OCD & PTSD
Comprehensive integrative medicine approach for lasting healing and complete recovery
Understanding OCD & PTSD
Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD) are distinct but often comorbid neuropsychiatric conditions characterized by dysregulated fear processing, intrusive mental phenomena, and maladaptive behavioral patterns. OCD involves recurrent obsessions (intrusive thoughts, images, or urges) and compulsions (repetitive behaviors performed to neutralize obsessions or prevent feared outcomes). PTSD develops following exposure to actual or threatened death, serious injury, or sexual violence, featuring intrusive re-experiencing, avoidance, negative alterations in cognition and mood, and marked alterations in arousal and reactivity. Both conditions involve amygdala hyperactivity, hippocampal dysfunction, prefrontal cortex impairment, and HPA axis dysregulation.
Recognizing OCD & PTSD
Common symptoms and warning signs to look for
Intrusive, unwanted thoughts or memories that feel impossible to control or dismiss
Repetitive behaviors or mental rituals you feel compelled to perform to prevent feared outcomes
Flashbacks or nightmares that make you feel like the traumatic event is happening again
Avoiding places, people, or situations that trigger distressing memories or urges
Constant hypervigilance and feeling on edge, unable to relax even in safe environments
What a Healthy System Looks Like
A healthy stress response system maintains appropriate threat detection through the amygdala while the prefrontal cortex provides top-down regulation to distinguish real from perceived danger. The hippocampus accurately contextualizes memories in time and place. The HPA axis responds to genuine threats with appropriate cortisol release, followed by efficient recovery and return to homeostasis. Fear extinction occurs naturally when threats pass. Intrusive thoughts are recognized as mental noise and dismissed without distress. Sleep architecture supports memory consolidation and emotional processing. The autonomic nervous system maintains balance between sympathetic activation and parasympathetic restoration.
How the Condition Develops
Understanding the biological mechanisms
OCD and PTSD share overlapping neurobiological mechanisms while maintaining distinct features: (1) Amygdala hyperactivity - the fear center demonstrates exaggerated responses to trauma-related or obsession-triggering stimuli, with reduced habituation to repeated exposures; (2) Hippocampal dysfunction - reduced volume and impaired function affect memory consolidation, contextual processing, and the ability to distinguish past trauma from present safety; (3) Prefrontal cortex impairment - reduced activity in the anterior cingulate cortex and orbitofrontal cortex impairs fear extinction, cognitive flexibility, and the ability to inhibit compulsive behaviors or trauma responses; (4) HPA axis dysregulation - altered cortisol patterns with either hyper- or hypo-cortisolism depending on chronicity and individual variation; (5) Neurotransmitter imbalance - serotonin depletion, dopamine dysregulation in reward circuits, norepinephrine excess, and GABAergic dysfunction; (6) Inflammatory cytokine elevation - IL-6, TNF-alpha, and CRP are elevated, affecting neuroplasticity and mood regulation; (7) Default mode network hyperconnectivity - excessive self-referential processing perpetuates rumination and intrusive thoughts; (8) Fear extinction failure - impaired mechanisms prevent the natural reduction of fear responses over time.
