Note that this is a guest blog by Dr. Caitlin Pinciotti, Assistant Professor at Baylor College of Medicine.
Although there is some debate about how the word “trauma” is defined, in the clinical world, we define trauma as exposure to actual or threatened death, serious injury, or sexual violence. This can include traumatic events like natural disasters (e.g., hurricane), car accidents, serious life-threatening illnesses or injuries, sexual and physical abuse or assault, combat, and sudden violent or accidental death.
Most commonly, we think of experiencing trauma as the event actually happening to you, but in reality there are several ways that we can experience and be impacted by trauma, including being a witness to the event, learning that the event happened to your close family member or friend, or being repeatedly exposed to details of the traumatic event through the course of your job (e.g., 9-1-1 telecommunicators, therapists, etc.). Given how many different types of events could be considered a trauma, it’s no surprise that most people will be exposed to a potentially traumatic event at least once in their lifetime.
While it’s common to experience an increase in trauma-related mental health symptoms following a traumatic event, fortunately, most people are able to recover from trauma on their own without any intervention needed. For those who are not able to recover on their own, they can experience any number of problems including posttraumatic stress disorder (PTSD), depression, substance misuse or addictions, or anxiety disorders, and more recently, research has begun to understand that some people who experience trauma may develop obsessive-compulsive disorder (OCD).
We don’t quite know yet exactly how many people develop OCD following trauma, or why some people develop OCD while others do not, but we do know that this happens more than previously believed, and can have a significant impact on OCD symptoms and severity.
There are a number of ways that trauma can influence OCD. First, the incredible stress associated with trauma exposure can create the conditions from which OCD can develop. In psychology, we use the “diathesis-stress model” to help us explain how nature and nurture can work together to influence the development of mental health conditions. The theory is that we all have unique susceptibilities to
certain mental (and physical) health concerns passed on through our family genes. For some, there is a really strong genetic predisposition – such as if a biological parent or twin sibling has a mental health concern. However, for others, there is less of a genetic predisposition if someone in our very extended family has a mental health concern (like your great, great, great Aunt Marge). Stressful conditions, such as early life experiences and trauma, can serve as a catalyst for developing a mental health condition by bumping us past the imaginary threshold needed in order to develop a given mental health condition.
Put simply, stressful conditions such as trauma can sometimes provide just the unwanted push our body needs to develop a mental health condition that we may have been genetically predisposed to — sort of like the old adage, “the straw that broke the camel’s back.” People who hold marginalized or minoritized identities, such as those who are LGBTQIA+ and BIPOC, are likely to experience a lot of identity-related discrimination, rejection, and mistreatment, which can also increase stress and lead to vulnerabilities to developing mental health concerns. Many people describe having family members with OCD or anxiety, but feel that, for them, their traumatic experience is what ultimately led to the development of their own OCD.
Trauma can also influence the way in which OCD symptoms present. As you probably know, OCD can look totally different from one person to another because it can latch onto virtually any theme contamination, morality, religion, harm, concern about making mistakes, ordering and arranging, identity, and so on. Some people describe feeling as though their traumatic experience has woven its way into their OCD symptoms, such as being the focus of intrusive thoughts and fears. Remember, this can happen even if you did not directly experience the trauma yourself but someone else did. If you are someone who learned of a traumatic event happening to a loved one, you may become fixated on that same event happening to you, or may doubt your memory recollection of your own traumatic experiences.
Similarly, many people with trauma and OCD describe feeling as though the function of their compulsions is related to their trauma. Perhaps your compulsions give you a sense of predictability or control that you felt you lost during the traumatic event, perhaps your compulsions serve to help prevent trauma from happening again, or are used to cope with the distress and other feelings and thoughts that come up when you are reminded of your trauma.
Lastly, trauma can influence the severity of OCD. People who develop OCD following trauma and PTSD have more severe obsessions and compulsions and are at greater risk for suicidal thoughts and behaviors. You may feel like your OCD and trauma-related responses (e.g., PTSD symptoms) rise and fall in tandem – whenever you experience a trauma trigger and subsequent trauma-related responses, you also experience an increase in OCD symptoms. Trauma reminders may also make you feel less able to regulate your OCD-related emotions under stress.
There is so much more work to be done to understand the complex relationship between OCD and trauma, and researchers are actively working to help answer these important questions. However, if this blog resonates with you, you can be assured that you are not alone and that there is help out there for you.
-Caitlin M. Pinciotti, PhD
Remember: this blog post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as mental health or medical advice. The information and education provided here is not intended or implied to supplement or replace professional advice of your own professional mental health or medical treatment, advice, and/or diagnosis. Always check with your own physician or medical or mental health professional before trying or implementing any information read here.