OCD symptoms can worsen if left untreated. Likewise, stress and other mental health symptoms like trauma, anxiety, and themes of perfectionism, can aggravate OCD. Sometimes, symptoms may worsen dramatically and suddenly, but it’s more likely for them to escalate gradually over time. Thankfully, OCD is treatable with exposure and response prevention (ERP) and medication for some.
What is the best therapy for OCD?
Exposure And Response Prevention Therapy (ERP) – Do live video sessions with a therapist specialized in ERP, the gold standard treatment for OCD. Treatment from NOCD is covered by many insurance plans. Start With A Free 15 Minute Call
What Is Obsessive Compulsive Disorder (OCD)?
OCD is associated with the presence of obsessions (intrusive thoughts) and compulsions (repetitive behaviors). Someone with OCD experiences intense anxieties about certain issues, including fears of contamination, aggressive thoughts, or needing a sense of order and control. They engage in compulsions to assuage the intensity of their obsessions.1
Research shows that OCD symptoms often first begin in childhood or adolescence. Symptoms tend to appear earlier in boys than girls, and most cases start before age 25.2
Does OCD Get Worse Over Time?
Symptoms of OCD sometimes start slowly and worsen as time progresses, especially if they are left untreated.3 When stress levels increase, OCD symptoms can also worsen in frequency and intensity. Once treatment is sought, chronic OCD symptoms typically improve, especially with a combination of therapy and medication.
There is also a type of OCD which is categorized as episodic. In episodic OCD, symptoms present during an episode and then disappear, not dependent on whether a person receives treatment.4 In episodic cases of OCD, symptoms improve or stop completely after an episode is over.
Does OCD Get Worse With Age?
OCD does worsen with age in most cases when left untreated. The strongest predictor of lifetime OCD is age.3 Symptoms tend to start early, with a peak in symptoms from 18-29, and tend to persist throughout life, as OCD is a chronic condition.3 Sometimes, people also delay their diagnosis due to feelings of embarrassment or shame, or because they don’t realize they need to seek formal treatment. When this happens, OCD symptoms can also worsen when they experience more life stressors as they age.
Can You Develop OCD Later in Life?
You can develop OCD later on in life, although it is relatively rare. Research indicates that developing OCD over the age of 30 is uncommon, but can happen.3 Most cases of OCD develop in childhood and adolescence. When OCD develops later in life, it is mostly due to environmental and neurological influences.5 For example, a person who develops OCD symptoms later in life may be triggered by stressors like job transitions, financial crises, or family stress.
Can OCD Come and Go?
OCD symptoms can fluctuate depending on stress and other environmental factors, like life transitions. It is common for the types of obsessions and compulsions to change over time, even with treatment. Examples of life situations where OCD symptoms may peak or wane include family stressors, job transitions, or changing relationships. Fortunately, exposure and response prevention treats the underlying pattern of obsessions and compulsions so that, even when specifics change, someone is able to cope with symptoms.
What Causes OCD to 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 one what causes your OCD to get worse, such as receiving a comorbid diagnosis, understanding your life stressors, and processing previous traumas, you can start to better manage your OCD symptoms with the help of a professional.
Here are 11 reasons why your OCD may be getting worse:
1. Comorbid Mental Health Conditions
Research shows that 75% of people with OCD also experience comorbid disorders.6 These comorbid symptoms may aggravate OCD, particularly if someone is not receiving adequate, comprehensive treatment.
Comorbid conditions that may worsen symptoms of OCD include:
- Depression: Research shows that most people with both depression and OCD experienced OCD symptoms first, suggesting that depression may be a response to OCD.7
- Attention deficit hyperactivity disorder (ADHD): ADHD can worsen OCD symptoms because ADHD is associated with impulsivity and poor executive function, which may result in more obsessive thoughts.
- Substance abuse disorders: Substance use disorders such as overusing alcohol may worsen OCD symptoms, especially if there are preexisting symptoms of psychosis or anxiety.
- Anorexia: OCD and eating disorders, especially anorexia, share numerous traits, including a need for control, obsessive thoughts, and desires for order and control. It is common for both conditions to exist concurrently.
- Social anxiety disorder: People with OCD may develop social anxiety disorder due to the shame they feel about their condition. They might discover being “found out” for their obsessions or compulsions, causing them to withdraw or feel awkward around others.
- Obsessive-compulsive personality disorder (OCPD): OCPD and OCD can be linked. Both disorders have a desire for perfectionism, orderliness, and control.8
2. Increased Stress
Some types of stress may 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.
3. Significant Life Transitions
Even if you don’t identify a specific change as stressful, 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.
4. Recent Trauma
Trauma can affect your entire sense of self. If life suddenly feels unsafe, OCD can act as a way to maintain a sense of control and order. There may be a sense of soothing that comes with the ritualistic behavior—it’s also sometimes a way to avoid feeling the emotions associated with a recent trauma.
5. Past Trauma
Past trauma can also heighten OCD symptoms, particularly if something triggers you to think about what happened. People with PTSD or C-PTSD may be more prone to developing OCD. The obsessions and compulsions can serve as a way to attempt to reestablish control and safety.
Treatment For OCD
NOCD: Online OCD Treatment Covered By Insurance – Regain your life from OCD. Do live video sessions with a licensed therapist specialized in treating OCD. Treatment from NOCD is covered by most major insurance plans. Learn how you can use your insurance benefits. Visit NOCD
Talkiatry: Is OCD Medication Right For You? Speak with A Doctor – Talkiatry can match you with a psychiatrist who takes your insurance and is accepting new patients. They’re in-network with major insurers and offer medication management with supportive therapy. Free Assessment
6. Enabling Behavior & Too Much Reassurance
If your loved ones enable your OCD and your 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.
