The Correlation between OCD and Trauma.
Author: Ruth Córdova. AIT Teacher and Supervisor.
The Correlation between OCD and Trauma
Obsessive Compulsive Disorder (OCD) is an anxiety disorder that is affecting 1.2% of the population of the United States every year. 2.3% of the population will have it during their life span (Wadsworth et al., 2021). In the present day, the most prevalent therapy for OCD is Cognitive Behavioral Therapy (CBT), which helps around 1 in 3 people with their symptoms, and some of them do not retain their positive outcome long term (Van der Kolk, 2014). CBT does not consider traumatic causes of the problem, but rather focuses on the symptoms and client´s responses, by repeatedly exposing the person to the feared obsessions, objects, or situations (Brewer, 2022). It also has a deficiency in working with feelings of depression and guilt that many times accompany anxiety disorders (Hartung & Galvin, 2003) (Van der Kolk, 2014).
According to Badour et al. (2012), the occurrence of OCD is significantly higher than the numbers given above for people with Post Traumatic Stress Disorder (PTSD). Finding a correlation between trauma exposure and OCD, would mean that the treatment needs to consider the existence of traumatic experiences in the client´s life, and redirect the focus to trauma work.
What is OCD?
OCD is no longer considered an anxiety disorder in the DSM V (American Psychiatric Association, 2013), that now focuses more on its neurological causes. It now supports the theory that a malfunction in the prefrontal striatal cortex explains the disorder (Kohrman-Glaser, 2014). It has two primary elements that characterize it: 1) Obsessions, which means having intrusive and repeated thoughts that are repugnant to the person having them (BBC Worldwide Learning, 2015) (APA, 2013). 2) Compulsions, which refer to conducts the individual has as an effort to control or eliminate the obsessions, or to avoid something terrible from occurring (BBC Worldwide Learning, 2015) (APA, 2013). Both symptoms are continuous and unmanageable for the person who have them. Individuals with OCD are persecuted by obsessions and compulsions and are not able to stop when they want.
Amongst the most widely accepted causes for OCD is the biological, meaning that the body can change its chemistry and brain functions at any given time. Another possibility would be genetic, with the acknowledgement that genes have not been identified yet. The last commonly recognized cause is learning, which indicates that obsessions and compulsions can be learned over time from watching others (Mayo Clinic, 2012).
Can OCD be caused by trauma?
In 2017, a study led by Ojserkis et al., found that clients with a long-lasting diagnosis of PTSD, had more acute and harming obsessions and compulsions. But what comes first? Is PTSD causing OCD, or is OCD exacerbating a PTSD diagnosis? An investigation with veterans found that 59% started with symptoms of OCD after a traumatic experience (Wadsworth et al., 2021). In that same study, almost 40% of the OCD cases developed after the onset of PTSD, the time frame was a year or more. In 2008, Gershuny et al., discovered that 82% of clients with OCD that were labeled as resistant to treatment, were trauma survivors.
In cases like this, OCD seems to have a function. The obsessions and compulsions help the client avoid traumatic memories and emotions and deliver a sense of control (Wadsworth et al., 2021). The treatment of those symptoms only, without trauma treatment, would then result in an increase in PTSD symptoms (Van Kirk et al., 2018). Moreover, some authors suggest that OCD symptoms have traumatic causes, and the obsessions and compulsions tell information about the trauma that occurred, and that may be where they originated (Rachman et al., 2012) (Clinton, 2015). An explicit example of this can be an obsession around being dirty and a compulsion that involves cleaning, disinfecting, not being able to touch things for fear of contamination, in a person who was sexually abused and “contaminated” by their perpetrator. A study conducted by Murayama et al. (2020), showed that clients with stressful life events showed more obsessions with contamination and fear, while clients who had gone through a traumatic event had more obsessions about hoarding. The participants who reported stressful life events, described having significant distress and viewing those events as traumatic. In a sample of 172 OCD patients, more than 60% had a stressful life experience, and about 57% survived a traumatic event before that beginning of the symptomatology.
Until now, the most prevalent treatment for OCD has been CBT, often combined with medication (Carr, 2019). With the DSM V cataloguing this disorder as caused by a neurological dysfunction, more and more professionals are transitioning to medication only, as the first option for treatment (Mayo Clinic, 2021). As a way to improve the results, CBT has incorporated mindfulness practices to its treatment that have proven to be effective with a variety of clients (Van der Kolk, 2014) (Brewer, 2022). However, if trauma is considered as a possible cause for OCD, trauma should be treated as part of the process to reduce or eliminate obsessions and compulsions. Two very effective trauma based methodologies that can be used to treat OCD are Eye Movement Desensitization and Reprocessing (EMDR) and Advanced Integrative Therapy (AIT).
EMDR uses the technique of bilateral movement to desensitize and reprocess trauma by engaging both cerebral hemispheres (Allon, 2003). In this way people can resolve and integrate their traumatic memories. The proposed treatment for OCD suggests targeted treatment to empower patients to stabilize their emotions (Kennan et al. 2018). It looks to also treat traumatic emotions, physical sensations, and cognitions related with traumatic memories. The focus will be on the past traumatic events, the present symptoms, and difficulties, and finally the future (Kennan et al. 2018).
AIT is a therapy who´s main focus is treating trauma by using the energy system in the body to release traumatic emotions, physical sensations, negative cognitions, as well as instill and develop positive qualities and cognitions. It has meditations to support the result of the work or provide tools during the treatment. Asha Clinton (2015), developer of AIT, structured a treatment designed specifically for OCD. This therapy considered trauma treatment of course but includes the functions in the nervous systems that have been altered. It also works on the past, present and future, including all aspects of the person: the psychological, physical, and spiritual.
Many studies have proved the correlation between OCD and childhood trauma. The nature of the obsessions and compulsions have been identified as an unconscious attempt to avoid traumatic emotions and memories, and to regain a sense of control (Dabel, 2018) (Rachman et al., 2012). Many clients with OCD report having the conviction that if they don´t do the compulsion, something terrible will happen, or if they do it, their obsessions will not come true. Given all this new information and findings, it´s probably time to reconsider the treatment that is being offered to people suffering from this disorder and include trauma treatment and trauma informed settings into the equation.
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