Childhood Trauma in Obsessive-Compulsive Disorder

Abstract

The strong overlap between the neurobiological correlates of childhood trauma and obsessive-compulsive disorder (OCD), and commonalities between cognitive models of trauma-related and obsessive-compulsive (OC) symptoms constitute the theoretical framework for investigating the role of stressful/traumatic events in the pathophysiology of the disorder. In the present chapter, we explore (1) how stressful/traumatic events in childhood may be a mechanism of OCD, as substantiated by preclinical research and longitudinal studies; (2) the existence of a specific antecedent vulnerability to the pathogenic effects of traumas/stressors in OCD, as investigated by studies exploring the incidence and effects of stressful/traumatic experiences in the disorder; and (3) the potentiality that OCD exists independently from exposure to traumatic events in childhood, but is exacerbated by the latters. Evidence exists that traumatic events do cause increased susceptibility to OCD by interacting with specific personality traits and genes (the pre-traumatic OCD phenotype) moderating the effect of stressful life events and the subsequent risk for psychopathology. In addition, individuals exposed to past trauma show more severe OCD symptoms associated with trauma severity, rather than to type of trauma. The putative post-traumatic OCD phenotype is characterized by contamination/cleaning, symmetry/ordering, and hoarding symptoms, suggesting that these OCD symptom dimensions are related to environmental stressful factors, and to the cumulative effect of traumas. We conclude that maladaptive functioning and cognitive distortions mediating the effect of repeated trauma exposure on the emergence of OCD should be targeted as to prevent the development of the disorder in traumatized youth.