Common Symptom Presentations in Individuals With Probable Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder

Misconceptions Among Mental Health Treatment Providers About OCD and PTSD

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) share overlapping features for which similar cognitive behavioral treatment (CBT) strategies can be employed. However, the comorbid presence of these conditions poses unique clinical considerations, and a nuanced approach to assessment, conceptualization, and treatment is needed when working with individuals with co-occurring OCD and PTSD. Treatment providers may not be aware of these nuances and may hold misconceptions about co-occurring OCD and PTSD, impacting their approach to assessment, conceptualization, and treatment. The current study sought to examine possible misconceptions among mental health treatment providers of differing specializations. Among 146 primarily CBT-oriented treatment providers (20.3% generalist, 13.0% PTSD specialist, 32.6% OCD specialist, and 34.1% OCD/PTSD specialist), exploratory factor analysis categorized misconceptions relating to Trepidation, Differential Diagnosis, Flexibility, OCD is Trauma, Trauma Misconceptions, and Compartmentalization. Overall, OCD specialists endorsed misconceptions most frequently, including those of Trepidation and underestimating the prevalence of trauma and PTSD in individuals with OCD. In contrast, PTSD specialists were more likely to endorse providing patients reassurance for their OCD-related fears, and OCD/PTSD providers were more likely to apply rigid Differential Diagnosis criteria not supported by research or diagnostic criteria to intrusive thoughts and safety behaviors. Misconceptions are explained through the lens of differing conceptualization and treatment approaches between areas of specialization.

Exploring OCD severity in treatment-seeking veterans: a cross-sectional comparison between post-traumatic stress disorder (PTSD) and complex-PTSD (C-PTSD)

The recent International Classifications of Diseases-11 (ICD-11) distinction of complex- post-traumatic stress disorder (C-PTSD) from post-traumatic stress disorder (PTSD), has highlighted a research gap in exploring how C-PTSD may relate to obsessive-compulsive disorder (OCD) differently than PTSD. Mental health disorders and comorbidities appear to be greater in military veterans compared to the general population. Thus, this study aimed to explore potential differences in OCD severity between probable PTSD and probable C-PTSD in a national clinical sample of UK military veterans. Data from 428 veterans were analysed using a previously collected dataset. The survey assessed sociodemographic characteristics, military experiences, physical and mental health, and well-being. Results indicated significant differences in OCD severity between probable PTSD and probable C-PTSD. OCD severity significantly increased as C-PTSD symptom severity increased for veterans with probable C-PTSD. Though no significant association was identified between OCD severity and PTSD scores within the probable PTSD group, this finding should be interpreted with caution, as the small sample may have limited statistical power. Greater C-PTSD severity significantly predicted greater OCD severity, but PTSD scores did not. Disturbances of self-organisations (DSO) symptoms within C-PTSD were more strongly associated to OCD severity compared to PTSD symptoms, indicating a seemingly complex interplay between C-PTSD's cluster of symptoms and OCD severity. Future research should focus on replication involving larger veteran samples and the general population, incorporating clinician-administered assessments alongside self-report measures to enhance diagnostic accuracy.

The Role of the Orbitofrontal Cortex in the Regulation of Fear Coping Strategies

ABSTRACT

Under threats, individuals exhibit freezing behavior and prepare for active coping. The ability to flexibly shift between freezing and active coping increases survival chances in animals and decreases susceptibility to mental disorders among human beings. For example, patients with psychiatric disorders, such as obsessive-compulsive disorder and posttraumatic stress disorder, often show maladaptive coping behaviors. The orbitofrontal cortex (OFC) is a critical hub to process higher cognitive functions, sensory inputs, reward learning, and decision-making. It also regulates negative emotions and its aberrant activation level often correlates with numerous mental disorders. The rodent OFC comprises different subdivisions with varying connections to cortical and subcortical regions. Among these subdivisions, the medial orbital area (MO) and the lateral orbital area (LO) have distinct functions in the regulation of fear. Here, we updated the existing rodent literature studying the function of the OFC, with a particular focus on the MO and the LO in different coping strategies of animals. By examining the role of the OFC in the mediation of defensive coping strategies, we aim to deepen the understanding of its functional importance on mental health.

