What Causes OCD to Get Worse?

16 Reasons OCD Can Get Worse

It can be disheartening for your OCD symptoms to worsen. You may feel worried about your prognosis or concerned that things will never get better. However, it’s important to consider the context of your situation. Once you get a handle on what causes your OCD to get worse, you can start to better manage your OCD symptoms with the help of a professional.

Here are sixteen reasons your OCD may be getting worse:

1. Giving into compulsions
2. Increased stress
3. Avoidance of triggers
4. Trauma
5. Depression
6. Other anxiety disorders
7. Substance misuse
8. Lack of sleep
9. Guilt and shame
10. Seeking reassurance
11. Significant life transitions
12. ADHD
13. Menstruation, pregnancy, and childbirth
14. Eating disorders
15. Physical illness
16. Beginning treatment

Giving Into Compulsions

One of the most common reasons a person’s OCD gets worse is when they are giving in to compulsions. When you give into a compulsion, you may feel short-term relief from your obsessive thoughts, urges, and images. However, giving in provides your brain the feedback that obsessions are valid and real and that compulsions can keep you safe from the obsessive thoughts. Over time, giving in to compulsions only reinforces the OCD cycle and makes a person’s OCD worse.

Increased Stress

Some types of stress can aggravate OCD symptoms. Acute stress, for instance, might make you feel dysregulated, which can trigger obsessive thoughts. Toxic stress (chronic and frequent stress without support) can also impact your OCD symptoms. If things feel overwhelming and hopeless, your mental health often suffers, and you may turn to compulsions to reduce the distress.

Avoidance of Triggers

Avoidance worsens OCD symptoms because it encourages you to think of your OCD triggers as dangerous. Obsessions often center around untrue beliefs that people, places, or situations are a threat to the person with OCD. When someone engages in avoidance of their triggers, they reinforce the beliefs behind obsessions.

Trauma

PTSD can trigger or worsen OCD.² If life suddenly feels unsafe, OCD obsessions and compulsions can serve as a way to attempt to reestablish control and safety. TCompulsions are incredibly soothing in the short term and are also sometimes a way to numb the emotions associated with a recent trauma. Past traumas can also heighten OCD symptoms, particularly around trauma anniversaries or if something triggers you to think about what happened.

Substance Misuse

Research documents that substance use is higher in OCD populations than in the general population, with alcohol being the most commonly misused substance.³ Individuals with OCD may turn to substances such as alcohol to cope with the distress of obsessions and compulsions. While substances can dampen intrusive thoughts in the short term, upon sobering, the intrusive thoughts return. Frequent substance use, such as drinking alcohol every night, increases anxiety and shame, which will exacerbate OCD symptoms. It can also begin to get in the way of showing up for treatment.³

Depression

OCD and depression often occur together. While there is no evidence that depression causes a person to develop OCD, having depression can worsen or intensify certain overlapping OCD symptoms like feelings of guilt, ruminating, and difficulty sleeping.

Depression can also impact the effectiveness of or someone’s participation in OCD treatment. Depressive symptoms, such as anhedonia, feelings of hopelessness, and decreased energy, can make it hard to put in the effort required for therapy and make it particularly difficult to participate in challenging treatments like exposure and response prevention therapy for OCD.

Other Anxiety Disorders

Other anxiety disorders may also worsen OCD symptoms. For example, having panic disorder makes an individual prone to body scanning, and body scanning is also a common compulsion found in somatic OCD. Additionally, individuals with social anxiety and “just right” OCD may avoid social gatherings for fear of not being able to speak in the “right” way. Separation anxiety, which causes someone to have a fear of being apart from loved ones, can intensify intrusive thoughts of harm OCD. For example, compulsively ruminating on what harm could happen to a loved one when they leave for work.

Lack of Sleep

Research shows a link between poor quality of sleep and OCD symptoms.⁵ As many as 48% of patients with OCD report sleep disturbances.⁵ When your sleep quality is interrupted, it can affect brain functioning, immune system responses, and even how your hormones are regulated.⁵ This can make it difficult to show up and stick to OCD treatment. Additionally, research indicates that worsened sleep can increase anxiety and depression, meaning that anyone who has both OCD and anxiety or depressive disorder could experience a worsening in overall mental health symptoms.

