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What is OCDRelated Symptoms & ConditionsCan Adverse Childhood Experiences (ACEs) cause distressing intrusive thoughts?

Can Adverse Childhood Experiences (ACEs) cause distressing intrusive thoughts?

7 min read
Aaron Hensley, MSW, LCSW

There’s no denying that our childhood experiences, both the positive and negative, can have lasting effects long into our adulthood. And in recent years, more attention has been given to the potentially lifelong mental health effects of childhood trauma. Childhood adversity can literally get into our heads. 

If you’re noticing that you have intrusive, unwanted thoughts and you also have experienced childhood trauma, you might be wondering if there’s a connection between your negative experiences growing up and the thoughts that plague you today. 

Keep reading for answers, and how to get help.

What are ACEs (adverse childhood experiences)?

ACEs is an acronym that stands for adverse childhood experiences. Original research on adverse childhood experiences, known as the ACE Study, was published in 1998. Out of that grew a commonly used measure of childhood adversity called an “ACE score.”

There are three types of ACEs that are commonly linked to mental and physical health issues in the future: abuse (of any kind), neglect, and household dysfunction. 

The chain of events that lead to health issues isn’t always immediately obvious, but if you look closely, you can sometimes illuminate the connection. For instance, take a child who experienced severe poverty growing up and as a result had limited access to healthy and affordable food. Their poor diet as a child led to childhood obesity, which led down the line to more health risks as an adult. Another example is a child who was neglected by primary caregivers growing up, and that neglect contributed to delays in social and emotional development. As an adult, this person now experiences issues with attachment and communication in all relationships, including romantic ones. 

What are intrusive thoughts?

Intrusive thoughts are something that everyone experiences, and are not necessarily an indicator of any mental health condition. Whether it’s a thought about causing harm to someone, or yelling obscenities in a crowded place, or driving off a cliff, everyone has unpleasant, unwanted thoughts that pop into their mind from time to time. 

However, although they are shared by everyone and harmless on their own, intrusive thoughts are also involved in serious mental health conditions, including OCD (obsessive-compulsive disorder).

How can ACEs lead to intrusive thoughts?

Past trauma or stress—yes, including the trauma experienced in childhood—can increase the chances that you’ll have more distressing intrusive thoughts in the future. For example, trauma can lead to Post-Traumatic Stress Disorder (PTSD), which, among other things, is characterized by intrusive experiences like flashbacks and nightmares. Stress can also precede and exacerbate the symptoms of OCD, including intrusive thoughts. Since intrusive thoughts thrive on negative experiences, any particularly stressful event or time in someone’s life can make intrusive thoughts more frequent and distressing.

Children are among the most vulnerable populations for adverse or traumatic experiences because of the number of things they do not have control over. Children who have adverse childhood experiences often develop fears about experiencing those situations again. For example, a child who goes through a traumatic sexual assault may develop a fear of a repeat occurrence. That same child could grow up to have intrusive memories of the assault, or could obsess persistently about not allowing that same harm to come to their child. 

The connection between OCD and childhood trauma

OCD is defined by two aspects: obsessions and compulsions. Obsessions are intrusive thoughts, images, or urges that create distress. To escape the discomfort, someone with OCD engages in repetitive thoughts or behaviors for relief, referred to as compulsions. Compulsions offer temporary relief from intrusive thoughts, but when the obsession happens again, which it always does, the compulsion is repeated, perpetuating the vicious cycle. 

There are countless studies showing the connection between childhood trauma or other mistreatment and OCD. But to illustrate, it often helps to consider real-world anecdotes. Imagine, just for a second, Tyler: a child playing baseball who gets hit by a wild pitch, and now is afraid of getting hit with another pitch. In the months following, he tries to remember every detail that led up to the pitch: What did he have for breakfast? What was the pitcher wearing? Was the wild pitch on a 1-2 count or a 1-1 count? Did he look to first base before the windup? He feels convinced that with every new detail he remembers, he can stay safe every time he walks to the plate. Over time, he builds up more and more rituals for different scenarios, feeling more and more that his safety depends on identifying and remembering the details of his past injury.

The problem is that compulsions create a false sense of safety which can lead the brain to believe that anything that produces a similar threatening feeling must be avoided. For example, a child who experiences threats to their safety growing up could develop a fear of losing safety in adulthood. The person’s safety is no longer in jeopardy, and the perceived threat to their safety may not even be related to their trauma. Nevertheless, they may feel a deep sense of responsibility to secure their safety or prevent danger at all costs. This is done through compulsions that can end up taking over their life. 

How to get help when childhood trauma is leading to intrusive thoughts

To get help when childhood trauma is leading to intrusive thoughts, you first need to establish whether the intrusive thoughts are related to PTSD, OCD, or another mental health condition. To do that you will need to meet with a therapist who specializes in trauma and/or OCD. Differentiating between the two is important because the treatment approaches for the two conditions are different. PTSD-related intrusive thoughts are generally more focused on a specific traumatic event. These thoughts could be memories of the trauma, fears of the trauma happening again, mental images of the perpetrator of the trauma, and even nightmares about the trauma. 

This differs from OCD mostly in the way one responds to their intrusive experiences. When someone has experienced a trauma, OCD often tries to “help” with strong urges for the person to engage in compulsions. It’s through these compulsions that OCD convinces the person that they can prevent bad things from happening again in the future. This is, of course, a lie told by OCD—but OCD is very convincing.

The most effective forms of treatment for PTSD and OCD both focus on helping the brain relearn how to interact with the intrusive thoughts, but they vary in how this is accomplished. Seeing a specialist in both trauma and OCD will ensure that your intrusive thoughts are being attributed to the right diagnosis for your best chance at recovery. 

Treatment for intrusive thoughts caused by OCD

If the intrusive thoughts you are experiencing are linked to OCD, then you should ensure that your therapist is trained in Exposure and Response Prevention, or ERP.  ERP is the most effective and most thoroughly researched form of treatment for OCD. What makes ERP so effective is its unique reliance on embracing fears through careful, targeted challenges—also known as exposures. These challenges allow a person to come into contact with their fears and worries in a controlled environment, and challenge the brain’s expectation that something bad will happen.

When we do this while simultaneously resisting compulsions, the brain begins to realize that the intrusive thoughts are not legitimate threats, and the compulsions are not needed in order to stay safe. For example, if a person has an intrusive thought that if they do not check their lock three times before bed someone will break into their house and assault them, then an exposure designed to target their fear might involve intentionally locking the door only once and going to bed without checking again to make sure it is locked. This allows the person to realize that they can go to bed without checking their lock three times, because their feared outcome does not occur, and their distress fades on its own without needing to engage in ritualistic checking. 

Finding an ERP therapist can be hard, and here at NOCD we aim to make it easier. Every therapist at NOCD receives training on OCD and ERP, as well as ongoing supervision with industry leaders in OCD treatment. Additionally, some NOCD Therapists can also treat PTSD with PE in people who suffer with both conditions. You can start today by scheduling a free phone call with the NOCD Care team

NOCD Therapists specialize in treating OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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