SLC6A4 methylation modifies the effect of the number of traumatic events on risk for posttraumatic stress disorder

Background: Posttraumatic stress disorder (PTSD) is a common and debilitating mental disorder that occurs following exposure to a traumatic event. However, most individuals do not develop PTSD following even a severe trauma, leading to a search for new variables, such as genetic and other molecular variation, associated with vulnerability and resilience in the face of trauma exposure. Method: We examined whether serotonin transporter (SLC6A4) promoter genotype and methylation status modified the association between number of traumatic events experienced and PTSD in a subset of 100 individuals from the Detroit Neighborhood Health Study. Results: Number of traumatic events was strongly associated with risk of PTSD. Neither SLC6A4 genotype nor methylation status was associated with PTSD in main effects models. However, SLC6A4 methylation levels modified the effect of the number of traumatic events on PTSD after controlling for SLC6A4 genotype. Persons with more traumatic events were at increased risk for PTSD, but only at lower methylation levels. At higher methylation levels, individuals with more traumatic events were protected from this disorder. This interaction was observed whether the outcome was PTSD diagnosis, symptom severity, or number of symptoms. Conclusions: Gene‐specific methylation patterns may offer potential molecular signatures of increased risk for and resilience to PTSD. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

PTSD,depression, and their comorbidity in relation to suicidality: cross‐sectional and prospective analyses of a national probability sample of women

Background: A growing body of literature implicates major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) as risk factors for suicidal ideation (SI) and suicide attempts (SA), though research has not adequately examined their differential contributions to increasing suicide risk prospectively or cross‐sectionally. Methods: The contribution of these disorders and their comorbidity to SI and SA was examined using a national household probability sample of women (N=3,085) and covarying for trauma history, substance abuse, and demographic variables. Results: Cross‐sectional analyses indicated that lifetime comorbidity of MDD and PTSD were associated with much higher prevalence of SI than either diagnosis alone; prevalence of SI was elevated and comparable for PTSD and MDD only. Comorbid diagnosis and PTSD only groups displayed greater prevalence of SA than those with MDD only. Lastly, a 2‐year prospective analysis indicated that PTSD only at baseline was predictive of greater subsequent SI risk than MDD only, though comorbid diagnosis did not differ from either PTSD only or MDD only. Conclusions: PTSD appears to be a particularly strong predictor of SI and SA. Overall, only 16% of women with lifetime SA did not have a history of MDD or PTSD, highlighting the importance of assessing these variables when assessing suicide risk. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Prevalence and predictors of posttraumatic stress symptoms in utility workers deployed to the World Trade Center following the attacks of September 11, 2001

Background: Recent attention has begun to be focused on the effects of disaster recovery work on nonrescue workers. The goal of this study was to assess the prevalence and predictors of posttraumatic stress disorder (PTSD) and related symptoms in a population of utility workers deployed to the World Trade Center (WTC) site in the aftermath of 9/11. Methods: Utility workers deployed to the WTC site were screened at their place of employment between 10 and 34 months following the WTC attacks, utilizing both structured interviews and self‐report measures. PTSD symptoms were assessed by the CAPS and the PCL; co‐morbid disorders were also assessed. 2,960 individuals with complete CAPS and PCL data were included in the analyses. Results: Eight percent of participants had symptoms consistent with full PTSD, 9.3% with subthreshold PTSD, 6% with MDD, 3.5% with GAD, and 2.5% with panic disorder. Although risk factors included psychiatric and trauma history, 51% of individuals with probable PTSD had neither; subjective perception of threat to one's life was the best predictor of probable PTSD. Extent of exposure predicted 89% of PTSD cases in those without a psychiatric or trauma history, but only 67% of cases among those with both. Conclusions: Nonrescue workers deployed to a disaster site are at risk for PTSD and depression. Extent of exposure affected the most vulnerable workers differently than the least vulnerable ones. These results suggest that the relationship among predictors of PTSD may be different for different vulnerability groups, and underscore the importance of screening, education, and prevention programs for disaster workers. Depression and Anxiety 28:210–217, 2011. © 2010 Wiley‐Liss, Inc.     

