According to the U.S. Department of Veteran Affairs (VA), an estimated 2.3% of people in the U.S. have a lifetime prevalence of obsessive-compulsive disorder (OCD). Although 2.3% may sound like a small percentage, that percentage represents millions of people in the U.S. alone. Further, as Frontiers in Psychiatry notes, despite being one of the ten most disabling conditions, only 30–40% of those with OCD seek treatment. Meanwhile, access to trauma-focused treatment can be a vital tool for addressing and treating OCD.
Yet, you may question what trauma-focused treatment has to do with OCD. Like many mental health disorders, OCD often co-occurs with other conditions and disorders. In particular, OCD shares a high co-occurrence with trauma. As the VA states, 10.6% of people develop OCD concurrently or after post-traumatic stress disorder (PTSD), whereas 4.1% of people develop OCD before meeting the criteria for PTSD. Due to the prevalence of co-occurring OCD and PTSD, trauma-focused treatment can support those with OCD.
At The Guest House, we know OCD is a chronic illness, and thus there is no cure-all treatment. We believe that effectively treating OCD and co-occurring trauma starts with trauma-focused treatment. Through a holistic trauma-focused treatment approach, we can address and treat the whole of your parts. Whether you face challenges with OCD and trauma or other co-occurring disorders like substance use disorder (SUD), trauma-focused treatment can help. We know focusing on one condition leaves little space for true healing. With trauma-focused treatment, you can heal in mind, body, and spirit to support symptom management and recovery.
However, you may question why OCD and trauma-related disorders like PTSD commonly co-occur. What do OCD and trauma-related conditions have in common? Trauma-related OCD can find many of its roots in the somatic nature of OCD and trauma. Thus, the somatic symptoms of OCD and trauma speak to their relationship with the nervous system. By increasing your awareness of the role your nervous system plays in OCD and trauma, you can better understand how to uncover and dismantle trauma-related OCD.
The Roots of OCD in the Nervous System
Despite the prevalence of OCD on its own and its co-occurrence with PTSD, many people have no treatment support. Several factors contribute to less than half of those with OCD receiving treatment. However, one of the many challenges in addressing OCD symptoms is a lack of awareness and knowledge of trauma-focused treatment. Few people in the public with and without OCD have a detailed or accurate understanding of OCD.
According to “Stigma and Recognition of Different Types of Symptoms in OCD” by Ryan J. McCarty et al. stigma and poor mental illness recognition are two major barriers to trauma-focused treatment for OCD. The public’s understanding of OCD, trauma, and other disorders like PTSD is broad and often limited to narrow media representations. Whether it is a well-meaning television character or a narrow focus on veterans, OCD and trauma are misunderstood. Many people perceive OCD as a combination of function-impairing obsessions and compulsions like obsessive cleaning.
However, symptoms can also include obsessive unwanted thoughts about sexual, aggressive, violent, and or religious taboos. It is often the taboo obsessive thoughts that can contribute to stigmatized feelings of shame. OCD stigma alone can lead to treatment avoidance. Thus, coupling stigma with poor mental health disorder recognition of your symptoms can decrease treatment seeking. Additionally, a lack of education on OCD and treatment options limits access to trauma-focused treatment options.
Although the public recognizes that OCD and trauma need treatment support, poor education adds another barrier to trauma-focused treatment. Meanwhile, due to barriers to accessing trauma-focused treatment, the public is more likely to perceive taboo obsessions as unacceptable and criminal. Therefore, understanding the roots of OCD is valuable to increasing mental health literacy and making trauma-focused treatment accessible.
The exact cause of OCD is unknown. However, many of OCD’s symptoms can be tied to genetics, brain biology, and environmental factors:
- Genetics and family history
- A first-degree relative (parent or sibling) has OCD
- Your risk for OCD is further increased if the relative with OCD developed the disorder as a child or teenager
- Biology
- Differences in brain structure and function
- Frontal cortex and subcortical structures
- Differences in areas that control behavior and emotional responses
- Several brain areas, brain networks, and biological processes impact symptoms
- Obsessive thoughts
- Compulsive behaviors
- Fear and anxiety
- Differences in brain structure and function
- Temperament
- Your behaviors are more reserved
- You are more likely to experience negative emotions
- Greater chance of depression and anxiety symptoms in childhood
- Childhood trauma
- Child abuse
- Physical, sexual, and emotional abuse
- Neglect
- Physical and emotional neglect
- Caregivers do not meet the child’s basic needs
- Physical and emotional neglect
- Abandonment
- Caregivers intentionally or unintentionally leave the child unsupervised for an extended period
- Child abuse
Looking at the biology-based risk factors for OCD in particular speaks to OCD’s relationship with trauma. Challenges with trauma are often rooted in stuck trauma. Traumatic experiences activate your flight-or-flight stress response as a survival mechanism to keep you safe. Typically, your stress response goes away when your body recognizes that you are no longer in danger. However, trauma can get stuck and leave you in a constant state of fight-or-flight.
