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How Trauma can Impact OCD

Lauren Wadsworth, PhD1, ABPP; Caitlin Pinciotti, PhD2; Nathaniel Van Kirk, PhD3

1Founding Director, Genesee Valley Psychology: www.gviproc.org; laurenwadsworth.com

2 Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; cmpinciotti.com 

3Director of Psychological Services, OCD Institute, McLean Hospital, Instructor in Psychology, Department of Psychiatry, Harvard Medical School

Obsessive Compulsive Disorder (OCD) and trauma frequently co-occur. Having a trauma history makes individuals more likely to develop OCD (Badour et al., 2012). Indeed, those with Post-Traumatic Stress Disorder (PTSD) are 3.6 times more likely to have OCD (Brown et al., 2001). PTSD often comes before OCD, leading researchers, clients, and clinicians alike to wonder if experiencing trauma can trigger development of OCD. 

There are multiple theories about how trauma could trigger the onset of OCD. First, many clients and clinicians think that OCD compulsions can provide a sense of control and predictability, which might help cope or self-sooth following a traumatic event. Changes in the brain could also be responsible, as trauma can lead to changes in the amygdala, which is the brain region involved in fear and anxiety, which may lead to increased anxiety-provoking intrusive thoughts (a key symptom of OCD).

Having a history of trauma can impact the treatment of OCD. Those with a history of trauma are likely to have more severe symptoms of OCD than those without a trauma history (Ojserkis et al., 2017). People in residential treatment for severe OCD are highly likely to have a trauma history- suggesting that trauma might cause more severe OCD symptoms and more difficulty treating the condition. Indeed, one study found that 82% of individuals with OCD identified as “treatment resistant” or “treatment refractory” (meaning they struggled to respond to gold-standard treatment for OCD) had a trauma history (Gershuny et al., 2007). Further, nearly one half of people in residential treatment for severe OCD believe that their OCD was directly caused by some sort of very stressful or traumatic experience (Pinciotti & Fisher, 2022).

PTSD and OCD symptoms can present in a number of ways. The symptoms might present as completely separate, or “static,” not interacting in terms of theme or function, but existing simultaneously (Rachman, 1991). For example, someone might have experienced trauma during military deployment (witnessing violence and death) and their OCD might focus on something unrelated- like relationships. Alternatively, symptoms might be “dynamic” overlapping in theme or function (Rachman, 1991). A dynamic presentation of OCD and trauma might look like excessive checking of locks and stoves following a housefire caused by a kitchen appliance.

Treating co-occurring OCD and PTSD can look a number of ways. If someone’s presentation is static, it might be best to treat OCD or PTSD symptoms first- starting with the one that seems the most impairing (Pinciotti et al., 2022). If someone has a dynamic presentation, it might be most effective to treat the symptoms simultaneously (e.g. Exposure and Response Prevention combined with and Prolonged Exposure or Cognitive Processing Therapy). 

To find a therapist that can help with your OCD, try the IOCDF “find help” tool: https://iocdf.org/

Similarities between OCD and PTSD

Lauren Wadsworth, PhD1, ABPP; Caitlin Pinciotti, PhD2; Nathaniel Van Kirk, PhD3

1Founding Director, Genesee Valley Psychology: www.gviproc.org; laurenwadsworth.com

2 Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; cmpinciotti.com

3Director of Psychological Services, OCD Institute, McLean Hospital, Instructor in Psychology, Department of Psychiatry, Harvard Medical School

Obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) frequently co-occur in the same person. Because of this, it can be confusing to understand the differences between the two conditions. Below are examples of ways that OCD and PTSD are similar and different. 

Similarities between OCD and PTSD

• Both are anxiety disorders

• Both include distressing thoughts: intrusive thoughts in OCD, intrusive memories and nightmares in PTSD

• Both often include avoidance of anxiety triggers

• Both respond to anti-anxiety medications

• Both respond to Cognitive Behavioral Therapies

Differences between OCD and PTSD

• In OCD, clients are usually concerned about bad things happening in the future, or they doubt whether something happened in the past

• In PTSD, client fears are usually surrounding past traumatic events- sometimes there is a focus on preventing a bad things from happening again, but these tend to be very specific to trauma

• People with PTSD tend to use safety behaviors to try to cope with their trauma or prevent future trauma, whereas people with OCD tend to use compulsions to try to obtain 100% certainty about an obsessional feared

• People with OCD may or may not have a history of trauma

To find a therapist that can help with your OCD, try the IOCDF “find help” tool: https://iocdf.org/