Posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) are distinct mental health conditions, but they can coexist and may have links to one another.
Research indicates people with PTSD are much more likely to also have OCD than the rest of the population. Some with OCD can also attribute the onset of their symptoms to a stressful event.
This article explores the symptoms of each condition, how trauma can contribute to the development of OCD, how often the two conditions occur together, and the best approaches for treatment.
OCD and PTSD are mental health conditions that can lead to some of the same experiences. For example, either could involve:
- anxiety
- difficulty sleeping
- hypervigilance, or always looking for signs of danger
- avoidance of people, places, or situations that might trigger symptoms
However, each condition has some symptoms that make them distinct.
PTSD
PTSD develops in response to a traumatic event or experience. This can include any event a person perceives as threatening.
The symptoms may begin in the months after the event or sometimes much later on. Some of the signs include:
- being easily startled
- feeling tense or “on edge”
- re-experiencing aspects of the event, via intrusive memories, physical sensations, or flashbacks
- nightmares
- dissociation, which is a feeling of detachment or unreality
- feeling angry, guilty, or numb
These symptoms may occur frequently or only when a person encounters a “trigger,” which is something that reminds them of the traumatic event.
OCD
OCD focuses on obsessions and compulsions. Obsessions stem from intrusive thoughts, which are involuntary thoughts that may be frightening, shameful, or anxiety-inducing.
Some examples of obsessions include:
- fear of contamination, such as from germs or pests
- fear of harm, such as burglary or violence
- fear of doing something immoral or shameful
Compulsions are repetitive behaviors that temporarily alleviate the anxiety. Some examples include:
- excessively cleaning or washing the hands
- checking doors to confirm they are locked
- ruminating on past actions or conversations
- frequently seeking reassurance from others
While compulsive behaviors might make a person feel more in control and less anxious initially, they do not effectively address the root cause of the anxiety and can ultimately increase it.
It is possible that trauma could trigger OCD in some people.
A 2020 study found that 61% of 281 participants had experienced stressful life events before the onset of OCD, and 57% had had a traumatic experience in the month before onset. This suggests a link between stress or trauma and the development of the condition.
However, the study also found that the trigger events people reported were very diverse. Many were not directly threatening but instead involved subjective feelings of shock or disgust, which are not included in the traditional definition of psychological trauma.
The authors suggest that a person’s perception or tolerance of these unpleasant emotions may play a key role. For example, those who feel disgust especially intensely or have less experience managing this feeling may be more likely to develop a fear of contamination.
The coexistence of PTSD and OCD is not uncommon.
A 2021 research review notes that previous studies have suggested these conditions occur together between 19% and 31% of the time.
The prevalence of OCD is significantly higher among individuals with PTSD than in the general population.
However, those with OCD are not more likely to have PTSD. This has led some researchers to suggest that PTSD may often precede OCD.
This link makes having a mental health professional provide a careful assessment particularly important, as having both conditions can affect the treatment approach.
Treatment for people with both PTSD and OCD involves addressing the effects of the trauma and then addressing OCD symptoms.
This is because many treatments for OCD involve gradual exposure to the things a person is afraid of. Doing this when a person has undiagnosed PTSD could prove very challenging.
Below are some of the treatment options.
Cognitive behavioral therapy (CBT)
CBT is a popular therapeutic approach for both PTSD and OCD. It involves identifying and challenging unhelpful thought patterns, and gradually replacing them with more balanced ones over time.
Cognitive processing therapy (CPT) is a form of CBT that helps with traumatic memories, while trauma-focused CBT is specifically for families who are helping children cope with trauma.
Exposure therapy
Exposure therapy involves gradual exposure to fearful situations. A type known as prolonged exposure is an option for PTSD, while exposure and response prevention (ERP) is the psychotherapy of choice for OCD.
ERP helps individuals with OCD face situations that cause them anxiety in small, manageable steps, and aims to reduce compulsive behaviors.
Eye movement desensitization and reprocessing (EMDR)
EMDR is a treatment that aims to alleviate the distress that individuals associate with traumatic memories. It uses guided eye movements to help reprocess the experiences, reducing their emotional impact.
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A 2021 review of past research notes there is evidence EMDR may be as effective as ERP and may be more effective than selective serotonin reuptake inhibitors (SSRIs).
Medication
Doctors may prescribe antidepressants, such as SSRIs, to help reduce the symptoms of PTSD or OCD.
These medications affect neurotransmitters in the brain, which can help reduce anxiety or depression symptoms in some people. They may also make it easier for a person to begin psychotherapy.
A psychiatrist can determine the appropriate medication based on individual needs and symptoms.
Individuals should consider reaching out to a mental health professional if they experience:
- persistent and distressing thoughts or behaviors that interfere with daily life
- severe anxiety or panic attacks
- recurrent nightmares or flashbacks
- compulsive behaviors that consume significant time
- avoidance of activities or places due to fear or distress
- feelings of detachment from themselves or the world around them
Early intervention can significantly help improve outcomes. Additionally, a mental health professional can work with an individual to provide a tailored treatment plan to address specific needs.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
- Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you’re not in the same household, stay on the phone with them until help arrives.
People can have PTSD, OCD, or both at the same time. Some research suggests that PTSD may precede OCD in some cases. However, trauma is not the only potential cause of this condition.
Experiences that cause shock or disgust may also lead to OCD, or general life stressors that are not directly threatening in the way traumatic experiences are.
Because some of the symptoms of PTSD and OCD overlap, it is important people with concerns speak with a mental health professional for advice. Either condition can significantly affect quality of life, but both are also treatable.
The right intervention and support can lead to individuals experiencing a reduction in symptoms and an improvement in their well-being.