Obsessive-compulsive disorder (OCD) is a serious, highly debilitating condition that involves disturbing mental content referred to as obsessions, which includes thoughts, images, urges, and ideas that are recurrent and evoke significant distress for the individual experiencing them. Most people with OCD respond to their obsessions and accompanying distress by engaging in compulsions, which are behaviors or mental actions aimed at reducing the resulting distress and neutralizing a perceived threat.
Trauma as a contributing factor to OCD
Among the many factors that can contribute to the development of OCD is trauma. According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), trauma refers to an experience in which a person is either directly exposed to or witnesses actual or threatened death or serious injury/violence. Experiencing trauma is a risk factor for developing a variety of mental disorders, and this includes OCD. In fact, research shows that a majority of individuals diagnosed with OCD have experienced at least one traumatic life event (Cromer et al., 2007).
In many cases, a traumatic experience can be a precipitating factor that directly contributes to the development of OCD. For example, imagine that a young child experiences the sudden, tragic loss of a parent in a motor vehicle accident. The child may develop obsessions about other family members dying in car accidents, as well as compulsions trying to prevent this from happening (e.g., “replacing” thoughts about a car accident with thoughts about family members being safe at home). This illustrates just one of an endless amount of examples of how a traumatic life experience could directly lead to the onset of OCD. Indeed, many of our members have shared with us that a traumatic event was a precipitating factor in the emergence of their OCD.
When trauma leads to PTSD
Of course, there are many other mental health challenges that can pop up during the post-trauma period. One of the most notable examples is posttraumatic stress disorder, or PTSD. PTSD is among the most common mental health conditions that people develop after experiencing trauma. The condition chiefly involves frequent and intrusive re-experiencing of the traumatic event, such as disturbing memories or flashbacks of the trauma as well as nightmares that disrupt sleep. Additionally, because of the emotional pain associated with trauma, individuals with PTSD attempt to avoid thinking or talking about their trauma and also avoid situations that remind them of the trauma (e.g., staying away from places near where the traumatic event occurred). PTSD also involves negative changes in mood, ability to concentrate, and general arousal (e.g., hypervigilance about potential dangers).
Unfortunately, PTSD and OCD tend to co-occur frequently. Research shows that among people diagnosed with PTSD, the probability of developing OCD within a year is about 30% (Brown et al., 2001). Additionally, up to 25% of people suffering from OCD will also meet the criteria for PTSD (Brown et al., 2001). What’s concerning is that when OCD and PTSD co-occur, the symptom severity of each condition tends to be higher and more challenging to treat (Pinciotti et al., 2021).
Can therapy be helpful to me?
The good news is that even if you have experienced trauma in your past, there is reason to be optimistic that treatment can be helpful for you. The most effective form of therapy for OCD is known as exposure and response prevention (ERP), which involves confronting the obsessional content that evokes distress while preventing the typical response to engage in compulsions to reduce the distress. For decades, ERP has proven to be an effective treatment in a variety of scientific studies, many of which have included people who experienced trauma as a contributing factor to developing OCD. Thus, you can be confident that ERP will be a helpful approach for you, even if trauma was involved in the development of your OCD.
If you struggle with OCD and PTSD concurrently, the good news for you is that these conditions can be effectively treated at the same time. In fact, the treatment approaches for the two are remarkably similar. Whereas ERP is the treatment of choice for OCD, one of the most effective treatments available for PTSD is prolonged exposure (PE), which helps someone move past their trauma by stopping the ongoing avoidance of thinking about the trauma and visiting trauma reminders. PE and ERP share a core principle of confronting what distresses us and not using any avoidance behaviors as “quick fixes” to relieve our anxiety at the moment. Although there can be some challenges that come with trying to do these two treatments simultaneously, there is emerging evidence that this combined approach (ERP + PE) can have major benefits (Pinciotti et al., 2022).
Here at NOCD, we have many therapists who have received specialty training in treating OCD and co-occurring PTSD, using both ERP and PE therapy together. By providing training in evidence-based treatment for PTSD, NOCD Therapists can serve the one in four people with OCD who also suffer from PTSD by gaining deep expertise in treating PTSD with PE. Many insurance providers also cover PE for NOCD Therapy members experiencing both OCD and PTSD, bringing even greater access to this underserved group in the OCD community.
If you are struggling with OCD and you’ve experienced some past trauma or are currently struggling with PTSD at the same time, NOCD can help. Please schedule a free 15-minute call with a member of our team to help get you started. We have many experienced therapists that know how to help individuals who have a history of trauma in the development of their OCD, and many also specialize in treating co-occurring PTSD. We look forward to working with you!