The impact of lifetime PTSD on the seven-year course and clinical characteristics of OCD

Abstract

Research has suggested that the co-occurrence of PTSD in individuals with OCD is associated with more severe symptoms and less responsivity to empirically supported treatment as compared to individuals with OCD and no history of PTSD. However, much of this work has been limited by non-empirical case report design, cross-sectional and retrospective analyses, or small sample sizes. The current study extended this research by comparing the clinical characteristics of individuals with OCD with and without a lifetime PTSD diagnosis in a large, naturalistic, longitudinal sample over the course of seven years. At baseline, individuals with comorbid lifetime PTSD reported significantly more severe symptoms of OCD (including symptom levels and insight), lower quality of life, and higher rates of comorbid lifetime mood and substance use disorders than participants without lifetime PTSD. Further, individuals with comorbid OCD and lifetime PTSD reported significantly more severe OCD symptoms over the course of seven years than those without lifetime PTSD. These results are largely consistent with the existing literature and support the need to consider PTSD symptoms in the assessment and treatment of OCD.

Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis

“…As discussed earlier, these seem to emerge from shared developmental/temperamental vulnerabilities between OCD and anxiety disorders in youth. The interactive influences of childhood traumatic experiences, dissociative experiences, and vulnerabilities to anxiety are interesting in this regard ( 91 , 92 ). Consistent with their emergence in young childhood and adolescence, comorbidity rates for ODD and BDD also fell with later AOO.…”

The effect of gender on the long-term course and outcome of schizophrenia in rural Ethiopia: a population-based cohort

“…Validated in diverse settings, and previously used in Ethiopia, the LIFE chart is a semi-structured questionnaire, designed to be used by clinicians to effectively summarise longitudinal clinical data. Primary rating scales for the LIFE chart include the Psychiatric Status Rating (PSR), used in the Butajira cohort (and elsewhere [33,34]) as an instrument to help clinicians capture the severity of symptoms at each monthly (or weekly) visit since enrollment: in our case enabling annual summarization of psychopathology and functional status of participants over 10-13 years of follow-up. For the Butajira study, four psychiatrists were trained in the LIFE chart approach [35].The PSR ratings were carried out using all available information: reports by patients and their caregivers following face to face interviews, family and psychiatric nurses, monthly clinical records, annual symptomatic and functional ratings, and reports from the project outreach workers who had monthly contacts with people living with severe mental disorders and their families [35].…”

Obsessive-compulsive symptom profiles in individuals exposed to interpersonal versus noninterpersonal trauma

“…Once supported by further research, this framework may guide the design of exposures surrounding OC symptoms and trauma-related stimuli and cognitions, as well as selection of specific acceptance and mindfulness-based approaches, given evidence that experiential avoidance mediates the relation between childhood trauma and OC symptoms (Kroska, Miller, Roche, Kroska, & O'Hara, 2018). Enhancing treatment for this population is critical given that lifetime PTSD is associated with more severe OCD symptoms and course than without lifetime PTSD (Fontenelle et al, 2012;Ojserkis et al, 2017).…”

“…A history of experiencing traumatic events may also be coupled with PTSD symptoms in some instances. For these individuals, understanding the specific connection between trauma, disgust, and OC symptoms is especially critical, given that individuals with OCD and lifetime PTSD report more severe OC symptoms and greater comorbidities (Fontenelle et al, 2012;Ojserkis et al, 2017) and improve less following evidence-based OCD treatment (Gershuny, Baer, Jenike, Minichiello, & Wilhelm, 2002) compared to those without PTSD.…”