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What is PTSD?

1 in 4 individuals with PTSD also experiences OCD. The role of trauma in PTSD is well-defined. Still, a new phenomenon called trauma-related OCD has been coined to refer to the link between PTSD and OCD. [1] In which a patient develops OCD after a traumatic event.

Post-traumatic stress disorder (PTSD) is the presence of recurrent, intrusive distressing memories, dreams, dissociative reactions such as flashbacks, and reactions to internal or external cues that symbolize or resemble an aspect of a traumatic event experienced by an individual. The traumatic event can be an actual or threatened case of death, serious injury, or sexual assault that affected an individual, close friend, or family member.

In response to these symptoms and PTSD triggers, individuals often attempt to avoid situations where they may be reminded about the trauma internally by controlling thoughts, memories, and emotions or by avoiding people, places, conversations, and situations that can trigger memories regarding the traumatic event. They may also exhibit changes in memory formation. For example, they may display selective amnesia – the inability to remember specific details surrounding the trauma unrelated to external causes such as substance use and physical trauma.

They may also develop a constellation of symptoms that mirrors major depressive disorder (MDD), including negative beliefs and expectations, negative emotional states, anhedonia, and social withdrawal. In addition to these symptoms, patients may experience changes in emotional reactivity, including irritability, self-destructive behavior, hypervigilance, sleep disturbance, and lack of concentration.

PTSD prevalence is 8.7% in the United States, with a prevalence of 3.5% during any given 12-month period. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), PTSD is more prevalent among military veterans, firefighters, police officers, and emergency medical personnel. Globally, the greatest prevalence is found among survivors of rape, military combat and captivity, and politically motivated genocide. [2]

What is OCD?

Obsessive-compulsive disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (“obsessions”) and behaviors (“compulsions”) that he or she feels the urge to repeat over and over.

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds. [3]

The signs and symptoms of OCD may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. If you think you have OCD, talk to your healthcare provider about your symptoms. If left untreated, OCD can interfere with all aspects of life.

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PTSD and OCD

Recent research has suggested that OCD and PTSD are, in fact, two disorders on the same continuum. NCBI research suggests that there is a tremendous overlap between the symptomatology of both OCD and PTSD. Both are characterized by recurrent and intrusive thoughts experienced as anxiety/fear-inducing. They discovered that as complex PTSD symptoms reduce, OCD symptoms increase, and as OCD symptoms are treated, PTSD symptoms take over.

Researchers argue that OCD symptoms do not appear to “replace” PTSD symptoms, but instead, OCD symptoms are used to cope with, reduce, and avoid trauma-related symptoms and memories. Furthermore, the link between OCD and PTSD has been evidenced by many researchers. [4]

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Obsession Symptoms

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

  • Fear of germs or contamination
  • Unwanted, forbidden, or taboo thoughts involving sex, religion, or harm
  • Aggressive thoughts toward others or self
  • Having things symmetrical or in a perfect order
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Compulsion Symptoms

Compulsions are repetitive behaviors that a person with OCD urges to do in response to an obsessive thought. Common compulsions include:

  • Excessive cleaning and handwashing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting

Not all rituals or habits are compulsions. Everyone double-checks things sometimes. But a person with OCD generally:

  • Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors

Complex PTSD and OCD

It’s not yet clear how OCD and complex PTSD conditions are linked. Still, it’s thought that a significant number of OCD sufferers have experienced some trauma in their past – and some PTSD symptoms such as hypervigilance can manifest themselves very similarly to OCD symptoms.

The onset of OCD is not limited to the original meaning of trauma. Instead, traumatic experiences such as unexpected exposure to contaminants or various stressful life events often cause the onset of OCD. Since conditioned anxieties and fears are worsened by performing compulsive behaviors in OCD, it would be better to intervene at an earlier time. Furthermore, a full understanding of the onset situation will bring good therapeutic cooperation and effective intervention. [5]

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Difference Between OCD and PTSD

How are OCD and PTSD different? OCD and PTSD are characterized by intrusive, distressing clinical phenomenology. Whereas OCD can start after a precipitating event, PTSD is defined by experiencing severe trauma. Both disorders are ameliorated by exposure during psychotherapy, suggesting an underlying common mechanism.

