The goal of this study was to see how co-occurring PTSD impacted intensive OCD treatment. Using a sample of 3,274 patients who received treatment in the intensive OCD programs at Rogers Behavioral Health and McLean Hospital OCD Institute, researchers looked at change in OCD severity across treatment and the length of treatment stay. Patients who had OCD and co-occurring PTSD (5.2%) had the same reduction in OCD severity as patients without co-occurring PTSD, and this reduction occurred at a similar rate. However, patients with OCD and co-occurring PTSD required nearly 11 additional treatment days to achieve this reduction. Patients with OCD and co-occurring PTSD also did not experience as much improvement in symptoms specifically related to unacceptable thoughts and symmetry. Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD and PTSD within intensive OCD treatment programs.

Citation: Pinciotti, C. M., Van Kirk, N., Horvath, G., Storch, E. A., Mancebo, M. C., Abramowitz, J. S., Fontenelle, L. F., Goodman, W. K., Riemann, B. C., & Cervin, M. (2024). Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response. Journal of Affective Disorders, 353, 109-116. https://doi.org/10.1016/j.jad.2024.03.004

The goal of this study was to see whether survivors of different types of trauma were more likely to experience certain OCD symptom dimensions. Using a sample of 329 adults who had experienced trauma, researchers looked at the trauma that impacted each participant the most (i.e., “index trauma”) and scores on self-report OCD measures. Participants whose index trauma involved physical or sexual abuse had the most severe OCD symptoms overall. Interestingly, whereas survivors of interpersonal traumas (e.g., sexual assault, child abuse, physical assault) had severe unacceptable thoughts, survivors of natural disasters had the least severe unacceptable thoughts across all trauma types. Findings suggest that different types of traumatic events may have unique associations with different OCD symptom dimensions.

Citation: Ojalehto, H. J., Pinciotti, C. M., Hellberg, S. N., Myers, N. S., DuBois, C. M., Rodriguez, C. S., & Abramowitz, J. S. (2023). Obsessive-compulsive symptom profiles vary by trauma type. Journal of Obsessive Compulsive and Related Disorders, 38, 100827. Advance online publication. https://doi.org/10.1016/j.jocrd.2023.100827  

The goal of this study was to see whether the way in which survivors of sexual trauma talked about their assault to other people impacted their symptoms of contamination. Using a sample of 106 sexual assault survivors, researchers looked at responses on self-report measures about past conversations about sexual assault and contamination symptoms. More severe contamination symptoms predicted greater sharing of assault-related details during these conversations, yet had no impact on sharing of emotions, thoughts, and beliefs. Findings suggest that survivors of sexual trauma experiencing contamination symptoms may be more likely to fixate on the contamination-invoking parts of their trauma memory when telling other people about their sexual assault.

Pinciotti, C. M., Luehrs, R., Horvath, G., Orchowski, L. M., & Badour, C. L. (2023). Disclosure of traumatic details and obsessive-compulsive contamination symptoms in sexual assault survivors. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/ 10.1037/tra0001485.

The goal of this study was to understand how people with OCD think about why their OCD developed. Using a sample of 45 patients with OCD in residential treatment, patients were asked an open-ended question about why their OCD developed. Researchers then coded these responses as related to trauma, stressful life events, and other (i.e., non-event, such as genetics). Nearly half of the sample (44.4%) believed their OCD developed following a traumatic or stressful event, six of whom identified an event that researchers could clearly tell was a traumatic event (13.3% overall). Those who perceived trauma to have caused their OCD reported more severe obsessions and compulsions, particularly in the past, and themes related to symmetry/exactness, repeating, checking, scrupulosity, pathological doubt, and hoarding. Findings suggest that events that happen before OCD onsets may be likely to be perceived as the cause for OCD and may impact the theme and severity of symptoms

Pinciotti, C. M., & Fisher, E. K. (2022). Perceived traumatic and stressful etiology of obsessive-compulsive disorder. Psychiatry Research Communications, 2(2), 100044. https://doi.org/10.1016/j.psycom.2022.100044

The goal of this study was to see how PTSD affects OCD treatment outcomes. A sample of 15 individuals with OCD who had not experienced improvements with therapy or medication in the past were included in the study. Of these 15 people, eight individuals also had PTSD.  Researchers looked at the effectiveness of residential therapy (which included exposure and response prevention) on OCD symptom severity across people with and without PTSD. Results showed that patients who had OCD and PTSD had less improvements in their symptoms compared to those with OCD only.  Researchers believe that some patients may have had an initial decrease in their OCD symptoms. However, this decrease may have led to an increase in PTSD-related flashbacks and intrusive memories, which then caused patients to engage in OCD compulsions to cope. The findings from this study showed that OCD and PTSD symptoms are related to one another, and that treating only one disorder may exacerbate both disorders and interfere with treatment. 

Gershuny, B. S., Baer, L., Jenike, M. A., Minichiello, W. E., & Wilhelm, S. (2002). Comorbid posttraumatic stress disorder: Impact on treatment outcome for obsessive-compulsive disorder. American Journal of Psychiatry, 159(5), 852-854. https://doi.org/10.1176/appi.ajp.159.5.852

The goal of this study was to looks at histories of traumatic events and PTSD in people seeking treatment for OCD. The sample included 104 people with OCD who had not experienced improvements with therapy or medication in the past. Results showed that 82% of people with OCD had experienced a traumatic event, and over 39% of all people with OCD also had diagnosable PTSD. Additionally, people were more likely to have PTSD (and more severe PTSD) if they had experienced or witnessed interpersonal violence. Individuals were also more likely to have PTSD if they also had major depressive disorder or borderline personality disorder. The findings from this study showed that PTSD may be common in people with OCD who have not responded to treatment in the past. 

Gershuny, B. S., Baer, L., Parker, H., Gentes, E. L., Infield, A. L., & Jenike, M. A. (2008). Trauma and posttraumatic stress disorder in treatment‐resistant obsessive‐compulsive disorder. Depression and Anxiety, 25(1), 69-71. 

The goal of this paper was to review the available research and theory about OCD, PTSD, and exposure therapy for OCD and PTSD, in order to provide clinical recommendations for assessing and treating co-occurring OCD and PTSD in the context of exposure therapy. This paper reviews the exposure therapy approaches for OCD and PTSD, including how they are similar and different, how to appropriately separate OCD symptoms from PTSD symptoms, and recommendations for doing exposure therapy in light of certain complications that may arise. Clinical case examples are provided.

Pinciotti, C. M. (2023). Adapting and integrating exposure therapies for obsessive–compulsive disorder and posttraumatic stress disorder: Translating research into clinical implementation. Clinical Psychology: Science and Practice, 30(2), 190–203. https://doi.org/10.1037/cps0000143