Perspective on OCD and Dissociation in Disorders of Extreme Stress (Trauma)

[borderlandman]

I have researched PTSD in some depth and tried to understand the origins of OCD symptoms that I have had for as long as I can remember. I have been diagnosed with PTSD and have been treated for OCD as well. Recent readings concerning the incidence of OCD symptoms in patients with PTSD and other disorders involving trauma have provided evidence that OCD symptoms are common in these disorders.

Relating these studies to my own situation, I would suggest a model of the correlation of OCD and disorders involving trauma can be explained as an adaptive response to prevent uncomfortable and frightening dissociative experiences. The mechanism of this adaptive response functions by our conscious or near conscious thoughts running on two or three tracks simultaneously in order to maximize the load on our brain?s conscious functioning capacity. By approaching our maximum conscious processing capacity we are broadening and directing our mindfulness upon ?acceptable? or tolerable content. This strategy helps to prevent retraction of consciousness involving knowing only trauma, either in the moment or for more protracted periods of time.

What dissociative phenomena constitute the most uncomfortable consciously available thoughts? With regard to myself, I have the most ongoing difficulty with positive psychoform dissociative symptoms. This category of symptoms include psychoform internal voices with different tones addressing me in four or five different ways; intrusions of internal voices telling me I am stupid, a loser, a wimp, or a voice expressing great fear and confusion, particularly with regard to spatial orientation and relations; intrusions of a persecutor personality narrowing my consciousness and ?directing? my empathy away from emotional intimate conversations or writing to people; intrusions of widely different worldviews, sense of self, perceptions of people; fantasy proneness under particular situations of stress enabling particular emotional parts and fantasies of situations in my life that were not true, though I wish they were; mood swings and affect dysregulation ( I was once diagnosed with bipolar II).

I have pretty well conquered the multiple somatoform symptoms I once experienced including a period of somatization disorder, ?fibromyalgia?, lack of sensation of my skin, transient paralysis episodes of my hands, choking when reminded of sexual abuse; mild pseudoseizures, etc. However, the above listed psychoform intrusive symptoms are a real problem. Despite autohypnosis directed toward these specific problems and working on meditation before, during and after going through DBT skills and coaching, I still have intrusions which are not only uncomfortable but which also cause me great fear. I am particularly phobic of the persecutor and perpetrator parts. They may be one and the same.

With regard to OCD, I find that I am largely unable to remain focused on just one objective. When I meditate and increase mindfulness centered on breathing or visualization, I have intrusions. I do not have intrusions when my mind wanders to other things or I focus simultaneously on verbal prompts and visualization along with some tune playing in my head in the background.

I have developed goals centered on being in good physical condition in general. I do resistance exercises (weight lifting) and hiking 9 to 19 miles with a 32 pound pack as if my hike is designed to be a multi-day venture. I have set a goal to do a 75 mile, 5 day hike on the last five segments of the Colorado Trail in a few weeks. My longer term goal for next year is to walk the entire Colorado Trail (485.5 miles). However, both hiking and weight lifting ?require? multiple trains of thought occurring simultaneously. With weight lifting, I keep a constant count of the number of repetitions and sets, monitoring my body, and carrying a tune in the background. During hiking, I keep an eye on the trail, keep an ear open for mountain bikers who might want to pass or who may run me over when going too fast, monitor my body states, keep track of where on the trail ahead I can get off without falling down a mountainside, and carry a tune in the background. This effort requires a kind of forced hypervigilance and I tend to have an exaggerated startle response for which a large percentage of these bikers provide an apology. If I happen to have a more relaxing hike with few bikers and am able to ?smell the roses?, there is a tendency to have an intrusion.

Personal experience suggests that OCD helps to prevent intrusions. Some of these intrusions are more than uncomfortable, leaving me exhausted, phobic, or depressed and listless. One of these intrusions leaves me feeling able, confident, and energized. However, it tips me into feeling superior to others, judging others, ramping up my sexual desires, and having persecutory thoughts. When this happens and I become more integrated between the rational and emotional sides, I feel used and fear the consequences of the other intrusive parts. This is a maladaptive way to live and OCD is a maladaptive solution to this problem of dissociative intrusions.

I intend to continue working on the problem and I seem to be alone in this effort. Therapy has emphasized emotional regulation, interpersonal relationships, mindfulness, and distress tolerance. Learning these skills have helped me in many ways and I am happy I have made them work for me. Nevertheless, they are not enough to help me with the internal struggles that continue to pester me. I have gone from no life to a life that is ?half full?. I still desire reaching a full life in the last 10-20 years I have left. (Optimism?)