Although people with OCD display similar behaviors to “block out” upsetting or disturbing images, there is a slight difference. People with complex trauma or PTSD are trying to “block out” or stop these images, feelings, and memories because of something horrible that occurred to them, while this may not be true for people with OCD – although it can be.

People with OCD act in certain behaviors because they feel like they have forgotten something. This feeling does not disappear until they perform certain compulsions (rituals or routines). While a person with PTSD avoids doing certain things or seeing certain people because they trigger painful memories of a traumatic event. This individual attempts to escape or avoid these things (behaviors triggered by memories, thoughts, or images) because they cause them distress. Thus, the intention behind the behaviors is different.

Also, people with OCD experience these recurring thoughts and perform these behaviors more repeatedly than those with PTSD. For instance, a person with OCD may need to perform their rituals and routines repeatedly throughout the day to experience relief. In contrast, people with PTSD may only be triggered periodically, for instance, when a memory arises or when they encounter an image that causes them to remember what happened. This may have an occurrence for a day, week, month, year, or after several years. It may not be a daily need or urge. So, with PTSD, there is usually a trigger that brings back the memory, which then causes the person to perform “avoidant behaviors.”

PTSD and OCD
With OCD and PTSD comorbidity, you may have intrusive thoughts and engage in neutralizing behaviors. Contact We Level Up FL today for PTSD and OCD treatment resources.

Medications for OCD and PTSD

The available treatments for OCD and PTSD comorbidity are almost the same for medication and psychotherapy. Researchers suggest that antidepressants, anti-anxiety, and psychotherapy, like CBT, can ease OCD and PTSD symptoms (i.e. flashbacks, negative thoughts and emotions, and ritualistic and avoidant behaviors).

Cognitive behavioral therapy (CBT) can help people with OCD or PTSD better understand how their unhealthy and aversive thoughts, perceptions, memories, emotions, and thought processes can affect their behavior and negatively impact their lives. It can also help these individuals identify their triggers and learn how to cope and manage their symptoms in healthier ways. Ultimately, CBT can help people with OCD and PTSD change their negative thoughts, emotions, and behaviors into more positive and healthier ones.

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Although ERP (Exposure and response prevention) has been used as the treatment of choice for OCD, many individuals still do not benefit from it. Over the last decade, clinicians have actively attempted to develop new approaches for treating OCD. CBT (cognitive behavioral therapy) has become a widely accepted treatment for trauma-related distress and OCD.

The goal of CBT is to correct faulty appraisals of intrusive thoughts. Obsessive-compulsive symptoms are maintained when the individual cannot reinterpret or consider alternative meanings for the intrusive thoughts. Through the identification of obsessions and compulsions, as well as the awareness of how the individual interprets the obsessions, individuals are taught to challenge their interpretations and reevaluate the threat they feel from them.

Furthermore, the therapist will challenge the client to behaviourally oppose his/her obsessions and compulsions as evidence contradicting the intrusive thoughts. The trauma memory and trauma-related thoughts need to be reinterpreted and integrated into a past-oriented mindset. Additionally, neutralizing behaviors need to be modified to inhibit the perpetuation of PTSD symptoms. Finally, maladaptive behaviors must be challenged and prevented to enhance the reinterpretation of trauma-related thoughts. [6]

Are OCD and PTSD linked?

The OCD treatment may vary if it occurs with PTSD, so discussing any trauma with your therapist is important. People with OCD that develops after trauma show different symptoms, including more severe symptoms such as suicidal thoughts, self-mutilation, panic disorder with agoraphobia, hoarding, compulsive spending, and greater anxiety or depression. However, none of these self-reported behaviors are enough to make a formal diagnosis.

Because trauma can complicate the treatment of OCD and have practical implications about the specific course of treatment, an accurate evaluation of the traumatic event, themes, and impact is necessary. Exposure therapies and CBT have been well-established as effective treatments for trauma-related disorders and OCD.

Regardless of the difference between PTSD and OCD, by neglecting the treatment of the trauma-related difficulties, the client will likely be resistant to OCD treatment and replace OCD symptomatology with other maladaptive coping techniques to manage the distress caused by the traumatic recall. By gaining a better understanding of the physical, psychological, and emotional distress the individual experienced as a result of the trauma, the healthcare providers may gain insight into the obsessions and compulsions of the client with OCD and thus be better equipped to direct the treatment to maximize efficacy and enhance the client’s quality of life.

