Comprehensive Psychiatry
Volume 45, Issue 5 , Pages 384-391 , September 2004

Dissociative experiences in obsessive-compulsive disorder and trichotillomania: Clinical and genetic findings

  • Christine Lochner

      Affiliations

    • Medical Research Council (MRC) Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
    • Corresponding Author InformationAddress reprint requests to Christine Lochner, M.A., MRC Unit on Anxiety Disorders, Department of Psychiatry, PO Box 19063, University of Stellenbosch, Tygerberg, Cape Town 7505, South Africa
  • ,
  • Soraya Seedat

      Affiliations

    • Medical Research Council (MRC) Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
  • ,
  • Sian M.J. Hemmings

      Affiliations

    • MRC/US Centre for Molecular and Cellular Biology, University of Stellenbosch, Cape Town, South Africa
  • ,
  • Craig J. Kinnear

      Affiliations

    • MRC/US Centre for Molecular and Cellular Biology, University of Stellenbosch, Cape Town, South Africa
  • ,
  • Valerie A. Corfield

      Affiliations

    • MRC/US Centre for Molecular and Cellular Biology, University of Stellenbosch, Cape Town, South Africa
  • ,
  • Dana J.H. Niehaus

      Affiliations

    • Medical Research Council (MRC) Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
  • ,
  • Johanna C. Moolman-Smook

      Affiliations

    • MRC/US Centre for Molecular and Cellular Biology, University of Stellenbosch, Cape Town, South Africa
  • ,
  • Dan J. Stein

      Affiliations

    • Medical Research Council (MRC) Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa

References 

  1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association; 1994;
  2. Atchison M, McFarlane A. A review of dissociation and dissociative disorders. Aust NZ J Psychiatry. 1994;28:591–599
  3. Bremner J, Southwick S, Brett E, Fontana A. Dissociation an posttraumatic stress disorder. Am J Psychiatry. 1992;149:328–332
  4. Dunn G, Paolo A, Ryan J, Van Fleet J. Dissociative symptoms in a substance abuse population. Am J Psychiatry. 1993;150:1043–1047
  5. Dunn G, Ryan J, Paolo A, Van Fleet J. Comorbidity of dissociative disorders among patients with substance use disorders. Psychiatr Serv. 1995;46:153–156
  6. Feeny N, Zoellner L, Fitzgibbons L, Foa E. Exploring the role of emotional numbing, depression and dissociation in PTSD. J Trauma Stress. 2000;13:489–498
  7. Irwin HJ. Proneness to dissociation and traumatic childhood events. J Nerv Ment Dis. 1994;182:456–460
  8. Tampke A, Irwin H. Dissociative experiences and symptoms of traumatic stress in Vietnam veterans. J Trauma Stress. 1999;12:723–725
  9. Spiegel D, Cardena E. Disintegrated experience (the dissociative disorders revisited). J Abnorm Psychol. 1991;100:366–378
  10. Van der Kolk B, Van der Hart O. Pierre Janet and the breakdown of adaptation in psychological trauma. Am J Psychiatry. 1989;146:1530–1540
  11. Lipschitz D, Kaplan M, Sorkenn J, Chorney P, Asnis G. Childhood abuse, adult assault, and dissocation. Compr Psychiatry. 1996;37:261–266
  12. Merckelbach H, Muris P. The causal link between self-reported trauma and dissociation (a critical review). Behav Res Ther. 2001;39:245–254
  13. Mulder RT, Beautrais AL, Joyce PR, Fergusson DM. Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample. Am J Psychiatry. 1998;155:806–811
  14. Herman J, Perry J, Van der Kolk B. Childhood trauma in borderline personality disorder. Am J Psychiatry. 1989;146:490–495
  15. Kluft R. Multiple personality disorder. In:  Speigel D editors. Dissociative Disorders. Lutherville, MD: Sidran; 1993;p. 17–44
  16. Putnam F, Guroff J, Silberman E, Barban L, Past R. The clinical phenomenology of multiple personality disorder (review of 100 recent cases). J Clin Psychiatry. 1986;47:285–293
  17. Simeon D, Guralnik O, Schmeidler J, Sirof B, Knutelska M. The role of childhood interpersonal trauma in depersonalization disorder. Am J Psychiatry. 2001;158:1027–1033
  18. Gershuny B, Thayer J. Relations among psychologial trauma, dissociative phenomena, and trauma-related distress (a review and integration). Clin Psychol Rev. 1999;19:651–657
  19. Goff DC, Olin JA, Jenike MA, Baer L, Buttolph ML. Dissociative symptoms in patients with obsessive-compulsive disorder. J Nerv Ment Dis. 1992;180:332–337
  20. Grabe H, Goldschmidt F, Lehmkuhl L, Gansicke M, Spitzer C, Freyberger H. Dissociative symptoms in obsessive-compulsive dimensions. Psychopathology. 1999;32:319–324
  21. Ross CA, Anderson G. Phenomenological overlap of multiple personality disorder and obsessive-compulsive disorder. J Nerv Ment Dis. 1988;176:295–299
  22. Watson D, Wu KD, Cutshall C. Symptom subtypes of obsessive-compulsive disorder and their relation to dissociation. J Anxiety Disord. In press.
  23. Christenson G, Mansueto C. Trichotillomania (descriptive characteristics and phenomenology). In:  Stein D,  Christenson G,  Hollander E editor. Trichotillomania. Washington, DC: American Psychiatric Press; 1999;p. 1–41
  24. Schnurr R, Davidson S. Trichotillomania in a ten year old boy (gender identity issues formulated in terms of individual and family factors). Can J Psychiatry. 1989;34:721–724
  25. Lochner C, du Toit PL, Zungu-Dirwayi N, Marais A, van Kradenburg J, Seedat S, et al.  Childhood trauma in obsessive-compulsive disorder, trichotillomania, and controls. Depress Anxiety. 2002;15:66–68
  26. Pauls DL, Alsobrook JP. The inheritance of obsessive-compulsive disorder. Child Adolesc Psychiatr Clin North Am. 1999;8:481–496
  27. Stein DJ. Neurobiology of the obsessive-compulsive spectrum disorders. Biol Psychiatry. 2000;47: 396–304
  28. Jang KL, Paris J, Zweig-Frank H, Livesley WJ. Twin study of dissociative experience. J Nerv Ment Dis. 1998;186:345–351
  29. First MB, Spitzer RL, Gobbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders—Patient Edition (SCID-I/P, Version 2.0:/98 revision). New York, NY: New York State Psychiatric Institute, Biometrics Research Department; 1998;
  30. du Toit PL, van Kradenburg J, Niehaus D, Stein DJ. Comparison of obsessive-compulsive disorder patients with and without comorbid putative obsessive-compulsive spectrum disorders using a structured clinical interview. Compr Psychiatry. 2001;42: 391–300
  31. Leckman JF, Riddle M, Hardin M, Ort S, Swartz K, Stevenson J, et al.  The Yale Global Tic Severity Scale (initial testing of a clinician-rated scale of tic severity). J Am Acad Child Adolesc Psychiatry. 1989;28:566–573
