User:Nicolereneestephenson/sandbox

Environment Section

Childhood trauma also referred to as adverse childhood experiences, are trauma occurrences that happen between the ages of 0-17. The most researched adverse childhood experiences are physical, sexual, and emotional abuse against a child, child neglect, a child being raised around substance abuse, serious mental illness, intimate partner violence, loss or abandonment of a parent, and incarceration of a caregiver. The neurobiological impact of trauma has been shown to increase an individual’s risk of adverse psychological effects. Specifically, exposure to a traumatic experience can create enduring effects on multiple areas in the brain, including the prefrontal cortex, hippocampus, and amygdala. The amygdala’s main function is to process fear and possible threats in the environment. Trauma can alter the functioning of the amygdala by increasing its activation and causing a sense of hyper-vigilance. In turn, the amygdala influences the basal ganglia, which is responsible for both behavior and emotional functioning, through low-frequency connections. Basal ganglia dysfunction is commonly associated with OCD. To reiterate, trauma can have long-lasting effects on the amygdala, the amygdala can impact the basal ganglia which is the area of the brain most commonly associated with OCD. Research has produced valid evidence of an association between childhood trauma and OCD.

Additionally, the development of obsessive-compulsive symptoms (OCS) has been related to an individual’s attempt to mitigate symptoms of post-traumatic stress disorder (PTSD) as a result of a traumatic experience. For example, a study examined the relationship between emotional and psychological distress during and immediately after a traumatic experience with post-traumatic symptoms, and OCS. Results indicated that person’s who endure interpersonal victimization, such as sexual or physical assault, frequently reported feelings of disgust and fear. These sensations of fear and disgust were then presented as contamination-based OCS which included frequent washing, and obsessions surrounding cleanliness. To simplify, the feeling of disgust that individuals felt after a traumatic event presented as contamination-based OCS as their method to protect themselves from the feeling of disgust.

Further evidence of the relationship between trauma experienced in an individual's environment and OCD has recently been researched. A 2021 study examined undergraduate students with high levels of OCS and found that indirect exposure to traumatic events, such as hearing of a traumatic event in the media or from a loved one, were significantly associated with just right OCS. Furthermore, this study found that over 94 percent of the participants surveyed with increased levels of OCS had experienced either a direct or indirect traumatic event. Although more research is needed to better understand the dynamic between a traumatic environment and OCD there does appear to be a direct overlap between traumatic occurrences and some individuals’ onset of OCD evidenced in the research.

Differential Diagnosis Section

Another diagnosis with symptoms congruent to OCD is post-traumatic stress disorder (PTSD). While approximately 1.5 percent of the world’s population experiences OCD and roughly 3.5 percent of the world’s population will experience PTSD, the prevalence of OCD developing in individuals who are diagnosed with PTSD is 30 percent. Additional evidence of the comorbidity between PTSD and OCD was highlighted in a study of veterans with combat exposure which found approximately 59 percent of the veteran participants who were exposed to a traumatic experience developed OCS. Even further research on the comorbidity between individuals who develop PTSD and OCD found that 54 percent of individuals, in the study, diagnosed with OCD experienced a traumatic event.

To better understand the relationship between a diagnosis of OCD and other trauma-related disorders it is imperative to look at their shared symptoms. OCD and PTSD share two common themes; intrusive thoughts and behaviors focused on reducing or avoiding distress. Although the words chosen to describe intrusive thoughts are different for the two disorders listed in the DSM-V, with intrusive thoughts called “flashbacks” or “repetitive thoughts” in the PTSD criteria and “obsessions” in the OCD criteria they are both unwanted processes of thought often cause an individual to engage in behaviors aimed to mitigate the distress caused by the intrusive thoughts. . Actions taken by individuals with PTSD to reduce the distress caused by the intrusive thoughts often appear as avoiding places, people, or behaviors such as not driving, checking the door is locked, or not smelling a certain scent that could trigger an intrusive thought. Whereas, individuals with OCD might engage in actions such as cleaning, checking, or avoiding people for fear of harming them as a means to evade experiencing the intrusive, obsessive, thoughts.

Due to the unique relationship and crossover between PTSD and  OCD symptoms and the high correlation between experiencing a traumatic event and developing OCS, some psychologists have discussed the possibility of creating a post-traumatic subtype of OCD. Research in the area of a post-traumatic subtype of OCD has sought to better understand what factors could be more closely linked to developing OCD, with findings suggesting that experiencing a traumatic event was a better predictor of developing OCD than genetic markers. Further thought on treatment methods of individuals experiencing OCD and PTSD has also been discussed in the academic literature since historically exposure therapy has been used with individuals experiencing OCD and cognitive behavioral therapy, and others, used with those diagnosed with PTSD. With a framework of a post-traumatic subtype of OCD, a different treatment approach will likely need to be implemented.

It has been suggested by experts in the field of OCD and PTSD that additional research is needed to better understand the relationships between the timeline of a traumatic event and the development of PTSD and OCD. Although there is a clear relationship between the shared symptoms of PTSD and OCD, along with the prevalence of comorbidity between the two disorders additional research is needed to develop assessments and gain further clarity on the dynamic between the two disorders.