Does mental contamination mediate the association between childhood trauma and obsessive-compulsive symptoms in adults?

BACKGROUND

Previous research has shown that individuals with obsessive-compulsive disorder (OCD) and OCD symptoms have higher rates of childhood trauma. Although it has been suggested that this relationship is due to mental contamination that developed in response to trauma, no studies have investigated the associations between childhood trauma, mental contamination, and OCD, and none have examined whether the relationship between childhood trauma and OCD is mediated by mental contamination.

OBJECTIVE

We hypothesized that OCD, childhood trauma, and mental contamination are positively correlated, and that mental contamination would mediate the association between childhood trauma and OCD symptoms PARTICIPANTS AND SETTING: We tested these hypotheses in a sample of 245 individuals, which comprised 158 MTurk workers recruited via CloudResearch.com and 87 individuals recruited through social media with OCD diagnoses or OCD symptoms above the clinical cutoff on the Obsessive-Compulsive Inventory-Revised.

METHODS

Participants completed online self-report questionnaires on childhood trauma, mental contamination, and OCD symptoms.

RESULTS

The results revealed statistically significant positive correlations between childhood trauma, mental contamination, and OCD, and statistically significant total and indirect effects for the simple mediational model. Exploratory re-analyses with participants who had high OCD symptoms (n = 87) showed similar results.

CONCLUSIONS

Our research shows that the association between childhood trauma and OCD may be explained by mental contamination. We recommend that mental contamination should be assessed and addressed in OCD patients with a history of childhood trauma.

Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response

BACKGROUND

Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs.

METHODS

The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n = 3083, 94.2 %) and OCD + PTSD (n = 191, 5.2 %) who received CBT with ERP in two major intensive OCD treatment programs.

RESULTS

Although patients with OCD + PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD + PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant to PTSD.

LIMITATIONS

Findings are limited by a naturalistic treatment sample with variation in treatment provision.

CONCLUSIONS

Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD + PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.

A protocol for a randomized controlled trial of exposure and response prevention for veterans with obsessive compulsive disorder

BACKGROUND

Obsessive compulsive disorder (OCD) is effectively treated with exposure and response prevention (ERP), yet very few veterans receive ERP for OCD within the Veterans Health Administration (VHA). Veterans are a clinically complex population, and no prior research has evaluated the effectiveness of ERP in veterans with OCD or comorbid OCD and posttraumatic stress disorder (PTSD). Given the limited accessibility of ERP-trained providers within VHA, assessment of video telehealth (VTH) delivery of ERP is warranted.

METHODS

A sample of 160 veterans with OCD (80 diagnosed with comorbid PTSD) will be randomly assigned to receive up to 16 sessions of ERP or a stress management training control delivered via VTH. Assessments will occur at baseline, posttreatment, and 6-month follow-up. The primary outcome will evaluate the impact of ERP on participants' functioning, and secondary outcomes will include quality of life and OCD symptoms. At posttreatment, qualitative interviews with veterans, clinicians, and administrators will explore barriers and facilitators to treatment delivery, and the implementation potential of ERP.

CONCLUSIONS

Results will provide direction for the treatment of OCD and comorbid PTSD in veterans, as well as guidance for future implementation efforts for ERP within VHA.

CLINICALTRIALS

gov Identifier:NCT05240924.

Assessment of Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are commonly comorbid and share prominent features (e.g., intrusions, safety behaviors, and avoidance). Excellent self-report and clinician-administered assessments exist for OCD and PTSD individually, but few assess both disorders, and even fewer provide instruction on differential diagnosis or detection of comorbid OCD and PTSD. To address this gap in the literature, the current paper aims to (1) highlight diagnostic and functional similarities and differences between OCD and PTSD to inform differential diagnosis, (2) outline assessment recommendations for individuals with suspected comorbid OCD and PTSD, OCD with a significant trauma history or posttraumatic symptoms, or PTSD with significant obsessive-compulsive symptoms, and (3) explore future directions to evaluate and improve methods for assessing co-occurring OCD and PTSD.

