Rituals and motor disturbances: polymorphic psychopathology in combined dissociative and obsessive disorders

In contemporary psychiatry, there is an increasing number of patients presenting with comorbid symptomatology that includes dissociative, obsessive–compulsive, and affective components. Such conditions complicate diagnosis by masking psychiatric disorders as neurological condition, which often leads to errors in clinical routing and treatment. This paper presents a clinical case of a patient with co-occurring dissociative and obsessive–compulsive disorders and analyzes diagnostic and management challenges in polymorphic psychiatric symptomatology. A clinical and psychiatric assessment was performed in a 34-year-old woman with long-standing motor, speech, and affective disorders initially interpreted as manifestations of neurological disease. The evaluation included psychopathological interviewing, observation, and instrumental studies (EEG, MRI). The patient exhibited pronounced motor and speech abnormalities, compulsive rituals, episodes of depressed mood, and dependency on close relatives. No evidence of organic condition was found. The condition met the ICD-10 criteria for mixed dissociative disorder (F44.7), obsessive–compulsive disorder (F42.2), and moderate depressive episode (F32.1) with underlying mixed personality disorder (F61). This case illustrates the importance of a multidisciplinary approach in the assessment of atypical motor disturbances. The comorbidity of dissociative and obsessive symptoms requires differential diagnosis with extrapyramidal disorders and comprehensive therapy that accounts for underlying personality condition.