BRIEF REPORT
Traumatic Experiences and Obsessive-Compulsive Symptoms
The Mediating Role of Dissociation
Gianluca Santoro, MSc,* Lucia Sideli, PhD,† Fanny Gugliemucci, PhD,‡
Grazia Terrone, PhD,§ and Adriano Schimmenti, PhD, DClinPsych*
Abstract: Accumulating evidence suggests that obsessive-compulsive symp-
toms (OCSs) are positively associated with exposure to traumatic experiences
and dissociative symptoms in both clinical and community samples. The current
study was aimed at investigating the relationships between traumatic experiences,
dissociation, and OCSs. A sample of 333 community adults (56.8% females)
aged from 18 to 56 years (mean [SD], 25.64 [6.70] years) completed measures
on traumatic experiences, dissociative symptoms, and OCSs. A structural equa-
tion modeling (SEM) framework was used to test if dissociative symptoms medi-
ated the relationship between traumatic experiences and OCSs. SEM analyses
showed that dissociation fully mediated the predictive association between trau-
matic experiences of emotional neglect and abuse and OCSs in the sample. Ac-
cordingly, some individuals suffering from OCSs might benefit from clinical in-
terventions aimed at processing and integrating traumatic experiences.
Key Words: Traumatic experiences, obsessive-compulsive symptoms,
dissociation, structural equation modeling
(J Nerv Ment Dis 2023;211: 543–549)
O bsessive-compulsive disorder (OCD) is characterized by recurrent
and intrusive thoughts and repetitive mental actions or behaviors
aimed at reducing anxiety or preventing dreaded events (American
Psychiatric Association, 2013). Extensive research investigated the role
of traumatic experiences in OCD, reporting inconsistent findings (e.g.,
Brander et al., 2016; Grabe et al., 2008; Ivarsson et al., 2016; Pinciotti
and Orcutt, 2020; Selvi et al., 2012; Visser et al., 2014). More convincing
evidence exists concerning the positive association between exposure to
traumatic experiences and obsessive-compulsive symptoms (OCSs),
such as checking, ordering, or repeating words in head (Destrée et al.,
2021; Orsillo et al., 1996; Ou et al., 2021; Raposo-Lima and Morgado,
2020). OCSs may result from different types of trauma exposure, in-
cluding physical and sexual assault, emotional and physical neglect
(Fontenelle et al., 2021), as well as indirect exposure to traumatic events
(e.g., learning about events occurring to someone else) (Pinciotti
et al., 2021b).
The relationship between OCSs and dissociation is well estab-
lished in literature, with extensive evidence in both clinical (Boger
et al., 2020; Boysan et al., 2018; Pozza and Dèttore, 2019; Tapancı
et al., 2018; Tatli et al., 2018) and nonclinical (Aardema and Wu,
2011; Boysan, 2014; Boysan et al., 2022; Soffer-Dudek, 2014, 2017,
2019; Soffer-Dudek et al., 2015) samples. Nosographic classification
systems describe dissociation as a disruption or discontinuity in the nor-
mal integration of psychological functions, including consciousness,
*Faculty of Human and Social Sciences, UKE-Kore University of Enna, Cittadella
Universitaria, Enna; †Department of Human Science, LUMSA University, Rome;
‡Department of Philosophy, Communication and Arts, University of Rome 3,
Rome; and §Department of History, Cultural Heritage, Education, and Society,
University of Rome Tor Vergata, Rome, Italy.
Send reprint requests to Gianluca Santoro, MSc, Faculty of Human and Social
Sciences, UKE-Kore University of Enna, Cittadella Universitaria, 94100, Enna,
Italy. E‐mail: gianluca.santoro@unikore.it.
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0022-3018/23/21107–0543
DOI: 10.1097/NMD.0000000000001649
The Journal of Nervous and Mental Disease • Volume 211, Number 7, July 2023
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
memory, identity, emotion, perception, body representation, motor con-
trol, and behavior (American Psychiatric Association, 2013; World
Health Organization, 2022).
