Severe OCD: Symptoms, Causes, & Treatment

What Is Severe OCD (Extreme OCD)?

Obsessive-Compulsive Disorder (OCD) is a mental health diagnosis in which a person experiences intrusive thoughts (obsessions) followed by behaviors that are meant to soothe these thoughts (compulsions).  A person with mild OCD will have the diagnostic symptoms present but may be able to see improvement without professional intervention. People struggling with moderate and severe OCD experience more intense symptoms, and often experience higher levels of anxiety related to their struggles, and their symptoms are typically so disruptive and time-consuming that any functioning is difficult or near-impossible.¹

Symptoms of Severe OCD

Severe OCD symptoms align with the OCD symptoms seen in mild cases, but are more intense, frequent, last longer, and disrupt functioning more than in mild cases. With mild OCD, a person typically has mild enough symptoms that they can maintain some functioning and only experience some disruption to their daily lives, while severe OCD interferes intensely to a debilitating degree.

Symptoms of severe OCD include:

Obsessive Thoughts

Obsessions are intrusive thoughts that cause extreme feelings of distress. In severe OCD, obsessions are almost constant, and take up several hours per day. These thoughts can be distressing enough that they trigger high anxiety or even panic attacks, and make it difficult to refocus attention away from the intrusive thought. Content of obsessive thoughts with severe OCD can be graphic, disturbing and feel like they are life-threatening and undeniably true/likely to occur.

Compulsions

Compulsive behaviors are actions that a person with OCD does in order to negate the obsessions or to soothe their feelings. This can include things like checking the doors are locked after an intrusive thought of someone breaking in, or washing hands after having fears of becoming sick. With severe OCD, compulsions can take a lot of time and don’t always help soothe the thoughts and make the urges go away. Engaging in compulsions with severe OCD often results in extreme life and functioning disruption, such as having raw/painful skin from excessive hand washing, not being able to sleep because of incessant checking, or living in a hoarding household with unsanitary living conditions.

The Impact of Severe OCD on Daily Life

Severe OCD is extremely disruptive to a person’s life, and impacts all areas of necessary functioning within their life – including their personal relationships, work performance, taking care of themselves, and satisfaction with their life overall. It also typically comes with emotional and social side effects, which can include shame, low self-esteem, isolation, anxiety, and depression.

Severe OCD can impact your life in many ways, including:

Disrupting Your Personal Life

Because the cycle and presence of obsessions and compulsions can take up large portions of a person’s day, it can be difficult for someone with severe OCD to be able to contribute the time and energy necessary for healthy relationships and taking care of themselves. This can happen by obsessions distracting you from being mentally present in conversations, being able to stick to routines, and being able to tend to basic self-care.

Creating Challenges in Your Professional Life

Employment usually rests on performance expectations that do not accommodate for the time and energy needed to manage obsessions and compulsions. This can make it difficult for a person with severe OCD to meet work expectations, maintain employment, and can even begin to cause relational issues with coworkers when they are not able to complete their portion of work projects.

Deterioration of Your Quality of Life Overall

Obsessions with severe OCD are intrusive and extremely upsetting, and compulsions are typically time-consuming and not always rationally correlated to the obsessions. This can leave a person feeling embarrassed, confused, isolated, anxious, and hopeless. These can be accompanied by low self-esteem or even self-loathing, and contribute to an overall dissatisfaction with life.

Causes of Severe OCD

OCD has long been considered a disorder that runs within families because there is a major hereditary component to the likelihood of a person developing OCD. Research estimated that a person is 7.2 times more likely to develop OCD if there is a family history of the disorder.²

In addition to genetics, there is also research that demonstrates abnormal brain functioning in individuals with severe OCD, particularly in the areas of the brain that are associated with physical sensations of anxiety, avoidance tendencies, and cognitive flexibility and rigidity.³ Individuals who have abnormal functioning in these areas of the brain are more likely to develop OCD because of how this impacts their emotional and thinking patterns.

There are also environmental factors that can influence whether a person develops OCD, although it is important to emphasize that these are influencing factors and are not considered true causes for developing OCD. Environmental factors that can affect the disorder can include parental behavior modeling, family conflict, family living accommodations, parenting styles, and excessive parental blame.^{4, 5}

There are also psychological factors that can contribute to a person developing severe OCD. While intrusive and distressing thoughts can happen to anyone, people with OCD tend to struggle to dismiss intrusive thoughts because of shame, guilt, or fear.⁶ A person can seek to soothe these intense feelings with a compulsion, even if the compulsion is not directly and rationally linked to the initial obsessive thought.

Other Conditions That May Co-Occur With Severe OCD

When more than one diagnosis occurs in a person, they are considered “co-morbid” or co-occurring conditions. OCD comorbidity rates are high, with research estimating that 90% of people who qualify for an OCD diagnosis typically meet the criteria for another psychiatric disorder in their lifetime.⁷ Common co-occurring psychiatric disorders that accompany severe OCD can include major depressive disorder, obsessive compulsive personality disorder, generalized anxiety disorder, specific phobias, and social phobias.⁸

How Is Severe OCD Diagnosed?

