OCD Attacks: What It Is & How to Cope

What Is an OCD Attack?

Obsessive-compulsive disorder (OCD) attacks are when obsessions peak quickly and intensely. Obsessions are unwanted intrusive thoughts, images, or urges. During an OCD episode or OCD attack, these obsessions onset rapidly and cause immediate distress. The distress leads a person to want to engage in compulsions, which are repetitive mental or physical behaviors to calm their anxiety.

OCD attack symptoms may vary for individuals with diagnosed obsessive-compulsive disorder. The key is that the intensity of the episode is a high level of distress that causes almost immediate engagement in compulsions.

Characteristics of OCD attacks include:

• Often an unexpected trigger
• Intense and rapid onset of anxiety
• Possibly uncomfortable physical sensations of anxiety, which lead to body scanning
• Racing thoughts 
• Immediate self-reassurance or compulsively seeking reassurance from others
• Rumination on the trigger and meaning behind the trigger
• Mental review of events before, during, or after the obsession
• Engaging in mental compulsions for safety, such as repeating affirmations or prayers

What Happens in the Brain and Body During an OCD Episode

Research provides support that individuals with OCD have an impaired stress response.^2,3 During an OCD attack, the body and brain are under intense stress. The brain perceives threat is near and initiates a hormonal cascade in the body, which is intended to prepare for survival situations. The problem is that during an OCD episode, the perceived threat is an obsession and not a real life-threatening event. OCD attacks happen many times for an individual with diagnosed OCD, meaning that the body and brain get hit with the impacts of stress over and over.

What Triggers an OCD Attack?

Triggers can differ for individuals with diagnosed OCD, but they often have patterns for each individual. Triggers often revolve around an individual’s obsessions, which may contain fears related to contamination, harm, relationships, religion, sexual orientation, or imperfections.¹ Identifying triggers and causes for your OCD attacks can help you track patterns of your symptoms to limit precipitating factors.

Research supports stress as both an initial cause and an exacerbator of OCD symptoms.³ Environmental factors that are also associated with developing OCD include childhood trauma, brain injury, neonatal complications, stressful events, and infection.³ Limiting stressful events and using coping strategies to establish a calmer sense of self can help minimize triggers for OCD attacks.

Impact of an OCD Attack

OCD is named one of the top ten most disabling disorders by the World Health Organization. OCD attacks take a daily emotional, mental, and physical toll on diagnosed individuals. The extent to which daily life is affected by OCD attacks is often associated with whether symptoms are treated or untreated.

When OCD is treated with therapy and medications, interference with daily life might be minimal or moderate. Untreated OCD symptoms tend to have a chronic and daily negative influence on an individual’s life, affecting work and personal life. OCD attacks will generally worsen in untreated individuals and increase without any intervention.

How to Cope With an OCD Episode

There are both short and long-term ways to cope with OCD attacks. In the short term, self-soothing strategies can calm your body and mind. Distractions, putting OCD obsessions off until later, and talking back to OCD are other strategies for short-term dealing with distress. One of the most evidence-based ways to deal with OCD episodes in the long term is exposure and response prevention.

Here are five ways to cope with an OCD attack:

1. Response Prevention

Exposure and response prevention (ERP) is considered the gold standard treatment for OCD. ERP should happen under the guidance of a specialized mental health professional. Response prevention during an OCD attack asks the individual to tolerate the distress of obsessions without having to “do” anything to change the intrusive thoughts.⁴ Coping with an OCD episode this way, over time, can teach the person that compulsions do not have to follow their obsessions.⁴

For example, someone can have the obsession that they will catch a cold from their colleague at work. Their desired compulsion might be to wipe down their whole office with disinfectant and leave work early. Response prevention requires sitting in the distress that they may or may not become sick until the anxiety passes and then continuing about their day.

2. Self-Soothing Techniques

Relaxation and self-soothing are important strategies for coping with an OCD attack, especially if you can start them at the beginning of an episode. Self-soothing involves techniques that calm your body and mind through engaging in the five senses. Self-soothing and relaxation techniques can help ground you when you are experiencing an OCD episode.

Here are some self-soothing techniques to try:

• Deep breathing: Deep breathing is intentionally controlling and managing your breath. During an OCD attack, deep breathing can calm the fight or flight reaction from progressing into compulsions. If counting is not one of your compulsions, you can combine slow breathwork with counting to help refocus your energy on anxiety reduction.
• Meditation: Meditation for OCD can help prior, during, or after an OCD episode to mitigate engaging in compulsions and refocus on anxiety reduction. Walking meditation can help during or after an OCD attack to change your environment and refocus on breathing and movement. Loving-kindness meditation may be helpful as a routine meditation to cultivate a more compassionate perception of yourself and others.
• Progressive muscle relaxation: Progressive muscle relaxation involves intentionally tensing and relaxing muscles to invoke the body’s natural relaxation response. During or directly prior to an OCD attack, muscles may become tense in response to increasing stress levels. You can choose to go through all the various steps of progressive muscle relaxation or choose a body area that seems to be most affected by OCD episodes.
• 54321: The 54321 Method is a strategy to ground yourself using the five senses in the present moment. During an OCD episode, your senses may become heightened due to a fight or flight response. Combining the 54321 method with deep breathing can be a helpful way to ground into the safety of the present moment.
• Soothe through senses mindfully: Pick a sense to soothe and find a mindful activity that feels pleasurable to you. You could choose to light your favorite candle and enjoy its scent as you watch the flame flickering. Or maybe you decide to get your favorite treat from a local bakery and eat it mindfully while sitting outside.

