Podcast Summary: "Understanding the Link Between PTSD and OCD"

Breaking the Rules: A Clinician's Guide to Treating OCD
Hosts: Dr. Celine Gelgec & Dr. Tori Miller
Date: December 29, 2025

Episode Overview

In this episode, Dr. Celine Gelgec and Dr. Tori Miller explore the nuanced relationship between Post-Traumatic Stress Disorder (PTSD) and Obsessive Compulsive Disorder (OCD). Aimed at mental health professionals, they address common clinical dilemmas: Can OCD arise as a coping mechanism after trauma? How should clinicians approach treatment when both disorders are present? Their conversation draws from real-world cases, supervision questions, and a trauma-informed lens, all to equip clinicians with confidence and flexibility in their practice.

Key Discussion Points and Insights

1. The Interplay Between PTSD and OCD

• OCD as a Maladaptive Coping Mechanism (02:45–04:10)
  • Trauma, including both major events and accumulative attachment trauma, can contribute to the development of OCD.
  • OCD may operate as a way for individuals to cope with overwhelming post-traumatic experiences.
• Complex Presentations
  • Trauma can amplify existing OCD predispositions or reshape the content and intensity of obsessions and compulsions.

Quote:

"I see it as OCD developing as almost a maladaptive coping mechanism in response to trauma."
— Dr. Celine Gelgec (02:45)

2. Trauma Themes Within OCD Symptomatology

• Obsession Themes and Family Dynamics (04:25–07:32)
  • Clients may develop OCD themes (like contamination or harm) linked to difficult family relationships or feelings of disgust, anger, or fear.
  • OCD rituals may manifest as efforts to manage emotions toward caregivers that are intolerable.

Quote:

"Is the client trying to cleanse themselves of the family member or do they feel angered or disgusted by that family member?"
— Dr. Celine Gelgec (04:52)

3. Clinical Challenges: Sequential vs. Integrated Treatment (07:32–10:11)

• The Myth of Linear Treatment Pathways
  • Many clinicians question whether to treat PTSD or OCD first, worrying about client safety and treatment efficacy.
  • Both hosts advocate for an integrated, trauma-informed approach, emphasizing flexibility rather than strict order.

Quote:

"You can do both. ... One week it's OCD, the next week it's PTSD ... and what do I do and how do I disentangle it?"
— Dr. Tori Miller (09:16)

• Trauma-Informed ERP
  • Exposure and Response Prevention (ERP) remains effective with trauma, provided there's attention to stabilization and the client's current capacity.

4. Practical Strategies for Integration (10:11–18:28)

• Skills Building & Window of Tolerance (14:14–15:15)
  • Emphasizing grounding and emotional regulation, especially for clients with a limited window of tolerance.
  • Recognize dissociation as a protective response that must be addressed to facilitate engagement.

Quote:

"If someone dissociates ... they're not being willful. They genuinely aren't connected."
— Dr. Celine Gelgec (14:58)

• ERP as 'Bookends' for Trauma Therapy (15:29–17:14)

  • Structured ERP exercises can serve as grounding anchors at the beginning and end of sessions that address trauma.
  • This blend supports both symptom management and emotional processing.

• Collaborative, Client-Guided Work (18:59–19:11)

  • Therapists should take their clients with them, not do treatment "to" them, building trust and insight collaboratively.

5. Borrowing Across Modalities and Practical Flexibility (20:27–22:49)

• No Need for Abrupt Modality Shifts
  • Integrate tools (e.g., imagery rescripting) from trauma therapies into OCD treatment as needed.
  • Informed consent and ongoing explanation are vital as techniques are introduced.

Quote:

"You can borrow technique ... imagery rescripting can be used as a standalone technique and there's a lot of research behind it, especially around this sort of situation."
— Dr. Celine Gelgec (21:17)

• Responsive, Not Rigid, Practice
  • Being able to fluidly adjust between CBT, supportive psychotherapy, or trauma-focused approaches fosters better client engagement.

6. Clinician Competence and Supervision (23:00–25:06)

• Expanding Comfort and Skill
  • Clinicians are encouraged to trust their training in CBT, ACT, or schema therapy as adequate preparation for treating co-occurring OCD and trauma.
  • When uncertain, seek supervision rather than immediately referring out.

Quote:

"I think that our competencies now, training as psychologists, make us very capable of pivoting, of learning new techniques, of weaving things together."
— Dr. Tori Miller (23:43)

• Pitfalls of Over-Referral
  • Over-cautiousness can inadvertently harm clients, especially those sensitive to rejection or abandonment.

Memorable Moments & Notable Quotes

• "You'll extinguish one [symptom], yeah, but it'll pop up over here."
  — Dr. Tori Miller (11:42)
• "It can be fluid. ... You can bring things in."
  — Dr. Celine Gelgec (22:12)
• "Let's not be so black and white."
  — Dr. Celine Gelgec (25:46)

Important Timestamps

• OCD as response to trauma: 02:45–04:10
• Family dynamics feeding OCD themes: 04:50–07:32
• Treating both OCD and PTSD simultaneously: 09:14–10:11
• Blended intervention strategy: 10:11–13:40
• Dissociation and emotional grounding: 14:44–15:27
• ERP as anchor in trauma sessions: 15:29–17:14
• Borrowing across modalities: 20:27–22:49
• Supervision and professional development: 23:00–25:09

Takeaway Messages

• Treat PTSD and OCD together: Integrated, trauma-informed approaches are not just possible, but often necessary and effective.
• Stay client-centered and flexible: Blend evidence-based techniques as needed, anchored by responsive, collaborative relationships.
• Trust your training and seek support: Competence grows with real-world experience, ongoing education, and supervision.
• Don’t let fear or rigidity create barriers: Avoidance or "black-and-white" thinking leads to disservice; engagement and curiosity foster growth for both clients and clinicians.

Final thought:

"We hope we've given you lots of reassurance without accommodating, but to be able to work with what's in front of you."
— Dr. Celine Gelgec (26:00)