Section Title: “OCD as a Trauma Response: When External Stressors Fuel the Fire”

( Toll: How Chronic Stress Turns Coping Into Compulsion”)

Key Argument:

For this patient, OCD rituals (e.g., contamination avoidance) are rational adaptations to an environment of pervasive threat—health decline, immigration precarity, environmental toxicity, and social isolation. Exposure therapy will fail unless these stressors are mitigated first, because:

1. The brain cannot unlearn “threats” that are real (e.g., contaminated food/water, pain flare-ups, financial ruin).

2. Compulsions are the only “control” the patient has in a life otherwise defined by powerlessness.

For many patients with OCD, symptoms aren’t just a neurological glitch – they’re rational adaptations to environments of pervasive threat. This case study reveals how chronic, real-world stressors create feedback loops that make traditional exposure therapy ineffective until basic needs are met.

The Stressor-OCD Feedback Loop

Why Standard Exposure Therapy Fails

Traditional ERP struggles here because:

• Exposure to “contamination” feels legitimately life-threatening when the local water is polluted and health vulnerabilities exist
• Compulsions are functional adaptations – hand washing is rational where hygiene infrastructure is poor
• The brain cannot unlearn threats that are objectively real in the patient’s environment

Trauma-Informed Treatment Plan

A New Understanding

This case reveals OCD as a trauma response to systemic failure – medical, economic, and political. Effective treatment requires addressing these root causes before tackling symptoms. Success isn’t necessarily complete remission, but reducing rituals enough to improve quality of life.