Trauma-Related Compulsions in Obsessive-Compulsive Disorder: Functional Insights From Factor Analysis

Resisting obsessive-compulsive disorder (OCD) compulsions is a key predictor of exposure and response prevention (ERP) effectiveness, yet trauma-exposed individuals with OCD endorse more severe compulsions and are more likely to be labelled 'treatment resistant.' Among trauma-exposed individuals, compulsions are theorised to function to prevent future trauma and cope with trauma-related responses. Recent findings suggest that certain compulsions in the context of trauma exposure differentially impact treatment outcomes, yet missing from extant literature is a larger empirically derived conceptualisation for how trauma may impact the underlying function of compulsions. In a sample of 662 adult patients enroled in intensive OCD treatment (40.3% trauma-exposed), factor analyses and structural equation models provided insight into the potential functionality connecting clusters of compulsions and their impact on treatment response. A unique Absolution factor observed only in the trauma-exposed group suggested a stronger trauma association with compulsions intended to absolve guilt, obligation, or punishment compared to individuals without trauma. Longer lengths of stay were found with sexual abuse through Cleanliness and Certainty Seeking compulsions, and bullying through Certainty Seeking compulsions. Relationships were observed between other trauma types and compulsion clusters, though these did not impact treatment response. Findings offer support that some compulsions may serve trauma-related functions related to preventing and/or coping with trauma. Trauma-related Cleanliness and Certainty Seeking compulsions are important targets for treatment given their propensity to impact treatment response.