Trauma is most often associated with psychiatric conditions like post-traumatic stress disorder (PTSD). However, it appears to have a strong link with obsessive-compulsive disorder (OCD) as well. While 2 percent of adults have OCD in any given year, this number increases dramatically when there is a history of trauma. Estimates suggest that 19 to 31 percent of those with post-traumatic stress disorder also have OCD.
These numbers raise a lot of questions. Can trauma cause OCD? If so, why? Can trauma make OCD worse? Can they be treated together? We spoke with Dr. Patrick McGrath, Chief Clinical Officer at NOCD, to answer these questions and more.
What Is OCD?
OCD is a psychiatric condition in which individuals experience intrusive thoughts, images, and urges (called obsessions) that cause anxiety or distress, leading them to engage in a range of ritualized behaviors (called compulsions) in an attempt to alleviate anxiety or prevent some negative outcome associated with their obsessions.
What Is Trauma?
The diagnostic and statistical manual of mental disorders (DSM-V) states that trauma involves “exposure to actual or threatened death, serious injury, or sexual violence.” In some cases, this can result in PTSD, characterized by intrusive thoughts and experiences related to the traumatic event, including flashbacks and nightmares, and avoidance behaviors designed to neutralize anxiety. However, as Dr. McGrath notes, not everyone who experiences trauma develops PTSD. In fact, this is the exception, not the norm.
Can Trauma Cause OCD?
We know that OCD and trauma are highly correlated. Is this because trauma causes OCD? As Dr. McGrath notes, that might be the wrong question. “Most people who have traumas still don’t develop OCD,” he says. “If trauma caused OCD, then almost everybody who had a trauma might then have OCD. But that’s not the way that it works.” However, we can ask whether experiencing trauma makes one more vulnerable or increases their chances of developing OCD.
There is strong evidence in support of this. We know that stress often precedes many psychiatric conditions, including OCD. One study found that compared to control groups, individuals with OCD were much more likely to report a stressful life event in the six months prior to the onset of their OCD. Some research has focused specifically on trauma and OCD. One group of researchers found that among individuals with both PTSD and OCD, 59 percent experienced the traumatic event first. Another study found that those 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 trauma history.
What seems clear, at minimum, is that trauma can make it more likely for one to develop OCD and that many people may not otherwise have developed the condition when they did without their traumatic experience.
How Might Trauma Result in OCD?
If trauma does increase one’s chances of developing OCD, why does this happen?
One general mechanism is stress. Traumatic events are incredibly stressful by definition, and studies suggest that stress is associated with a higher rate of OCD, as well as more severe symptoms in people with OCD. Severe stress can also cause significant changes in the brain. As some researchers have noted, many of these changes impact regions of the brain in ways that mirror the dysfunction found in OCD. These experts suggest that by producing similar changes in the brain, trauma and stress can make one more disposed to display the symptoms of OCD.
Stress is a general phenomenon that can worsen OCD, regardless of whether it comes from a traumatic experience. But there are also some reasons why trauma leads to OCD that are more specific to trauma. Dr. McGrath highlights the strong parallels between trauma and PTSD: “There’s a lot of avoidance behaviors that we see in PTSD,” he shares. “Well, avoidance is a safety behavior, and we talk about safety behaviors in OCD as well. For example, compulsions are a safety behavior. So the two have a lot of similarities.”
Because compulsions can serve as a safety behavior, they might pop up after a traumatic event to provide short-term relief from intrusive thoughts and images related to the experience. As Dr. McGrath says, “OCD develops almost as a protective mechanism to try to prevent the trauma from happening again.” Ultimately, this results in more obsessions, as compulsions do nothing to keep intrusive thoughts from persisting, which gives rise to more compulsions as the cycle continues.
Are Some People More Likely to Develop OCD After a Traumatic Event Than Others?
Not everyone who experiences a traumatic event goes on to develop OCD. This means that other factors can help explain why some people develop OCD in response to a traumatic experience and not others. While we are still learning about what might predispose people to develop OCD in response to trauma, experts have gained valuable insight.
For example, one group of researchers found that a disposition toward depression and anxiety increased the odds of developing OCD after trauma. In other words, traumatic events were more likely to result in OCD in individuals who had a strong tendency to be anxious and depressed before the event occurred.