Key Laboratory Markers
Important values for diagnosis and monitoring
| Test | Normal Range | Optimal | Significance |
|---|---|---|---|
| Cortisol (Morning) | 5-25 mcg/dL | 8-14 mcg/dL | HPA axis function; PTSD often shows elevated or blunted morning cortisol |
| Cortisol (Evening) | <10 mcg/dL | <5 mcg/dL | Flattened diurnal curve common in PTSD; impaired recovery from daily stress |
| DHEA-S | 150-350 mcg/dL | 200-300 mcg/dL | Adrenal reserve; often depleted in chronic PTSD and OCD |
| Serotonin | 50-200 ng/mL | 100-150 ng/mL | Mood and impulse regulation; deficiency linked to OCD and PTSD severity |
| C-Reactive Protein (hs-CRP) | <3.0 mg/L | <1.0 mg/L | Systemic inflammation; elevated in PTSD and associated with symptom severity |
| Homocysteine | <15 umol/L | <10 umol/L | Methylation status; elevated levels impair neurotransmitter synthesis |
| Vitamin D | 30-100 ng/mL | 50-70 ng/mL | Neuroprotection and mood regulation; deficiency associated with both conditions |
| Magnesium (RBC) | 4.0-6.4 mg/dL | 5.0-6.0 mg/dL | Nervous system relaxation; deficiency exacerbates hyperarousal symptoms |
| B12 | 200-900 pg/mL | 500-800 pg/mL | Neurological function and methylation; deficiency affects cognitive symptoms |
| TSH | 0.4-4.0 mIU/L | 1.0-2.0 mIU/L | Thyroid function; dysregulation can mimic or worsen anxiety symptoms |
| Omega-3 Index | >4% | 8-12% | Neuroinflammation marker; low levels associated with mood disorders |
| 8-OHdG (Oxidative Stress) | <500 ng/mg creatinine | <300 ng/mg creatinine | DNA oxidative damage marker; elevated in chronic stress states |
Root Causes We Address
The underlying factors contributing to your condition
{"cause":"Trauma Exposure (PTSD-specific)","contribution":"90% - Direct exposure to actual or threatened death, serious injury, or sexual violence is required for PTSD diagnosis; trauma type, severity, and duration affect risk","assessment":"Comprehensive trauma history including childhood adversity, combat exposure, assault, accidents, natural disasters; assess peritraumatic dissociation"}
{"cause":"Genetic Predisposition","contribution":"30-40% - Family history increases risk 2-4x; serotonin transporter gene (5-HTTLPR), COMT, and BDNF polymorphisms implicated","assessment":"Family psychiatric history; genetic testing for relevant polymorphisms affecting neurotransmitter metabolism and stress response"}
{"cause":"Childhood Adversity and Attachment","contribution":"50-60% for PTSD, 30% for OCD - Early life stress alters developing stress response systems and creates vulnerability","assessment":"ACE (Adverse Childhood Experiences) score; attachment style assessment; developmental history including neglect, abuse, or household dysfunction"}
{"cause":"HPA Axis Dysregulation","contribution":"40% - Chronic or severe stress dysregulates hypothalamic-pituitary-adrenal axis function","assessment":"Cortisol testing (morning, evening, diurnal curves); DHEA-S; ACTH levels; evaluate stress history and coping capacity"}
{"cause":"Neurotransmitter Imbalance","contribution":"35% - Serotonin depletion, dopamine dysregulation, and GABA deficiency impair fear processing and behavioral inhibition","assessment":"Urinary neurotransmitter panels; amino acid testing; methylation status (MTHFR, homocysteine); response to SSRI trial"}
{"cause":"Neuroinflammation","contribution":"25% - Elevated pro-inflammatory cytokines affect neuroplasticity, neurotransmitter metabolism, and blood-brain barrier integrity","assessment":"Inflammatory markers (CRP, IL-6, TNF-alpha); gut permeability testing; infectious disease screening; autoimmune markers"}
{"cause":"Gut Microbiome Dysbiosis","contribution":"20% - Altered gut bacteria reduce GABA and serotonin production, increase systemic inflammation, and impair vagus nerve signaling","assessment":"Comprehensive stool analysis; SIBO breath testing; assessment of antibiotic history, diet, and digestive symptoms"}
{"cause":"Nutrient Deficiencies","contribution":"20% - B vitamins, magnesium, zinc, omega-3s, and vitamin D are essential for neurotransmitter synthesis and neuronal health","assessment":"Comprehensive micronutrient panel; RBC magnesium; omega-3 index; vitamin D levels; dietary assessment"}
{"cause":"Brain Structure and Function","contribution":"25% - Reduced hippocampal and prefrontal cortex volume; amygdala hyperactivity; default mode network dysfunction","assessment":"Neuropsychological testing; qEEG brain mapping; structural MRI if indicated; functional connectivity assessment"}
