PTSD & OCD: Understanding the Link

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a mental health condition that some people develop after experiencing, witnessing, or hearing about a traumatic event that involves death or threats of death, sexual assault, or violence. PTSD develops when the stress and trauma of an experience overwhelms a person’s ability to cope with it, causing lasting negative impacts on their mental health. While most people experience trauma in their lives, only about 6-8% will develop PTSD.⁴

PTSD symptoms begin after the traumatic event, persist for at least one month, and are severe enough to cause significant distress or impairment. The person will experience intrusive, unwanted thoughts and vivid flashbacks about the trauma that make them feel like they’re re-experiencing the trauma. Because of how scary and distressing these memories are, people with PTSD also try to avoid thoughts and things that remind them of the traumatic experience. This avoidance coping can become unhealthy, interfering with their ability to live a normal and fulfilling life.^1,5

What Is OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition that involves intrusive thoughts (aka OCD obsessions) that cause a lot of anxiety or distress. To cope, many people with OCD develop rigid routines or rituals (aka OCD compulsions) that help them alleviate their anxiety and feel more in control of their circumstances.^1,5

The specific types of OCD obsessions and compulsions a person has vary depending on the type of OCD but usually revolve around thoughts that cause doubt, anxiety, or distress. The compulsions they develop are usually an attempt to alleviate those fears and doubts but instead worsen symptoms and impairments in the long run.

Differentiating Between PTSD & OCD

The symptoms of PTSD and OCD can overlap considerably. For example, PTSD and OCD involve unwanted intrusive thoughts that cause distress and an extreme avoidance of triggers that begin to interrupt the ability to function.^1,5 The most important difference between OCD and PTSD is that OCD symptoms can begin at any time, while PTSD symptoms always develop shortly after a traumatic experience.^1,4,5

While it’s true that PTSD and OCD often co-occur, this is not always the case. It’s possible to only be diagnosed with PTSD or OCD, and the symptoms of each are different enough to distinguish between the two disorders.

Some of the key differences between PTSD and OCD are listed below:^1,5

Onset of Symptoms

People are only diagnosed with PTSD after they have experienced a recent traumatic event that triggered specific changes in their mood, thinking, and behavior. Because of this, the onset of PTSD is more predictable than the onset of OCD symptoms, which can begin at any time.

Also, PTSD symptoms are directly caused by a traumatic experience, while OCD symptoms are believed to be caused by a family history of OCD and environmental factors.¹ While stressful situations or traumatic experiences can trigger the onset of OCD symptoms, it’s also possible for people to develop these symptoms without experiencing stress or trauma.⁵

Types of Intrusive Thoughts

While intrusive thoughts can be a symptom of either PTSD or OCD, the specific kinds of thoughts differ for each disorder. People with PTSD have intrusive thoughts, memories, flashbacks, or nightmares about the traumatic event that are vivid and make them feel like they’re ‘reliving’ the trauma instead of just remembering it. These PTSD memories can be so realistic that they cause PTSD dissociative symptoms.⁵

People with OCD, on the other hand, can have intrusive thoughts about a wide variety of things. Intrusive thoughts related to OCD include themes of perfectionism, self-doubt, or just strong preferences for how things are done. Unlike PTSD intrusions, OCD obsessions are not typically as narrow or vivid and don’t usually cause dissociation.

Types of Behavior Patterns

People with OCD develop rigid routines, strict schedules, and time-consuming rituals to manage their intrusive thoughts and the anxiety they cause. These rigid behavior patterns help them feel more in control of themselves and their lives, which temporarily relieves some of their OCD-related distress and anxiety. Examples of common compulsive behavior patterns include OCD-induced excessive cleaning, OCD checking, researching, or strict rules related to eating, sleeping, or exercising.⁵

Rigid and ritualistic behavior patterns are not a common feature in PTSD. Instead, people with PTSD are more likely to behave in somewhat erratic or impulsive ways. Sometimes, people with PTSD adopt destructive habits like substance use or promiscuous sexual behavior following a traumatic event.^4,5 These patterns are much less common in people with OCD, who tend to act more cautiously.

Avoidance Behaviors

People with both PTSD and OCD have avoidant behaviors, but these can look very different in both disorders. People with PTSD often avoid people, places, and situations that remind them of the traumatic experience, while OCD-related avoidance can involve a wider range of triggers.

Also, avoidance of trauma triggers and memories is usually a part of PTSD and can manifest as a person trying not to think about their traumatic experience. In OCD, it’s more common for people to obsessively ruminate over their intrusive thoughts rather than trying to suppress or avoid them.

Underlying Fears

Both PTSD and OCD are closely linked to feelings of anxiety which drive the compulsive and avoidance behaviors, but the specific underlying fears can be very different. In PTSD, the underlying fear is normally related to the fear of the traumatic event happening again. For example, people who have PTSD related to car accidents are often terrified to drive in case they get in another wreck.

In OCD, the underlying fears vary more, depending on the specific OCD subtype the person has. Fears can revolve around the person with OCD becoming contaminated or failing, getting sick, going crazy, being gay, or doing something violent or criminal. While PTSD fears revolve around an actual traumatic event that has happened before, OCD fears can involve events that have never been experienced and that are unlikely to occur.