There is also consistent evidence supporting the relationship be-
tween traumatic experiences and dissociative symptoms (Dalenberg
et al., 2012; Vonderlin et al., 2018). Research suggests that cumulative
traumatic experiences might engender persistent dissociative processes,
impairing mind-body integration and increasing the risk for psychopa-
thology (Granieri et al., 2018; Schimmenti, 2017, 2018; Vismara
et al., 2022).
Surprisingly, there is a paucity of research investigating the rela-
tionship between traumatic experiences, dissociation, and OCSs. Only
one study has examined the mediating role of dissociation in the relation-
ship between childhood maltreatment and symptoms severity in OCD pa-
tients (Boger et al., 2020), but this relationship has not been investigated
among individuals from the community. It is possible that some individ-
uals exposed to traumatic experiences fail in elaborating and integrating
these distressing experiences and thus dissociate them. This may result
in avoidance of mental contents (Schimmenti and Caretti, 2016) and di-
version of attention toward other internal and external stimuli, which
might create a template for OCSs (Liotti and Costantini, 2011).
In line with these premises, we investigated whether dissociation
mediates the relationship between traumatic experiences and OCSs in a
sample of individuals from the community.
METHODS
Participants and Procedure
The sample comprised 333 adults from the community (189
women, 56.8%) between 18 and 56 years old (mean [SD], 25.64
[6.70] years). The average years of education was 14.78 (SD, 2.79). A
total of 299 participants (89.8%) reported being not married. No signif-
icant sex differences were observed for age (t331 = 0.46; p = 0.646) and
years of education (t331 = −1.51; p = 0.133).
Potential participants were recruited through advertisements
placed in public areas. People were asked to contact the research office
for more information about the procedures of the study. As the aim of
this study was to model the relationship among traumatic experiences,
dissociation, and OCSs in nonclinical samples, researchers asked po-
tential participants to report any diagnosis or treatment for severe men-
tal disorders (e.g., schizophrenic disorders, bipolar disorders, severe de-
pression). The researchers sent an email linked to an anonymous online
survey to those who volunteered to take part in the study, did not report
any major psychiatric diagnosis, and agreed to participate. All partici-
pants signed the online informed consent. The survey contained a
sociodemographic schedule and three self-report measures for the as-
sessment of the relevant constructs investigated in the current study.
No compensation was provided.
Measures
The Traumatic Experiences Checklist (TEC; Nijenhuis et al., 2002;
Italian translation by Schimmenti, 2018) is a self-report questionnaire
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Santoro et al. The Journal of Nervous and Mental Disease • Volume 211, Number 7, July 2023
evaluating the occurrence of 29 potentially traumatic events, including
emotional neglect (3 items), emotional abuse (3 items), physical abuse
(4 items), sexual harassment and abuse (6 items), and other types of
trauma (13 items). Items are dichotomous, so they are scored as 0 (ab-
sent) or 1 (present). An example item is “Threat to life from illness, an
operation, or an accident.” The TEC has shown adequate internal con-
sistency, test-retest reliability, and convergent validity (Nijenhuis et al.,
2002; Schimmenti, 2018; Schimmenti et al., 2020; van Duijl et al.,
2010). The TEC total score is obtained by summing all items, and scale
scores are obtained by summing item scores of the relevant scale. In this
study, the KR-20 for the TEC total score was 0.82.
