Is There A Link Between PTSD And OCD?
Post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) are distinct mental health conditions that have their own diagnostic criteria and treatment methods. Research shows that those who live with PTSD are 3.62 times more likely to experience OCD. This article will go over the similarities 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) is a mental health condition involving persistent fear and worry that arises out of a traumatic event. Obsessive-compulsive disorder (OCD) is a mental health condition 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 hearing a sound or seeing an object. The mental images in flashbacks can be very realistic 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, leading to sleep issues. [1]
Intrusive thoughts in OCD 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. [2] For instance, a person might get an intrusive thought regarding contamination and disease. To avoid illness, they may repeatedly wash their hands.
Like PTSD, intrusive thoughts associated with OCD can be triggered by certain events or hearing about something through the media or through 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.
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 is indicative of OCD and can be time consuming and distressing. [2]
Although these thoughts function differently in each illness, the anxiety that they cause can be similar. In fact, both OCD and PTSD were categorized as anxiety disorders in the DSM-IV, though 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 impairments 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. [3]
Similarly, those living with OCD can 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.
Returning to the example earlier 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 to using the stove.
Repetitive and compulsive behaviors, including avoidance, can become instilled habits; and when experiencing an intrusive thought, the individual may naturally gravitate towards using these learned actions because it reduces anxiety and provides reassurance by neutralizing the thoughts. This then becomes a conditioned response of fear and anxiety. [4]
The same concept occurs in PTSD, and it is believed that avoidance behaviors are detrimental because they can strengthen fear. At the same time, , making it harder to become deconditioned to the triggers. [5] This is why some forms of therapy, like exposure therapy, are based on confronting one’s 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, recent , and that their symptoms can work off of each other. [6] Studies show 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 a replacement for the PTSD symptoms; instead, they are a coping mechanism for the symptoms. [6] 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 often involves similar protocols. A class of antidepressant drugs known as selective serotonin reuptake inhibitors (SSRIs) has been shown to provide relief for reexperiencing symptoms, like flashbacks, and to reduce avoidance behaviors. [7] SSRIs are also a primary treatment method for those who live with OCD. [8] SSRIs can help alleviate anxiety-related symptoms and also 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 and exposure therapy can help the participant confront their fears and reframe thought patterns that may lead to maladaptive emotions and behaviors
An increasingly large body of evidence suggests that online therapy can help individuals manage mental health conditions like OCD and PTSD. For example, in one review, researchers examined evidence from two online cognitive behavioral therapy trials on OCD and one on PTSD, concluding that online therapy is as effective as face-to-face treatment. Cognitive behavioral therapy can 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 hard to leave home.
Takeaway
Post-traumatic stress disorder and obsessive-compulsive disorder are closely connected, often producing symptoms that overlap and sometimes developing alongside one another. Both of these mental health conditions can have a significant effect on an individual’s daily life. If you’re living with PTSD, OCD, or a similar mental health challenge, consider reaching out to a therapist online. With the support of a professional, you can better understand how certain disorders interact, address your symptoms, and improve your mental well-being.
References
American Psychiatric Association. (2017, January). What Is Posttraumatic Stress Disorder? Retrieved June 25, 2019, from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
American Psychiatric Association. (2017, July). What Is Obsessive-Compulsive Disorder? Retrieved June 25, 2019, from https://www.psychiatry.org/patients-families/ocd/what-is-obsessive-compulsive-disorder
National Institute of Mental Health. (2019, May). Post-Traumatic Stress Disorder. Retrieved June 25, 2019, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Gillan, C. M., Morein-Zamir, S., Urcelay, G. P., Sule, A., Voon, V., Apergis-Schoute, A. M., . . . Robbins, T. W. (2014). Enhanced Avoidance Habits in Obsessive-Compulsive Disorder. Biological Psychiatry, 75(8), 631-638. doi:10.1016/j.biopsych.2013.02.002
Sripada, R. K., Garfinkel, S. N., & Liberzon, I. (2013). Avoidant symptoms in PTSD predict fear circuit activation during multimodal fear extinction. Frontiers in Human Neuroscience, 7. doi:10.3389/fnhum.2013.00672
Dykshoorn, K. L. (2014). Trauma-related obsessive-compulsive disorder: A review. Health Psychology and Behavioral Medicine, 2(1), 517-528. doi:10.1080/21642850.2014.905207
Lancaster, C., Teeters, J., Gros, D., & Back, S. (2016). Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Journal of Clinical Medicine, 5(11), 105. doi:10.3390/jcm5110105
Kellner, M. (2010). Drug treatment of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, 12(2), 187-197. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181958/.