{"cause":"Infectious and Toxic Contributors","contribution":"15% - PANDAS/PANS (pediatric autoimmune), Lyme disease, mold toxicity, and heavy metals can trigger or exacerbate symptoms","assessment":"ASO and anti-DNase B titers; Lyme and co-infection testing; mycotoxin panel; heavy metal screening"}
{"cause":"Cognitive and Learning Factors","contribution":"30% - Thought-action fusion, intolerance of uncertainty, and anxiety sensitivity maintain OCD; maladaptive cognitions maintain PTSD","assessment":"Validated questionnaires (OBQ, IIQ, ASI); cognitive assessment; trauma-related cognitions inventory"}
Risks of Inaction
What happens if left untreated
{"complication":"Chronic Neurobiological Dysregulation","timeline":"Months to years","impact":"Untreated OCD/PTSD causes progressive changes in brain structure and function, including hippocampal atrophy and prefrontal cortex impairment, making recovery increasingly difficult"}
{"complication":"Treatment Resistance Development","timeline":"Years","impact":"Longer duration of untreated illness predicts poorer response to treatment; neural pathways become more entrenched; may require more intensive interventions"}
{"complication":"Substance Abuse and Dependence","timeline":"Often within first year of symptom onset","impact":"Self-medication with alcohol, benzodiazepines, cannabis, or other substances leads to addiction; dual diagnosis complicates treatment and worsens outcomes"}
{"complication":"Major Depression Development","timeline":"Months to years","impact":"60-80% of untreated PTSD and 50% of untreated OCD develop comorbid depression; suicide risk increases significantly with combined conditions"}
{"complication":"Cardiovascular Disease","timeline":"Years to decades","impact":"Chronic sympathetic activation and inflammation increase risk of hypertension, coronary artery disease, and stroke; PTSD associated with 2x cardiovascular mortality"}
{"complication":"Metabolic Syndrome and Diabetes","timeline":"Years","impact":"Chronic cortisol dysregulation promotes insulin resistance, weight gain, and metabolic dysfunction"}
{"complication":"Autoimmune Disease","timeline":"Years","impact":"Chronic inflammation and immune dysregulation increase risk of autoimmune conditions including rheumatoid arthritis, lupus, and thyroid disease"}
{"complication":"Relationship and Social Deterioration","timeline":"Progressive","impact":"Avoidance behaviors, emotional numbing, and symptom preoccupation damage intimate relationships; social isolation increases; divorce rates elevated"}
{"complication":"Occupational Disability","timeline":"Months to years","impact":"Concentration impairment, avoidance, and symptom severity reduce work performance; many patients become unable to work; significant economic impact"}
{"complication":"Suicide Risk","timeline":"Ongoing risk","impact":"OCD carries 10x increased suicide risk; PTSD associated with significant suicide risk, especially with comorbid depression; requires vigilant monitoring"}
{"complication":"Physical Health Comorbidities","timeline":"Years","impact":"Chronic pain, gastrointestinal disorders, respiratory conditions, and immune dysfunction become increasingly prevalent"}
{"complication":"Quality of Life Degradation","timeline":"Immediate and progressive","impact":"Symptoms consume increasing time and energy; joy and fulfillment diminish; life becomes organized around symptoms rather than values and goals"}
How We Diagnose
Comprehensive assessment methods we use
{"test":"Comprehensive Psychiatric Evaluation","purpose":"Establish diagnosis and assess severity","whatItShows":"Structured clinical interview for DSM-5 criteria; differential diagnosis; comorbidity assessment; suicide risk evaluation"}
{"test":"Yale-Brown Obsessive Compulsive Scale (Y-BOCS)","purpose":"Assess OCD symptom severity","whatItShows":"Quantified obsessions, compulsions, avoidance, and insight; tracks treatment progress; scores >16 indicate clinically significant symptoms"}
{"test":"Clinician-Administered PTSD Scale (CAPS-5)","purpose":"Gold standard PTSD assessment","whatItShows":"Frequency and intensity of all PTSD symptom clusters; diagnostic confirmation; severity rating; treatment response monitoring"}
{"test":"PCL-5 (PTSD Checklist)","purpose":"Self-report PTSD screening","whatItShows":"Symptom presence and severity; score >31-33 suggests probable PTSD; useful for tracking changes"}