Combat‐related guilt mediates the relations between exposure to combat‐related abusive violence and psychiatric diagnoses

Background: This study examined the degree to which combat‐related guilt mediated the relations between exposure to combat‐related abusive violence and both Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) in Vietnam Veterans. Methods: Secondary analyses were conducted on data collected from 1,323 male Vietnam Veterans as part of a larger, multisite study. Results: Results revealed that combat‐related guilt partially mediated the association between exposure to combat‐related abusive violence and PTSD, but completely mediated the association with MDD, with overall combat exposure held constant in the model. Follow‐up analyses showed that, when comparing those participants who actually participated in combat‐related abusive violence with those who only observed it, combat‐related guilt completely mediated the association between participation in abusive violence and both PTSD and MDD. Moreover, when comparing those participants who observed combat‐related abusive violence with those who had no exposure at all to it, combat‐related guilt completely mediated the association between observation of combat‐related abusive violence and MDD, but only partially mediated the association with PTSD. Conclusions: These findings suggest that guilt may be a mechanism through which abusive violence is related to PTSD and MDD among combat‐deployed Veterans. These findings also suggest the importance of assessing abusive‐violence related guilt among combat‐deployed Veterans and implementing relevant interventions for such guilt whenever indicated. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Suicide risk and its correlate in adolescents who experienced typhoon-induced mudslides: a structural equation model

Background: The aims of this study were to examine the direct and indirect effects of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), disaster‐exposure experience, gender, and perceived family support on suicide risk (including suicide ideation and attempt) in adolescents 3 months after they had experienced Typhoon Morakot‐associated mudslides in Taiwan using a structural equation model (SEM). Methods: Two hundred and seventy‐one adolescents in the worst affected mountainous regions of southern Taiwan were recruited. Suicide risk and diagnoses of PTSD and MDD were assessed using the Mini‐International Neuropsychiatric Interview for Children and Adolescents. The direct and indirect effects of PTSD, MDD, disaster‐exposure experience, gender, and perceived family support on suicide risk were examined using SEM. Results: The results of SEM indicated that increased disaster‐exposure experience and female gender had direct influences on an increased suicide risk and indirect influences on increased suicide risk that were mediated by PTSD and MDD. Perceived high family support directly decreased suicide risk. Both PTSD and MDD had direct influences on an increased suicide risk, and PTSD had an indirect influence on an increased suicide risk that was mediated by MDD. Conclusions: Gender, disaster‐exposure experience, perceived high family support, PTSD, and MDD all had effects on suicide risk in adolescents who had experienced the threat of mudslides caused by Typhoon Morakot. The results provide healthcare professionals with a comprehensive understanding to develop intervention programs to prevent and intervene in suicide risk. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Comorbid posttraumatic stress disorder and major depressive disorder: The usefulness of a sequential treatment approach within a randomised design

Cognitive Processing Therapy (CPT) and Behavioural Activation Therapy (BA) were used to treat individuals with comorbid posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Fifty-two individuals (48 women, 4 men) were randomized to CPT alone (n = 18), CPT then BA for MDD (n = 17), or BA then CPT (n = 17). Presenting trauma was primarily interpersonal (87 %). Participants were assessed at pre-, posttreatment, and 6-month follow-up. PTSD and MDD symptoms were the main outcome of interest; trauma cognitions, rumination, and emotional numbing were secondary outcomes. All groups showed sizeable reductions in PTSD and depression (effect sizes at follow-up ranging between 1.02–2.54). A pattern of findings indicated CPT/BA showed better outcomes in terms of larger effect sizes and loss of diagnoses relative to CPT alone and BA/CPT. At follow-up greater numbers of the CPT/BA group were estimated to have achieved good end-state for remission of both PTSD and depression (49 %, CI₉₅ [.26, .73]) relative to CPT alone (18 %, CI₉₅ [.03, .38]) and BA/CPT (11 %, CI₉₅ [.01, .29]). Although tempered by the modest sample size, the findings suggest that individuals with comorbid PTSD and MDD may benefit from having PTSD targeted first before remaining MDD symptoms are addressed.     

