When OCD and Trauma Combine
You started working with a therapist to address your obsessions and compulsions. You start doing the work identifying your anxieties and managing the discomfort. Things are going well: your compulsions are more manageable, you are able to move through intrusive thoughts more easy—it’s working!
Suddenly, you begin having nightmares and flashbacks. You begin to feel unsafe in your body and your space. You’re remembering more details of your past. Soon, you feel like you’re spiraling in a whirlpool of trauma.
It doesn’t stop there. You then experience intrusive thoughts about the sudden increase in your trauma symptoms and notice you’re creating new anxieties. You lose sleep. You’re compulsively avoiding places and things that once felt good. Wasn’t therapy supposed to be helping? Why are you feeling worse than you did when you started?!
If this sounds like you, it likely means you encountered an all-too-common situation. When you started working on your OCD, the treatment didn’t address your trauma symptoms (alternatively, the treatment incidentally pushed you into addressing trauma triggers before you properly worked through your trauma). Because of this, your PTSD escalated to compensate for the decrease in OCD symptoms.
What is the relationship between PTSD and OCD?
A combination of OCD and trauma is an under-studied comorbidity, and research is relatively recent (going back as early as 10-15 years). One systematic study of 28 articles published in March 2026 identified a strong relationship between the two diagnoses. What it revealed was that individuals with a history of significant emotional neglect, physical abuse, and sexual assault were more likely to develop obsessive-compulsive disorder (Zenoni et al., 2026).
Why might this be the case? One suggestion is that OCD may develop as a way of coping with past trauma, and these repetitive rituals serve as a means of distraction and self-soothing when the body and mind feel unsafe.
How do we treat both?
OCD and trauma treatment can sometimes appear at odds: to address trauma, one must learn to create a sense of safety and certainty in the body before exposure, but for OCD, one must learn to tolerate distress and uncertainty in the body through exposure. There are methods that can help, though. Treating trauma first through a modality such as Accelerated Resolution Therapy (ART) and Eye Movement Desensitization and Reprocessing (EMDR) can guide the body and mind towards a sense of safety and grounding. Then, moving on to Inference-Based Cognitive Behavioral Therapy (I-CBT) or Exposure and Response Prevention (ERP) to address OCD compulsions and anxieties. A third option is starting with I-CBT until OCD symptoms feel more managed, and then diving into trauma treatment using ART or EMDR. This option also incorporates stabilizing skills for creating more of a sense of safety in the brain and body.
Note: I-CBT is an evidence-based treatment for OCD; however, ERP is still recommended for sensory-related OCD symptoms, such as disgust OCD and emetophobia, where the sensation itself is the trigger.
Having a provider who understands both diagnoses is helpful in finding relief. I practice both ART and I-CBT when working with these kinds of clients. If you feel this combination of therapies might be a good fit for you, please reach out to schedule with me.
References
Zenoni, M., Lopez, M. R., Archer, S., & Milton, A. L. (2026). Trauma-related pathways inobsessive-compulsive disorder: A systematic review of aetiology, symptom dimensions and severity. Comprehensive Psychiatry, 146, 152664. https://doi.org/10.1016/j.comppsych.2026.152664