The Dissociative Experiences Scale-II (DES-II; Carlson and
Putnam, 1993; Italian translation by Schimmenti, 2016) is a
self-report questionnaire that evaluates dissociative experiences. The
DES-II consists of 28 items that are scored on an 11-point scale ranging
from 0% (“never”) to 100% (“always”), with 10% intervals. Partici-
pants are asked to report how often they suffer from dissociative symp-
toms by rating the proper percentage of the time (e.g., “Some people
have the experience of feeling that their body does not seem to belong
to them. Circle a number to show what percentage of time this happens
to you”; related to depersonalization/derealization experiences). The
DES-II includes a total score and three subscale scores, which evaluates
depersonalization/derealization (six items), dissociative amnesia (eight
items), and absorption and imaginative involvement (nine items). The
DES-II has shown good reliability and validity worldwide (Carlson
and Putnam, 1993; Van Ijzendoorn and Schuengel, 1996). The
DES-II total score and subscales scores are calculated by averaging
all items. In this study, Cronbach's alpha of the DES-II was 0.95.
The Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994;
Italian translation by Prunas et al., 2012) is a self-report questionnaire
consisting of 90 items rated on a 5-point Likert scale (from 0 = “not at
all” to 4 = “extremely”) that assesses nine symptom domains, namely, so-
matization, OCSs, interpersonal sensitivity, depression, anxiety, hostility,
phobic anxiety, paranoid ideation, and psychoticism. The SCL-90-R has
been widely used, demonstrating satisfactory validity and reliability
(Sereda and Dembitskyi, 2016; Tomioka et al., 2008). For the research
purpose, only the obsessive-compulsive scale of the SCL-90-R (10
items) was used. An example item is “Having to check and
double-check what you do.” In this study, Cronbach's alpha of the
SCL-90-R obsessive-compulsive scale was 0.89.
Statistical Analyses
Descriptive statistics were computed for all the examined vari-
ables. Sex differences were investigated using the t-test. Correlations
between traumatic experiences, dissociative symptoms, and OCSs were
examined using Pearson's r correlation. Assumptions for structural
equation modeling (SEM) were verified (Kline, 2012), and SEM anal-
yses were performed to investigate the effects of dissociation on the re-
lationship between traumatic experiences and OCSs.
First, we tested a mediation model that included scores on TEC
subscales (i.e., emotional neglect, emotional abuse, physical abuse, sex-
ual harassment/abuse, and other types of trauma) as indicators of a la-
tent variable for cumulative traumatic experiences. In fact, previous re-
search showed that different types of traumatic experiences are closely
related to each other, suggesting that they are likely to cooccur during
lifespan (Bifulco and Schimmenti, 2019; Granieri et al., 2018; Midolo
et al., 2020; Schimmenti, 2018).
Also, Schimmenti and Şar (2019) reported that clinical dissociation
may emerge as an interaction of multiple types of dissociative phenomena.
Thus, we used scores on DES subscales (i.e., depersonalization/derealization,
dissociative amnesia, and absorption/imaginative involvement) as indi-
cators of latent variable for dissociation.
Because the SCL-90-R obsessive-compulsive scale consists of
10 items, which resulted in poor fit of the scale, three parcels were used
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as indicators of the latent dependent variable for OCSs, thus avoiding
type I error (Bandalos and Finney, 2001). Parcels comprising the SCL-
90-R items were selected via a randomized algorithm (Matsunaga, 2008).
Subsequently, we used SEM to test the effects of different types
of traumatic experiences on dissociation and OCSs, to increase the
specificity of our findings. For each of these analyses, the mediation
models included scores on a specific TEC subscale as a manifest vari-
able, scores on DES subscales as indicators of the latent variable for dis-
sociation, and the three parcels of SCL-90-R obsessive-compulsive
scale as indicators of the latent variable for OCSs. All models were es-
timated through the maximum likelihood method, and the following in-
dices were used to examine goodness of fit: chi-square/degrees of free-
dom ratio (χ2/df ), comparative fit index (CFI), Tucker-Lewis index
(TLI), standardized root-mean-square residual (SRMR), and root-
mean-square error of approximation (RMSEA). The model displays a
good fit if the χ2/df value is ≤2, CFI value is >0.95, TLI value is
>0.95, SRMR value is <0.05, and RMSEA value is <0.06 (Hooper
et al., 2008; Hu and Bentler, 1999). SEM analyses were performed
using lavaan package (Rosseel, 2012) for R.