  32. Goodman WK, Price L, Rasmussen SA, Mazure C, Fleischmann R, Hill C, et al.  The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46:1006–1011
  33. Keuthen NJ, O’Sullivan RL, Ricciardi JN, Shera D, Savage CR, Borgmann AS, et al.  The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. Development and factor analyses. Psychother Psychosom. 1995;64:141–145
  34. Schneier FR, Heckelman LR, Garfinkel R, Campeas R, Fallon BA, Gitow A, et al.  Functional impairment in social phobia. J Clin Psychiatry. 1994;55:322–331
  35. Guy W. ECDEU Assessment Manual for Psychopharmacology. Publication No. 76-3381976. Superintendent of Documents, US Government Printing Office, US Department of Health, Education, and Welfare, Washington, DC
  36. Bernstein EM, Putnam FW. Development, reliability and validity of a dissociation scale. J Nerv Ment Dis. 1986;174:727–735
  37. Van Ijzendoorn M, Schuengel C. The measurement of dissociation in normal and clinical population (meta-analytic validation of the Dissociation Experiences Scale (DES)). Clin Psychol Rev. 1996;16:365–382
  38. Demitrack MA, Putnam FW, Brewerton TD, Brandt HA, Gold PW. Relation of clinical variables to dissociative phenomena in eating disorders. Am J Psychiatry. 1990;147:1184–1188
  39. Bernstein EM, Fink L, Handelsman L, Foote J, Lovejoy M, Wentzel K, et al.  Initial reliability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994;151:1132–1136
  40. Lichter JB, Barr CL, Kennedy JL, Van Tol HH, Kidd KK, Livak KJ. A hypervariable segment in the human dopamine receptor D4 (DRD4) gene. Hum Mol Genet. 1993;2:767–773
  41. Vandenbergh DJ, Persico AM, Hawkins AL, Griffin CA, Li X, Jabs EW, et al.  Human dopamine transporter gene (DAT1) maps to chromosome 5p15.3 and displays a VNTR. Genomics. 1992;14:1104–1106
  42. Heils A, Teufel A, Petri S, Stober G, Riederer P, Bengel D, et al.  Allelic variation of human serotonin transporter gene expression. J Neurochem. 1996;66:2621–2624
  43. Sidenberg DG, Bassett AS, Demchyshyn L, Niznik HB, Macciardi F, Kamble AB, et al.  New polymorphism for the human serotonin 1D receptor variant (5-HT1D beta) not linked to schizophrenia in five Canadian pedigrees. Hum Hered. 1993;43:315–318
  44. Warren JT, Peacock ML, Rodriguez LC, Fink JK. An MspI polymorphism in the hyman serotonin receptor gene (HTR2) (detection by DGGE and RFLP analysis). Hum Mol Genet. 1993;2:338
  45. Ishiguro H, Arinami T, Saito T, Akazawa S, Enomoto M, Mitushio H, et al.  Systematic search for variations in the tyrosine hydroxylase gene and their associations with schizophrenia, affective disorders, and alcoholism. Am J Med Genet. 1998;81:388–396
  46. Karayiorgou M, Altemus M, Galke BL, Goldman D, Murphy DL, Ott J, et al.  Genotype determining low catechol-O-methyltransferase activity as a risk factor for obsessive-compulsive disorder. Proc Natl Acad Sci USA. 1997;94:4572–4575
  47. Hotamisligil GS, Breakefield XO. Human monoamine oxidase A gene determines levels of enzyme activity. Am J Hum Genet. 1991;49:383–392
  48. Hemmings SMJ, Kinnear CJ, Niehaus DJH, Moolman-Smook JC, Knowles JA, Lochner C, et al.  Investigating the role of dopaminergic and serotonergic candidate genes in obsessive-compulsive disorder. Eur Neuropsychopharmacol. 2003;13:93–98
  49. Putnam FW, Carlson EB, Ross CA, Anderson G, Clark P, Torem M, et al.  Patterns of dissociation in clinical and nonclinical samples. J Nerv Ment Dis. 1996;184:673–679
  50. Ross CA, Joshi S, Currie R. Dissociative experiences in the general population. Am J Psychiatry. 1900;147:1547–1552
  51. Warshaw MG, Fierman E, Pratt L, Hunt M, Yonkers KA, Massion AO, et al.  Quality of life and dissociation in anxiety disorder patients with histories of trauma or PTSD. Am J Psychiatry. 1993;150:1512–1516
  52. Rasmussen SA, Eisen JL. Phenomenology of OCD (clinical subtypes, heterogeneity and coexistence). In:  Zohar Y,  Insel TR,  Rasmussen SA editor. Psychobiology of OCD. New York, NY: Springer-Verlag; 1991;p. 13–43
  53. Thierry AM, Tassin JP, Blanc G, Glowinsky U. Selective activation of the mesocortical dopamine system by stress. Nature. 1976;263:242–244
  54. Davidson K. Episodic depersonalization (observation on seven patients). Br J Psychiatry. 1964;110:505–513
  55. Roth M. The phobic anxiety-depersonalization syndrome. Prog R Soc Med. 1959;52:587–595
  56. Torch E. Review of the relationship between obsession and depersonalisation. Acta Psychiatr Scand. 1978;58:191–198
  57. Simeon D, Hollander E, Stein DJ, DeCaria C, Cohen LJ, Saoud JB, et al.  Induction of depersonalization by the serotonin agonist meta-chlorophenylpiperazine. Psychiatry Res. 1995;58:161–164

 Supported by the MRC of South Africa. This study was funded by the Obsessive-Compulsive Foundation (DJS), the Harry & Doris Crossley Foundation (CL), as well as the National Research Foundation (CL).

PII: S0010-440X(04)00046-X

doi: 10.1016/j.comppsych.2004.03.010

Comprehensive Psychiatry
Volume 45, Issue 5 , Pages 384-391 , September 2004