New‐Onset Obsessive–Compulsive Symptoms After MDMA‐Assisted Psychotherapy in a Patient With Refractory PTSD: A Case Report
Case Reports in Psychiatry January 1, 2026 Ridhi J. Vyas, Ryan Hood, Jeremy Hsiang et al.
A 31-year-old woman with chronic PTSD and a history of childhood compulsions developed new-onset obsessive-compulsive disorder (OCD) after undergoing MDMA-assisted psychotherapy (MDMA-AP) in a clinical trial. Her PTSD had been resistant to multiple medications, and she reported significant improvements in flashbacks and suicidal ideation after the first session. Following a delayed second session, she experienced intrusive guilt, scrupulosity, and compulsive urges to confess, leading to a DSM-5 diagnosis of OCD. OCD symptoms persisted for over a year, with a Y-BOCS score of 17 indicating moderate severity, and improved with escitalopram. This case suggests that MDMA-AP may trigger obsessive-compulsive pathology in individuals with complex trauma and prior obsessive-compulsive tendencies, possibly through serotonergic effects on frontostriatal circuits, and highlights the need for screening and long-term monitoring in such protocols.