RESULTS
Descriptive statistics are reported in Table 1. No significant sex
differences were observed for OCSs, traumatic experiences, and dissociation.
Bivariate correlations are shown in Table 2. The overall number
of traumatic experiences, as well as experiences of emotional neglect
and emotional abuse, positively correlated with both dissociative symp-
toms and OCSs; experiences of physical abuse correlated positively
with OCSs. Positive correlations were also found between all dissocia-
tion subscales and OCSs. Age and education negatively correlated with
all dissociation subscales and OCSs. A positive correlation was found
between age and the overall number of traumatic experiences, experi-
ences of sexual harassment/abuse, and other types of trauma.
SEM analyses showed that the relationship between overall trau-
matic experiences and OCSs was fully mediated by dissociation in the
sample (direct effect: β = 0.05, p = 0.331; indirect effect: β = 0.11,
p = 0.005; total effect: β = 0.17, p = 0.009). The model showed a good
fit (χ2/df = 1.81; CFI = 0.98, TLI = 0.98, SRMR = 0.04, RMSEA = 0.05
[90% confidence interval (CI), 0.03–0.07]). Standardized coefficients
of the model are shown in Figure 1.
Further SEM analyses on TEC subscale scores as independent
predictors showed that dissociation fully mediated the relationship be-
tween emotional neglect and OCSs (direct effect: β = 0.01, p = 0.868;
indirect effect: β = 0.12, p = 0.002; total effect: β = 0.12, p = 0.030),
and the relationship between emotional abuse and OCSs (direct effect:
β = 0.05, p = 0.262; indirect effect: β = 0.10, p = 0.010; total effect:
β = 0.15, p = 0.009). Both these models displayed a good fit (emotional
neglect: χ2/df = 1.40, CFI = 1.00, TLI = 0.99, SRMR = 0.02,
RMSEA = 0.04 [90% CI, 0.00–0.07]; emotional abuse: χ2/df = 1.42,
CFI = 1.00, TLI = 0.99, SRMR = 0.02, RMSEA = 0.04 [90% CI,
0.00–0.07]). However, dissociation was not a significant mediator in
the relationship between physical abuse and OCSs (direct effect:
β = 0.12, p = 0.016; indirect effect: β = 0.04, p = 0.283; total effect:
β = 0.15, p = 0.007), sexual harassment/abuse and OCSs (direct effect:
β = 0.04, p = 0.361; indirect effect: β = 0.04, p = 0.282; total effect:
β = 0.08, p = 0.15), and other types of trauma and OCSs (direct effect:
β = −0.01, p = 0.908; indirect effect: β = 0.07, p = 0.068; total effect:
β = 0.06, p = 0.279).
DISCUSSION
The current study examined the mediating role of dissociation in
the relationship between traumatic experiences and OCSs in a commu-
nity sample. The findings of this study represent preliminary evidence
of a potential explanatory mechanism of OCSs in some individuals,
which is based on posttraumatic dissociation. Consistent with previous
© 2023 Wolters Kluwer Health, Inc. All rights reserved.
