Trauma and OCD

What's the relationship between the two?

Posted Jul 08, 2020

Sean Shinnock / Used with permission
Source: Sean Shinnock / Used with permission

I believe that given the perfect combination of circumstances, trauma can indeed turn into full-blown OCD. However, since OCD is a neurobiological disorder, I feel a person has to have a genetic predisposition in order to be triggered. In other words, a person who does not have a predisposition toward OCD can survive a trauma and not be at risk of developing OCD. 

Years ago, I had a client who lived through a devastating trauma in her early 20's. When I began treating her for OCD, she was in her early 30's. After her trauma, she began a series of checking rituals. She had a nighttime routine that involved checking again and again all the locks and windows in her home.

She also would check her security cameras and alarm sometimes every 15 times to make sure everything was on. She would walk into her son's room 20 times to check and re-check his windows. She needed to say prayers with him in a very specific way and if it went wrong, it was re-done until it felt right. This highly compulsive routine would sometimes go on for three hours!

I believe this particular client was always predisposed to OCD. Her mother had a diagnosis as well as her uncle. The trauma was enough of a stressful environmental trigger to push her into performing compulsions. Starting to perform compulsive behaviors strengthened her obsession that the trauma she experienced could happen to her son (her obsessive fear). She then became trapped in a horrific OCD cycle that tricked her into thinking that she needed her compulsions or else her worst fears would happen and her son would be hurt or killed. 

All of the clients I have worked with who have a diagnosis of both PTSD and OCD report feeling as if the compulsions give them some sort of control over preventing traumatic events from happening to them again. Although they realize that this way of thinking is not logically correct, it still feels like there is a chance it could be true. 

That being said, I have had some clients whose obsessions are not directly related to the trauma they experienced but a totally different fear.

For example, I once treated a man in his late 30's who witnessed his brother being fatally shot in front of him. His OCD was not related to guns, but he was obsessed with battery acid. His entire mission in life was to prevent coming in contact with battery acid, to the point that he could not function anymore.

Even though battery acid and getting shot are two separate concepts, I believe that the compulsions he would carry out to avoid battery acid were really about preventing anyone in his family from getting hurt or dying. His compulsions were trying to stop him from ever having to experience that horrific helpless feeling that he felt when his brother died. On a deeper level, the compulsions became an attempt at saving his brother, and every compulsion he did he was trying to not let his brother die. 

Treatment can be tricky when dealing with OCD sufferers who have experienced trauma, because therapy puts them in a vulnerable position to have to deal with feelings of discomfort, contamination, fear, and helplessness, and asks them to do nothing to stop those feelings. Many times, this can bring them back to the original trauma. In these cases, I give clients strategies to deal with the trauma in a way that does not involve compulsions. 

In fact, it is a great idea to try to prevent trauma victims from getting into the habit of using compulsions in the first place. Purely hypothetically speaking, perhaps there is a chance of preventing OCD from even starting after a person experiences a strong environmental trigger. (See my post, "Can Coronavirus Health Behaviors Trigger OCD?")

It is very important to seek immediate psychological help if you or a loved one has experienced a significant and stressful life event and you begin doing a series of rituals or compulsive behaviors. If you notice that you can not stop performing the compulsions on your own please reach out to a qualified professional for help.