When you are stuck in survival mode, your trauma manifests itself as physical symptoms through your nervous system. Yet, how does the nervous system relate to physical symptoms of trauma? How does the nervous system relate to the roots of OCD? The nervous system is made of two parts, the central nervous system (CNS) and the peripheral nervous system (PNS). Moreover, the CNS is also made of two parts, the brain and the spinal cord.
The brain and spinal cord are the processing centers for your entire nervous system. Thus, your CNS controls all your bodily functions, including your thoughts, memories, emotions, and behaviors. The PNS, on the other hand, is made up of the nerves outside of the brain and spinal cord. This part of the nervous system controls your ability to think, learn, and process memories. The level of control the nervous system exercises over you highlights a mind-body connection where trauma manifests as physical symptoms.
Similarly, the obsessive and compulsive symptoms of OCD are physical manifestations of impairment to parts of the nervous system. According to the Psychiatric Times, structural and functional changes within the brain are tied to OCD. The symptoms of OCD speak to impairment or difficulty managing thoughts and behaviors. Within the cortical and subcortical regions of the brain are a series of functional circuits that influence your thoughts and behaviors. Often in those with OCD areas of the cortical and subcortical regions have abnormalities.
More specifically, the orbitofrontal cortex and basal ganglia or the orbitofrontal circuit, which are in the cortical and subcortical regions respectively show impairment for OCD. The orbitofrontal circuit works together to enact complex behaviors like decision-making, reward processing, and emotional regulation. Additionally, OCD involves changes across a broad range of frontostriatal loop circuits which is a neural pathway that connects the frontal lobe to the basal ganglia. Through the frontostriatal loop, important cognitive, motor, and behavioral functions are engaged.
OCD shares a strong relationship with brain function through the nervous system. Therefore, building a treatment plan like trauma-focused treatment can be vital to addressing the brain changes that connect trauma and OCD. Furthermore, looking at the intersecting symptoms of trauma and OCD can further highlight the importance of brain structure and function in understanding and treating trauma-related OCD.
Intersecting Symptoms: Trauma and OCD
Learning to recognize OCD and trauma symptoms is an important step toward building a trauma-focused treatment plan to address your specific needs. As MedlinePlus notes, OCD is a mental health disorder characterized by uncontrollable recurring thoughts (obsessions) and repetitive behaviors or rituals (compulsions). It is important to clarify the distinction between typical obsessions, repetitive behaviors, and OCD symptoms. Many people experience distressing and repetitive thoughts like rumination without it disrupting their lives. Rumination itself is not always an indication of a mental health disorder.
The intrusive thoughts of rumination can also be triggered by short-term stress or anxiety, whereas distressing thoughts and behaviors in OCD are persistent and rigid in their compulsion. Meanwhile, the obsessions and compulsions of OCD are typically out of your control and significantly impair your ability to function in your daily life. Listed below are some of the common signs and symptoms of OCD obsessions and compulsions:
Obsessions
- Fear of germs or contamination from other people or the environment
- Excessive worry about harm to yourself or loved ones
- Fear of losing control over your behavior
- Aggressive thoughts toward yourself and others
- Fear of losing, discarding, or misplacing things
- The need for precise organization and symmetry
- Things need to be lined up exactly
- Items must be arranged in a particular way or an order
- Unwanted, taboo, and disturbing sexual thoughts and images
- Forbidden and taboo thoughts and fears about religion
Compulsions
- Engaging in excessive or ritualized cleaning, hand washing, showering, and or teeth brushing
- Excessive need to repeatedly check things
- Checking if the door is locked
- Double-checking if the oven/stove is on
- Flipping light switches on and off
- Checking if appliances are on
- A need to organize and arrange things in precise and particular ways
- Number based rituals
- Counting numbers
- Repeating numbers
- Excessive preference for certain numbers
- Avoidance of certain numbers
- Repeating certain words silently
- Constantly seeking reassurance and approval
- Avoidance behavior to alleviate distress and triggers for obsessions and compulsions
- You may avoid certain people, places, and situations
Similarly, to the obsessions and compulsions of OCD, trauma can include symptoms like:
- Changes in how you think: A shift in the way you think about yourself, others, and the world
- Your sense of safety in the world has been shattered
- You feel unable to trust in yourself or others
- Feeling on edge: An overstimulation of your fight-or-flight stress response
- Being stuck in fight-or-flight leads you to perceive things as a threat even when they are not
- Deregulation: Your emotional and behavioral responses are out of proportion with situations
- You may be overly irritable or angry in your interactions with others
- Avoidance behaviors: To feel safer, you avoid people, places, and things that remind you of the trauma
Trauma-related OCD can contribute to emotional deregulation, intense fear and worry, and avoidance. The symptoms of OCD and trauma alone are detrimental to your well-being. Together, trauma-related OCD can make it feel impossible to function in your daily life and relationships.