The Journal of Nervous and Mental Disease • Volume 211, Number 7, July 2023 Trauma, Dissociation, and OCD Symptoms

TABLE 1. Descriptive Statistics

Full Sample (N = 333) Men (n = 144) Women (n = 189)

Mean SD Observed Range Mean SD Mean SD t331 p
Age, y 25.64 6.70 18–56 25.83 6.83 25.49 6.62 0.46 0.646
Years of education 14.78 2.79 5–22 14.51 2.91 14.98 2.70 −1.51 0.133
Emotional neglect 0.44 0.84 0–3 0.45 0.84 0.43 0.84 0.25 0.806
Emotional abuse 0.38 0.70 0–3 0.40 0.73 0.35 0.68 0.62 0.535
Physical abuse 0.11 0.39 0–3 0.15 0.44 0.09 0.35 1.28 0.201
Sexual harassment/abuse 0.10 0.37 0–3 0.13 0.46 0.08 0.29 1.11 0.267
Other types of trauma 1.05 1.46 0–6 1.23 1.55 0.92 1.37 1.93 0.055
Overall traumatic experiences 2.08 2.97 0–15 2.35 3.18 1.87 2.79 1.47 0.143
Depersonalization/derealization 18.38 19.26 0–85 16.46 18.48 19.84 19.76 −1.59 0.112
Dissociative amnesia 20.45 17.38 0–90 20.37 18.18 20.51 16.80 −0.07 0.944
Absorption and imaginative involvement 41.12 20.70 0–91.11 38.68 19.96 42.98 21.10 −1.89 0.060
Dissociation total score 28.61 16.89 0–82.50 27.12 16.83 29.74 16.89 −1.41 0.161
OCSs 1.26 0.90 0–3.90 1.22 0.89 1.29 0.90 −0.69 0.488

studies (Boysan et al., 2022; Miller and Brock, 2017; Muris et al., 2003;
Schimmenti, 2018), significant and positive correlations were found be-
tween exposure to multiple traumatic experiences, dissociation, and
OCSs. Specifically, OCSs were positively correlated with emotional ne-
glect, emotional abuse, and physical abuse. This supports the findings of
a large cohort study (Vidal-Ribas et al., 2015) showing that abuse and
family disruption might foster OCSs and increase their severity, even
accounting for the effect of genetic liability and depressive symptoms.
Furthermore, almost 30 years ago, McElroy et al. (1994) showed
that several mental disorders shared core OCSs, proposing the existence of
an “affective source” for them. This conceptualization of OCSs—only par-
tially accepted in the current nosographic manuals—is sustained by recent
research indicating significant linkages between OCSs and negative feel-
ings of uncertainty and insecurity (Pinciotti et al., 2021a; Szechtman and
Woody, 2004, 2006). Following these premises, our findings are consistent
with the hypothesis that in some cases, OCSs might represent maladaptive
attempts to gain control over a threating environment and to cope with
negative emotions and beliefs arising from traumatic experiences
(Briggs and Price, 2009; Kroska et al., 2018).
In line with recent findings on patients with clinically diagnosed
OCD (Boger et al., 2020), this study found a full mediation of dissoci-
ation in the relationship between overall exposure to traumatic experi-
ences and OCSs, between emotional neglect and OCSs, and between
emotional abuse and OCSs, providing further insight on the psycholog-
ical processes involved in OCSs. The mediating role of dissociation in
the relationship between traumatic experiences and OCSs might be un-
derstood by referring to the paradoxically protective function of disso-
ciation for traumatized individuals (Granieri et al., 2018; Şar, 2017; Şar
et al., 2007; Schimmenti, 2018, 2022), especially for individuals whose
emotional needs have not been recognized and met since the early stages
of their development (Schimmenti, 2017; Schimmenti and Caretti, 2016).
In fact, dissociation may be conceptualized as a psychological mechanism

TABLE 2. Pearson's Correlation Among the Investigated Variables

2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

1. Age 0.26*** 0.06 0.08 0.01 0.13* 0.19** 0.15** −0.15** −0.15** −0.30*** −0.25*** −0.17**
2. Years of education – −0.08 −0.02 −0.03 −0.06 0.01 −0.03 −0.20*** −0.16** −0.21*** −0.22*** −0.27***
3. Emotional neglect - 0.64*** 0.39*** 0.37*** 0.55*** 0.80*** 0.15** 0.13* 0.19*** 0.17** 0.12*
4. Emotional abuse – 0.42*** 0.47*** 0.58*** 0.82*** 0.16** 0.11* 0.12* 0.14** 0.15**
5. Physical abuse – 0.46*** 0.36*** 0.58*** 0.05 0.01 0.10 0.08 0.15**
6. Sexual harassment/abuse – 0.39*** 0.59*** 0.06 0.05 0.05 0.07 0.09
7. Other types of trauma – 0.88*** 0.09 0.09 0.09 0.10 0.06
8. Overall traumatic – 0.14* 0.11* 0.15** 0.15** 0.13*
experiences
9. Depersonalization/ – 0.73*** 0.70*** 0.85*** 0.51***
derealization
10. Dissociative amnesia – 0.73*** 0.90*** 0.51***
11. Absorption and imaginative – 0.92*** 0.53***
involvement
12. Dissociation total score – 0.59***
13. OCSs –
* p < 0.05.
