What Causes OCD to Get Worse? 7 Triggers to Be Aware of

What Is Obsessive Compulsive Disorder (OCD)?

OCD is associated with the presence of obsessions (also known as 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

OCD is characterized by the presence of:

Obsessions

Obsessions refer to disturbing, unwanted, and otherwise intrusive thoughts. These thoughts often feel so consuming that the individual feels they must act out in their compulsions to eliminate or mitigate them.¹

Common obsessive thoughts include:

• Fear of contamination
• Fear of dying or loved ones dying
• Fear of having unwanted or taboo thoughts
• Fear of acting out inappropriately in social settings
• Fear of hurting yourself
• Fear of being trapped or unsafe in a situation

Compulsions

Compulsions refer to ritualistic behavior that becomes repetitive and time-consuming. If someone can’t engage in a compulsion at a certain time, they often feel distressed. Even if they recognize the compulsion as irrational, they still feel compelled to do it. Unlike some other compulsive behaviors, a person with OCD doesn’t derive pleasure from their activity.

Examples of compulsive behaviors include:

• Excessive hand washing or showering
• Setting things in certain orders
• Counting in particular sequences
• Repeatedly checking things like ovens or door locks
• Seeking ongoing reassurance from others

7 Reasons Why Your OCD Is Getting 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.

Below are 7 reasons why your OCD may get worse:

1. Comorbid Mental Health Conditions

Research shows that 75% of people with OCD also experience comorbid disorders.³ 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.⁴
• 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 may worsen OCD symptoms, especially if there are preexisting symptoms of psychosis or anxiety.
• Anorexia: Anorexia and OCD 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.⁵

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 prone to OCD. The obsessions and compulsions can serve as a way to attempt to reestablish control and safety.

6. Enabling Behavior

If your loved ones enable your OCD, 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. 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.

How to Prevent OCD from Getting Worse

While there isn’t a cure, 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.

Therapy options for OCD may include:

• Exposure and response prevention (ERP): ERP is known as the gold standard of OCD 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 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.

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 meditating 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 coping 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.

Final Thoughts

Living with OCD can be challenging. That said, despite your circumstances, it is possible to feel better and overcome your symptoms. Seeking treatment can help you take the next best step forward.