Dreams in obsessive-compulsive disorder: An analysis of semantic and emotional content compared to controls
Introduction
Dreaming remains a mysterious process for which conflicting theories have been put forward. Some consider that REM sleep plays a role in memory storage of day events [1], [2], [3], while others see it as instrumental in the elaboration of complex cognitive programs including the control of stressful experiences and emotions [4], [5].
A study of the dreams related by depressed patients at varying intervals of time after awakening has shown that these patients dream of masochistic themes [6], [7], [8]. In panic disorder, a similar method of delayed dream collection has found the recurrence of the theme of separation anxiety [9]. In schizophrenia, dreams have been reported to be short, arid, unelaborated, and devoid of emotional content [10].
Certain methodological problems limit the reliability of all these studies: (1) The first concerns the delayed recollection of the dreams recounted. To what extent is the version subsequently related by the patient influenced by diurnal contingencies? Sleep laboratory studies reduce this risk but introduce an experimental bias, in that the normal context of sleep is modified [11]. (2) The objectivity of the dream scoring technique used is, in general, questionable. Interpretation of dream recollections is not sufficiently controlled. (3) There is finally the added fact that the pathologies explored, whether they are depression, panic disorder, or schizophrenia, cover a wide variety of clinical features. This introduces the problem of diagnosis and the interpretation of results in the light of this diagnosis.
The present study investigates the role played by dreaming in obsessive-compulsive disorder (OCD), a condition that has the advantage of a clear clinical definition. It was considered that the recording at home over a period of 7 days of these recollections would allow more natural sleep and avoid the «laboratory dreams» engendered by a laboratory procedure. We therefore devised a method of immediate dream collection on awakening in order to limit the influence of a conscious elaboration of the dream recollected. Dreams were analyzed under blind conditions.
We started from the following hypothesis: if dreaming plays a role in the memory storage of events of the day, one should then find in the dreams recounted in the morning by the patient evidence of the obsessive or ritual themes of the day, in the same way that in depression and in panic disorder, one finds dreams relevant to these conditions.
Therefore, we designed a study to compare the dream contents of normal subjects and patients suffering from OCD (more than 2 hours of rituals per day) to confirm the relationship between diurnal activity and dream contents.
Section snippets
Subjects
Ten nondepressed patients [Hamilton Depression Scale (HAM-D) and Montgomery and Äsberg Depression Rating Scale (MADRS) <17] suffering from OCD and losing at least 2 hours/day in obsessive and/or ritual behavior were compared with 11 control subjects matched for age, sex, marital status, and level of education as defined in ADIS-R [12]. Patients were recruited amongst outpatients under treatment in our psychiatric department. The control group consisted of volunteers, most of them belonging to
Subjects
Sociodemographic data and clinical data are presented in Table 1, Table 2. After analyzing symptom reports of patients according to DSM IV diagnostic criteria, we classified our group of OCD patients in eight subjects presenting pure ritual behavior (one ruminator, three washers, and four checkers) and two subjects presenting mixed behavior (one predominant washer and one predominant checker). None of the OCD patients or controls was under psychotropic medication or psychological treatment.
Dream classification
Discussion
In both the OCD group and controls, about one-third of subjects recollected having dreams with obsessive-compulsive themes. However, the actual number of dreams concerned is small in both groups. These themes appear to be a common, albeit infrequent, characteristic of dreaming in general but would seem to be independent of obsessive-compulsive symptoms. This would indicate the distance between dreaming and wakeful activity and in a sense counteracts the theory of integrating daily events during
Acknowledgements
We like to thank Professors Michel Jouvet, MD (Lyon, France), Aaron T. Beck, MD (Philadelphia, USA), and Jean Cottraux, MD (Lyon, France) for having revised the manuscript. Our thanks also to Luc Letenneur, Moufid Hajjar, MD, and Geneviève Chene, MD (INSERM 330, Bordeaux, France) for their help with statistics and to Professor Marc Bourgeois, MD (Bordeaux, France) for allowing us to carry out this study in his department.
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