{"test":"Comprehensive Blood Panel","purpose":"Rule out medical causes and assess biological contributors","whatItShows":"CBC, CMP, thyroid function, inflammatory markers, cortisol, DHEA-S, vitamin D, B12, magnesium, homocysteine"}
{"test":"Neurotransmitter Panel","purpose":"Assess neurochemical status","whatItShows":"Urinary levels of serotonin, dopamine, norepinephrine, GABA, glutamate; guides targeted amino acid therapy"}
{"test":"Adrenal Function Testing","purpose":"Evaluate HPA axis status","whatItShows":"Diurnal cortisol curves, DHEA-S, cortisol awakening response; reveals dysregulation patterns"}
{"test":"Stool Microbiome Analysis","purpose":"Assess gut-brain axis contribution","whatItShows":"Bacterial diversity, pathogenic organisms, inflammation markers, SCFA production, leaky gut indicators"}
{"test":"Nutritional and Micronutrient Testing","purpose":"Identify deficiencies affecting brain function","whatItShows":"Comprehensive vitamin, mineral, amino acid, and fatty acid status; omega-3 index"}
{"test":"Genetic Testing","purpose":"Identify genetic factors affecting treatment","whatItShows":"MTHFR, COMT, 5-HTTLPR, BDNF Val66Met; informs medication selection and nutrient therapy"}
{"test":"qEEG Brain Mapping","purpose":"Assess brain electrical activity patterns","whatItShows":"Abnormalities in frontal lobe function, amygdala connectivity, and fear circuitry; guides neurofeedback if indicated"}
{"test":"Trauma and Attachment Assessment","purpose":"Comprehensive trauma history and impact","whatItShows":"ACE score, trauma type/severity, attachment style, dissociation levels, complex PTSD features"}
{"test":"Toxic and Infectious Screening","purpose":"Rule out environmental contributors","whatItShows":"Heavy metals, mycotoxins, Lyme disease, PANDAS/PANS markers when clinically indicated"}
Our Treatment Approach
How we help you overcome OCD & PTSD
Healers Trauma and OCD Recovery Protocol
Healers Trauma and OCD Recovery Protocol
Diet & Lifestyle
Recommendations for optimal recovery
Lifestyle Modifications
{"lifestyleModifications":["Morning sunlight exposure (10-30 min) - circadian regulation","Regular aerobic exercise (30-45 min, 4-5x/week) - neuroplasticity","Strength training 2-3x/week - HPA axis regulation","Yoga or tai chi - parasympathetic activation","Nature exposure and forest bathing - cortisol reduction","Consistent sleep schedule (10pm-6am) - memory consolidation","Sleep hygiene optimization - cool, dark, quiet environment","Digital sunset (no screens 1-2 hours before bed)","Deep breathing exercises (4-7-8 technique, box breathing)","Progressive muscle relaxation daily","Mindfulness meditation practice (20-30 min daily)","Journaling for processing and cognitive restructuring","Social connection and support group participation","Creative expression (art, music, writing)","Service to others and meaning-making activities","Time in nature and grounding/earthing practices"]}
Recovery Timeline
What to expect on your healing journey
{"initialImprovement":"4-8 weeks - patients typically notice reduced symptom intensity, improved sleep, and increased ability to engage in daily activities; biological interventions begin showing effects","significantChanges":"3-6 months - substantial reduction in intrusive symptoms, improved emotional regulation, restored functioning in work and relationships; trauma processing or ERP hierarchy completion","maintenancePhase":"6-18 months - continued consolidation of gains, maintenance of coping skills, gradual reduction of acute interventions, focus on flourishing and post-traumatic growth"}
How We Measure Success
Outcomes that matter
Y-BOCS score reduction to <16 (subclinical range) for OCD
PCL-5 score reduction to <31-33 for PTSD
Ability to experience intrusive thoughts/trauma triggers without significant distress
Elimination of compulsive behaviors or safety behaviors
Restored sleep quality with minimal nightmares
Return to full occupational and social functioning
Stable mood without significant anxiety or hyperarousal episodes
Improved relationships and social connection
Reduced physiological reactivity to triggers
Ability to tolerate uncertainty and distress
Values-based living rather than symptom-driven existence
Resilience in face of life stressors without relapse
Frequently Asked Questions
Common questions from patients
What is the difference between OCD and PTSD?
