Is There A Link Between PTSD And OCD?

Nonetheless, the relationship between the two conditions can be complex. 

Below, we’ll explore the similarities and differences between PTSD and OCD and discuss the treatment methods that are used to manage both conditions.

Connections Between PTSD And OCD

Post-traumatic stress disorder (PTSD) typically involves persistent fear and worry stemming from a traumatic event. Obsessive-compulsive disorder (OCD) is typically characterized by unwanted thoughts (obsessions) that lead to specific actions (compulsions) that are meant to alleviate distress. While the two conditions have many differences, they also have several commonalities and can be comorbid in some cases. The following symptoms illustrate the often-close connection between PTSD and OCD.

Intrusive Thoughts

One of the most significant crossovers in terms of symptomology is the existence of intrusive thoughts that can cause mental and physical symptoms. Intrusive thoughts are ideas, words, or images that are unwanted and can lead to maladaptive behaviors or emotions.

In PTSD, intrusive thoughts often take the form of flashbacks and are typically based on a previous traumatic event. Flashbacks can be debilitating for people with PTSD because they can be triggered suddenly by stimuli, such as a sound or an object. The mental images in flashbacks can seem very real and can make a person feel like they are reliving their traumatic experience. Additionally, a person with PTSD can experience nightmares that may lead to intrusive thoughts late at night, which can lead to trouble sleeping. 

Intrusive thoughts in OCD typically work differently and do not necessarily involve trauma. In OCD, intrusive thoughts can come in a similar form as they do in PTSD, but they are typically based on irrational fears of a potential future event. These fears may evolve into obsessions, which can cause the individual to develop compulsions to respond to them and reduce the anxiety associated with the intrusive thoughts. For instance, a person might have an intrusive thought regarding contamination and disease. To avoid illness, they may repeatedly wash their hands.

As with PTSD, intrusive thoughts associated with OCD can be triggered by certain events or by news from the media or word-of-mouth. For example, a person might hear about a house burning down because the stove was left on. Later on, they may have an intrusive thought about their own home being on fire and go back to check the stove and other appliances multiple times.

This can lead to recurring irrational beliefs about the stove being on. In response, the individual might develop compulsions like checking over and over to make sure all appliances are off, which can be time-consuming and distressing. 

Although intrusive thoughts can function differently in each illness, the anxiety that they cause can be similar. Both OCD and PTSD were categorized as anxiety disorders in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), but they have each been moved to more disorder-specific categories in the DSM-V.

Neutralizing Behaviors

In PTSD and OCD, people typically go to great lengths to avoid the triggers for their intrusive thoughts so that they do not experience distress or impairment to functioning. Those who live with PTSD often deliberately stay away from specific people, places, and things that remind them of traumatic events, reducing the likelihood of a flashback or other reexperiencing symptom. For example, someone whose PTSD is linked to a serious car accident might avoid driving along the street where it occurred. 

Similarly, those living with OCD may display excessive avoidance behaviors in order to prevent the possibility of experiencing a compulsion. For example, an individual whose obsession is related to the potential danger of germs may take extreme measures (e.g., avoiding leaving home altogether) to prevent encounters with public places. This can lead to isolation and worsening symptoms of OCD.

In the example above regarding the stove, a person might avoid cooking entirely so that they reduce the chances of a fire. Over time, they could also develop an attached fear of using the stove.

Repetitive and compulsive behaviors, including avoidance, can become instilled habits. When experiencing an intrusive thought, an individual may naturally gravitate toward using these learned behaviors because they reduce anxiety and provide reassurance by neutralizing the thoughts. This can become a conditioned response to fear and anxiety. 

The same concept can occur in PTSD, and avoidance behaviors are thought to be detrimental because they can strengthen fear. They may make it harder to become deconditioned to the triggers. This is why some forms of therapy, like exposure therapy, focus on helping a person gradually confront their triggers so that they can become desensitized to them.

The Links Between OCD And Trauma

Although trauma is a necessary component of PTSD, it is not always part of OCD. However, in some cases, a traumatic event can contribute to or worsen the symptoms of OCD. In the example of a car accident, the individual involved can develop intrusive thoughts related to driving that arise when they’re behind the wheel. In order to cope with these thoughts, they may avoid driving on busy streets during peak times, repeatedly check their mirrors, and perform other repetitive actions that help ensure another accident doesn’t occur. This can be a sign of the existence of both PTSD and OCD.

Despite being in separate categories in the DSM-V, these conditions have symptoms that can work off of each other. Research shows that, in some situations, when PTSD symptoms decrease, OCD symptoms increase, and as OCD symptoms are treated, PTSD symptoms can worsen. The OCD symptoms are not considered a replacement of the PTSD symptoms; instead, they are thought to be a coping mechanism for the symptoms. 

In other situations, PTSD and OCD symptoms can be unrelated yet still exist at the same time and interact with one another. Because of the strong links between the two disorders, some researchers have proposed that trauma-related OCD should be considered a separate condition.

Treatment

Because PTSD and OCD have similarities, treatment for both disorders may involve similar protocols. A class of antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs) has been shown to provide relief for reexperiencing symptoms, such as flashbacks, in addition to reducing avoidance behaviors. SSRIs are also a primary treatment method for those who live with OCD. SSRIs may help alleviate anxiety-related symptoms and reduce depression, which is another common comorbidity with OCD.

For both conditions, psychotherapy is often part of an individual’s treatment plan. Therapeutic modalities like cognitive behavioral therapy (CBT) and exposure therapy may help the participant confront their fears and reframe thought patterns that may lead to maladaptive behaviors.  

If trauma- or OCD-related fears make it hard to leave home, you might consider online therapy, which many peer-reviewed studies have shown to be effective. For example, in one review, researchers examined evidence from multiple trials, including two online cognitive behavioral therapy trials on OCD and one on PTSD, concluding that online therapy is an effective form of treatment for anxiety disorders. Cognitive behavioral therapy can often help address the intrusive thoughts and other common symptoms that are often present in both of these complex mental health conditions.

If you are living with PTSD, OCD, or other mental health-related concerns, know that support is available. With an online therapy platform like BetterHelp, you can participate in therapy remotely, which can be helpful if trauma- or OCD-related fears make it difficult to leave home. You can connect with a therapist in a way that is most comfortable for you, such as audio, live chat, or videoconferencing. 

You can also contact your therapist at any time through in-app messaging, and they’ll respond as soon as they can. This may be helpful if you experience symptoms in between sessions and want to document them instead of waiting until the next session to share them.