7. Lack of Sleep
Research shows a link between poor quality of sleep and OCD symptoms.9 As many as 48% of patients with OCD report sleep disturbances.9 As symptoms worsen, your sleep quality may also be disrupted. You may have trouble falling asleep, staying asleep, or sleeping for uninterrupted periods of time. Some people with OCD also find that they wake up early due to ruminations when symptoms flare.
8. Giving Into Compulsions
Giving into compulsions can worsen OCD because it feeds the idea that the compulsions keep you safe. 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 fix or save you from the obsessive thoughts. Over time, giving into compulsions only reinforces the OCD cycle.
9. Avoidance
Avoidance coping is a common compulsion used by people with OCD to manage distress caused by obsessive thoughts, images, and urges. Avoidance worsens OCD symptoms because it encourages you to think of your triggers as dangerous. Obsessions often center on 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.
10. Menstruation, Pregnancy, & Childbirth
Research indicates that hormonal shifts can sometimes onset or exacerbate symptoms of OCD. Hormonal shifts like puberty, pregnancy, menstrual cycles, or menopause are examples of hormonal changes that can affect OCD symptoms.10 Some women with OCD may find that obsessions or compulsions change, worsen, or occur more often during these life changes, such as postpartum OCD that focuses on dangers to the baby. Some research indicates that changes to levels of estrogen, oxytocin, and progesterone may contribute to worsening OCD during pregnancy.11
11. 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 likely feel relief if you stick with the process.
Can Smoking & Drinking Make OCD Worse?
Substance use can worsen OCD symptoms. Research documents substance use that is higher in OCD populations than in the general population, with alcohol being the most commonly misused substance.12 Rates of alcohol use in OCD are five times higher than in the general population. Depression and anxiety are factors that can contribute to whether or not someone with OCD decides to misuse substances to cope.12
When smoking and drinking routinely occur with OCD, they can worsen treatment outcomes, increase impairment, and heighten distress.12 Unfortunately, substance misuse can also increase someone’s chances of experiencing thoughts of suicidality.12 Avoidance of others is a common compulsion for someone with OCD and substance use issues, as well as obsessions related to fears of judgment.12
Why Is My OCD Worse at Night?
OCD can worsen at night because there is generally more opportunity for rumination. Rumination at night often includes a mental review of the day or past situations of anxiety. Engaging in rumination at night can also lead to the use of other compulsions. Common compulsions for someone with OCD at night might include mentally reviewing past situations, excessive checking of schedules or household items, or seeking reassurance from others.
How much do you know about OCD?
Take This 11-Question OCD Quiz From NOCD. If you or a loved one are struggling with OCD, NOCD provides convenient, affordable, and effective OCD treatment covered by most major insurance plans.
How to Prevent 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.
Below are ways to prevent worsening OCD symptoms:
Seeking OCD Therapy
Therapy is typically the front-line response for addressing and improving OCD symptoms. Therapy is a safe and effective resource for helping you understand your anxiety and work through your distress. When looking for the right therapist, prioritize finding a professional specializing in OCD. You can get started with our online therapist directory. There are also lots of online OCD resources for people looking to seek treatment from home, such as NOCD.
Therapy options for OCD may include:
- Exposure and response prevention (ERP): ERP for OCD is known as the gold standard treatment, and it focuses on safely and gradually facing feared situations.
- Cognitive-behavioral therapy (CBT): CBT for OCD includes a diverse range of interventions focused on identifying negative thought patterns and choosing healthier behavioral responses.
- Acceptance and commitment therapy (ACT): Some research shows that ACT for OCD may be promising in helping you practice more acceptance and mindfulness over your symptoms.
- Eye movement desensitization and reprocessing (EMDR): EMDR can also treat OCD, particularly if underlying trauma exists.
- Group therapy: Support or psychoeducational groups can be helpful for treating OCD. Peer support offers a sense of accountability and positive prosocial connections.
Taking & Reviewing Medications
Taking medication for OCD can reduce your stress levels. 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.
Prioritizing 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.
Practicing Mindfulness
People with OCD catastrophize about the worst-case scenario happening. Mindfulness 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.
Embracing Acceptance
Acceptance is another branch of mindfulness. 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.
Working 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.
Implementing Healthy Coping Skills
In general, prioritizing healthy OCD coping skills is always optimal for your mental health. Try to put these skills into practice even when things are going well. That way, they will feel more natural if life becomes challenging. 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.
Redefining Your Struggles
It may be helpful to avoid using stigmatizing language when discussing your OCD. For example, terms like failure or 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.
Will OCD Ever Go Away?
In rare cases, OCD symptoms can disappear with or without treatment. These episodic cases of OCD are relatively rare, however, and most cases of OCD are chronic. In chronic cases of OCD, symptoms are generally lifelong. Although obsessions may not ever entirely disappear, they can be managed. Remission, or at least lessening of symptoms, can happen with treatment.
Additional Resources
To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.
OCD Therapy
NOCD: Effective, Affordable, & Convenient OCD Therapy Do live, face-to-face video sessions with a therapist who specializes in treating OCD and get 24/7 support between sessions. NOCD is covered by many insurance plans and is available nationwide. Visit NOCD
Treatment From An Online Psychiatrist
Talkiatry OCD is treatable. Talkiatry specializes in OCD and provides personalized care with medication and additional support. Get started with a short assessment.
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What Causes OCD to Get Worse Infographics