There’s no doubt about it: trauma and maltreatment of children impact OCD in both children and adults. Surely, trauma must be causal to OCD? Not so fast.

Trauma not Causal to OCD (So Far As We Know)

Trauma is not a definitive cause of OCD (Dykshoorn, 2014). However, it has some strong associations. If you don’t read any further than this, know:

• It’s crucial to assess for trauma in the clinical treatment of OCD (or any reputable psychiatric assessment).

• Trauma’s impact has significant implications for the course OCD takes. Good treatment keeps all relevant factors in mind, including not overemphasizing trauma or stress when not the most helpful to support recovery.
  

• There is hope.

Why I Start With That….

I am very quick to educate that trauma is not thought to be causal to OCD because of the many misconceptions and misdirections that are pursued with this line of thinking. A long sentence history on this: much of psychology is still heavily influenced by Freudian ideals that deeper, under-the-surface issues must be brought out for healing; much of the therapy establishment today is trauma-centric. I have seen substantially more cases where someone didn’t get the correct treatment because of a protracted “witch hunt” for trauma in their past than I have seen instances where trauma was minimized. I have rarely encountered cases where clinicians minimized clients’ trauma but often saw the opposite: hunting for trauma and deeper meaning when it was most helpful to shift into other work and recovery (especially with OCD and Anxiety Disorders).

I wish to make no errors with clients in either camp. I start with the education that trauma is not known to be causal, so we can get on a helpful page immediately and direct our attention to what usually helps the most people quickly. With OCD, the severity of symptoms of both OCD and other disorders, including trauma, must be considered. However, often Exposure with Response Prevention (ERP) still needs to be utilized first, or at least simultaneously with trauma work.  (For those of you who may follow teachers who emphasize all life suffering has trauma at its root, to you, I challenge that then the word ‘trauma’ has no clinical meaning and needs to be relegated to the camp of general human suffering.)

Trauma and childhood maltreatment (CM) is quite a heavy topic. The positive news is that trauma is treatable. Additionally, while unfortunately common—familiar enough to affect many people you know—we can take this to heart: people are resilient. The person near you who has gone through horrendous trauma may be functioning quite well.

Trauma can complicate treatment and have specific implications about directions to take.

“Thus, the clinician has the opportunity to treat both significant concerns simultaneously or consecutively (de Silva & Marks, 1999) depending on his/her clinical judgement regarding the most pervasive mechanism in the client’s dysfunction. By neglecting the treatment of the trauma-related difficulties, the client will likely be resistant to OCD treatment and/or simply replace OCD symptomatology with other maladaptive coping techniques to manage the distress caused by the traumatic recall. By gaining a better understanding of the physical, psychological, and emotional distress the individual experienced as a result of the trauma, the clinician may gain insight into the obsessions and compulsions of the client with OCD and thus be better equipped to direct the treatment to maximize efficacy and enhance the client’s quality of life.” (Dykshoorn, 2014).

Research

Here are some important tidbits of research to consider:

• Child maltreatment predicts higher OCD symptom severity (Boger et al., 2020).
• Decreased self-esteem and increased depression result from childhood abuse in cases of those who have OCD (Raya et al., 2024).
• Childhood Maltreatment (CM) is associated with more depressive symptoms and severe obsessive-compulsive symptoms (Ou et al., 2021).
• The risk of developing OCD increases significantly with sexual abuse, though it’s not causal. More severe OCD symptoms show up with trauma in childhood.
• There is yet to be a link to trauma as a cause of OCD, though stress is a known precipitator of OCD. Not to be dismissive, trauma is linked with most mental disorders (Hovens et al., 2009). Relapse is also connected to stress (de Silva & Marks, 1999).
• Religious OCD does have a link to childhood sexual abuse (CSA), and sexual abuse is also associated with CSA (Bhattacharya, 2022).
• Treatment-resistant OCD has a solid link to trauma (Gershuny et al., 2008).

Conclusion

The impacts of trauma and maltreatment of children are no small matter, and these have severe implications for OCD and its treatment. Taking it seriously also means rigorous adherence to best practices. Prioritization of treatment factors and direction must come from competent care.