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OCD and PTSD Therapy Near Me

Posttraumatic stress disorder (PTSD) is a chronic, often debilitating mental health disorder that may develop after a traumatic life event, such as military combat, natural disaster, sexual assault, or unexpected loss of a loved one. Most of the U.S. population is exposed to a traumatic event during their lifetime, and shortly after exposure, many people experience some symptoms of PTSD. Although among most individuals, these symptoms resolve within several weeks, approximately 10%-20% of individuals exposed to trauma experience PTSD symptoms that persist and are associated with impairment. [6]

The diagnosis of what is now accepted as Post Traumatic Stress Disorder (PTSD) has changed over the years as we have gained a better understanding of the stress response and its longer-term impact on the body and the brain. PTSD treatment works. Those who have gone through trauma can learn to feel safe in the world and cope with stress.

Deciding to get help and taking steps to start can be hard. There are several effective PTSD treatments. This means you have options. Many professionals provide evidence-based talk therapy and medication to people who go through trauma. Treatments with the strongest evidence should be the first line of treatment for PTSD whenever possible, considering patient preferences, values, and clinician expertise.

OCD is typically treated with medication, psychotherapy, or a combination of the two. Although most patients with OCD respond to treatment, some continue to experience symptoms. Sometimes people with OCD also have other mental disorders, such as anxiety, depression, and body dysmorphic disorder, a disorder in which someone mistakenly believes that a part of their body is abnormal. It is important to consider these other disorders when making treatment decisions.

PTSD and OCD
It’s estimated that between 4% and 22% of people with PTSD also have a diagnosis of OCD. Locate the PTSD and OCD therapy near you now and call us for treatment resources.

Medications for OCD

Serotonin reuptake inhibitors (SRIs), which include selective serotonin reuptake inhibitors (SSRIs), are used to help reduce OCD symptoms. SRIs often require higher daily doses in treating OCD than depression and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.

Research shows that some patients may respond well to antipsychotic medication if symptoms do not improve with SRIs or SSRIs. Although research shows that an antipsychotic medication may help manage symptoms for people with OCD and a tic disorder, research on the effectiveness of antipsychotics in treating OCD is mixed.

If you are prescribed medications for OCD and PTSD, be sure you:

  • Talk with your healthcare provider or pharmacist to ensure you understand the medications’ risks and benefits.
  • Do not stop taking the medication without talking to your healthcare provider first. Suddenly stopping a medication may lead to a “rebound” or worsening OCD symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.
  • Report any concerns about side effects to your healthcare provider right away. You may need a change in the dose or a different medication.

Psychotherapy

Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy and OCD therapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training), can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP)—spending time in the very situation that triggers compulsions (e.g. touching dirty objects) but then being prevented from undertaking the usual resulting compulsion (e.g. handwashing)—is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication.

As with most mental disorders, treatment is usually personalized and might begin with either medication, psychotherapy, or a combination of both. For many patients, EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms or vice versa for individuals who begin treatment with psychotherapy.

We Level Up FL provides world-class care with round-the-clock medical professionals available to help you cope. All work as a team, providing PTSD and OCD treatment for successful recovery. Make this your opportunity to reclaim your life. Call today to speak with one of our treatment specialists. Your call is private and confidential, and there is never any obligation.

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Sources:

[1,6] Liriano F, Hatten C, Schwartz TL. Ketamine as a treatment for post-traumatic stress disorder: a review. Ketamine PTSD Drugs Context. 2019 Apr 8;8:212305. DOI: 10.7573/dic.212305. PMID: 31007698; PMCID: PMC6457782. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457782/
[2] Examining the Differential Diagnosis Between OCD and PTSD Fact Sheet – https://www.mirecc.va.gov/visn16/docs/ocd-and-ptsd-fact-sheet.pdf
[3] Obsessive-Compulsive Disorder – https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd NIMH National Institute of Mental Health
[4] Dykshoorn KL. Trauma-related obsessive-compulsive disorder: a review. Health Psychol Behav Med. 2014 Jan 1;2(1):517-528. DOI: 10.1080/21642850.2014.905207. Epub 2014 Apr 23. PMID: 25750799; PMCID: PMC4346088. – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346088/
[5] Impacts of Stressful Life Events and Traumatic Experiences on Onset of Obsessive-Compulsive Disorder – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744562/
[6] Posttraumatic stress disorder: from diagnosis to prevention. –  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161419/