On the Books: Featured Publication

Childhood trauma exposure is associated with posttraumatic stress symptoms (PTSS) and suicidality and is also a risk factor for obsessive-compulsive disorder (OCD) arising in adulthood. Research examining the relationship between childhood trauma and OCD in youth is mixed, and there is a lack of research examining the associations among OCD, PTSS, and suicidality. No study has examined the clinical characteristics associated with OCD in trauma-exposed youth, nor its associations with PTSS and suicidality over time. This study examines the clinical characteristics associated with OCD and the long-term relationships among OCD, PTSS, and suicidality among trauma-exposed youth.

What was the study about?

It’s common to think of trauma as a cause of PTSD or depression, but researchers wanted to see if trauma is also linked to Obsessive-Compulsive Disorder (OCD) in kids and teens.

The researchers wanted to know:

1. How common is OCD in kids who have been through trauma?
2. Do kids with both trauma and OCD have worse mental health than kids with trauma but without OCD?
3. What sorts of characteristics or experiences might be associated with OCD for kids who have been through trauma?

What did the researchers do?

The researchers looked at a large group of 2,068 youth ages 8 to 20 who are part of the Texas Childhood Trauma Research Network.

• They used professional interviews and surveys to see who had OCD, what types of trauma they experienced, and how OCD impacted symptoms of PTSD and suicidal thoughts and behaviors.
• They didn't just look at them once. They followed up with the children over 6 to 12 months to see how their symptoms changed over time.
• They compared kids who had experienced trauma and developed OCD to kids who had experienced trauma but had not developed OCD.

What were the findings?

The Trauma Link: About 11% of the youth in this trauma-focused group had OCD. This is much higher than the general population, where it’s usually only between 1-3%.

Worse Symptoms: Kids who had both trauma and OCD were struggling far worse than kids who had trauma but no OCD. They had higher rates of suicidal thoughts, more severe PTSD symptoms, and more mental health problems overall.

Specific Traumas: Trauma caused by other people (interpersonal trauma, like abuse) was a stronger predictor of OCD than accidents or natural disasters.

Long-Term Effects: Kids who were female, had more mental health concerns, and had more severe PTSD symptoms during their first study visit continued to have more severe PTSD symptoms 12 months later. Similarly, kids who were female, had more mental health concerns, and who expressed more severe suicidal thoughts and behaviors during their first study visit continued to have more severe suicidal thoughts and behaviors 12 months later. Surprisingly, OCD did not appear to impact the severity of PTSD symptoms or suicidality over time.

What does this mean?

This means that for some children, OCD is actually a trauma-related condition. Instead of just being a brain chemistry issue that happens for no reason, their obsessions and compulsions might be a way of trying to feel in control after something scary or violent has happened. It also means that if a doctor sees a child with OCD, they should probably check to see if that child has a hidden history of trauma, because that child might be at a higher risk for suicide.

Why is this important?

Doctors often focus so much on a child's PTSD that they forget to check for OCD. This study shows they must check for both. If a child’s OCD is driven by trauma, standard OCD treatments might not work perfectly unless the therapist also helps the child process their trauma, resulting in better treatment options. Identifying these kids early can literally save lives. We now know that an early intervention can help a child before the OCD becomes a full-blown disorder.

Caitlin M. Pinciotti, Paul J. Rathouz, Andrew G. Guzick, Jeffrey D. Shahidullah, Emily J. Bivins, David B. Riddle, Ogechi "Cynthia" Onyeka, Eric A. Storch, Wayne K. Goodman, Kelli Franco, Justin F. Rousseau, D. Jeffrey Newport, Karen Dineen Wagner, Charles B. Nemeroff, Clinical characteristics and longitudinal associations with obsessive-compulsive disorder in youth exposed to trauma. Journal of Mood and Anxiety Disorders; Volume 10, June 2025.