When OCD and Trauma Intersect: A Guide to Understanding and Healing

Living with Obsessive-Compulsive Disorder (OCD) can be challenging on its own, but when it coexists with a trauma history, the experience becomes even more complex. Maybe your intrusive thoughts feel tangled up with memories you'd rather forget. Perhaps your compulsions offer not just relief from obsessive fears, but also a sense of control when everything else feels chaotic. 

You're not alone in this experience. Whether it's childhood adversity, a single traumatic event, or ongoing distressing experiences, trauma can significantly influence the development and course of OCD. Understanding this connection is essential when seeking effective treatment and lasting relief.

How Trauma and OCD Connect

Trauma probably isn’t what comes to mind when you think of OCD but the connection between trauma and OCD is more common than you might think. Studies estimate that about 30% of people with PTSD also have OCD, a rate significantly higher than the general population. Even more striking, studies have found that about 50-80% of people with OCD have a trauma history, with a significant number also meeting criteria for PTSD. 

But here's an important distinction: all trauma does not result in PTSD, and you don't need to have PTSD for trauma to affect your OCD. In fact, only a small percentage of people who experience even severe, life-threatening events develop PTSD. And many more people experience distressing or frightening events that significantly impact them without meeting all the criteria for a PTSD diagnosis. This doesn’t mean that their trauma is any less significant. It simply means that each person processes their trauma differently. Traumatic experiences can still play a major role in the manifestation of your OCD.

Timing seems to matter too. In one study, 59% of people with both OCD and a trauma history developed their OCD symptoms after experiencing a traumatic event. For others, OCD came first, and trauma intensified existing symptoms. Some people (about 21%) developed both conditions around the same time. Understanding your own timeline can help guide treatment decisions.

The Challenge of Co-occurring OCD and Trauma

When OCD and trauma occur together, things can get complicated. 

Both OCD and trauma involve unwanted, intrusive thoughts that cause distress. Both lead to avoidance, whether you're avoiding trauma reminders or situations that trigger obsessions. 

People with both OCD and trauma tend to have more severe symptoms overall, including:

• More intense anxiety and depression
• Poor sleep quality
• Poor insight into their OCD symptoms
• Lower quality of life

If you've felt like your OCD is harder to manage than what you've read about or heard from others, trauma might be interfering. 

Here's something else that might surprise you: when you have both OCD and trauma, your compulsions might be doing double duty. They're not just trying to neutralize your obsessive fears. They might also be helping you avoid or manage distressing trauma-related feelings and memories. In other words, OCD rituals might serve as a coping mechanism to reduce or avoid trauma-related thoughts or images. 

This connection can create a tricky situation. Studies have shown that when OCD symptoms decrease during treatment, PTSD symptoms like flashbacks and nightmares can sometimes get worse, and vice versa. It's like the two conditions are holding each other in place. Treating one without addressing the other often doesn't lead to lasting symptom reduction.

Does this mean you can’t get better? Not at all! It simply means that you need a treatment approach that is tailored to address both your OCD and your trauma-related symptoms.

What Helps

The encouraging news is that effective treatments exist for treating OCD and trauma together, rather than treating them separately.

Exposure-Based Therapies: The Gold Standard

Exposure-based therapies are among the preferred approaches for treating both disorders.  

For OCD, Exposure and Response Prevention (ERP) remains the gold standard for treatment. This approach involves gradually facing situations that trigger your obsessions while resisting the urge to do compulsions. 

For trauma, a similar approach called Prolonged Exposure (PE) helps you process traumatic memories by gradually confronting trauma-related thoughts and situations you've been avoiding. 

Recent research shows that using ERP and PE together can be highly effective for people with both conditions, with patients experiencing significant reductions in both OCD and PTSD symptoms. This concurrent approach acknowledges that both conditions need attention. 

It’s important to note, however, that these are not the only approaches to consider, and one or both may need to be adjusted to meet an individual’s needs. There are also other approaches to treating trauma, such as Eye Movement Desensitization and Reprocessing (EMDR) or Cognitive Processing Therapy (CPT)  that may be preferred in some cases. The importance of approaching treatment through a trauma-informed lens cannot be understated and helps to ensure that treatment feels safe and doesn't inadvertently trigger overwhelming trauma responses. A therapist who understands both OCD and trauma is key.