Guilt & Shame

Feelings of guilt and shame can make OCD worse by triggering compulsions and encouraging secrecy that leads to withdrawal and isolation. People with OCD often possess a heightened sense of moral responsibility and fear of acting immorally. For someone already experiencing guilt and shame, everyday occurrences may trigger intrusive thoughts or urges that violate their moral code, triggering compulsions and further feeding a guilt and shame cycle.

Guilt and shame can also lead a person with OCD to secrecy, discouraging them from sharing their thoughts, symptoms, and compulsions with others because they’re afraid of being ridiculed or judged. This can lead to withdrawal from others and a reduced likelihood of seeking support and professional treatment, which can make OCD worse.

Being Enabled & Given Too Much Reassurance

If your loved ones enable your OCD and your obsessive reassurance-seeking, you may feel more justified to engage in your actions. Of course, this doesn’t mean your support system should be cruel or dismissive. But if they don’t say anything at all—or if they continue providing reassurance even when it isn’t appropriate—they may contribute to worsening your symptoms.

Significant Life Transitions

Adapting to new transitions (starting a new job, getting married, having a baby, relocating) can take a toll on your mental health. You may have anxiety about things not going well, or you might experience regret over your decisions. And if life feels out of control, the OCD may serve as a way to reestablish control.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Certain ADHD symptoms, such as disorganization and forgetfulness, can exacerbate OCD symptoms. For example, someone may miss scheduled appointments or due dates, leaving an opportunity for OCD-induced rumination and guilt. Additionally, the disorganization common with ADHD can come into conflict with and exacerbate OCD perfectionism, organization, and symmetry compulsions. In terms of ADHD treatments that can worsen OCD, ADHD stimulant medication can sometimes worsen OCD symptoms. As an example, people with ADHD and OCD sometimes find that stimulants make them hyperfocus on their obsessions.

When ADHD and OCD co-occur, they share many symptoms, such as impulsivity, difficulties with relationships, struggles to hold employment, sleep issues, and gastrointestinal issues. These shared symptoms can become doubly difficult to manage when someone has both disorders. For example, individuals may struggle to keep a job, battle insomnia, or have increased issues with eating and digesting meals.

Menstruation, Pregnancy, & Childbirth

Research indicates that hormonal shifts like puberty, pregnancy, menstrual cycles, or menopause can sometimes onset or exacerbate symptoms of OCD.^{6, 7} Some women with OCD may find that obsessions or compulsions change, worsen, or occur more often during these life changes. Some women even develop a subtype of OCD after giving birth, called postpartum OCD.

Eating Disorders

OCD has a high rate of co-occurrence with eating disorders, with anorexia nervosa being the eating disorder that most commonly occurs alongside OCD. Eating disorders can make OCD symptoms worse because of the intense desire for control and the use of compulsive behaviors to cope. Someone may use their eating disorder to cope with the distress they experience from their OCD. Additionally, eating disorders can cause malnutrition, fatigue, and health-related issues that can complicate someone’s ability to seek and follow through on OCD treatment.

Physical Illness

OCD symptoms can worsen when someone is sick. When someone is physically ill, it puts stress on the body both physically and mentally. This can create anxiety, exacerbating OCD obsessions and compulsions. Additionally, someone who has both OCD and a physical illness may not have the energy to engage in exposure therapy work or challenge their obsessional thoughts. Without this work, symptoms can continue to worsen.

Seeking OCD Support

Although it may seem paradoxical, it is common for people to feel worse before they feel better once they seek treatment. Getting OCD support may increase feelings of guilt, shame, or fear, which can temporarily intensify your obsessions and compulsions. That said, you will feel relief if you stick with the process.