3. Healthy Distraction

Distraction can be a helpful tool for someone who has OCD as long as it is not used to the level of compulsion. Healthy distraction would mean choosing to intentionally and mindfully engage in an activity to refocus after successfully avoiding a compulsion. Unhealthy distraction becomes a compulsion when distraction strategies are used impulsively and become a person’s main source of avoiding distress caused by obsessions.

Keep in mind that whether distraction is healthy or unhealthy is highly unique to the individual. You can keep distraction from becoming a compulsion by having other strategies you use to cope with an OCD episode.

Here are some examples of healthy distractions and activities:

• Engaging in movement you enjoy, like hiking, running, or playing a spot
• Cooking your favorite meal with a loved one
• Refocusing on completing a work project
• Walking or playing with a pet
• Focusing your attention on a hobby or fun activity

4. Put OCD Thoughts “On a Shelf”

Much of the distress from an OCD episode can be worsened through engaging in compulsions like rumination or mental review. Individuals with OCD generally experience heightened anxiety when they engage in figuring out the meaning behind their intrusive thoughts. In reality, there is no meaning behind obsessions.

An individual can learn to put OCD obsessions “on a shelf” by acknowledging the intrusive thought and intentionally choosing to worry about it later. You can even visualize putting the obsession “on a shelf.” Make a mental note that you will worry about the content later in the evening or at your next therapy session.

5. Talk Back to OCD

Individuals who have been diagnosed with OCD sometimes feel powerless to fight their compulsions. During an OCD attack, the urge to perform compulsions is high because obsessions are likely louder than usual. Becoming angry at OCD can help because it allows you to recognize your obsessions as obsessions and not reality. It can also help you redirect some of your anxious energy.

Here are some examples of what to say to your OCD:

• OCD, I see what game you are trying to play, and I’m not interested.
• I already know you want me to worry about X, but I’m putting that off for later.
• I know your goal is to make me spiral, but I recognize this as an obsession and not reality.
• No matter what you say, I can survive these anxious thoughts.
• Yeah, maybe XYZ will happen like you say, or maybe it won’t, but I can tolerate that uncertainty.

What Not to Do When Having an OCD Attack

During OCD attacks, it is important not to engage in actions that might worsen the episode. Behaviors often used in an attempt to provide relief to an OCD attack are compulsions. However, although they may provide short-term relief, they will never reduce distress in the long term and actually intensify cycles of OCD.

Here are some things not to do when having an OCD attack:

• Avoiding self-criticism and guilt: Self-criticism and OCD-related guilt during an OCD attack can spiral you into rumination. Recognizing self-disparaging intrusive thoughts and stopping yourself from continuing can help you avoid engaging in compulsions.
• Spiral into rumination: Rumination is a common OCD mental compulsion. One study found that mind-wandering and rumination were significantly associated with worsening severity of OCD symptoms.⁵ You can catch yourself before your obsessions spiral into rumination and avoid heightening your distress during an OCD attack.
• Immediately seek reassurance: Seeking reassurance is one of the most common compulsions when someone is experiencing an OCD episode. Impulsively seeking reassurance in the middle of an OCD attack only confirms that you need another person’s validation to calm distress. If needed, try to sit next to a loved one while you practice anxiety reduction instead of asking them to provide you with reassurance.
• Begin body scanning: Body scanning is a somatic compulsion where someone becomes overly focused on certain physical sensations. During an OCD attack, bodily sensations can become heightened. Although you may want to do a body scan to “check” on certain bodily functions, avoid doing this compulsion and worsening symptoms like increased heart rate, blood pressure, and sweating.
• Start mental reviewing: Mental reviewing is a compulsion where someone mentally goes over sequences of events or conversations that occurred prior to an obsession. The idea is often to find where an obsession started or what the obsession means. During an OCD attack, mental reviewing will only heighten distress caused by the obsession and may even prompt new obsessions.

How to Help Someone Who Is Having an OCD Episode

It can be overwhelming to watch a loved one dealing with OCD episodes on a regular basis. Support systems play a vital role in the prevention and maintenance of OCD symptoms, and it can help to know what to do when someone is having an OCD attack. Sometimes, loved ones are involved in the cycle of giving excessive reassurance in the midst of obsessions.

Of course, you want to tell them everything will be okay, especially when they are anxious! This reassurance cures short-term distress, but long-term prevents the person from learning to face anxiety on their own. Instead, say, “I know you want my reassurance, but I also know you can do this on your own. I believe in you to figure this out, so I’m not going to reassure you right now.”