 

[Daniel E.]

Relating these studies to my own situation, I would suggest a model of the correlation of OCD and disorders involving trauma can be explained as an adaptive response to prevent uncomfortable and frightening dissociative experiences.

That explanation seems to ignore far more common factors. Certainly, one common factor is an overactive amygdala, which is at play in all anxiety disorders, depression, etc.

And, of course, both PTSD and OCD can be different ways of experiencing/exhibiting an underlying anxiety, with the experience of trauma increasing the likelihood that one will develop that underlying anxiety:

One study found that 54% of people with a diagnosis of OCD report having experienced at least one traumatic event in their lifetime.

PTSD and OCD - Relationship between PTSD and OCD

Therapy has emphasized emotional regulation, interpersonal relationships, mindfulness, and distress tolerance.

And, as I am sure you know, behavior therapy, which in the case of anxiety disorders is usually exposure therapy.

 

[David Baxter PhD]

Additionally, I think OCD has less to do with attempts to manage dissociation per se and more to do with attempts to impose control and predictability and certainty on a world which is inherently unpredictable and uncertain, and perhaps especially for PTSD patients, anything but in control.

 

[Daniel E.]

Personal experience suggests that OCD helps to prevent intrusions. Some of these intrusions are more than uncomfortable, leaving me exhausted, phobic, or depressed and listless...

Certainly, rumination is a common but ineffective (short-term) coping mechanism for anxiety and other unwanted emotions, e.g.

Three key findings emerged in this study. First, negative meanings of intrusive memories were correlated with depression, even after intrusion frequency and memory severity were accounted for. Negative meanings of intrusions were the best predictor of depression, explaining a significant proportion of variance over and above intrusion frequency. Second, negative meanings of intrusive memories were positively associated with intrusion-related distress and cognitive avoidance strategies, even after intrusion frequency and memory severity were partialled out. Third, both intrusion generated distress and the use of ruminative coping responses were significantly correlated with depression.

The role of negative interpretations of intrusive memories in depression

And OCD is sufficient but not necessary for one to engage in chronic rumination:

Whereas RNT [repetitive negative thinking] has initially nearly exclusively been studied in the context of depression and GAD, there is now evidence that RNT [repetitive negative thinking] is being present in nearly all Axis I disorders. In addition, results from prospective as well as experimental studies suggest that RNT is causally involved in the maintenance of several emotional disorders. These studies have been conducted in the context of a number of different disorders,including depression, GAD, PTSD, insomnia and psychosis.

Repetitive Negative Thinking as a Transdiagnostic Process

 

[Daniel E.]

From a new research paper on PTSD and OCD:

Several case reports and case series have documented the co-occurrence of OCD and PTSD following an exposure to traumatic event (Gershuny et al., 2003; Pitman, 1993; Sasson etal., 2005). Others, however, have suggested that the recurrent ideas, thoughts, and images of OCD overlap the recurrent intrusive recollections of PTSD and do not point on a comorbidity of these two diseases independently (Solomon et al., 1991; Huppert et al., 2005; Lipinski and Pope, 1994). Indeed, PTSD and OCD have similar elements in symptomatology and etiology. Both PTSD and OCD have repeated intrusive thoughts that cause distress and are hard to neutralize; have avoidance behavior that is directed by the need to avoid any cue cause distress; and include behaviors that are performed in order to reduce the anxiety (De Silva and Marks, 1999, 2001). PTSD and OCD are also associated with negative thoughts and memories which evoke and intensify anxiety and lead to labeling of stimuli as threatening (Dinn et al., 1999), and both are associated with classical conditioning to an anxiety-provoking stimulus that, in turn, is reinforced by behaviors that reduce this anxiety (De Silva and Marks, 1999; Zohar et al., 2009).

High prevalence of obsessive compulsive disorder among posttraumatic stress disorder patients

 

[borderlandman]

Thank you for the reply. This was helpful!

I just returned from a solo hiking/camping trip to a series of lakes above 12,500 ft. It would be difficult to explain the benefit I received from this trip. The beauty and solitude were therapeutic - totally awesome. THis opened me up to visual and auditory intrusions that have been asking to be heard for so long. Trust among parts allows the adult in me to take general control and emotional regulation when painful intrusions arise.

As I returned coming down the trail, I had such a huge grin on my face that people smiled, said hello, and talked with me. They saw how my face beamed when I told them about the beauty above. This experience has been a life changer no matter how much work I have left to do on my problems.

 

[Always Changing]

The beauty and solitude were therapeutic - totally awesome.

Peace within and without. (maybe)?