STRESSFUL LIFE EVENTS AND OCD TREATMENT

Trauma exposure, including interpersonal violence (IPV), is associated with increased risk and severity of obsessive-compulsive disorder (OCD). Exposure and response prevention (ERP) is the treatment of choice for OCD, yet research suggests a history of trauma and comorbid PTSD may adversely impact treatment outcomes. No studies have yet evaluated patient perspectives on the relationship between trauma, IPV and related sequelae and OCD treatment. The present study applies reflexive thematic analysis to interviews from individuals with a history of IPV who received exposure-based therapy for OCD. Interviews explored the influence of posttraumatic distress, impairment, and psychopathology on the treatment of OCD, as well as the influence of OCD treatment on trauma-related symptomology. Participants incorporated stressful life events (SLEs) when discussing their experiences of trauma and abuse. Thus, the scope of the study was expanded to include these stressors. Six themes were developed: 1) ‘OCD and SLEs: A Perfect Storm,’ 2) ‘A Slower, More Painstaking OCD Treatment Experience,’ 3) ‘Falling by the Wayside,’ 4) ‘SLEs as Motivation: The Good and the Bad,’ 5) ‘A New Perspective on SLEs,’ and 6) ‘Treat Wisely: The Need for Expertise, Integration and Intentionality in Treatment.’ These themes highlight challenges that can arise in OCD treatment due to past SLEs. They point to the role of stressors as motivation for therapy engagement, and the impact of OCD treatment on patients’ attitudes and behavioral responses to SLE-related symptomology. Finally, they highlight the need for an integrated treatment approach that carefully considers the overlap of stress, trauma, and OCD.