Medication Support

Selective Serotonin Reuptake Inhibitors (SSRIs) are generally considered first-line medication treatment for both OCD and PTSD. These medications can help reduce the intensity of obsessions and compulsions while also helping with trauma-related symptoms like hypervigilance and intrusive memories.

Medication alone isn't usually enough for lasting change, but it can reduce symptoms enough to make therapy more manageable. Some people find that medication helps create a window of stability that makes it possible to engage in the hard work of therapy.

Supportive Practices

Self-care is an important part of your healing journey. Things like getting fresh air, exercise, adequate sleep, and connecting with supportive friends and family can help manage symptoms and support a sense of well-being. These aren't replacements for professional treatment, but they're important pieces of a comprehensive approach to healing.

What to Look for in Treatment

When you're seeking help, it's important to find a provider who understands the unique challenges of having both OCD and trauma. Here's what good, trauma-informed treatment should include:

• Thorough Assessment: Your provider should take time to understand both your OCD symptoms and your trauma history, including how they might be connected. Tools like the OCD Trauma Timeline Interview (OTTI) have been developed to help clinicians and clients understand symptom origins, overlaps, and connections, which can then inform how treatment is structured. Not every clinician will use every tool but know that, if they do use an assessment tool, it is not a test and you’re not “passing” or “failing”. It is simply one way to understand your experience. 
• Safety First: Treatment should never feel retraumatizing. A skilled therapist will work at a pace that feels manageable and will help you develop coping skills you will need for the work ahead. Remember, you are always in control of the process and can let your therapist know if you feel unsafe or uncomfortable at any point.
• Distinguishing Symptoms: Part of the assessment process is distinguishing between PTSD-related hypervigilance and safety behaviors versus OCD rituals. While these may look similar on the surface, they require different approaches. Your therapist will ask a lot of questions and should be able to explain these symptoms to you. 
• Appropriate Sequencing: Where your starting point in therapy is will be as unique as you are. Some people benefit from addressing trauma first, while others might do better starting with OCD treatment or working on both simultaneously. It is a decision to make collaboratively with your therapist based on your specific needs rather than a rigid protocol.
• Avoiding Unhelpful Approaches: Not every approach is right for every person and there are multiple ways to approach treatment. A therapist who specializes in both conditions will know when to use which approaches. It’s also important for you to give your therapist feedback on the work you’re doing together so that adjustments can be made if needed. 

Finding the Right Support

If you’re struggling with OCD and trauma, finding the right therapist can feel overwhelming. Here are some practical tips: 

1. Seek Specialists: Look for a therapist who specifically mentions experience treating both OCD and trauma/PTSD. Not every therapist has the specialized training needed for this dynamic.
2. Ask Questions: When you contact potential therapists, ask about their experience with comorbid OCD and trauma, what treatment approaches they use, and how they approach working with co-occurring disorders. 
3. Be Patient With The Process: Finding the right therapist is sometimes like finding the perfect shoe. You might have to try on a few before you find “the one”. It’s perfectly OK to connect with a few therapists before deciding who to work with. The therapeutic relationship plays a powerful role in the treatment process. 

Moving Forward with Hope

Living with both OCD and trauma is genuinely challenging. Your compulsions might feel like the only thing keeping you safe or in control. Treatment can feel scary, especially if past attempts haven't been helpful or the idea of facing your fears feels overwhelming.

But here's the truth: recovery is possible and there is help. Research supports that addressing both conditions using evidence-based approaches results in people experiencing significant improvement in their symptoms and quality of life. You don't have to live with the intensity of symptoms you're experiencing forever. While it won’t be quick or easy, treatment is worth pursuing and can set you on the path to recovery. 

If you're struggling with OCD and trauma, you’re not alone and help is available. At StopOCD, we understand the complexities of dealing with OCD and co-occurring disorders. Here you’ll find resources and tools, information and support. We also have a team of compassionate, experienced therapists who can help you find healthy strategies to manage your symptoms effectively. And online therapy means you can see your therapist when it is most convenient and comfortable for you. You don't have to figure this out alone, and you can have a life that's no longer dominated by unwanted thoughts and behaviors. That life is waiting for you.

References

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