The role of trauma in pediatric obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder whose etiology remains poorly understood. Besides genetic factors, environmental risk factors such as traumatic events seem to play a role in the development and trajectory of OCD. While the role of trauma in OCD development, expression, and treatment has been studied in adults, less attention has been paid to children and adolescents. The present study aimed to (a) examine the nature of potentially traumatic events (PTEs) in pediatric OCD, including exposure frequency, type, and temporal precedence; (b) investigate the relationship between lifetime PTE exposure and OCD expression; and (c) explore OCD treatment effects based on lifetime PTE exposure. Data from an OCD-affected youth sample, aged 6 to 19 years (N = 113, M = 13.4 years), from a specialized OCD clinic were analyzed using descriptive analyses, multiple linear regression, and mixed linear effect models. First, results indicate that the majority (~82%) of OCD-affected youth have experienced at least one PTE type in their lifetime. One third (~35%) have experienced a PTE within 12 months prior to OCD onset, with the death of someone close being the most frequently endorsed. Second, findings suggest that cumulative lifetime PTE exposure is not associated with OCD severity or OCD-related functional impairment. Third, lifetime PTE exposure did not seem to affect treatment response. However, exposure to certain types of PTEs (physical abuse, emotional abuse, and death of someone close) had differential impacts on the rates of improvement. Findings highlight the need for adopting a trauma-informed lens when assessing and treating youth with OCD. More research is needed to fully understand the role of trauma in OCD etiology, expression, and treatment in order to improve services and outcomes for families affected with pediatric OCD.