Trauma is most commonly associated with mental health conditions like post-traumatic stress disorder (PTSD), but growing research suggests it may also play a significant role in obsessive-compulsive disorder (OCD).
While about two percent of adults are diagnosed with OCD in any given year, that number rises sharply among those with a history of trauma. In fact, studies estimate that between 19% and 31% of people with PTSD also experience OCD symptoms.
These statistics raise important questions: Can trauma actually cause OCD? Does trauma make OCD symptoms more severe? And, can both conditions be treated at the same time?
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What is OCD?
OCD is a chronic mental health condition with two core components: obsessions and compulsions. Obsessions are unwanted and recurrent intrusive thoughts, feelings, urges, images, and sensations that cause fear and anxiety. In response to obsessions, people with OCD engage in compulsions—repetitive physical behaviors or mental acts meant to reduce anxiety, neutralize intrusive thoughts, or prevent something bad from happening.
What is trauma?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), trauma refers to experiencing or being exposed to something deeply distressing or dangerous, like near-death experiences, serious injury, or sexual violence. Trauma can come from living through the event yourself, seeing it happen to someone else, or repeatedly hearing upsetting details.
It’s important to note that trauma is highly individual. Two people might go through the same event, but only one may develop lasting psychological effects. Your past experiences, personality, support system, and overall mental health all influence how you process and recover from trauma.
Can trauma cause OCD?
According to licensed therapist Tracie Ibrahim, MA, LMFT, CST, research shows that trauma can increase the likelihood of developing OCD. But, that doesn’t mean trauma always leads to OCD.
“Most people who have trauma still don’t develop OCD,” says Dr. Patrick McGrath, Chief Clinical Officer at NOCD.
However, research indicates that:
- People with OCD are much more likely to report a stressful life event in the six months prior to the onset of their OCD.
- Among people with both PTSD and OCD, 59% experienced a traumatic event before developing these conditions.
- People who reported exposure to traumatic events in childhood are five to nine times more likely to be diagnosed with OCD in adulthood than those without a history of trauma.
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How can trauma cause OCD?
One big reason trauma can increase the chances of developing OCD is stress. Traumatic events are, by nature, extremely stressful—and studies show that high levels of stress are linked to both a higher risk of OCD and symptom flare-ups in people who already have the condition.
According to Dr. McGrath, some avoidance and safety behaviors associated with PTSD can also overlap with OCD symptoms. “OCD develops almost as a protective mechanism to try to prevent the trauma from happening again,” he says. However, instead of providing lasting relief, these safety behaviors—or compulsions (in the case of OCD)—only strengthen the cycle of symptoms.
What increases the risk of OCD?
While trauma may be a widespread trigger of OCD, there are several other factors worth noting:
- Stress: As mentioned above, stress can trigger the onset of OCD. This is true regardless of whether the stress is triggered by a traumatic event.
- Age: OCD frequently begins in adolescence or early adulthood, when you are more likely to be experiencing major life changes.
- Illnesses: OCD is associated with some illnesses, such as Lyme disease and strep throat (especially pediatric strep cases that lead to PANDAS).
- Genetic predisposition: While we are still uncovering the biological bases of OCD, it seems that having a family member with OCD may increase your likelihood of developing the condition.
- Learning/observation during upbringing: Observing others displaying obsessive and compulsive behaviors repeatedly during childhood can increase your odds of developing OCD.
- Substance use: Studies have shown that some drugs, such as stimulants, may contribute to OCD.
- Co-occurring mental health conditions: Although more research is needed, studies have found that people who already have anxiety or depression may be more likely to develop OCD after a traumatic experience.
Of course, any one of these potential “causes” won’t lead to OCD in most people. They have to occur in the proper context, alongside any number of other factors.
Does a specific type of trauma cause OCD?
Some types of traumatic experiences seem to have a stronger connection to the development of OCD than others. For example, studies have found that sexual abuse may be more likely to trigger OCD than other types of trauma. Some experts also believe that more severe traumatic experiences are more likely to cause OCD. With that said, there is still a lot to learn.
Dr. McGrath notes that sometimes, “the particular trauma or stressor one experiences could influence what their OCD focuses on.” For example, if a child experiences a traumatic death in the family, they may go on to develop obsessions and compulsions related to preventing the deaths of other loved ones.
Treatment for OCD
Exposure and response prevention (ERP) therapy, is a specialized form of cognitive behavioral therapy (CBT) where you’ll work with a therapist to gradually expose yourself to fears that trigger intrusive thoughts, while resisting the urge to do compulsions.
You’ll work with your therapist to identify your fears and create a list of exercises meant to help you face your fears while resisting compulsions. The list will be ranked from the least anxiety-inducing to the most, and you’ll slowly work your way up—moving at your own pace.
The goal of ERP therapy is to help you build tolerance to the anxiety obsessions trigger, sit with discomfort (which will dissipate with time), and reduce the need to engage in rituals to alleviate that anxiety. Over time, you’ll gain confidence in managing anxiety without relying on rituals.
Treatment for trauma
One of the most popular and effective treatments for trauma is called prolonged exposure (PE) therapy, in which you very gradually approach trauma-related memories, feelings, and situations. This helps you learn that these trauma-related cues are not dangerous and, over time, reduces the feelings of anxiety associated with them.
Eye movement desensitization and reprocessing (EMDR) therapy is another potential treatment option, which involves a therapist guiding you in back-and-forth eye movements, while helping you recall painful memories. You’ll acknowledge any feelings or thoughts that arise during the session, lessening the emotional response you have to triggers, and allowing you to “reprocess” them.
How to manage both OCD and trauma
If you’ve experienced trauma and have OCD, both conditions can be treated simultaneously, with great success.
One study suggests that the combination of both ERP and PE is highly effective, since both treatments function similarly. Both ERP and PE help you rely less on safety behaviors, increase tolerance for uncertainty, and reduce the prevalence and power of intrusive thoughts and memories.
With that said, Dr. McGrath says PTSD can make it difficult to embark on OCD treatment. “In many cases, we’ll typically address the trauma first, then we’ll go back to the ERP afterward,” he explains. “That’s why it’s important to find a professional who is experienced and sensitive to the challenges of alleviating the symptoms of trauma and OCD simultaneously.”
Medications can also support both OCD and trauma-focused therapies, making it easier for you to engage in ERP exercises and stay grounded when symptoms feel overwhelming. These drugs don’t “cure” OCD or trauma, but for many people, they can reduce the intensity of anxiety, intrusive thoughts, or mood symptoms—creating more space to engage in the hard work of therapy. For both OCD and trauma, selective-serotonin reuptake inhibitors (SSRIs), such as fluoxetine or sertraline, are typically prescribed.
Bottom line
Trauma can increase the risk of developing OCD, especially for those already vulnerable due to other health conditions, genetics, or stress. If you’re dealing with both trauma and OCD, a tailored treatment plan is essential. A specialist in OCD and trauma can help address your specific needs, using therapies like ERP, PE, or medications. Getting the right support can make things feel a lot less overwhelming—and a lot more possible.