Dissociation and dissociative mechanisms in panic disorder, obsessive–compulsive disorder, and depression: A review and heuristic framework.

Dissociative experiences predict increased symptoms, poor adherence to treatment, and poor prognosis in several psychiatric conditions, including panic disorder (PD), obsessive–compulsive disorder (OCD), and depression. Nevertheless, dissociative experiences have been extensively studied and reviewed primarily in relation to the dissociative disorders and posttraumatic stress disorder (PTSD), and often neglected in other disorders. The purpose of this review was to (a) summarize existing research on dissociative symptoms in psychopathologies other than the dissociative disorders and PTSD; specifically, anxiety, OCD, and depression, and (b) to suggest specific mechanisms through which these symptoms interact. A thorough search of the literature revealed that dissociation is related to panic and other anxiety symptoms, obsessive–compulsive symptoms, and depressive symptoms. Nevertheless, most extant research is cross-sectional and precludes the determination of causality. In addition, many studies report only general dissociation scores, despite the fact that dissociation is multifaceted. Three models are proposed. Specifically, it is postulated that absorption is the dissociative factor especially relevant to OCD because of poor confidence in reality monitoring, and that depersonalization and derealization are the dissociative factors particularly relevant to both depression, because of sleep alterations, and to panic, because of a combination of physiological and cognitive factors. Dissociative amnesia is hypothesized to interact with OCD and depressive symptoms in different ways. Practical suggestions for clinicians and researchers are offered. (PsycINFO Database Record (c) 2016 APA, all rights reserved)