How to Stop OCD From Getting Worse

While there isn’t a cure for OCD, you can learn to manage your condition with proper treatment methods for OCD. In many cases, people experience a substantial partial or full remission from their symptoms. If you sense that your condition is worsening, seek help as soon as you can. Early intervention can prevent current symptoms from escalating or new ones from emerging.

Here are some tips for preventing OCD symptoms from getting worse:

Begin Therapy ASAP

Exposure and response prevention (ERP) for OCD is the gold standard treatment for addressing and improving OCD symptoms. ERP focuses on safely and gradually facing your obsessive thoughts and learning coping skills to manage the anxiety instead of returning to your go-to compulsions.

Although ERP is the frontline treatment, there are other types of therapy that effectively treat OCD. Some research shows that acceptance and commitment therapy (ACT) for OCD may be promising in helping you practice more acceptance and mindfulness of your symptoms. Alternatively, EMDR can treat OCD, particularly if underlying trauma exists. Support groups can be a helpful addition to individual therapy. Groups offer a sense of accountability and shared empathy.

When looking for the right therapist, prioritize finding a professional specializing in OCD. You can get started with our local therapist directory. There are also lots of online OCD resources for people looking to seek treatment from home, such as NOCD.

Free Hierarchy of Fears Worksheet

The hierarchy of fears provides a structured plan to gradually face and overcome one’s fears in manageable steps, reducing anxiety over time.

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Consistently Practice Your Coping Skills

It is crucial to take the OCD coping skills you learned in therapy and practice them over and over again. Coping skills are not a magic pill, and after using them once, you likely won’t feel relief. But if you keep at it, over time, you will begin to see your symptoms reducing in intensity and frequency. Remember that one skill probably won’t work all the time—it’s better to have a set of tools you can refer to at a given moment.

Consider or Re-Consider Medication

Taking medication for OCD can reduce your stress levels and decrease the intensity of obsessive thoughts and compulsive urges. Many different medications can treat OCD, although SSRIs like Zoloft, Celexa, Paxil, and Prozac are the most common prescriptions. These medications can take up to 8-12 weeks to work fully.

If you are already taking a medication, you may want to speak to your psychiatrist about switching to a different medication. There are many different online psychiatrist services that make speaking with a psychiatrist who specializes in OCD easy and affordable.

Prioritize Stress Management

It’s impossible to eliminate all stress, but trying to manage it as best you can may reduce the intensity of your OCD symptoms. Stress management looks different for everyone, but it may entail seeking healthy social support, engaging in meaningful self-care activities, and prioritizing rest and relaxation.

Practice Mindfulness

People with OCD catastrophize about the worst-case scenario happening. Mindfulness for OCD can help you stay more present with your feelings and thoughts. The next time you feel overwhelmed, consider doing an OCD meditation for a few moments. It doesn’t need to be a formal practice—simply focusing on your breath intentionally can make a dramatic difference.

Embrace Acceptance

When you can accept your current situation, thoughts, and fears, you may feel like they have less power over you. Remember that acceptance doesn’t mean you like what’s happening. Instead, you can simply acknowledge it for what it is—without trying to suppress or deny your reality.

Work Through Perfectionism

Sometimes, OCD can coincide with perfectionism. This can cause rigid expectations and a heightened need to control a situation. Aiming to let go of perfectionism and settle for “good enough” may help reduce some of the anxiety you experience.

Talk to Yourself Kindly

It may be helpful to avoid using stigmatizing language that feeds into harmful OCD myths. For example, terms like “failure” or “OCD relapse” may perpetuate a sense of shame. Instead, remind yourself that most chronic health conditions come with easy days and hard days. The hard days don’t define your worth, and they often do pass.

Free Personal Strengths Inventory Worksheet

Creating a personal strengths inventory can be a powerful tool to combat self-criticism and negative self-talk.

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Will OCD Ever Go Away?

OCD is typically a chronic condition, and it is highly unusual for OCD symptoms to be cured entirely. However, research shows that OCD symptoms tend to peak from 18 to 29.⁸ Individuals who are receiving proper treatment for their OCD will develop coping skills and can experience an almost complete OCD recovery for the majority of their adult life.