In recent years, the intersecting realms of trauma-related disorders and obsessive-compulsive disorder (OCD) have garnered increasing attention within psychiatric research. A newly published study by Howlett, Sudera, Biscoe, and colleagues, appearing in BMC Psychology (2025), delves into the nuanced relationship between OCD severity and trauma in a population of treatment-seeking military veterans. This research undertakes a rigorous cross-sectional comparison between two distinct trauma-related diagnoses: post-traumatic stress disorder (PTSD) and its more complex counterpart, complex PTSD (C-PTSD). The findings illuminate previously underappreciated dimensions of OCD presentation that may be shaped or exacerbated by underlying trauma histories, with profound implications for diagnosis, treatment planning, and veteran mental health policy.
Military veterans represent a uniquely vulnerable population within psychiatric care due to the high prevalence of both PTSD and associated disorders. PTSD, as defined in the DSM-5, arises from exposure to a traumatic event and manifests through symptoms such as intrusive memories, avoidance behaviors, hyperarousal, and negative alterations in cognition and mood. C-PTSD, a newer diagnostic construct recognized by the ICD-11 but still emerging in DSM frameworks, extends this profile to encompass broader disturbances in self-organization, including affect dysregulation, negative self-concept, and relational difficulties. The study by Howlett et al. innovatively explores how these syndromes overlap with and influence OCD, a disorder characterized by intrusive obsessions and compulsive behaviors aimed at alleviating anxiety.
Understanding the intersection of trauma and OCD poses significant clinical challenges. While OCD is classically conceptualized as a distinct disorder with neurobiological underpinnings involving fronto-striatal circuits, the overlay of trauma symptoms may produce atypical clinical presentations. For veterans grappling with both conditions, distinguishing whether compulsions are a manifestation of trauma-related coping or intrinsic OCD symptoms can be daunting. These diagnostic ambiguities risk misidentification, under-treatment, or overly narrow therapeutic approaches. Hence, a detailed examination of symptom severity and patterns within trauma subpopulations provides vital insights for tailoring effective interventions.
The methodology employed by Howlett and colleagues utilizes a cross-sectional design focused on veterans actively seeking treatment for OCD symptoms. Participants were categorized based on rigorous clinical assessment into PTSD and C-PTSD groups leveraging validated instruments, including structured diagnostic interviews and symptom severity scales specific to both trauma and obsessive-compulsive domains. This comparative framework allowed the researchers to elucidate how OCD severity varies between the two trauma phenotypes, potentially revealing mechanisms by which complex trauma influences compulsive symptomatology.
One of the pivotal discoveries of the study is that veterans with C-PTSD exhibited significantly greater OCD severity relative to their PTSD counterparts. This suggests that the deeper entrenchment of affective and self-concept disturbances typical of C-PTSD may intensify compulsive behaviors or increase susceptibility to obsessive phenomena. The authors propose several neuropsychological explanations, including dysregulation of emotion processing neural networks and maladaptive coping strategies that perpetuate interference of trauma memories with cognitive control, leading to compulsions as a means to regain psychological equilibrium.
Further, the study sheds light on how trauma complexity may alter the phenomenology of OCD. For example, veterans with C-PTSD demonstrated higher rates of compulsions related to control and contamination fears, possibly reflecting an attempt to counteract pervasive feelings of vulnerability and bodily threat associated with interpersonal trauma. Conversely, those with standard PTSD exhibited more circumscribed symptom clusters. This symptom differentiation enhances current understandings of OCD heterogeneity and underscores the necessity of trauma-informed assessments to discern underlying etiologies.
Biological underpinnings of these observations link to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and limbic system alterations stemming from prolonged trauma exposure in C-PTSD. Such neuroendocrine changes can exacerbate anxiety circuits and disrupt executive functioning, facilitating OCD manifestations. The interplay between neuroinflammation, neuroplasticity, and genetic predispositions potentially converges to heighten compulsive symptom severity. These findings fortify the biopsychosocial model of OCD in traumatized populations by integrating neurobiological and experiential dimensions.