Regulating the Nervous System With Trauma-Focused Treatment
The thought of overcoming functional impairments to your nervous system can feel daunting. It can be difficult to imagine how you can manage and or heal impairments to the structure and function of your brain. There is no overnight fix or cure-all for any condition, whether it is a chronic disorder like OCD or not. However, with the support of trauma-focused treatment, you can engage in modalities that support regulating your nervous system. Mind-body regulation techniques like somatic experiencing (SE), eye movement desensitization and reprocessing (EMDR), and brainspotting can help you find connection and a sense of safety in yourself and with others.
Through bodily awareness, trauma-focused treatments like SE, EMDR, and brainspotting increase self-awareness and self-understanding of your experiences and symptoms. In trauma-related OCD, you often experience somatic obsessions that overwhelm every waking moment like traumatic responses alone. The somatic obsessions of trauma-related OCD force you to constantly pay attention to and get stuck on things like continuously breathing, swallowing, blinking, or your heartbeat. Hyperawareness of your bodily functions, coupled with the trauma-related fight-flight-freeze system makes trauma-focused treatments invaluable to symptom management and recovery.
Value of Trauma-Focused Treatment for Trauma and Trauma-Related OCD
Trauma-focused treatments like SE, EMDR, and brainspotting address the mind-body relationship between trauma, OCD, and physical symptoms. Listed below are some of the ways SE, EMDR, and brainspotting can help regulate your nervous system for recovery:
- Somatic experiencing (SE):
- Recognizes that trauma often manifests as stress in the body
- Focuses on the physical sensations in your body
- Engages bodily awareness by considering how you feel in your body
- Teaches you to regulate your stress responses
- Decreases physical symptoms from an overstimulated stress response
- Improves bodily awareness
- Guided imagery encourages you to focus on positive sensations, thoughts, and memories
- Supports relaxation
- Replaces negative thoughts, feelings, and sensations with positive ones
- Recognizes that trauma often manifests as stress in the body
- Eye movement desensitization and reprocessing (EMDR):
- Recognizes that the brain stores typical and traumatic memories differently
- Uses specific rapid eye movements, powered by the nervous system to reprogram traumatic memories with a new positive belief
- Using your eyes, you focus on a clinician’s finger, alternating hand taps, or sound while thinking or talking about a traumatic memory, trigger, or emotion
- Helps you to focus on the dysfunctionally stored memory
- Reduces and changes maladaptive emotions, thoughts, or behaviors
- Helps you to focus on the dysfunctionally stored memory
- Brainspotting:
- Recognizes that the brain and body work in tandem through the nervous system to function
- Utilizes eye movement to focus on a specific target using a visual point for activation
- Observe your bodily responses to describing traumatic experiences
- By observing a specific or resonating spot in your visual field, you can pinpoint trauma that manifests physically
- You build a connection between your physical sensations and emotions
- Increases self-awareness and self-understanding of your physical symptoms and somatic obsessions as trauma
- Helps you process and release trauma
Trauma-focused treatment through a holistic approach to care gives you a wide variety of treatment options. There is no one right way to heal or a one-size-fits-all treatment. Therefore, you deserve access to a holistic treatment that meets you where you are to address your specific experiences and needs.
Healing With Trauma-Focused Treatment at The Guest House
At The Guest House, we believe in providing a highly personalized treatment plan to address your specific recovery needs. We know OCD and trauma are typically rooted in various somatic symptoms that contribute to co-occurring challenges like SUD and PTSD. With a holistic and trauma-focused treatment plan, you can discover the tools you need to thrive in recovery. Therefore, we are committed to providing a wide range of therapeutic trauma-specific modalities like SE, EMDR, and brainspotting to regulate your nervous system recovery. Even when you face challenges with chronic conditions like OCD, you deserve access to treatment that supports leading a fulfilling life.
Therapies like SE, EMDR, and brainspotting recognize that the brain and body are interconnected with the nervous system. Thus, when trauma and OCD impair functioning, you can access modalities to build an individualized treatment plan that meets you where you are on your recovery journey. With access to a variety of accessible mind-body treatment options, trauma can no longer hold your body and mind hostage. You are not alone in addressing your challenges, we are here to provide a space where you have support and guidance on every step of your journey to long-term recovery.
OCD and trauma can impair functioning, impede relationships, and harm your physical and psychological well-being. When left unaddressed, trauma and OCD can overwhelm your nervous system and manifest as physical symptoms and somatic obsessions. The somatic nature of trauma-related OCD highlights the importance of the mind-body connection for treating OCD and trauma. Thus, trauma-focused treatment like SE, EMDR, and brainspotting can be invaluable to managing symptoms and fostering recovery. Looking at trauma-related OCD as a mind-body challenge supports regulating the nervous system to heal as a whole person. Therefore, at The Guest House, we are committed to providing a wide range of holistic trauma-specific approaches to care to address your specific needs. Call us at (855) 483-7800 to learn more.