Psychiatric disorders among disaster bereaved: an interview study of individuals directly or not directly exposed to the 2004 tsunami

Background: Few studies have explored the long‐term mental health consequences of disaster losses in bereaved, either exposed to the disaster themselves or not. This study examined the prevalence and predictors of mental disorders and psychological distress in bereaved individuals either directly or not directly exposed to the 2004 tsunami disaster. Method: A cross‐sectional study of 111 bereaved Norwegians (32 directly and 79 not directly exposed) was conducted 2 years postdisaster. We used a face‐to‐face structured clinical interview to diagnose current posttraumatic stress disorder (PTSD) and depression (major depressive disorder, MDD) and a self‐report scale to measure prolonged grief disorder (PGD). Results: The prevalence of psychiatric disorders was twice as high among individuals directly exposed to the disaster compared to individuals who were not directly exposed (46.9 vs. 22.8 per 100). The prevalence of disorders among the directly exposed was PTSD (34.4%), MDD (25%), and PGD (23.3%), whereas the prevalence among the not directly exposed was PGD (14.3%), MDD (10.1%), and PTSD (5.2%). The co‐occurrence of disorders was higher among the directly exposed (21.9 vs. 5.2%). Low education and loss of a child predicted PGD, whereas direct exposure to the disaster predicted PTSD. All three disorders were independently associated with functional impairment. Conclusions: The dual burden of direct trauma and loss can inflict a complex set of long‐term reactions and mental health problems in bereaved individuals. The relationship between PGD and impaired functioning actualizes the incorporation of PGD in future diagnostic manuals of psychiatric disorders. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Testing the dimensionality of posttraumatic stress responses in young Chinese adult earthquake survivors: further evidence for "dysphoric arousal" as a unique PTSD construct

Background: This study investigated an alternative five‐factor diagnostic model for posttraumatic stress disorder (PTSD) symptoms, and tested external convergent and discriminant validity of the model in a young Chinese sample of earthquake survivors. Methods: A total of 938 participants (456 women, 482 men) aged 15–20 years were recruited from a vocational school originally located in Beichuan County Town which was almost completely destroyed by the “Wenchuan Earthquake.” The participants were administrated with the PTSD Checklist and the Hopkins Symptoms Checklist‐25 12 months after the earthquake. Results: The results of confirmatory factor analysis showed that the five‐factor intercorrelated model (intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal) fit the data significantly better than the four‐factor numbing model proposed by King et al. (1998: Psychol Assess 10:90–96) and the four‐factor dysphoria model proposed by Simms et al. (2002: J Abnorm Psychol 111:637–647). Further analyses indicated that four out of five PTSD factors yielded significantly different correlations with external measures of anxiety versus depression. Conclusions: The findings provide further empirical evidence in favor of the five‐factor diagnostic model of PTSD, and carry implications for the upcoming DSM‐5. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.     

Transdiagnostic emotion regulation processes explain how emotion-related factors affect co-occurring PTSD and MDD in relation to trauma

BackgroundPosttraumatic stress disorder (PTSD) and major depressive disorder (MDD) co-occur at high rates and greater disorder severity. Studies examining the contributions of specific emotion regulation (ER) processes and negative affect (NA) to PTSD and MDD co-occurrence are scarce. This study investigated a transdiagnostic understanding of the nature of PTSD and MDD co-occurrence by examining the roles of NA, ER processes, and negative mood regulation (NMR) expectancies in PTSD and MDD in relation to trauma.MethodsStructural equation modeling was used to examine the roles of emotionality, PTSD, and MDD constructs in 200 individuals with primary PTSD.ResultsER processes fully mediated the relationships between NA and PTSD (β = .40, p < .001) and MDD (β = .48, p < .001), and NMR expectancies and PTSD (β = −.31, p < .001) and MDD (β = −.37, p < .001).ConclusionsNA and NMR expectancies exert their effects on PTSD and MDD almost entirely through ER processes. ER appears to be a transdiagnostic process, partly accounting for the co-occurrence between PTSD and MDD. Co-occurrence models could benefit by incorporating ER processes to inform diagnostic classification and criteria and clinical intervention improved by specifically targeting ER processes.     