How to Know If You Have PTSD or OCD

When OCD symptoms begin shortly after a highly stressful and traumatic experience, it can be difficult to determine what symptoms are related to the trauma and which may be indicators of OCD. Only a licensed medical or mental health provider can diagnose mental health disorders. Most of the time, this happens in the initial intake appointment.⁴

To verify a correct diagnosis, clinicians sometimes use standardized assessments with questions that may be asked before or during the appointment. Other times, the diagnostic process involves informal questions and a conversation with the client about their symptoms. To differentiate a diagnosis of PTSD from OCD, this assessment will likely involve questions about the timeline of traumatic events, which are compared to the timeline of when symptoms began.⁵

Some of the questions that a clinician might ask to determine a diagnosis of PTSD, OCD, or both include:

• What kinds of intrusive thoughts are you having, and what triggers them?
• What changes in your behavior when these intrusive thoughts arise?
• What kind of traumatic events do you believe may be impacting your symptoms?
• When did these traumatic experiences occur, and when did your symptoms begin?
• Do you have a history of these symptoms prior to the traumatic event?

The Connection Between Trauma & OCD

In recent years, more research has been conducted to understand better the close connection between trauma and obsessive compulsive disorder. From this research, it’s clear that experiencing trauma and developing symptoms of PTSD increases the risk of developing OCD symptoms. It’s also clear that having both disorders can worsen the severity of symptoms and complicate treatment.^1,2,3,6,7

While there is considerable overlap and a strong correlation between the symptoms of PTSD and OCD, there is no consensus yet to explain how the two disorders are related.^1,3,6 Some experts believe that traumatic experiences can trigger OCD, and when this happens, OCD compulsions can become a maladaptive behavior used to cope with PTSD symptoms.² Others believe that the link between the two disorders is mediated by other factors, like the presence of depression.⁸

The Impact of Having Both PTSD & OCD

Co-occurring PTSD and OCD pose unique challenges in treatment, as the different disorders require different approaches. Research indicates that individuals with both disorders often experience more severe symptoms. Additionally, symptoms of PTSD can worsen as the symptoms of OCD improve and vice versa, which can slow or even stall progress in treatment.^2,7

Treatment for PTSD & OCD

Research on comorbid PTSD and OCD suggests that having both conditions complicates the treatment process, leading to slower or less successful progress. Therapy is a frontline treatment for both PTSD and OCD. Specific types of cognitive behavioral therapy (CBT) and exposure therapy are effective in treating PTSD and treating OCD separately but may need to be modified for people diagnosed with both conditions.^2,3,6,7

Evidence-based treatments for PTSD and OCD include:^7,9

• Cognitive behavioral therapy (CBT): CBT is one of the most common types of therapy used to treat some of the most common mental health conditions, including PTSD and OCD. In 12-24 sessions, CBT for PTSD and CBT for OCD therapy helps people identify and adjust unhelpful thoughts and behaviors that are worsening their symptoms, replacing them with healthier coping skills.
• Exposure therapy: Exposure and response prevention (ERP) is a specific kind of exposure therapy for OCD, which helps a person to respond differently to obsessive thoughts and compulsive urges. Exposure therapies like prolonged exposure are sometimes used to treat PTSD and focus on helping people become gradually de-sensitized to trauma triggers and reminders.
• Acceptance and commitment therapy (ACT): ACT is an evidence-based treatment for OCD and involves teaching clients skills to use mindfulness to unhook from unhelpful thoughts and cope with distressing feelings. ACT also encouraged people to identify and act on their core values rather than letting their emotions or urges control their behavior.
• Eye movement desensitization and reprocessing (EMDR): EMDR for PTSD is an evidence-based therapy that uses bilateral stimulation to help people access and process thoughts and feelings related to their trauma. EMDR is a newer trauma therapy that has gained popularity because it can help some people process traumatic memories in just a few sessions.
• Cognitive processing therapy (CPT): CPT is an evidence-based therapy used for PTSD and involves helping people to process difficult memories and thoughts related to their trauma in a gradual way. In about 12 sessions, CPT focuses on helping people identify and adjust their beliefs about what happened to them and why it happened.
• Medication for OCD: In some cases, medication for OCD is also recommended to help people struggling with severe symptoms. SRI or SSRI antidepressants, anti-anxiety medications, and even antipsychotics are sometimes used to help people with OCD.

When to Seek Professional Support

If you are struggling with the symptoms of OCD, PTSD, or both, it’s important to seek professional help. If untreated, PTSD and OCD conditions will get worse to the point that symptoms begin to interfere with a person’s ability to function. Instead of waiting for this to happen, getting help soon after the traumatic experience happens or when symptoms begin can make it easier to treat the symptoms and make a full recovery.⁴

When you begin your search for a therapist, it’s a good idea to look for someone who specializes in PTSD and OCD. This will help to ensure you are accurately diagnosed and treated for both conditions. Many people begin their search for a therapist by using an online directory that allows them to filter their search by location, insurance accepted by the therapist, and specialty area.

In My Experience

In my experience, traumatic experiences can trigger a wide range of mental health disorders, including OCD. Research estimates that having a diagnosis of PTSD makes you 3.62 times more likely to develop OCD, and this often happens within a year of when the trauma occurred.² When PTSD and OCD co-occur, the symptoms of each often affect each other, which can complicate treatment.¹ Finding a skilled therapist who has experience in treating both conditions can help to improve the odds of making a successful recovery.