Others argue that individual responses to and interpretations of traumatic events may be another factor. They suggest that those who are more likely to see traumatic experiences as threatening or appraise them with feelings of helplessness and fear might be more likely to develop OCD and other psychiatric conditions afterward.
There are also a variety of genetic and environmental factors that predispose one to develop OCD. When those are in place, the odds of trauma tipping the scales are likely higher.
Does Trauma Make OCD worse?
Research suggests that trauma can exacerbate the symptoms of OCD. For example, one study found links between several types of trauma and the severity of compulsions. As noted above, we also know that stress, in general, whether from traumatic experiences or otherwise, commonly results in more severe OCD symptoms.
Does the Type of Trauma Matter?
Some types of traumatic experiences seem to have a stronger connection to the development of OCD than others. For example, studies have found sexual abuse may be more likely to trigger OCD than other types of abuse. More generally, experts have argued that as the severity of the traumatic experience increases, so does the probability that one will develop OCD and experience worse symptoms when they do. With that said, there is still a lot to learn.
Dr. McGrath notes that aside from certain types of trauma being linked with a greater likelihood of OCD or more severe symptoms, “the particular trauma or stressor one experiences could influence what their OCD focuses on.” For example, imagine that 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.
What Other Factors Make People More Susceptible To Developing OCD?
While trauma may be a widespread trigger of OCD, several others are worth noting. Here are some of the more prominent factors that can increase one’s chances of developing the condition.
- Stress: As mentioned above, stress can make one more disposed to develop OCD. This is true whether the stress is triggered by a traumatic event or not.
- Age: OCD frequently begins in adolescence or early adulthood when one is experiencing major life changes.
- Substance use: As Dr. McGrath highlights, substance abuse is common among individuals with PTSD. Studies have shown that some drugs, such as stimulants, may contribute to OCD.
- Illnesses: OCD is associated with some illnesses, many of which are more common in childhood, such as Lyme disease or strep throat.
- Genetic predisposition: While we are still uncovering the biological bases of OCD, it is clear that a genetic component is involved in many people with the condition.
- Learning/observation during upbringing: Observing others displaying obsessive and compulsive tendencies repeatedly during childhood can increase one’s odds of developing OCD.
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.
How are OCD and Trauma Treated?
OCD can be treated with the proper therapy, medication, or both. When it comes to therapy, exposure and response prevention (ERP) therapy is the most effective treatment. In this form of therapy, individuals are guided in triggering one of their obsessions and resisting the urge to engage in compulsions to alleviate the resulting anxiety. Over time, this helps people with OCD to learn to cope with uncertainty and anxiety, and leads to decreased frequency and intensity of obsessions and compulsions.
Trauma can be treated with a variety of therapies. One of the most popular and effective is called prolonged exposure therapy (PE), in which individuals very gradually approach trauma-related memories, feelings, and situations. This helps them learn that these trauma-related cues are not dangerous and, over time, reduces the feelings of anxiety associated with them. There are also other treatment options, such as eye movement desensitization and reprocessing therapy (EMDR) and cognitive processing therapy.
Medications can support therapy in more severe cases. For both OCD and trauma, this is typically a selective-serotonin reuptake inhibitor (SSRI), such as fluoxetine or sertraline, which prevents the reabsorption of serotonin, a chemical messenger in the brain associated with fear, anxiety, and rumination.
Can Trauma and OCD Be Treated at the Same Time?
If you’ve experienced trauma and have OCD, you may be worried about whether it’s possible to treat both at the same time.
The answer is yes: both conditions can be and are often treated simultaneously, with great success. Recent experimental evidence suggests that the combination of both ERP and PE is a highly effective intervention. This makes sense, given that the primary mechanisms of both treatments are very similar. Both individuals who have experienced trauma and those with OCD engage in avoidance behaviors that provide short-term relief but ultimately sustain their fear and anxiety. ERP and PE are designed to interfere with that response, increase tolerance for uncertainty, and reduce the prevalence and power of intrusive thoughts and experiences.
With that said, there are some obstacles to be aware of. “We’ve noticed that PTSD can interfere with some of the OCD treatment because of all the nightmares, flashbacks, and avoidance behavior,” shares Dr. McGrath. “So in many cases, we’ll typically address the trauma first, then we’ll go back to the ERP afterward. 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 PTSD simultaneously.”
If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.