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Obsessive-compulsive disorder (OCD)

Q: Dear Dr. Ochberg

I have PTSD, OCD and major depression. My OCD seems to be tied to my PTSD because the OCD functions to get rid of thoughts from the trauma experiences. My question is- is treatment for PTSD more difficult since the OCD is there as well or will the OCD likely go away when the PTSD is treated? How would you go about treatment? I just finished DBT training because my therapist felt it would be good to have this background to help with the strong emotions and suicidal thoughts. Any thoughts?

Almost out of soap and low on hope in Virginia. Thank you. J

A: Dear J, I know this is a serious request, but I had to chuckle at your last line about soap and hope. I take it the OCD involves hand washing. Your OCD should not necessarily make treatment for PTSD more difficult.
Informed treatment for PTSD should reduce unwanted, disturbing dreams, flashbacks and intense recollections.

I use "the counting method" ( http://countingmethod.com/ ) but there are other equally effective ways of overcoming the "re-experiencing" symptoms of PTSD. EMDR is the most popular technique because it has been the most researched and publicized. Counting or EMDR are specific elements of a broader approach. I call the broader approach "PTT"
or "post traumatic therapy."

Here's a good paper on the philosophy and elements of PTT: http://www.giftfromwithin.org/html/trauma.html

Without knowing you, but assuming that you suffered a serious trauma -- maybe more than one -- and that it causes haunting and painful memories, and that OCD helps reduce the fear and, possibly, humiliation, and that DBT helps you learn to reduce the intensity of strong negative feelings and of destructive impulses, I'd strongly recommend treatment by a therapist who has expertise and experience with PTSD, or by a therapist you like and trust who has access to a trauma expert as a consultant. The PTSD symptoms may be at the heart of all the mental health conditions you face.

As the PTT paper explains, trauma therapists who share my general approach help their patients understand PTSD, improve their resilience (including diet, fitness, humor, spirituality, personal relationships and self-esteem), ameliorate symptoms and assure that all important medical issues are addressed. Some medications are quite useful for OCD, depression and PTSD. You may already have found one or more that work for you. Usually, it takes rather high doses of Prozac or a related medication to reduce the OCD symptoms, and, often, it takes more than Prozac alone to overcome persistent depression. This being the case, a non-MD trauma therapist needs the help of a family doc or a psychiatrist to assure proper use of medications.

I have a high opinion of DBT and I have a feeling that your therapist is on the right track. The combination of issues you describe is not uncommon, but can be challenging for a trauma survivor and for her therapist.

My very best wishes,
Frank Ochberg, MD

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Page created on 18 January 2010
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