**p < 0.01.
***p < 0.001.

© 2023 Wolters Kluwer Health, Inc. All rights reserved. www.jonmd.com 545

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Santoro et al. The Journal of Nervous and Mental Disease • Volume 211, Number 7, July 2023
FIGURE 1. Structural equation model of the relationships among traumatic experiences, dissociation, and obsessive-compulsive symptoms. *p < 0.01;
**p < 0.001.
that insulates trauma-related ideas, emotions, and sensations and puts them
outside of normal awareness (Frewen and Lanius, 2014; Lanius, 2015).
Obsessions and compulsions constitute, respectively, intrusive thoughts
and compelling behaviors that lead individuals to focus their attention on
them. Thus, OCSs might emerge as dysfunctional and automatic mental
phenomena that serve to divert the attention from trauma-related stimuli
and to cope, albeit dysfunctionally, with them. This theoretical model is
consistent with meta-analytic research suggesting that dissociation is linked
with attentional and behavioral avoidance and cognitive perseverations
(Cavicchioli et al., 2021).
In fact, when considering the relationship between traumatic expe-
riences, dissociation, and OCSs, two posttraumatic processes might be
taken into account: (1) the difficulty in maintaining the compatibility
and consistency of the existing representations of the self and the world
with those arising from traumatic experiences and (2) the subsequent
meaning-making processes (i.e., appraising or assigning a new meaning
to traumatic events). Traumatic experiences are often associated with in-
tense negative emotions and with representations of the world as uncer-
tain and unsafe, and of the self as powerless and helplessness, incompat-
ible with an image of the self as an active agent (Park, 2022). Relevant
literature suggests that intrusive thoughts and rumination are associated
with negative emotions and the effort to find a meaning after distressing
experiences (Kamijo and Yukawa, 2018). Furthermore, emotion dysreg-
ulation and maladaptive coping strategies are related to OCSs through
self-inconsistency (i.e., disharmony and lack of coherence among differ-
ent emotions and representations of the self ) (Wu et al., 2020).
Therefore, we tentatively propose that some individuals might
develop dissociation and OCSs to reprocess traumatic experiences,
managing distressing emotions and reconciling incompatible images
of the self and the world. This hypothesis appears compatible with cur-
rent theoretical considerations and research findings on the relation-
ships between traumatic exposure, dissociation, and OCSs. However,
this theoretical model might not exhaustively explain the relationship
between trauma, dissociation, and OCSs. In fact, correlation analyses
showed that the explained variance of OCSs ranged from 1.44% to
2.25% for traumatic experiences and from 26.01% to 34.81% for disso-
ciative experiences. Thus, traumatic experiences could be significantly
associated with OCSs only in some cases, and other risk factors could
be involved in the association between dissociation and OCSs. For ex-
ample, individuals who are prone to be highly absorbed into fantasy or
into a specific stimulus might perceive blurring boundaries between
imagination and reality and engage in compulsive checking to cope
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Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
with confusion (Aardema and Wu, 2011; Salomon-Small et al., 2021;
Soffer-Dudek, 2014, 2015). Moreover, Buchnik-Daniely et al. (2021)
suggested that distress could be understood as a proximal factor of dis-
sociation in different mental disorders that are not closely related to
traumatic experiences, such as anxiety, depression, and OCD. Thus,
personality traits and current distressing experiences could be relevant
risk factors that could further explain the moderate association between
dissociation and OCSs.
