Trauma-related obsessive–compulsive disorder: a review

Obsessive-compulsive disorder (OCD) is a highly researched and conceptualized disorder, and yet it remains one of the most debilitating, widespread, and expensive disorders one can be afflicted with [Real, E., Labad, J., Alonso, P., Segalas, C., Jimenez-Murcia, S., Bueno, B., … Menchon, J. M. (2011). Stressful life events at onset of obsessive-compulsive disorder are associated with a distinct clinical pattern. Depression and Anxiety, 28, 367-376. doi:10.1002/da.20792]. Exposure treatments and cognitive-behavioural therapy (CBT) have been largely accepted as best practice for those with OCD, and yet there are still many who are left with "treatment-resistant OCD" [Rowa, K., Antony, M., & Swinson, R. (2007). Exposure and response prevention. In C. Purdon, M. Antony, & L. J. Summerfeldt (Eds.), Psychological treatment of obsessive-compulsive disorder: Fundamentals and beyond (pp. 79-109). Washington, DC: American Psychological Association; Foa, E. B. (2010). Cognitive behavioural therapy of obsessive-compulsive disorder. Dialogues of Clinical Neuroscience, 12, 199-207]. Similarly, exposure treatments and CBT have been accepted as best practice for trauma-related distress (i.e. post-traumatic stress disorder; Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2009). Effective treatments for PTSD: Practice guidelines from the international society for traumatic studies (2nd ed.). New York, NY: The Guilford Press). From a literature review, evidence has been provided that demonstrates a high prevalence rate (30-82%) of OCD among individuals with a traumatic history in comparison to the prevalence rate of the general population (1.1-1.8%; [Cromer, K. R., Schmidt, N. B., & Murphy, D. L. (2006). An investigation of traumatic life events and obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 1683-1691. doi:10.1016/j.brat.2006.08.018; Fontenelle, L. F., Cocchi, L., Harrison, B. J., Shavitt, R. G., do Rosario, M. C., Ferrao, Y. A., … Torres, A. R. (2012). Towards a post-traumatic subtype of obsessive-compulsive disorder. Journal of Anxiety Disorders, 26, 377-383. doi:10.1016/j.janxdis.2011.12.001; Gershuny, B. S., Baer, L., Parker, H., Gentes, E. L., Infield, A. L., & Jenike, M. A. (2008). Trauma and posttraumatic stress disorder in treatment-resistant obsessive-compulsive disorder. Depression and Anxiety, 25, 69-71. doi:10.1002/da.20284]). Evidence was collected for a post-traumatic OCD and treatments of trauma-related OCD were considered. OCD and traumatic histories have a significant enough overlap that trauma should be a consideration when treating an individual with OCD. Given the overlap of the client base with OCD and traumatic histories, as well as the overlap in treatment options for those who experience OCD and trauma-induced symptoms, the author will discuss the importance of assessing for traumatic history in clients with OCD as well as approaching treatment from a dual-focus orientation.