A proposed decision-making tool for addressing OCD and co-occurring PTSD within a MED-DBT framework

Co-occurring obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are common and clinically consequential among adults with eating disorders (EDs), yet clear guidance for treatment prioritization and sequencing remains limited. This brief report introduces a structured decision-making tool designed to support Stage-2 prioritization of OCD versus PTSD treatment within a multi-diagnostic ED-dialectical behavior therapy (MED-DBT) program. The tool integrates readiness criteria, diagnostic confirmation, and decision points to guide clinicians in treatment planning. We describe the feasibility of integrating and delivering this structured decision-making tool within a MED-DBT program, along with preliminary clinical trends from a pilot sample. More than half of program admissions during the study period flagged for probable OCD/PTSD, though only a small subgroup met Stage-2 readiness criteria, consistent with patterns in higher levels of care. Among patients receiving protocol-based exposure and response prevention or trauma treatment, early symptom trajectories were favorable across ED, OCD, PTSD, and impairment domains. These preliminary findings support the feasibility of structured prioritization within MED-DBT and highlight pathways for future evaluation.