The Ball of Yarn: Disentangling Intersections Between Trauma and Obsessive-Compulsive Disorder

Background Individuals with obsessive-compulsive disorder (OCD) experience trauma at high rates; however, it is not clear how often these experiences impact OCD etiology, form, or function (ie, dynamic or related presentation). A growing literature supports a range of potential OCD-trauma intersections (eg, trauma-related compulsions), yet no empirical study has characterized these. Methods The present study used data from 2508 adults with self-reported OCD enrolled in The National OCD Survey ( M age = 33.6, SD = 11.9) to evaluate the weighted prevalence of dynamic OCD-trauma presentations and their associations with OCD severity. Results In total, 76.9% of the sample endorsed a dynamic presentation, including 52.6% who reported trauma-related compulsions. OCD severity was higher for those with a dynamic (versus static or unrelated) presentation, particularly for those endorsing trauma-related OCD onset, exacerbation of existing OCD symptoms, compulsions, and punishment beliefs. Physical assault, sexual assault, and sudden accidental death perceived as related to OCD were also associated with more severe OCD symptoms. Conclusions Findings suggest that dynamic OCD-trauma intersections are common in broad OCD samples and are associated with worsened OCD severity. Clinicians should assess not only trauma history but OCD-relatedness and align their case conceptualization and treatment approach to account for these impacts.