What is the association between traumatic life events and alcohol abuse/dependence in people with and without PTSD? Findings from a nationally representative sample

Background: Approximately 60–90% of the general population will experience a traumatic event during their lifetime. However, relatively few will develop a trauma‐related psychological disorder. Possible psychological sequelae of trauma include posttraumatic stress disorder (PTSD) and alcohol‐use disorders (AUDs). While AUDs often occur in the context of PTSD, little is known about the degree to which AUDs are attributable to specific traumatic events. The purpose of the present investigation was to assess the degree to which specific traumatic events are predictive of AUDs in people with and without PTSD. Methods: The current sample was selected from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC; N = 34,160), a nationally representative sample of American adults. Multiple logistic regressions were performed to examine odds ratios of 27 traumatic events among individuals with and without PTSD in the prediction of AUD diagnoses. Results: Results indicated significant positive odds ratios among individuals meeting criteria for PTSD and having experienced a childhood trauma (OR = 1.40 [95% CI: 1.08–1.83], P<.01) or assaultive violence (OR = 1.41 [95% CI: 1.13–1.77], P<.01) for predicting AUDs. Also, among individuals without PTSD, childhood trauma (OR = 1.32 [95% CI: 1.23–1.41], P<.001), assaultive violence (OR = 1.42 [95% CI: 1.13–1.78], P<.001), unexpected death (OR = 1.19 [95% CI: 1.12–1.28], P<.001), and learning of trauma (OR = 1.22 [95% CI: 1.13–1.30], P<.001) positively predicted the presence of AUDs. Conclusions: Results indicate significant positive relationships between traumatic events and AUDs, particularly among individuals without PTSD. Specific associations and theoretical implications will be discussed. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Posttraumatic stress disorder and dyslipidemia: Previous research and novel findings from patients with PTSD caused by myocardial infarction

Abstract

Objectives. Based on a brief systematic review suggesting dyslipidemia in posttraumatic stress disorder (PTSD), we studied, for the first time, levels of blood lipids in patients with a DSM-IV diagnosis of PTSD caused by myocardial infarction (MI). Methods. Study participants were eight patients with full PTSD, eight patients with subsyndromal PTSD, and 31 patients with no PTSD who were diagnosed using the Clinician-Administered PTSD Scale (CAPS) interview after a mean of 32±8 months after MI. Levels of total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and high-density lipoprotein-cholesterol (HDL-C) were determined in plasma. Results. Patients with full PTSD had lower HDL-C than patients with subsyndromal PTSD (P= 0.044) and those with no PTSD (P= 0.014) controlling for sex, body mass index, and statin equivalent dosage. Moreover, HDL-C levels were inversely associated with PTSD total symptoms (r = ?0.33, P= 0.027), re-experiencing symptoms (r = ?0.32, P= 0.036), and avoidance symptoms (r = ?0.34, P= 0.025). There were no significant associations of PTSD diagnostic status and symptomatology with the three other lipid measures. Conclusion. Chronic PTSD caused by MI was associated with lower plasma levels of HDL-C. The finding concurs with the notion of dyslipidemia partially underlying the atherosclerotic risk in individuals with PTSD caused by different types of trauma.     

Social trauma and its association with posttraumatic stress disorder and social anxiety disorder

The key characteristic of a traumatic event as defined by the Diagnostic and Mental Manual of Mental Disorders (DSM) seems to be a threat to life. However, evidence suggests that other types of threats may play a role in the development of PTSD and other disorders such as social anxiety disorder (SAD). One such threat is social trauma, which involves humiliation and rejection in social situations. In this study, we explored whether there were differences in the frequency, type and severity of social trauma endured by individuals with a primary diagnosis of SAD (n = 60) compared to a clinical control group of individuals with a primary diagnosis of obsessive compulsive disorder (OCD, n = 19) and a control group of individuals with no psychiatric disorders (n = 60). The results showed that most participants in this study had experienced social trauma. There were no clear differences in the types of experiences between the groups. However, one third of participants in the SAD group (but none in the other groups) met criteria for PTSD or suffered from clinically significant PTSD symptoms in response to their most significant social trauma. This group of SAD patients described more severe social trauma than other participants. This line of research could have implications for theoretical models of both PTSD and SAD, and for the treatment of individuals with SAD suffering from PTSD after social trauma.     

