When OCD Latches On to Trauma

Hi, I’m Michelle Puerner. I’m an LCSW who specializes in OCD and I’m based in Montana. I have a lot of ideas, I love passing down knowledge, and I care deeply about advocating for the OCD community, so it felt like it was time to start a blog. And… don’t tell anyone, but I’m avoiding work right now. I tend to get creative when I’m avoiding work.

After nearly fifteen years as a therapist, I rarely see clean diagnostic lines. Most people show up with layers. Anxiety mixed with trauma. OCD tangled with grief. Patterns that don’t live neatly inside a box. What fascinates me is not just the symptoms, but the engines underneath them. From an ACT perspective, that means paying attention to how people relate to their thoughts, their inner experience, and their attempts to stay safe. It’s less about what shows up in the mind and more about how the mind tries to handle it.

When something painful happens, or when we feel pain, our brains try to make sense of it. The wound is real. For some people it’s psychological. For others it’s physical. Sometimes it’s both. The reasons people develop OCD are still not fully understood, but we do know that OCD is a neurobiological disorder with a different function in the brain than anxiety. That’s why it’s no longer classified as an anxiety disorder.

OCD doesn’t just respond to fear. It responds to uncertainty. It shows up as an attempt to prevent harm, regret, danger, or moral failure. And when trauma is part of someone’s story, OCD often latches right onto it.

Trauma does not cause OCD and many people with OCD have no trauma history at all. OCD is a neurobiological disorder that can attach itself to anything that matters. What I’m describing here is not the origin of OCD, but what often happens when trauma is part of someone’s story. In these cases, OCD frequently weaves itself into the wound.

This is where things get complicated.

When someone has been hurt, betrayed, gotten sick, lost control, or had something truly frightening happen, the mind quite reasonably says, “Never again.” It scans for risk, replays what happened, asks endless questions, tries to make meaning, and creates rules to make sure that a feared outcome never happens. Often this is a five year old brain saying, “If I never tell a lie and I’m always honest, I will never feel alone.” You can see how this rule might have kept a five year old safe, but no longer serves them at thirty when they are confessing every potential wrongdoing.

That same five year old logic shows up in lots of forms. For some people, it becomes a moral rule. For others, it becomes an emotional one. The structure is the same.

In trauma therapy, this person may come in and describe a chaotic childhood and identify a core belief like, “I’m only safe if I’m perfect,” or “It’s unsafe to feel.” In trauma work, that belief makes sense. In an unsafe environment, feeling deeply might have led to punishment, abandonment, or overwhelm. Numbing, suppressing, or staying hyper-controlled may have been the only way to get through.

When “it’s unsafe to feel” becomes the rule, life starts to narrow in subtle ways. A person might notice a tightness in their chest and immediately wonder what it means. Did I overreact? Am I spiraling? Is this a sign something is wrong with me? A passing wave of sadness becomes something to manage. Anger feels dangerous. Excitement feels risky. Every emotional shift gets treated like a potential emergency.

So they start shrinking themselves. They leave conversations that feel charged. They avoid movies that might make them cry. They replay interactions in their head to make sure they didn’t feel “too much.” They try to get back to neutral as fast as possible. Not because they’re fragile, but because their mind has learned that feelings are a threat.

At this point, the person isn’t just carrying a trauma belief. They’re living inside a constant internal surveillance system. Emotions aren’t allowed to rise and fall. They have to be evaluated, contained, and neutralized.

This is no longer just trauma. It’s OCD’s rulebook.

And none of this makes someone broken. It makes them human. These rules were created in an effort to survive. The work is not to shame them, but to gently loosen them. Not by erasing what happened, but by helping the mind learn that safety does not require certainty.

That’s a different kind of healing.