An OCD diagnosis is evaluated and applied by a mental health professional, such as a therapist, psychologist, or psychiatrist. The professional will take a full biopsychosocial history, as well as working to outline a list of symptoms with the patient. The professional will also have the patient fill out some assessments in order to identify the types of obsessions and compulsions present, as well as to determine the severity of the OCD present. OCD severity is most commonly identified using an assessment tool called the Yale-Brown Obsessive-Compulsive Scale (Y-BCOS), which pinpoints specific types of obsessions and compulsions and is considered the gold standard in OCD assessment.⁹ Physical testing – such as brain scans and blood work – is not currently used as part of the diagnostic process.

Treatment Options for Severe OCD

There are several OCD treatment options available for severe OCD, including psychotherapy, brain stimulation procedures, as well as medication. Severe OCD typically requires an intensive combination of approaches in order to manage symptoms and see progress, and treatment should be tailored to an individual’s specific OCD type. In severe cases, hospitalization or residential treatment programs may be needed to stabilize and initially manage symptoms.

Treatment options for severe OCD include:

• Exposure and Response Prevention (ERP): ERP for OCD is a type of CBT therapy that repeatedly exposes a person to their triggers in order to reduce their reactivity, practice using coping skills, and resist urges. ERP is considered the gold standard therapeutic treatment for OCD.¹⁰
• Cognitive behavioral therapy (CBT): CBT for OCD can help by helping a person to understand the interconnectedness of their thoughts, feelings, and behaviors; then, an individual is able to exert influence over one of these areas in order to begin feelings changes in the other areas. This is particularly important for challenging and reframing obsessions (thoughts) as well as challenging the necessity of compulsions (behaviors).
• Acceptance and commitment therapy(ACT): ACT for OCD can help by helping a person to think of their obsessions in a more neutral manner in order to decrease the intensity of engaging with their compulsions for soothing.
• Transcranial Magnetic Stimulation (TMS): TMS is a non-invasive procedure that uses an electromagnetic field to stimulate underperforming brain regions. TMS for OCD can help by supplementing therapy and medication that are not producing satisfactory results.¹¹ This is most beneficial for people who have comorbid OCD and depression.¹²
• Medication: A combination of therapy and medication for OCD is usually suggested for treatment. Medications can help by decreasing symptom severity so that therapeutic interventions can be integrated more fully and easily, and to help improve a patient’s quality of life.

Coping Strategies for Severe OCD

Severe OCD comes with jarring intrusive thoughts, intense feelings, and compulsions that feel automatic and necessary. While it’s impossible to erase uncomfortable feelings altogether, there are many coping strategies for OCD to help individuals with severe OCD. While engaging with coping strategies, remember that it is also important to lean on support systems, including family involvement, support groups, and community resources.

Individual coping strategies for severe OCD include:

• Therapy: Therapy is a crucial component to coping with severe OCD because a mental health professional can help continue progress, recognize regression, and provide encouragement to persist in managing and coping with symptoms.
• Journaling: Journaling can help with OCD because it helps a person to identify their severe OCD triggers, make sense of their obsessions, identify their feelings, and track the pattern of engaging with compulsions.
• Mindfulness: Mindfulness can help with OCD by helping a person to notice their obsessions and feelings of discomfort in the moment, which decreases the likelihood of engaging with their compulsions.
• Meditation: Meditation for OCD can help a person to induce the feelings of calm and soothing that they are actually seeking when they engage in their compulsions. Meditation can help them to do this in an actually helpful way, and to practice approaching their obsessive thoughts in a more nonjudgmental manner.
• Complete the Stress Cycle: People with OCD are stuck in a cycle of feeling stress and being unsure of how to process that stress out of their systems, which leads to engaging in compulsions and feeling heightened related to obsessions. Getting this stress out through movement, laughter, crying and creativity can help a person to more productively process their stress and feel empowered to tend to their own well-being.
• Check your self-talk: Negative inner self-talk and being self-critical increases stress and anxiety related to obsessions and compulsions, which can ultimately lead to a vicious cycle of engaging in them further. Checking and altering negative self-talk can help a person with severe OCD to stay consistent in therapy, continue working on their goals when they slide into old patterns, and to build confidence.
• Self-soothe: Engaging in self-soothing activities that are pleasant, calming and comforting can help slow a person with severe OCD down enough to challenge obsessions, tolerate uncomfortable feelings, and resist compulsions.
• Grounding: Grounding is the act of bringing your awareness and focus into the present moment and what is happening. This can help a person with severe OCD to challenge the truth and helpfulness of their obsessions and recognize any feelings that are coming up.
• Distraction: At the beginning of dealing with severe OCD, inserting a distraction can be a helpful tool to begin breaking the link between an obsession occurring and automatically engaging in a compulsion.

When to Seek Professional Help

If you read through this article and felt like much of the struggles mentioned here resonated with your own experience, it could be time to consider getting professional help. A mental health professional can help you cope with stressors and to gain functionality within your life. If you feel ready to begin taking your life back, starting your search with an online therapist directory or looking through online psychiatrist options can be good places to start with finding a mental health professional who can help.