How to Prevent Future OCD Attacks

Treatment options for OCD episodes include medication, therapy, or combination treatment. It is important to accept and recognize that OCD symptoms often require lifelong management, and there is no magic cure for stopping intrusive thoughts. However, through therapy and perhaps medication, you can learn new ways of relating to your obsessions and avoid engaging in compulsions.

Here are some tips for how to prevent future OCD attacks:

Begin or Maintain Treatment

OCD treatment may include therapy, medication, or a combination of these treatments. OCD attacks may not improve without treatment and can worsen when left untreated. Exploring options and maintaining treatment are the best ways to prevent or manage OCD episodes.

Treatment options for OCD include:

• Exposure-response therapy (ERP): Exposure therapy for OCD involves gradually confronting obsessions and tolerating the distress without using compulsions. Over time, this therapy results in someone becoming more comfortable in not assigning meaning to OCD obsessions.
• Medications: Medications for OCD generally include antidepressants, such as SSRIs. SSRIs work by regulating the flow of the neurotransmitter serotonin in the brain.
• Cognitive behavioral therapy (CBT): CBT for OCD involves understanding the relationship between thoughts, emotions, and behaviors. A therapist can help develop insight into how negative thought patterns lead to unhealthy behaviors and help the person replace them with more adaptive thoughts and emotions.
• Couples therapy: Couples therapy for OCD can be helpful when compulsions involve reassurance seeking from the partner. Couples therapy for OCD attacks might involve helping the partner avoid reassuring the person with OCD and helping the person with OCD learn how to manage anxiety on their own.
• Family therapy: Family therapy for OCD can help when OCD episodes are generational. OCD has a high genetic rate, and helping family members understand how OCD functions in the family system is important to recovery.
• Group therapy: CBT group therapy is an evidence-based treatment for the reduction of OCD symptoms.⁶ Group therapy offers a person an environment to feel accepted and understood while also learning new skills for OCD management.

Stress Management Strategies

Stress reduction and management are important to incorporate into daily life for mitigating future OCD episodes. Stress management techniques can help provide a more stable mental and physical well-being, which in turn can help minimize the effect of OCD attacks on a person’s quality of life. Stress management strategies can also be cheap and simple, making them easier to try than other costly or timely treatments.

Here are some stress management techniques to try:

• Mindfulness meditation: One study found that combination therapy, medication, and meditation-based intervention for OCD provided better improvement in symptoms than medication alone.⁷ You can begin a mindfulness meditation practice by beginning with short, guided meditations from reliable sources. It is more important to practice in shorter and more frequent intervals to build a habit than it is to practice for a few short stretches.
• Incorporating movement: Some studies document the role of physical exercise in reducing the severity of OCD symptoms.⁸ You can begin by finding a form of movement you enjoy. Make sure it is manageable to incorporate around other time commitments and then move up frequency as directed by your treatment team or other health professional.
• Good sleep hygiene: Research supports the majority of OCD sufferers struggle with sleep difficulties, such as OCD-induced insomnia.⁹ You can begin a good sleep routine by limiting distractions before bedtime and eating a dinner that is easily digestible for your body’s needs. Sleeping in a comfortable temperature and dark environment is also generally advisable for improving most sleep routines.
• Managing vitamin levels: Some studies have looked at the role of certain Vitamin deficiencies in the maintenance of OCD symptoms. One study found vitamin D to be lower in diagnosed OCD individuals than healthy controls.¹⁰ Vitamin levels are specific to individuals, and it may be beneficial for you to ask about testing your vitamin levels during your annual physical check-up with a doctor.

Medication and Treatment Adjustments

OCD medication and treatment adjustments might be necessary to lessen future OCD episodes. Your treatment team or provider can help you monitor medications and suggest adjustments. It can be helpful to keep a journal or log of medication dosages and side effects or reactions to therapy interventions to discuss with your prescribing provider and therapist.

Building a Strong Support System

Research documents the positive role that social support plays in improving mental health outcomes.¹¹ Although both quality and quantity of relationships can be important, the quality of relationships is more important for beneficial mental health outcomes.¹¹

When building a strong support network, it is helpful to consider the different domains of your life. For example, finding good colleagues and a work mentor can be helpful in professional life. Similarly, finding a therapist and psychiatrist can help with mental health. Or, finding a spiritual leader and community can help you build a support network that shares your beliefs.

Here are a few ways to reach out to loved ones for support:

• After an OCD attack, seeking in-person support from a friend
• Asking your cultural community if there are traditions that may help alleviate symptoms
• Turning to your spiritual community for faith-based answers to OCD symptoms
• Leaning on family support for help with your children when OCD episodes are heightened
• Asking a colleague for help with a work project when OCD attacks

When to Seek Professional Support

If OCD attacks are becoming more frequent and symptoms are worsening, it may be time to seek professional help. An online therapist directory or online OCD resources can assist with providing mental health support and interventions for OCD episodes. If you don’t have one already, online psychiatrist options are available to help you access a provider for OCD medication management.