The Overlooked Link Between OCD and Trauma

As a therapist, I’ve had the privilege of sitting with many clients who live with obsessive-compulsive disorder (OCD). One thing that often surprises people is how often OCD and trauma are intertwined. While OCD is usually explained in terms of brain chemistry or genetics, my clinical experience — and a growing body of research — suggests that trauma plays a significant role in shaping obsessive thoughts and compulsive behaviors.

This doesn’t mean trauma causes OCD in a simple way. But it does mean that for many people, understanding the relationship between OCD and trauma is key to unlocking healing.

OCD and Trauma: What’s the Connection?

When someone experiences trauma — whether a single event or ongoing childhood adversity — the nervous system adapts to survive. Hypervigilance, fear, and the need to regain control can linger long after the danger has passed. For some, OCD becomes a way to cope with this overwhelm.

• A person who lived through a frightening medical crisis may develop contamination fears, washing or cleaning in an effort to prevent further harm.

• Someone who grew up with emotional neglect may turn to perfectionism or moral scrupulosity, terrified that even a small mistake could lead to rejection or punishment.

In these cases, compulsions become more than “bad habits” — they are attempts to soothe an anxious nervous system and manage the uncertainty that trauma leaves behind.

One of the most important messages I share with clients is this: OCD is not a flaw in who you are. When trauma is part of the story, OCD often reflects the creative — though exhausting — ways your mind and body tried to protect you.

ERP: A Trauma-Informed Approach to OCD

Exposure and Response Prevention (ERP) therapy is the gold standard for OCD treatment. The process involves gradually facing obsessive fears without giving in to compulsions, retraining the brain to recognize that feared outcomes don’t come true. Over time, this reduces both the intensity and the grip of OCD.

But when trauma is present, ERP needs to be tailored. Pushing too hard or too fast can overwhelm a nervous system already carrying old wounds. That’s why I use a trauma-informed ERP approach that emphasizes:

• Safety first – Before starting exposure work, we focus on building a trusting therapeutic relationship and helping clients feel grounded. Without safety, ERP can feel re-traumatizing.

• Understanding the deeper fear – Obsessions often carry symbolic meaning: fear of being unsafe, unloved, or out of control. Exploring these layers makes ERP more effective.

• Adjusting pace and intensity – We set exposures at a level that is challenging but tolerable, using grounding and regulation skills along the way.

• Integrating body and mind – Somatic therapy, EMDR, or Internal Family Systems (IFS) can complement ERP by addressing the emotional residue that compulsions alone don’t resolve.

  
  

Healing the Connection Between OCD and Trauma

I’ve worked with many people who come into therapy feeling ashamed of their OCD, especially when it’s linked to painful memories or traumatic experiences. What I want them to know — and what I’ll say here — is that healing is absolutely possible.

When OCD and trauma are addressed together, clients often find a greater sense of freedom. They learn not only how to resist compulsions but also how to soothe the nervous system, reconnect with their bodies, and build resilience for the future.

If you or someone you care about is struggling with OCD, especially when trauma is part of the picture, know that you’re not alone — and you’re not broken. With the right support, it’s possible to face those fears, loosen OCD’s grip, and reclaim the parts of life that matter most.