Trauma and OCD

Seventy percent of adults in the United States have experienced trauma. Trauma occurs when a person is overwhelmed by events or circumstances. When trauma occurs, feelings like intense fear, helplessness and terror might arise. Extreme stress can overwhelm a person’s capacity to cope.

We can all acknowledge that trauma occurs during wartimes and natural disasters. However, trauma can also occur through experiences like: facing a devastating break-up; being bullied in school, childhood emotional abuse, and racism and social injustice. In the trauma world, we talk about this as “little t trauma.” These are experiences that create a trauma-like response, but don’t meet the criteria for trauma in the Diagnostic and Statistical Manual.

Trauma occurs when any event or situation overwhelms our ability to cope and we can no longer ensure safety in mind and body.

Only about 20% of adults who’ve experienced trauma meet the Diagnostic Statistical Manual (DSM-5) criteria for Post Traumatic Stress Disorder (PTSD). The impact of trauma on people’s psyche and cognitive processes is profound. Trauma creates the inner environment by which physical and mental illnesses can develop because trauma overwhelms our inner systems and forces them to compensate for the lack of safety. If we are being emotionally abused in childhood, we learn to stay quiet, avoiding drawing too much attention to ourselves, in hopes of making our environment safer and more tolerable.

After the Vietnam War, many Americans became familiar with "shell shock" or as it later became known, PTSD. Forty years later, people seem to understand and even expect that someone might develop PTSD after a traumatic event. However, PTSD is only one potential outcome of trauma exposure. Another equally devastating outcome that isn't as widely known, is the development of Obsessive Compulsive Disorder (OCD).

Obsessive Compulsive Disorder is an anxiety disorder in which people experience recurrent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions). “If you step on a crack , you break your mother’s back” (obsession), so you avoid the sidewalk cracks (compulsion) or you snap your fingers 3 times (compulsion) to “undo” or eliminate the consequence of accidently stepping on a crack . Compulsions “work” to soothe the anxiety associated with the obsessions.

If you’re someone who’s experienced trauma, it’s likely you’ve experienced a lack of control over your environment, body, and mind. You might have lacked the resources to keep yourself safe by no fault of your own. Obsessions and compulsions create a feeling of having more control over your environment. OCD can serve as a helpful barrier between you and the feelings of unsafety and aloneness associated with the aftermath of traumatic experiences. The OCD may feel like an unwelcome guest, but it serves a valuable purpose in creating a greater sense of safety and predictability in your world because it puts you in “control” of managing all the scary things in life by performing certain behaviors (compulsions).

Examples

It’s important to get to know how OCD shows up in your life. Because we’re all complex beings with varying life experiences, obsessions and compulsions differ in presentation from person to person. There is no one size fits all experience of obsessive compulsive disorder, and some subtypes of OCD are harder to identify than others. In the following examples we will explore two iterations of obsessive compulsive disorder and how symptoms can relate to traumatic experience.

Contamination OCD

Obsessions and compulsions centered around germs, contamination and illness is a common subtype that’s often stereotyped in TVs and movies. Contamination OCD includes people afraid of contracting illness, spreading disease or feeling as though they’re in an unsafe, germ-filled environment.

Obsessions

This place is filled with contagions. I can feel it!
I’m infected, and I’ve just given my friends and family the sickness.
My hands are carrying the virus, I know it.

Compulsions

Repeatedly cleaning rooms in the home.
Avoiding friends and family.
Washing hands excessively.

Due to Covid-19, most of us have been concerned about disease transmission, which makes this a little tricky. Folks who suffer from contamination OCD are having an especially hard time during the global pandemic, because it’s impossible to be 100% sure if you are carrying the virus. The uncertainty around who has the virus might increase fears around transmission and drive up compulsive behavior for folks with and without an OCD diagnosis.

However, if it’s possible to visualize pre-pandemic times, we can see that in most cases there was minimal risk of being in a place filled with contagions that were deadly enough to seriously harm anyone. If someone becomes obsessed with the idea that they’re carrying something that can harm others, their actions (compulsions) can result in alienation, excessive cleaning and harm to hands and skin from repeated washing.

We live in a world that’s unpredictable. When trauma occurs, it’s common for people to experience “the turning upside down” of their individual world. Contamination OCD can be a way to create predictability in an unstable world. If you can guarantee the safety of your friends and family by keeping your distance from them, there’s comfort that can be derived from that. If you can guarantee personal safety by washing your hands, you’ve found a way to regain some control over your environment, including your physical body.

Relationship OCD

Obsessions and compulsions revolving around intimate relationships. People with Relationship OCD have trouble tolerating the uncertainty of romantic relationships; the feelings their partner has for them; their partner’s commitments to them; their partner’s past; and whether or not their relationship is “right.” This type of OCD can be more subtle and less easy to identify because many of the compulsions are completed inwardly and are not as easily measured.

Obsessions

Is this the right person for me?
How do I compare to my partner’s ex?
What if my partner leaves me? What if they don’t, and we’re stuck together even though they don’t want to be with me?

Compulsions

Reviewing/remembering recent interactions with your significant other, trying to find evidence that “things are okay.” Or, trying to find a moment that proves the relationship is not okay, or that the person isn’t right for you. This form of Mental Checking, is an attempt at finding relief through an attempt at gaining certainty. However, mental checking rarely provides relief and more often, it just keeps you stuck in your mind.
Looking at your partner’s pictures on social media. “Facebook stalking” their exes.
Excessively asking for reassurance from your partner. Excessively checking in about the relationship.

Relationship OCD may result in compulsions that are difficult to see. If you’re suffering from Relationship OCD, you may be “mentally checking” for imperfect moments within the relationship as a way to relieve the fear/uncertainty associated with the obsession, “Is this person right for me” or, “Is this relationship okay?” If you can review every moment you spent with your partner last week, then maybe you can find the reassurance you’re hoping for. Or, you can correct “the imperfect moments” by curbing your behavior in the present. Relationship OCD is a powerful force that’s often overlooked or categorized as general relationship insecurity.

If you’ve experienced trauma in relationships, it may be hard to trust others. Intimacy can be difficult; loving someone else is a vulnerable act. If you’ve experienced abuse in a relationship, traumatic infidelity or have a fear of abandonment, it makes sense to implement a system in which you can attempt to gain control and certainty that you won’t be hurt again in the same way. Trauma in relationships can lead us away from a sense of self-trust, especially if the trauma was sustained over a long period of time. Relationship OCD can serve as a strategy to keep us safe and protected in the vulnerable world of relationships.

Conclusion

Contamination and Relational OCD are only two of the numerous subtypes of OCD (Harm OCD, Symmetry OCD, Pure Obsession OCD) that can impact our lives or exacerbate our traumas.Viewing Obsessive Compulsive Disorder as a protective, adaptive force can help you to develop self-compassion and self-acceptance. No matter the biological predisposition, most experiences we are having in the present have a purpose and are serving us in some way. OCD is often a frustrating experience, and understanding the connection it has to past traumatic experience is no easy task. However, the right therapist can help you to start unpacking this complex dynamic so that you can gain more genuine control over your life.

You can self schedule an in-person or virtual therapy session at the Center for Growth by calling (215) 922- LOVE (5683) x 100.

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