Therapeutically, the study’s revelations bear crucial significance. Conventional OCD treatments predominantly feature cognitive-behavioral therapy (CBT), specifically exposure and response prevention (ERP). However, veterans with C-PTSD may respond suboptimally to standard protocols due to the complexity of their symptoms and trauma-related cognitive schemas. Howlett et al. advocate for integrated treatments that concurrently target trauma processing and compulsive behaviors, perhaps incorporating trauma-focused cognitive therapies, EMDR, or novel pharmacotherapies aimed at neurobiological dysregulation. Additionally, the enhancement of therapeutic alliance and stabilization strategies prior to ERP may optimize outcomes in this subgroup.
The implications extend beyond individual therapy to systemic mental health care provision for veterans. Recognition of the high OCD burden among those with complex trauma advocates for routine screening of obsessive-compulsive symptoms in PTSD and C-PTSD treatment programs. Mental health services in military and veteran contexts must adapt to encompass multidimensional formulations that address the confluence of trauma and OCD. This perspective champions holistic, patient-centered care rather than fragmented approaches and encourages research on mechanisms facilitating comorbidity.
Moreover, the documented elevated OCD severity in veterans with C-PTSD raises important public health considerations given the substantial functional impairment and quality-of-life reductions associated with combined disorders. Untreated or inadequately treated OCD exacerbated by trauma has associations with increased risk of comorbid depression, suicidality, and social isolation. Innovations in stepped-care models and interdisciplinary collaborations could mitigate this burden by ensuring early identification and tailored intervention strategies.
The study’s cross-sectional nature merits cautious interpretation but offers a crucial foundation for longitudinal research exploring causal relationships and treatment trajectories. Future investigations might explore neuroimaging correlates of OCD severity in trauma spectra or test efficacy of integrated therapy protocols in randomized controlled trials. Such work would deepen mechanistic insights and translate findings into clinical guidelines.
From a neuroscientific vantage, this research invites exploration of specific neurocircuitry involved in the OCD-trauma nexus, such as the connectivity between the amygdala, prefrontal cortex, and striatum. Understanding how trauma remodels these circuits to predispose or aggravate compulsive behaviors is an exciting frontier that may inspire biomarker development and personalized medicine approaches.
Socially and culturally, the unique stressors faced by veterans—comprising combat exposure, military culture, and reintegration challenges—interact with OCD and trauma symptomatology. Recognition of these contextual factors shapes comprehensive care that attends to identity, stigma, and resilience factors influencing veteran outcomes.
In summary, Howlett et al.’s study demarcates a critical intersection of OCD and trauma disorders among veterans, emphasizing greater severity and distinct clinical presentations associated with complex PTSD. These insights urge reconceptualization of diagnostic frameworks and encourage innovation in treatment modalities tailored for trauma-affected populations experiencing obsessive-compulsive symptoms. As mental health systems evolve, such evidence-based knowledge propels progress toward alleviating the dual burden of trauma and OCD, improving veterans’ mental health and societal integration.
Subject of Research: Exploring obsessive-compulsive disorder (OCD) severity in treatment-seeking veterans with post-traumatic stress disorder (PTSD) and complex PTSD (C-PTSD).
Article Title: Exploring OCD severity in treatment-seeking veterans: a cross-sectional comparison between post-traumatic stress disorder (PTSD) and complex-PTSD (C-PTSD).
Article References:
Howlett, P., Sudera, T.L.R., Biscoe, N. et al. Exploring OCD severity in treatment-seeking veterans: a cross-sectional comparison between post-traumatic stress disorder (PTSD) and complex-PTSD (C-PTSD). BMC Psychol 13, 422 (2025). https://doi.org/10.1186/s40359-025-02446-0
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