Dissociation: it’s an unsettling sensation that can show up in several ways. Your own body may feel foreign as if you’re an observer trapped within it. Time may warp, seconds elongating into minutes, collapsing into instants. Emotions can blur, becoming muted or exaggerated. The words that escape your lips might seem disconnected, as if spoken by someone else.
The theme running through each of these unique dissociative experiences is a marked detachment from reality: a disconcerting mix of numbness and surreal awareness, leaving you questioning the solidity of your existence.
Exactly why we dissociate is not entirely clear. A leading theory is that these experiences are the byproducts of the brain protecting itself from overwhelming emotions and experiences. While dissociation is not a mental health condition itself, it’s a complex and often severe experience that can result from symptoms of several different conditions
In this article, we’ll investigate whether the overwhelming emotions and experiences associated with Obsessive-Compulsive Disorder (OCD) are capable of causing dissociation. We’ll learn more about the potential connection between OCD and dissociative experiences, and how treating OCD as the root cause of dissociation can reduce the frequency and severity of these disquieting phenomena.
How are OCD and dissociation linked?
Several things can trigger dissociative experiences. Among them are trauma, the use and misuse of certain substances, medical conditions, sleep disorders, and a handful of dissociative disorders, including dissociative identity disorder (DID), dissociative amnesia, or depersonalization/derealization disorder. Some scientists theorize that dissociative experiences occur when the brain is overwhelmed, and dissociation happens as a defense mechanism.
When people with OCD feel that their personal experience has become detached from reality and they can’t figure out why, overwhelming anxiety or distress may be to blame. Anxiety, after all, is a common feature of the OCD cycle.
The OCD cycle
The cycle begins with an intrusive thought, image, or urge. If you don’t have OCD, thoughts like these are easily dismissed as random or insignificant, but OCD causes people to fixate on certain intrusive experiences, leading to significant distress, fear, or anxiety. Simply put, these thoughts become obsessions—the O in OCD—and the first stage in the OCD cycle.
It’s important to remember that these often obsessive thoughts are ego-dystonic, meaning they conflict with a person’s identity, beliefs, and values. Think of it as OCD latching on to the values one cares about most and fixating on thoughts that conflict with them. Imagine, for example, a woman who became a kindergarten teacher to help children get the best possible start in life.
Sadly, she develops OCD when she starts experiencing intrusive thoughts about harming the children in her care, causing potentially overwhelming anxiety and distress. She feels that these thoughts are impossible to dismiss, leading to an intense urge to take some sort of action to feel absolutely certain that she could never harm a child. These behaviors and actions are called compulsions—the C in OCD—and can manifest in various ways.
Avoidance behaviors, checking behaviors, mental rituals, physical rituals, reassurance-seeking, and other types of compulsions are done in an attempt to reduce the discomfort caused by obsessions. It often works—but only temporarily. Soon, obsessions return even stronger than before, and this short-lived relief only reinforces the OCD cycle as it begins anew.
How dissociative experiences show up for people with OCD
That final stage of the OCD cycle—relief—actually perpetuates the cycle by reinforcing the idea that compulsions serve to prevent a real threat, even though obsessions pose no threat whatsoever. As a result, obsessions feel more and more dangerous over time, causing greater distress and anxiety when they occur—and eventually, though rarely, it can lead to dissociative episodes.
There are other theories as to why dissociative experiences are more common in people with OCD. These include the poor sleep quality in people with OCD, the belief that a sufferer’s thoughts can actually influence the world around them (known as “magical thinking”), and the inward focus associated with OCD symptoms like rumination and memory checking, causing a sense of detachment from time and space.
It’s important to note that dissociative experiences aren’t going to be experienced by everyone with OCD, though they are more common in the OCD population than in the general public.
“When it comes to OCD, I think dissociative episodes are more likely to occur in people with a strong fear response,” says Amalia Sirica, LCSW. Sirica adds that while there’s little research on which subtypes are more likely to result in dissociative experiences, somatic OCD—which is characterized by intrusive and distressing thoughts related to bodily sensations, functions, or physical health, leading to excessive worry and compulsive behaviors—may be one of them.
“People with somatic OCD are in their bodies, turned inwards constantly,” explains Sirica. “They’re often thinking about all of the things that their body does every second of every minute of every day, and engaging in checking compulsions to feel better. I suspect that could be a link between this specific type of OCD and dissociation, as a means of avoiding all the triggers that come with feeling connected to one’s body.”
The impact of dissociative episodes in OCD
“One of the diagnostic criteria for OCD is already that it impairs normal functioning,” says Sirica. “When you’re having dissociative episodes on top of that, you can imagine how much more disruptive it can be. It feels like you’re on autopilot. You’re not tasting your food, and your emotions are numbed. You might get through from moment to moment, but it’s almost like being in a fugue state. Even short periods of dissociation can interfere in your life in a distressing way.”
People with OCD and dissociation can feel trapped in a cycle of anxiety and disconnection, which can be extremely difficult to break out of without proper treatment. The proven most effective therapy for dissociation and all other symptoms that come as a result of is exposure and response prevention therapy (ERP).
Exposure and response prevention therapy (ERP) explained
Exposure and Response Prevention (ERP) is a highly effective therapeutic approach used to treat obsessive-compulsive disorder (OCD) and reduce its symptoms, including dissociative episodes that may occur as a result. ERP involves exposing people to their obsessions or triggers in a controlled way while preventing them from engaging in their usual compulsive behaviors or mental rituals.
The principal aim of ERP is to break the OCD cycle. By confronting feared situations or thoughts directly, you can gradually learn that the associated distress can be tolerated without resorting to performing compulsions. This process is guided by a therapist who collaboratively designs a hierarchy of exposure exercises tailored to your specific obsessions and compulsions.
“When I’m working with members who are experiencing dissociation with their OCD, I’m constantly watching to make sure I don’t overwhelm them to the point that they’re no longer present,” says Sirica. “If they’re not fully present, they won’t be able to do the exposure work effectively. So with these members, I’d spend more in-session time processing, creating space for them, and breaking up exposures to more bite-sized chunks to ensure we’re always moving forward.”
Research has shown that a large majority of people with OCD who receive ERP experience a significant reduction in their symptoms. ERP is considered the gold standard treatment for OCD and is recommended by various professional organizations and experts in the field. Although ERP can initially be challenging and evoke anxiety, with time and practice and working collaboratively with a therapist trained in ERP, you can develop increased confidence in your ability to tolerate distress and resist compulsions.
If you think you might have OCD and want to learn how it’s treated with ERP, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD Care team to learn more about how we can help you.
All of our therapists specialize in OCD and receive ERP-specific training. You can also get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.