings mean that the symptoms of OCD may ape dissociation in some people.
The Treatment Overlap Between OCD and DID
While obsessive-compulsive disorder is treated with medications and sometimes deep brain stimulation, what is has in common for treatment with dissociative identity disorder is psychotherapy.
To be clear, dissociative identity disorder has no medications that are implicated for its treatment, however, medicine can alleviate some of the symptoms of comorbid diagnoses such as OCD.
It is vital that survivors who are experiencing symptoms of obsessive-compulsive disorder to tell their doctor or therapist of any obsessive (unwanted thoughts) or compulsions (unwanted urges to do things repeatedly) immediately. It is only by being honest with clinicians that survivors can find relief and regain their lives from both OCD and DID.
- Belli, H., Ural, C., Vardar, M. K., Yesılyurt, S., & Oncu, F. (2012). Dissociative symptoms and dissociative disorder comorbidity in patients with obsessive-compulsive disorder. Comprehensive Psychiatry, 53(7), 975-980.
- Shapiro, D. (1969). Department of Psychiatry, Harvard Medical School. Personal communication, October.