The Relationship Between Trauma Exposure and Obsessive-Compulsive Disorder in Youth: A Systematic Review

Extant literature suggests a possible relationship between childhood trauma exposure and the development and trajectory of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD); however, this relationship is poorly understood. We conducted a systematic review that examined trauma exposure and OCS/OCD in youth. Primary inclusion criteria were English-language articles that addressed a sample with participants under 18 years of age. 46 articles met criteria for review, and were categorized into three groups of overlap: Post-traumatic Stress Disorder (PTSD) and OCS or OCD (n = 3), clearly defined Criterion A event trauma exposure and OCS or OCD (n = 30), and less well-defined potential trauma exposure and OCS or OCD (n = 13). There was mixed evidence linking trauma exposure and the development of OCS or OCD in youth. Major methodological limitations preclude formal conclusions. More research on co-occurring trauma exposure and OCD/OCS in youth is needed to advance research and improve treatment.

Obsessive-Compulsive Symptoms and Daily Experiences of Posttraumatic Stress and Mental Contamination Following Sexual Trauma

Although cross-sectional research highlights similarities between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) among individuals exposed to sexual trauma, little is known about how these disorders relate over time. The goal of the present study was to examine whether 1) OCD symptoms prospectively predicted daily symptoms of PTSD, and 2) OCD and PTSD symptoms prospectively predicted daily experiences of sexual trauma-related mental contamination (i.e., dirtiness in the absence of a physical pollutant). Forty-one women with a sexual trauma history completed baseline measures of OCD and PTSD, as well as twice-daily assessments of PTSD symptoms and mental contamination over a two-week period. Total OCD symptoms and the unacceptable thoughts dimension significantly predicted daily PTSD symptoms after accounting for other OCD dimensions. Only total OCD symptoms significantly predicted daily mental contamination when examined together with total PTSD symptoms. No individual PTSD or OCD clusters/dimensions significantly predicted daily mental contamination when examined simultaneously. Findings from this study highlight the nuanced associations among OCD symptoms, PTSD symptoms, and experiences of mental contamination. Future research is needed to further understand the development of PTSD, OCD, and mental contamination over time to inform targets for intervention.

Symptom severity and presentation in comorbid OCD and PTSD: A clinical replication

Individuals with comorbid obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) experience more severe OCD symptoms and poorer treatment response. Despite some evidence linking OCD symptom domains to trauma, only one study to date has examined typical OCD and PTSD presentations in individuals with OCD+PTSD, and findings were based on a nonclinical sample. The current study sought to replicate findings in a clinical sample of 1,014 patients diagnosed with OCD (n = 928), PTSD (n = 40), and OCD+PTSD (n = 46) in specialty OCD and anxiety treatment programs. Consistent with previous research, patients with OCD+PTSD reported more severe OCD yet similar severity PTSD symptoms and did not evidence a unique phenotypic presentation once symptom overlap and comorbid mood and personality disorders were considered. OCD+PTSD is equally as heterogeneous as OCD and PTSD alone. Implications for the research and treatment of OCD+PTSD are discussed, and assessment and treatment recommendations are provided.

Does a unique co-occurring OCD and PTSD factor structure exist?: Examination of overlapping OCD and PTSD symptom clusters

OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Extant factor analytic research supports a model of PTSD at odds with current DSM-5 criteria, and no examination of the factor structure of comorbid OCD+PTSD currently exists despite the noted overlap in symptomatology and high rates of comorbidity. Using a sample of 4073 patients diagnosed with OCD and/or PTSD enrolled in intensive treatment programs for OCD or PTSD, multigroup confirmatory factor analysis (MGCFA) and measurement invariance tests were run to determine the best fitting model of OCD and PTSD symptoms in patients with OCD+PTSD. Four models were compared across patients with OCD, PTSD, and OCD+PTSD: DSM-5 and 7-factor hybrid PTSD models with OCD symptoms structured as either combined or comorbid constructs. The comorbid hybrid model proved the best fit, and both hybrid models evidenced better fit than DSM-5 models. The current study lends additional support for the hybrid model of PTSD and suggests that there is no existence of a unique factor structure of OCD and PTSD symptoms in individuals with the comorbid conditions.