PTSD symptom severity and psychiatric comorbidity in recent motor vehicle accident victims: A latent class analysis

We conducted a latent class analysis (LCA) on 249 recent motor vehicle accident (MVA) victims to examine subgroups that differed in posttraumatic stress disorder (PTSD) symptom severity, current major depressive disorder and alcohol/other drug use disorders (MDD/AoDs), gender, and interpersonal trauma history 6-weeks post-MVA. A 4-class model best fit the data with a resilient class displaying asymptomatic PTSD symptom levels/low levels of comorbid disorders; a mild psychopathology class displaying mild PTSD symptom severity and current MDD; a moderate psychopathology class displaying severe PTSD symptom severity and current MDD/AoDs; and a severe psychopathology class displaying extreme PTSD symptom severity and current MDD. Classes also differed with respect to gender composition and history of interpersonal trauma experience. These findings may aid in the development of targeted interventions for recent MVA victims through the identification of subgroups distinguished by different patterns of psychiatric problems experienced 6-weeks post-MVA.     

Neuropeptide Y in PTSD,MDD, and chronic stress: A systematic review and meta-analysis

Previous studies have suggested that neuropeptide Y (NPY) levels may be altered in patients with major depressive disorder (MDD), post-traumatic stress disorder (PTSD) and chronic stress. We investigated, through systematic review and meta-analysis, whether the mean levels of NPY are significantly different in patients with MDD, PTSD or chronic stress, compared to controls. The main outcome was the pooled standardized mean difference (SMD) with 95% confidence intervals between cases and controls, using the random-effects model. Heterogeneity and publication bias were evaluated. Thirty-five studies met eligibility criteria. Meta-regression determined that medication and sex could explain 27% of the between-study variance. Females and participants currently prescribed psychotropic medications had significantly higher levels of NPY. NPY levels were significantly lower in plasma and cerebrospinal fluid (CSF) in PTSD patients versus controls. Patients with MDD had significantly lower levels of NPY in plasma compared to controls, but not in the CSF. The magnitudes of the decrease in plasma NPY levels were not significantly different between PTSD and MDD. However, chronic stress patients had significantly higher plasma NPY levels compared to controls, PTSD or MDD. Our findings may imply a shared role of NPY in trauma and depression: nevertheless, it is not clear that the association is specific to these disorders. Psychotropic medications may help restore NPY levels. Further controlled studies are needed to better delineate the contribution of confounding variables such as type of depression, body mass index, appetite or sleep architecture.     

The influence of data-driven versus conceptually-driven processing on the development of PTSD-like symptoms

Ehlers and Clark [(2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345] propose that a predominance of data-driven processing during the trauma predicts subsequent PTSD. We wondered whether, apart from data-driven encoding, sustained data-driven processing after the trauma is also crucial for the development of PTSD. Both hypotheses were tested in two analogue experiments. Experiment 1 demonstrated that relative to conceptually-driven processing (n = 20), data-driven processing after the film (n = 14), resulted in more intrusions. Experiment 2 demonstrated that relative to the neutral condition (n = 24) and the data-driven encoding condition (n = 24), conceptual encoding (n = 25) reduced suppression of intrusions and a trend emerged for memory fragmentation. The difference between the two encoding styles was due to the beneficial effect of induced conceptual encoding and not to the detrimental effect of data-driven encoding. The data support the viability of the distinction between data-driven/conceptually-driven processing for the understanding of the development of PTSD.     

