OCD and Trauma
Folks with OCD occasionally develop an intense fear of experiencing severe OCD again. Often this is due to an intersection of trauma and OCD. However, there are a few different ways that trauma and OCD can interact. The differences between each scenario are important to assess because they indicate different treatment paths to help the client. There are three main ways I have identified that trauma and OCD can interact.
Situation A: OCD about OCD (Meta-OCD).
Some folks develop an OCD theme about a fear of experiencing severe OCD again, a theme I call meta-OCD. People with this theme may obsess about the intensity, duration, content, and/or frequency of their intrusive thoughts as well as the extent to which they are following treatment correctly. They may find themselves frequently asking themselves, clinicians, or the internet:
Am I doing therapy right? How do I know if I’m doing therapy right?
What’s the difference between an intrusive thought and a compulsion?
Is my OCD getting worse?
Am I developing a new OCD theme, or is an old theme coming back?
Can you explain [insert therapeutic concept] again? I need to be sure I understand it perfectly.
Meta-OCD can be treated like any other variation of OCD. Exposure and response prevention along with ACT skills are applied to the fear of experiencing severe OCD again. The client learns to tolerate the urge to seek answers to their obsessive questions and to instead sit with uncertainty. As with other OCD themes, when a client learns to sit with uncertainty, the intensity of the theme will often die down and they will gain a sense of clarity and increased calm.
Situation B: Trauma reactions to OCD.
The loss of control and helplessness that one experiences with OCD can have a strong impact on an individual. Although this may not meet criteria for Post-traumatic Stress Disorder (PTSD), which according to the DSM must be in reaction to “actual or threatened death, serious injury, or sexual violation”, the loss of control and helplessness that one experiences with severe OCD can produce a similar experience. In these cases, clients may benefit from processing their experience with OCD. Understanding what about the OCD was so impactful and challenging, identifying the conclusions that one has made in response to their experience (e.g; OCD can get so bad that I lose all agency, I am sometimes unable to do anything to make my experience of OCD easier) and helping the client challenge those conclusions can help relieve the impact of that experience.
Situation C: PTSD and OCD.
In some situations, clients may meet clinical criteria for both OCD and PTSD. These are cases where the client both meets full criteria for OCD and has undergone an experience that generated clinical criteria for PTSD, such as a near-death experience or sexual assault. In these cases, OCD and PTSD are often tied to similar themes. In general, the PTSD should be treated first. Otherwise, a client can have PTSD reactions to OCD exposures. The full treatment of PTSD is beyond the scope of this article, but it is important to note that there are many similarities between treatments for the two disorders, so after treating one, a client will have skills that can be applied to the other.