In sum, our findings might be explained through a trauma-based
model of OCSs, according to which a subgroup of individuals exposed
to emotional traumatic experiences might develop OCSs as a result of
dissociative processes that prevent integration of trauma memories.
However, other theoretical models might concur to explain the results,
calling for further research.
Furthermore, the findings of the study should be considered in
light of some limitations. The cross-sectional study design does not allow
drawing any conclusion about causal relationship; thus, longitudinal
studies are greatly needed. Moreover, the study was based on a conve-
nience sample, which affects its generalizability. Although well-
validated, psychometrically robust, and worldwide used self-report mea-
sures were used in this study, future research might use interview-based
measures on trauma, dissociation, and OCSs to increase the validity of
the findings. Also, in our sample, the average DES-II total score was near
the clinical cut-off for the measure (i.e., 30; Carlson et al., 1993), and this
might have influenced our results. A possible explanation is that the sam-
ple may be considered a specific subgroup of the general population
more interested in collaborating on psychological research and more
prone to display dissociation; an alternative hypothesis, rooted in psycho-
metric studies on the DES-II structure using different methods with re-
spect to factor analysis (e.g., Rasch model and network analysis), is that
our results on the DES-II are affected by high scores on certain items re-
ferring to general symptoms of mild detachment from reality and rela-
tionships (Saggino et al., 2020; Schimmenti, 2016). Finally, because trau-
matic events have been more strongly related to compulsions than to ob-
sessions in the relevant literature (Miller and Brock, 2017), future studies
should investigate the mediating effect of dissociation in the relationship
between trauma exposure and different OCD symptom domains.
CONCLUSIONS
The current study found that the association between lifetime
traumatic events and OCSs in a sample of the general population was
© 2023 Wolters Kluwer Health, Inc. All rights reserved.
The Journal of Nervous and Mental Disease • Volume 211, Number 7, July 2023
fully mediated by dissociative experiences. This model especially held
with emotional abuse and emotional neglect as specific predictors of
dissociation and OCSs. Given the negative impact of dissociative
symptoms on the course and outcome of OCD (Besiroglu, 2016;
Rufer et al., 2006; Semiz et al., 2014), it is important that traumatic ex-
periences (especially those concerning relational experiences of ne-
glect, rejection, and psychological abuse) and dissociation are carefully
evaluated in patients suffering from OCSs (Liotti and Costantini, 2011).
For some emotionally traumatized individuals with OCSs, clinical in-
terventions aimed to improve mentalizing and metacognitive capacities,
self-regulation skills, and meaning reconstruction (Bateman and
Fonagy, 2013; Bluett et al., 2014; Peeters et al., 2021) might minimize
the activation of dissociative processes and foster integration of mental
states related to traumatic experiences, helping these people to heal
from their posttraumatic vulnerabilities.
DISCLOSURES
Statement of ethical considerations: This study was carried out in
accordance with the Declaration of Helsinki. All participants signed the
informed consent schedule, ensuring data anonymity. The Internal Re-
view Board for Psychological Research of the UKE-Kore University of
Enna (code: UKE-IRBPSY-160218) provided the ethical clearance for
the study.
Author contributions: G. S., L. S., and A. S. designed the study.
G. T. performed data collection. G. S. and F. G. computed statistical
analyses. G. S., L. S., and F. G. wrote the first draft of the manuscript.
All authors sequentially and critically revised the manuscript, provid-
ing relevant theoretical and methodological contributions. All authors
agreed to be accountable for all aspects of the work in ensuring that
questions related to the accuracy or integrity of any part of the work
are appropriately investigated and resolved. All authors have read
and approved the final version of the manuscript.
The authors declare no conflict of interest.
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