While both involve intrusive thoughts and anxiety, they have distinct features. OCD is characterized by ego-dystonic obsessions (unwanted intrusive thoughts) and compulsions performed to neutralize anxiety or prevent feared outcomes. PTSD develops after exposure to trauma and involves re-experiencing phenomena (flashbacks, nightmares), avoidance of trauma reminders, negative alterations in cognition and mood, and hyperarousal. They can co-occur, and both involve fear circuitry dysfunction, but treatment approaches differ in emphasis.
Can OCD or PTSD be completely cured?
Many individuals achieve significant remission and live symptom-free or nearly symptom-free lives. OCD is considered highly treatable, with ERP showing 60-70% response rates. PTSD also has strong evidence for recovery with trauma-focused therapies. However, 'cure' may not be the best framing - these conditions represent learned neural patterns that can be rewired but may require ongoing maintenance. Some individuals experience complete resolution, while others achieve substantial improvement with occasional symptom flare-ups that are manageable with learned skills.
What are the most effective treatments for OCD and PTSD?
For OCD, Exposure and Response Prevention (ERP) is the gold standard psychological treatment, showing the strongest evidence. For PTSD, trauma-focused therapies including Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and EMDR have robust evidence. SSRIs (particularly sertraline, fluoxetine, paroxetine) are first-line medications for both conditions. Combination therapy (medication plus psychotherapy) often outperforms either alone. For treatment-resistant cases, ketamine-assisted psychotherapy, TMS, and intensive outpatient programs may be considered.
How long does treatment take?
Treatment timelines vary based on severity, chronicity, and individual factors. OCD treatment typically requires 12-20 weeks of intensive ERP for significant improvement, with maintenance therapy for 6-12 months. PTSD treatment generally involves 8-15 sessions of trauma-focused therapy for single-incident trauma; complex PTSD may require 1-2 years. Biological interventions often show effects within 4-8 weeks. Full recovery with lifestyle integration may take 6-12 months. Longer duration of illness before treatment predicts longer treatment courses.
What causes OCD and PTSD to develop?
PTSD requires exposure to trauma - actual or threatened death, serious injury, or sexual violence. Risk factors include trauma severity, peritraumatic dissociation, lack of social support, and prior trauma history. OCD etiology is multifactorial: genetic predisposition (30-40% heritability), neurobiological factors (serotonin dysfunction, brain circuitry abnormalities), environmental factors (infections like PANDAS, stress), and cognitive factors (thought-action fusion, intolerance of uncertainty). Both conditions involve dysregulation of fear processing circuits.
Can childhood trauma cause OCD or PTSD in adults?
Childhood trauma is a significant risk factor for both conditions. Childhood PTSD can persist into adulthood or present with delayed expression. Early adverse experiences alter developing stress response systems, increasing vulnerability to PTSD when later trauma occurs. Childhood trauma, particularly emotional abuse and neglect, is associated with increased OCD risk. PANDAS/PANS (pediatric autoimmune neuropsychiatric disorders) can trigger sudden-onset OCD in children following streptococcal infection. Early intervention improves outcomes significantly.
Medical References
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