The Relationship Between Trauma and OCD
Have you ever considered why there seems to be such a high rate of trauma or PTSD tied to those who also are diagnosed with OCD? Well I have!
I found a very helpful article on this discussion and wanted to share key points for those of you who are interested in the information surrounding this concept.
The article shared is a review article, this review summarizes the findings from many other studies completed, thus the information will have many different perspectives dependent on the studies reviewed and their individual premises. Please keep that in mind as you read and feel free to ask questions!
I first wanted to start off with the concept that OCD comes from multiple different 'origins'. The most commonly referred to origin is considered to be genetic. As a trauma and OCD therapist however, I actually have encountered very few "OCD only" clients. This is what lead to my search around the prevalence of trauma or PTSD within OCD.
For context, the average rate of OCD diagnosed in the general population is around 1.1-1.8%, however in those diagnosed with a dual diagnosis of PTSD, this significantly increases to a range of 30-82%. Even if we were to only take the studies that found that rate to be on the lower end (the 30%), this is still approximately 15-30x higher than the average population!
This article emphasizes that we cannot with certainty confirm if the overlap of PTSD and OCD is consistently based in the two diagnoses having shared traits, but what we can identify is that those with a trauma history seem to be more likely to develop OCD symptoms as well. (If you'd like to understand the alternative perspectives on this you can research about epigenetics within mental health!)
Where I drew a comparison between the two diagnoses was hypervigilance within trauma and intrusive thoughts within OCD.
Hypervigilance is a safety or coping mechanism taught to the body after a traumatic experience that causes the body and mind to respond with a hyper or high awareness to external stimulus. For example, if your father regularly yelled at you after coming home from work if you were seen sitting on the couch, you may develop hypervigilance toward a garage door opening, a key in a doorknob, or a door opening. These all cause a fight or flight response in the body to jump up and run to your room so as to not get yelled at. When we examine hypervigilance at its core, we notice that it is based in fear or anxiety. And what is OCD? An anxiety disorder!
Let's also look at the fundamentals of intrusive thoughts: they are there to 'help' awareness of possible outcomes be more obvious or present to the mind. That is to say, intrusive thoughts are what cause us to 'think ahead' to what could happen. AKA "helpful" thoughts that bring on anxiety so that we can think ahead to what we can control to "fix" it.
When someone has trauma and reacts with hypervigilance, it makes sense that the mind starts to generalize this toward other areas in our lives. "If dad yells at me when he gets home, even after I move out, I should be cautious about my roommate or partner yelling at me when they get home". This reasoning is where we start to see how an individual might start down many other anxiety induced paths.
So what differs between a trauma response and OCD? The core of it lies in the rationality of these thoughts and the response to them. In the above example, the thought itself isn't completely irrational and the desire to run to your room wouldn't be either. This would technically still be a trauma response of hypervigilance.
Where it might turn to intrusive thoughts and compulsions is when we start to say "If my partner yells at me for sitting on the couch, then I need to break up with them." Notice how we have added the expectation of our partner yelling and a response that may seem strong or irrational for the issue. The overlap between trauma and OCD starts to blur here.
Okay, back to the article! Now that we understand that both trauma and OCD are attempting to 'help' by giving some form of action (fight or flight or a compulsion), we can start to piece together how neutralizing the distress connects these two disorders.
It's been noted for several decades that obsessions appear to be more likely after a stressful event. The higher the distress faced, the greater the frequency of the intrusive thought/obsession.
In both arenas, we're toying with the concept of anxiety as a helper to decrease possible future discomfort. Within OCD it starts to show up within how we can 'control' the situation. Within PTSD it shows up in how you might feel 'responsible' for a situation.
When you feel as though you can control a situation or are responsible for the outcomes of past, present, or future situations, it means that you've made meaning of previous events. In OCD, it might look like assigning blame toward something such as "I touched a dirty hand rail and that's the reason I got sick." Now you respond by not touching the hand rails. However, within PTSD, it might look more mental through self-blame. "Because I didn't check my car mirrors well enough, I caused an accident." Now you consistently check the mirrors excessively.
I find it important to understand the differences between these two diagnoses, while also still understanding the significant overlap in many areas. This review article also discusses how when OCD symptoms reduce, PTSD symptoms increase and vice versa. This means we need to approach both at the same time.
Now, I have heavily prioritized the PTSD work when I work with those who have both OCD and PTSD, and this is usually due to exactly what this article discussed: a traumatic event often is the root cause for obsessions and compulsions to begin. However, I want to add that we're still doing OCD work when we're doing trauma work. Think about if you do a trauma modality like EMDR (Eye Movement Desensitization and Reprocessing) or IFS (Internal Family Systems) or many others, doesn't it feel like a form of ERP (Exposure and Response Prevention)? ERP is ideal for OCD treatment as it's considered the 'gold standard', however exposure therapy is EVERYWHERE in almost every modality. In DBT, we refer to it as 'opposite action', in EMDR, we ask people to recall the distressing event and to remember and process it, just as some examples.
So, I write this post to help encourage those who have noticed both PTSD and OCD symptoms in their lives to actively practice not just trauma work and not just ERP, but to instead view them as a cohesive intervention that is needed to help guide you toward your own healing.
If you have thoughts or questions, please feel free to share!!
If you'd like to read the entire article, it is linked here: https://pmc.ncbi.nlm.nih.gov/articles/PMC4346088/