Compulsions in trauma-exposed patients with obsessive-compulsive disorder: Differences in prevalence and impact on treatment response

The effectiveness of exposure and response prevention (ERP), a front-line treatment for obsessive-compulsive disorder (OCD), is contingent on reducing engagement in compulsions, though recent research has found that certain compulsions may be less amenable to ERP. Given the impact of trauma exposure on OCD compulsions, the present study sought to examine whether compulsion-specific differences in treatment response may be attributable to trauma exposure. Using a sample of 622 patients diagnosed with OCD receiving intensive treatment (39.7 % trauma-exposed), certain compulsions were found to be more prevalent among trauma-exposed patients and differentially impacted treatment effectiveness. Trauma-exposed patients were more likely to engage in reassurance, rumination, and hair pulling, and less likely to engage in self-assurance compulsions compared to non-trauma exposed patients. Interestingly, among trauma-exposed patients, engaging in self-assurance compulsions was associated with better treatment outcomes and engaging in reassurance compulsions was associated with worsened treatment outcomes. Findings converge with trauma-focused treatment approaches, wherein functional self-assurance is not only permitted but encouraged. Although historically any form of assurance in ERP is discouraged, clinicians treating trauma-exposed patients with OCD may consider leveraging engagement in non-compulsive self-assurance to increase self-efficacy and treatment motivation and challenge distorted trauma-related beliefs. Findings highlight the importance of considering with nuance the function of underlying behaviors.