The postdisaster prevalence of major depression relative to PTSD in survivors of the 9/11 attacks on the world trade center selected from affected workplaces

BackgroundStudies of survivors of the September 11, 2001 attacks on the World Trade Center in New York City suggest that postdisaster depressive disorders may be at least as prevalent, or even more prevalent, than posttraumatic stress disorder (PTSD), unlike findings from most other disaster studies. The relative prevalence and incidence of major depressive disorder (MDD) and PTSD were examined after the 9/11 attacks relative to trauma exposures.MethodsThis study used full diagnostic assessment methods and careful categorization of exposure groups based on DSM-IV-TR criteria for PTSD to examine 373 employees of 9/11-affected New York City workplaces.ResultsPostdisaster new MDD episode (26%) in the entire sample was significantly more prevalent (p < .001) than 9/11-related PTSD (14%). Limiting the comparison to participants with 9/11 trauma exposures, the prevalence of postdisaster new MDD episode and 9/11-related PTSD did not differ (p = .446). The only 9/11 trauma exposure group with a significant difference in relative prevalence of MDD and PTSD were those with a 9/11 trauma-exposed close associate, for whom postdisaster new MDD episode (45%) was more prevalent (p = .046) than 9/11-related PTSD (31%).ConclusionsBecause of the conditional definition of PTSD requiring trauma exposure that is not part of MDD criteria, prevalence comparisons of these two disorders must be limited to groups with qualifying trauma exposures to be meaningful. Findings from this study suggest distinct mechanisms underlying these two disorders that differentially relate to direct exposure to trauma vs. the magnitude of the disaster and personal connectedness to disaster and community-wide effects.     

Tools for translational neuroscience: PTSD is associated with heightened fear responses using acoustic startle but not skin conductance measures

Background: Posttraumatic stress disorder (PTSD) patients show heightened fear responses to trauma reminders and an inability to inhibit fear in the presence of safety reminders. Brain imaging studies suggest that this is in part due to amygdala over‐reactivity as well as deficient top‐down cortical inhibition of the amygdala. Consistent with these findings, previous studies, using fear‐potentiated startle (FPS), have shown exaggerated startle and deficits in fear inhibition in PTSD participants. However, many PTSD studies using the skin conductance response (SCR) report no group differences in fear acquisition. Method: The study included 41 participants with PTSD and 70 without PTSD. The fear conditioning session included a reinforced conditioned stimulus (CS+, danger cue) paired with an aversive airblast, and a nonreinforced conditioned stimulus (CS?, safety cue). Acoustic startle responses and SCR were acquired during the presentation of each CS. Results: The results showed that fear conditioned responses were captured in both the FPS and SCR measures. Furthermore, PTSD participants had higher FPS to the danger cue and safety cue compared to trauma controls. However, SCR did not differ between groups. Finally, we found that FPS to the danger cue predicted re‐experiencing symptoms, whereas FPS to the safety cue predicted hyper‐arousal symptoms. However, SCR did not contribute to PTSD symptom variance. Conclusions: Replicating earlier studies, we showed increased FPS in PTSD participants. However, although SCR was a good measure of differential conditioning, it did not differentiate between PTSD groups. These data suggest that FPS may be a useful tool for translational research. Depression and Anxiety, 2011. © 2011 Wiley Periodicals, Inc.     

Trauma and posttraumatic stress disorder in treatment-resistant obsessive-compulsive disorder

Prior research has indicated a seemingly unique relation between obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) that appears to relate to negative treatment outcome for OCD. However, to date, the prevalence of trauma and PTSD in individuals seeking treatment for OCD is unclear. To begin to address this gap, this study assessed history of traumatic experiences and current PTSD in individuals seeking treatment for treatment-resistant OCD. Trauma predictors of PTSD severity also were examined in this sample. Participants included 104 individuals diagnosed with treatment-resistant OCD who sought treatment over the course of 1 year from OCD specialty treatment facilities. Data were collected via naturalistic retrospective chart reviews of pre-treatment clinical intake files. Findings revealed that 82% of participants reported a history of trauma. Over 39% of the overall sample met criteria for PTSD, whereas almost 50% of individuals with a trauma history met criteria for PTSD. Interpersonal traumas and greater frequency of traumas were most predictive of PTSD severity, and individuals diagnosed with OCD and additional major depressive disorder (MDD) or borderline personality disorder (BPD) appeared at particular risk for a comorbid PTSD diagnosis. PTSD may be relatively common in individuals diagnosed with treatment-resistant OCD; and interpersonal traumas, MDD, and BPD may play a relatively strong predictive role in PTSD diagnosis and severity in such OCD patients.