Content Note: abuse, trauma, OCD

Obsessive-compulsive disorder, abbreviated to OCD, is an anxiety disorder characterised by intrusive thoughts that lead to compulsions to ameliorate the associated pain, fear, and distress. Though there is a gap of assessment and a lack of studies on the neurodevelopmental indications of the onset of OCD, there is some evidence that experiencing traumatic events throughout one’s formative years can be causative in developing OCD. Recent findings suggest that OCD and PTSD are on the same continuum, as the symptoms of both disorders have major overlap. Of course, one must consider both environmental and genetic factors when analysing any person’s psychology and mental state, and therefore, any correlation discussed is relatively speculative.

Trauma, as defined by the Cambridge Dictionary, is a ‘severe and lasting shock and pain caused by an extremely upsetting experience’. However, it resides on a spectrum of experience and severity: in severe cases of PTSD, it may be a response to death, the threat of death, severe injury, violence, or abuse, but when adopting a more liberal definition, it can include conflict, bullying, illness, divorce, or exposure to prolonged maltreatment, among others. Psychological perturbation of trauma victims often manifests as flashbacks, panic, hypervigilance, or nightmares, which are all a form of intrusive thoughts (which are also fundamentally symptomatic of OCD - the intrusive thoughts of someone suffering from OCD result in an obsession, the compulsion an act of alleviating the distress of that intrusive thought pattern).

“Recent findings suggest that OCD and PTSD are on the same continuum”

Furthermore, the compulsions of OCD may act as a semblance of reinstating control in one’s life, a way of coping and ameliorating memories and symptoms related to the trauma experienced. In “contamination OCD” (perhaps the most known type) one may have intrusive thoughts of disgust and contamination which may lead to compulsive cleaning and washing. In “moral scrupulosity OCD”, one’s thoughts may be plagued by constant concern over absolute honesty, correct moral action and obsessive examination of their past actions, which may also result in excessive checking of hobs, door-locks, and other potential hazards, excessive cleaning, or attempting to minimise harm. Similarly, if a trauma victim has experienced sexual abuse or violence, they may often blame themselves. They may feel contaminated and impure, thus resulting in “excessive” cleaning of themselves or their environment. The rituals may act as a form of “correcting” the trauma and pre-empting/creating avoidance of the potentiality of the trauma occurring again, whether conscious or unconscious.

Additionally, trauma occurring throughout childhood or one’s formative years is recognised as causative for the development of several psychological disorders. The childhood and adolescent years are when human beings should receive unconditional support, care, love, and guidance. If a child does not experience this, they may feel responsible for something inherently ‘wrong’ with them to have circumstances deviating from that expectation, which applies to other forms of trauma, such as bullying. Bullying is an intensely distressing and formative experience in which a group of people isolate one individual to verbally and/or physically harass them. Understandably, the sufferer may blame themselves as they may see themselves as the ‘reason’ or ‘factor’ as to why the bully chose to target them. In both examples, self-blame and taking of ‘responsibility’ can lead to compulsions to ameliorate the distress of the flashbacks and concern for events reoccurring. If someone can take responsibility for what has happened to them, one may feel as though they have regained control and ‘righted the wrong’ of the trauma that has occurred for them and prevents future occurrence.

“The compulsions of OCD may act as a semblance of reinstating control in one’s life”

As mentioned, with any disorder or psychological state of being characterised as divergent from the norm, one must acknowledge both environmental factors as well as genetic predisposition and comorbidities (in the example of OCD, it may be generalised anxiety, depression, eating disorders, or indeed PTSD). With all disorders, there are shared symptoms with another disorder and the spectrum of severity may vary. Despite the lack of sufficient evidence to make a strong conclusion on the correlation between OCD and experiencing trauma, it is certainly an understandable connection and should be considered in the future as a potential factor when approaching treatment-resistant OCD